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Region of interest
33-37 Implant pre surg
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Normal bone at site 46
The bone at site 46 appears normal radiographically and has a density that is similar to that of the adjacent trabecular bone.
1. Rarefying osteitis on tooth 44: Unfilled lingual canal
Periapical rarefying osteitis is present at the apex of tooth 44. The existing obturation is buccally positioned, which suggests an unfilled lingual canal is the source of this area of persistent endodontic pathology. No signs of root fracture are present.
2. Resorbed impacted tooth at site 35
A severely resorbed impacted tooth is present in the alveolar bone adjacent to the crest of site 35. The resorbed crown of the impacted tooth is positioned at the alveolar crest. The left mandibular nerve canal passes buccal to the root of this impacted tooth at the midroot level and is slightly compressed. The left mental foramen is positioned mesial and buccal to the impacted tooth 35. This entity should be removed before implant placement.
3. Fractured suprastructure + exposed threads on implant 34
The suprastructure of the implant abutment at site 34 is fractured. The implant is mesially tilted and abuts the distal surface of the crown of tooth 33, but no damage is evident on tooth 33 otherwise. The coronal third of the buccal aspect of the implant 34 is not fully embedded in bone. The remainder of the implant appears to be normally osseointegrated.
4. Widened PDL space on tooth 37M
There is widening of the periodontal ligament space around the mesial root apex of the endodontically-treated tooth 37. The existing obturations in the mesiobuccal, mesiolingual, and distal canals of this tooth are filled short of their radiographic apices. There are no signs of root perforation or fracture. These findings could suggest the presence of persistent low-grade endodontic pathology or a healing post-treatment appearance. Continued radiographic monitoring may aid in making this distinction. Vertical bone loss is present around the coronal third of the tooth.
Generalized horizontal bone loss
Generalized mild to moderate horizontal periodontal bone loss is present around the existing teeth.
5. Mild mucositis of right maxillary sinus
The right maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.
6. Calcified stylohyoid ligaments
The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.
7. History of fracture and malformation of C1: Possible Jefferson fracture in combination with split atlas
The posterior arch of C1 exhibits a developmental cleft. The cortical borders of the separated parts of the posterior arch appear normal, which supports the diagnosis of a congenital split atlas. The anterior arch of C1 exhibits a displaced fracture plane. These have caused displacement of the lateral mass of the atlas beyond the margin of the body of C2. Referral of the patient to a neurosurgeon is warranted.
Axial views of C1/C2
These axial cross-sectional images demonstrate a fracture plane at the anterior arch of C1 and a concomitant congenital cleft at the posterior arch. Note the displacement of the lateral mass of C1 beyond the body of C2. The osseous structures of C2 and the occipital bone appear normal otherwise.
Posterior 3D view of cervical vertebrae
This 3D view demonstrates the congenital cleft at the posterior arch of C1.
Anterior 3D view of the cervical vertebrae
This 3D view demonstrates the possible displaced fracture plane at the anterior arch of atlas.