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Case 115344

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Wisdom Teeth

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Canaray 115344

Volume rendering of tooth 48

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1. Odontogenic keratocyst associated with impacted tooth 48

A well-defined, corticated radiolucency is associated with the impacted tooth 48. This radiolucency extends from the distal aspect of tooth 47 into the right mandibular ramus, and from the level of the alveolar crest to the superior cortex of the inferior alveolar nerve canal. The periphery of this radiolucency exhibits a slightly scalloping contour, and a prominent septation is present inferior to tooth 48. Negligible buccolingual expansion is evident, given the mesiodistal extent. The attachment point of this radiolucency to tooth 48 is apical to the cementoenamel junction on the distal aspect of the tooth. The root apices of tooth 47 are mesially tipped, but no resorption is noted.

This radiographic appearance is most consistent with an odontogenic keratocyst associated with the impacted tooth 48. Biopsy and histopathologic confirmation is indicated.

Orthogonal views of odontogenic keratocyst

These orthogonal cross-sectional images demonstrate the approximate dimensions of the odontogenic keratocyst in the right posterior mandible and ramus.

Right mandibular nerve inferior to tooth 48

The right inferior alveolar nerve canal passes inferior to the horizontally impacted tooth 48 and the associated odontogenic keratocyst. The canal is inferiorly deflected, and the superior cortex is partially effaced. The crown of tooth 48 is oriented in extreme linguoversion.

Axial views of posterior 4th quadrant

These axial cross-sectional images demonstrate the longitudinal growth pattern of the radiolucency in the right posterior mandible, which has resulted in minimal buccolingual expansion. No resorption is present on tooth 47.

Mesiodistal views of posterior 4th quadrant

These mesiodistal cross-sectional images demonstrate the prominent septum inferior to the impacted tooth 48. The alveolar crest is thinned and mildly elevated adjacent to the cystic lesion associated with tooth 48. Inferior displacement of the right mandibular nerve canal is also evident.

2. Calcified stylohyoid ligament

The right stylohyoid ligament is partially calcified. This is an incidental finding with no clinical significance.