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Referral details

Case 68798

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Referral category

Impacted / delayed / malpositioned / extra teeth

Region of interest

(13) palatally impacted - high up

Referral reason

[Only visible to logged-in users]

0 Files Info

Canaray 68798

Volume rendering of tooth 13

Windows media video file

Horizontally impacted tooth 13

Tooth 13 is horizontally impacted. The follicle surrounding the crown of the tooth is slightly hyperplastic. The cusp tip of the tooth is positioned apically to tooth 21. No root resorption or damage has occurred to teeth 11, 12, or 21. The root of tooth 13 is fully formed. The eruption of tooth 13 has been prevented by the presence of fibrous dysplasia in the mid-first quadrant apical to sites 13, 14, and 15.

Normal tooth 15

Tooth 15 has not been affected by the impacted tooth 13. The fibrous dysplasia that is present in the mid-first quadrant is evident in the apical regions of tooth 15. The root apex of tooth 13 is positioned at the palatal aspect of the alveolar process adjacent to the nasal floor.

Absent tooth 14

Tooth 14 is not radiographically evident in this scan. The tooth may be congenitally absent.

Normal tooth 54

Tooth 54 appears normal radiographically, and exhibits mild physiologic root resorption, which is expected and normal.

Normal tooth 53

Tooth 53 appears normal radiographically. Minimal resorption of the root of the tooth has occurred. The granular appearance of the bone within the zone of fibrous dysplasia is evident in the periapical region of tooth 53.

Normal tooth 12

Tooth 12 has not been affected by the impacted tooth 13 or by the adjacent zone of fibrous dysplasia.

Normal tooth 11

Tooth 11 has not been affected by the impacted tooth 13. The crown of tooth 13 is positioned palatally to the root apex of tooth 11.

Normal tooth 21

The cusp tip of tooth 13 is positioned apically to the root of tooth 21. No root resorption or damage has occurred to tooth 21.

Axial views of tooth 13

These axial cross-sectional images demonstrate the palatal position of tooth 13 in the alveolar process, as well as the normal appearance of the follicle surrounding the crown of the tooth. The cusp tip of the tooth is positioned apically to tooth 21.

1. Fibrous dysplasia in first quadrant

A broad zone of granular bone is present in the periapical regions of sites 13, 14, and 15. The bone in this region has a heterogeneous appearance and has caused localized expansion of the alveolar process. No capsule surrounds this region of altered bone. The periphery of the region of granular bone is continuous with the adjacent trabecular bone. No damage or resorption has occurred to the teeth in the first quadrant. Other than the prevention of the eruption of tooth 13, there have been no effects on the surrounding structures. This radiographic appearance is consistent with a localized zone of fibrous dysplasia in the mid-first quadrant.

2. Larger CBCT scan demonstrating full extent of fibrous dysplasia

A larger CT scan was performed after the initial small field scan in order to completely capture the extent of the fibrous dysplasia in the anterior first quadrant. The floor of the right maxillary sinus has been locally displaced. The shape of the lateral border of the nasal floor has been slightly altered. This radiographic appearance is consistent with fibrous dysplasia.

Axial views of anterior first quadrant

These axial cross-sectional images demonstrate the localized enlargement of the right maxilla in the region apical to sites 13, 14, and 15, as well as the slight displacement of the anterior wall of the right maxillary sinus.

Coronal views of right maxilla

These coronal cross-sectional images demonstrate the granular heterogeneous appearance of the bone within the fibrous dysplasia in the mid-first quadrant.

Sagittal views of first quadrant

These sagittal cross-sectional images demonstrate the localized displacement of the sinus floor by the fibrous dysplasia. Note the absence of any displacement of the erupted teeth in the first quadrant. The periodontal ligament spaces remain intact around the teeth.

Horizontally impacted tooth 38

Tooth 38 is fully formed and is horizontally impacted. The tooth is not in close proximity to the inferior alveolar nerve canal. No damage has occurred to the distal surface of tooth 37.