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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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Volume rendering of #48
MP4 Video: Suitable for Apple, Windows and mobile devices
1. Dens invaginatus + rarefying osteitis on tooth 48
An enamel-lined cavity extends from the occlusal surface of tooth 48 to the level of the pulpal floor, which reflects a morphologic variant of dens invaginatus. Periapical rarefying osteitis is present on tooth 48, which has resulted in dehiscence of the contiguous buccal cortical plate. This appearance suggests tooth 48 is at least partially devitalized, which has likely resulted from communication between the oral cavity and the pulpal tissues via the enamel invagination. This tooth is not amenable to endodontic treatment and requires extraction.
Axial views of tooth 48
These axial cross-sectional images demonstrate the periapical epicenter of bone loss associated with tooth 48. Bone loss extending along the mesial surface of the root suggests a draining sinus tract is present through the ligament space in this area.
Mesiodistal views of tooth 48
These mesiodistal cross-sectional images demonstrate the broad zone of rarefying osteitis associated with the roots of tooth 48. The enamel invagination within the crown of tooth 48 extends to the level of the pulpal floor, and is the probable source of rarefying osteitis.
Buccolingual views of tooth 48
These buccolingual cross-sectional images demonstrate loss of the buccal cortical plate overlying the region of periapical rarefying osteitis associated with tooth 48. This suggests the presence of a draining sinus tract. The mesial and distal root apices are separated from the right mandibular nerve canal by 4.2mm and 4.1mm, respectively.
2. Gross caries on tooth 47D
The distal surface of the crown of tooth 47 exhibits gross caries. No periapical pathology is present at this time.
Axial views of tooth 47
These axial cross-sectional images demonstrate the normal appearance of the alveolar bone surrounding tooth 47. No signs of root fracture are present. The area of carious decay extends in close proximity to the root canal system.
Mesiodistal views of tooth 47
These mesiodistal cross-sectional images demonstrate the normal appearance of the periapical and periradicular bone surrounding the roots of tooth 47.
Buccolingual views of tooth 47
These buccolingual cross-sectional images demonstrate approximately 0.9mm between the mesial and distal root apices of tooth 47 and the mandibular nerve canal. The buccal and lingual periradicular bone remains intact.