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Case 99969

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Referral category

Disease / syndrome / tumor / condition

Region of interest

posterior 4th quadrant

Referral reason

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Canaray 99969

Volume rendering of the posterior 4th quadrant

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1. Complex odontoma in posterior right mandible

There is a large, well-defined, and irregularly shaped radiopacity located within the posterior right mandible, near the base of the right mandibular ramus. This radiopacity is surrounded by a thin radiolucent lining of uniform width, which appears similar to a periodontal ligament space. The internal structure of this entity appears heterogeneous: the majority of the entity demonstrates an attenuation comparable to dentin or cortical bone, intermixed with relatively radiolucent regions with a density comparable to pulp canal space. This entity has caused mild expansion of the buccal and lingual cortical plates adjacent to this region. The right inferior alveolar nerve canal courses immediately inferior to this entity, and the nerve canal appears mildly compressed in this region. These findings are consistent with a complex odontoma in the posterior right mandible. Surgical excision is curative.

Axial views of the posterior right mandible

These axial cross-sectional images demonstrate the presence of a well-defined radiopaque mass just distal to tooth 48. This mass demonstrates a density comparable to dentin or cortical bone, and appears to be surrounded by a radiolucent lining of uniform width. The adjacent buccal and lingual cortical plates appear thinned, and the buccal and lingual surfaces of the mandible appears slightly expanded in this region.

Mesiodistal views of the posterior right mandible

These mesiodistal cross-sectional images demonstrate the inferior passage of the right inferior alveolar nerve canal relative to this radiopaque mass. Also evident in these cross-sectional images is the presence of radiolucent channels within this radiopaque mass, which demonstrate a density comparable to pulp canal space.

Buccolingual views of the posterior right mandible

These buccolingual cross-sectional images demonstrate the thinned but intact appearances of the buccal and lingual cortical plates adjacent to this radiopaque mass. The right inferior alveolar nerve canal passes immediately inferior to this entity, and appears mildly compressed in this region.

Hypercementosis + ankylosis of tooth 48

Tooth 48 appears erupted with its crown in slight linguoversion. The roots of tooth 48 exhibit excessive cementum formation, which is consistent with hypercementosis. This region of hypercementosis appears to extend distally to abut the complex odontoma located just distal to tooth 48. The periodontal ligament space is not completely visualized around the root circumference of this impacted tooth, which suggests the possibility of ankylosis. This tooth has not caused any damage to the adjacent tooth 47. The right inferior alveolar nerve canal passes inferior to tooth 48, and is not in close proximity to this tooth.

Axial views of tooth 48

These axial cross-sectional images demonstrate the incomplete visualization of a periodontal ligament space surrounding the root circumference of tooth 48, which suggests the possibility of ankylosis.

2. Periapical osseous dysplasia on tooth 48M

There is a small, well-defined focus of granular bone located periapical to the mesial root of tooth 48. This area is surrounded by a thin margin of slightly sclerotic appearing bone. This finding represents an immature focus of periapical cemental dysplasia, which does not require treatment.

Mesiodistal views of posterior right mandible

These mesiodistal cross-sectional images demonstrate the presence of extensive cementum formation around the roots of tooth 48, which is consistent with hypercementosis. This region of hypercementosis appears to extend distally to abut the complex odontoma located just distal to tooth 48. The right inferior alveolar nerve canal courses inferior to tooth 48.

3. Possible caries on tooth 16

Tooth 16 is partially captured in this imaging volume. Radiolucent areas are observed deep to the occlusal restorations placed on tooth 16, which could represent recurrent caries or large restorative voids.

4. Open margin on tooth 46D

Tooth 46 is partially captured in this imaging volume. A radiolucent gap is observed just apical to the restoration placed along the distal aspect of tooth 46. This restoration also appears undercontoured. Clinical correlation is recommended to rule out the presence of recurrent caries.