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Referral details

Case 50560

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Referral category

Impacted / delayed / malpositioned / extra teeth

Region of interest

22-23

Referral reason

[Only visible to logged-in users]

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Canaray 50560

1. Compound odontoma causing impaction of tooth 23

A compound odontoma is present in the maxillary alveolar process occlusal to the crown and coronal half of the root of the impacted tooth 23 and apical to tooth 63. The radiographic features that support this interpretation are the presence of multiple small tooth-like structures surrounded by a radiolucent capsule and corticated periphery. Excision of this compound odontoma will be required to facilitate the eruption of tooth 23. The compound odontoma can be accessed from the buccal aspect of the alveolar process interproximal to the middle and apical thirds of the roots of teeth 22 and 24.

Buccolingual views of compound odontoma

These buccolingual cross-sectional images demonstrate multiple small tooth-like structures coronal to the root of the impacted tooth 23 and apical to the retained tooth 63. Tooth 63 exhibits apical root resorption. Extraction of tooth 63 and surgical removal of the compound odontoma will be required to facilitate orthodontic repositioning of tooth 23.

Impacted tooth 23

The crown of the horizontally impacted tooth 23 is positioned apical to the root apices of teeth 21 and 22. No root resorption has occurred to teeth 21, 22, and 24. The follicle surrounding the crown of tooth 23 appears normal and is continuous with the buccal cortex of the maxilla. The root of tooth 23 is fully formed and the periodontal ligament space is visible around the entire root circumference, which suggests that the tooth is not ankylosed. The crown of tooth 23 can be surgically accessed from the buccal aspect of the alveolar process apical to the root apices of teeth 21 and 22.

Normal tooth 24

Tooth 24 has not been affected by the impacted tooth 23. The apical third of the root of tooth 23 is positioned apical to the buccal root apex of tooth 24.

Retained tooth 63

Tooth 63 is over-retained but exhibits significant physiologic root resorption. The compound odontoma and coronal third of the root of tooth 23 are positioned apical to the residual root apex of tooth 63.

Normal tooth 22

Tooth 22 has not been affected by the impacted tooth 23. The crown of tooth 23 is positioned apical to the root apex of tooth 22.

Normal tooth 21

Tooth 21 has not been affected by the impacted tooth 23. The cusp tip of tooth 23 is positioned apical to the root apex of tooth 21.

Axial views of anterior 2nd quadrant

These axial cross-sectional images demonstrate the apical position of the crown of tooth 23 relative to tooth 22. These images also exhibit the presence of a compound odontoma occlusal to the crown of the impacted tooth 23. No root resorption involves teeth 21, 22, and 24.

2. Maxillary sinus mucositis + antroliths in left maxillary sinus

Mild mucositis is present within the left maxillary sinus. Small calcifications are also present along the inferolateral sinus wall, an appearance consistent with antroliths. These findings are incidental in nature and do not bear any clinical significance.