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Case 42004

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Referral category

Dental implants

Region of interest

12

Referral reason

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Canaray 42004

1. Rarefying osteitis on tooth 12

Tooth 12 exhibits macrodont morphology, which likely resulted from fusion between a supernumerary tooth and the lateral incisor. The distal root canal appears adequately obturated. The mesial root canal is enlarged, which may be due to prior instrumentation or malformation of the root canal system. There is no evidence of obturation material in the mesial root canal, and a zone of rarefying osteitis with buccal cortical dehiscence is present at the root apex. The presence of a widely patent apex associated with the mesial root canal system may complicate conventional endodontic re-treatment.

Axial views of tooth 12

These axial cross-sectional images demonstrate the slight inflection point along the palatal surface of the crown and coronal third of the root of tooth 12, which suggests this macrodont is the product of fusion between the lateral incisor and a supernumerary tooth. The absence of obturation material in the mesial root canal system is evident, as is the patent radiographic apex.

Mesiodistal views of tooth 12

These mesiodistal cross-sectional images demonstrate the unobturated mesial root canal system within the root of tooth 12, which has resulted in periapical rarefying osteitis.

Buccolingual views of tooth 12

These buccolingual cross-sectional images demonstrate dehiscence of the buccal cortical plate overlying the apex of tooth 12. This has reduced the bone volume available for potential implant placement.

Site 12: Inadequate buccal bone

A 4x13mm cylinder was overlaid on the adjacent images at site 12. Due to the presence of rarefying osteitis associated with tooth 12, inadequate buccal bone exists for the apical half of this cylinder to be fully embedded at this site without additional bone augmentation.

2. Dense bone islands adjacent to teeth 23 and 24

Two small dense bone islands are present in the maxillary alveolar process, one distal to the apical third of the root of tooth 23 and the other distal to the apex of tooth 24. This represents an incidental finding with no clinical significance.