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Case 32568

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Referral category

Wisdom Teeth

Region of interest

38

Referral reason

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Canaray 32568

1. Marsupializing dentigerous cyst on tooth 38

The pericoronal radiolucency associated with tooth 38 exhibits low density granular bone at the periphery of this entity, which suggests that reparative bone formation is occurring secondary to marsupialization. A small residual radiolucent region is associated with the area coronal and mesial to the crown of tooth 38, and extends to the alveolar crest. The periphery of the entity is associated with the cementoenamel junction of tooth 38. These radiographic findings are suggestive of a marsupializing dentigerous cyst around tooth 38.

Sagittal views of posterior 3rd quadrant

These sagittal cross-sectional images demonstrate peripheral infill of the pericoronal radiolucency associated with tooth 38 with a granular bone pattern, an appearance consistent with normal osseous healing due to marsupialization. The residual radiolucent defect coronal and mesial to the crown of tooth 38 is evident, as is the presence of a radiolucent curvilinear structure suggestive of a Penrose drain.

Axial views of posterior 3rd quadrant

These axial cross-sectional images exhibit the presence of infill of the former pericoronal radiolucency associated with tooth 38 with a granular bone pattern. The previously noted buccolingual expansion of the alveolar process has been reduced, and the left posterior mandible exhibits near normal anatomic contours.

Overlay of prior tumor size (red) on current scan

The original size of of the dentigerous in the left posterior mandible and ramus is shown in red over the current scan of the patient. Marsupialization of the lesion has resulted in a decrease in the size of the entity, as well as the formation of reparative bone at the periphery of the entity. Only a small residual radiolucent defect is present coronal and mesial to the crown of tooth 38.

Coronal views of posterior 3rd quadrant with overlay

These coronal cross-sectional images demonstrate an outline of the prior periphery of the dentigerous cyst associated with the impacted tooth 38 superimposed over the current scan data. Peripheral infill with granular bone suggests the marsupialization procedure has been successful. The residual radiolucent defect coronal and mesial to the crown of tooth 38 is also evident in these images.

Left mandibular nerve lingual to tooth 38

The left mandibular nerve courses lingually to the midroot region of tooth 38 and is moderately compressed in this region. The nerve then courses lingually to the root apex of the distal root of tooth 38 and exhibits mild compression. The periodontal ligament space around the roots of tooth 38 is visible, which suggests this tooth is not ankylosed. Tooth 38 has not caused damage to the distal root of tooth 37.

2. Widened PDL space on tooth 36M+D

The mesial and distal roots of tooth 36 exhibit apical periodontal ligament space widening, which suggests the presence of early periapical pathology associated with tooth 36.

Retained tooth 85

Tooth 85 is retained and exhibits no evidence of physiologic resorption. Tooth 45 is congenitally missing.

3. Widened PDL space on tooth 46M

The mesial root of the endodontically treated tooth 46 exhibits apical periodontal ligament space widening. The existing endodontic obturation is filled short of the radiographic apex. Clinical assessment of tooth 46 is recommended to evaluate for signs and symptoms of persistent periapical pathology due to incomplete endodontic obturation.

Right mandibular nerve lingual to tooth 48

The right mandibular nerve courses lingual to the mesial and distal root apices of the vertically impacted tooth 48. The nerve is mildly compressed by the roots of tooth 48. The residual follicle surrounding the crown of tooth 48 appears hypoplastic, and the crown exhibits extensive resorption. The periodontal ligament space is visible around the root circumference, which suggests this tooth is not ankylosed. Tooth 48 has not caused damage to the distal surface of tooth 47.

4. Left palatine tonsillolith

A tonsillolith is present in the left palatine tonsil. This is an incidental finding with no clinical significance due to the spontaneous exfoliation of tonsilloliths.

5. Calcified stylohyoid ligaments

The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.