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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
Posterior 4th quadrant
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1. Large draining periapical lesion originating from tooth 47
A large radiolucent cystic lesion is present in the posterior inferior right mandibular body. This entity appears to originate from the root apices of tooth 46, extends distally to the apical region of tooth 47, tracks inferiorly and lingually to the inferior mandibular border, and drains into the right submandibular space. The lesion extends along the lingual surface of the inferior alveolar nerve canal.
Sagittal views of posterior fourth quadrant with linear measurements
These sagittal cross-sectional images demonstrate the large radiolucent cystic lesion that extends from the apical regions of teeth 46 and 47 to the submandibular space at the lingual border of the mandible. The distance from the cusp tip of tooth 46 to the distal root apex is 19.6 mm. The distance from the distal root apex of tooth 46 to the superior border of the inferior alveolar nerve canal is 5.4 mm. Therefore, a safe zone for a biopsy from the buccal aspect of the alveolar process would be in the zone that is 20.0-24.0mm inferior to the distobuccal cusp of tooth 46.
2. Rarefying osteitis at tooth 46
Rarefying osteitis at both root apices of tooth 46 extends into the lumen of the radiolucent lesion in this region. This suggests that tooth 46 is the source of the lesion.
Axial views of tooth 46
These axial cross-sectional images demonstrate the periapical epicenter of the rarefying osteitis originating from tooth 46. No signs of root fracture are present.
Sagittal views of tooth 46
These sagittal cross-sectional images demonstrate the continuity of the apices of tooth 46 with the large zone of rarefying osteitis in this region. The apical foramen of tooth 47 does not extend into the lesion.
Coronal views of tooth 46
These coronal cross-sectional images demonstrate the extension of the periapical region through the lingual cortex of the alveolar process in the periapical region of tooth 46. Both roots of the tooth are separated from the inferior alveolar nerve canals by 5.1 mm.
3. Secondarily infected tooth 47
The radiolucent lesion in the posterior fourth quadrant extends into the apical region of tooth 47. However, the apical foramen of the tooth does not appear to be involved, which suggests that tooth 47 is secondarily infected rather than the source of this entity.
Axial views of tooth 47
These axial cross-sectional images demonstrate the intact alveolar bone around the apical foramen of tooth 47, which is supportive of the diagnosis of this tooth being secondarily infected by the lesion. Periodontal bone loss is present around the coronal third of the root of the tooth.
Coronal views of tooth 47
The root apex of tooth 47 is separated from the inferior alveolar nerve canal by 3.5 mm. Note the loss of the lingual cortex of the mandibular alveolar process in the region apical to this tooth.