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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Infected cemental dysplasia in right posterior maxilla; rule out osteomyelitis or osteonecrosis
There is a broad zone of ill-defined bone loss in the posterior right maxilla that is composed of mixed radiolucent radiopaque foci. This bone loss extends from the distal surface of tooth 17 that is captured to the mesial surface of tooth 16. The alveolar crest and maxillary buccal cortical plate appear dehiscent in this region. The floor of the right maxillary sinus is thin, elevated and partially dehiscent overlying the roots of teeth 17 and 16. Moderate mucosal thickening is present within the maxillary sinus. There are several sclerotic bone foci within the areas of bone loss, which is suggestive of the presence of sequestra. These findings are suggestive of a secondarily infected cemento-osseous dysplasia at this region. Clinical correlation is required to rule out the presence of osteomyelitis.
Axial views of posterior first quadrant
These axial cross-sectional images demonstrate the large mixed radiolucent/radiopaque entity around tooth 16 and 17. Note the localized dehiscence in the buccal cortical plate and the sinus floor.
Mesiodistal views of the posterior first quadrant
These mesiodistal cross-sectional images demonstrate the elevation, thinning, and partial dehiscence of the right maxillary sinus floor, as well as a separated focus of sclerotic bone between the roots of teeth 16 and 17, which may represent a sequestrum.
Buccolingual views of posterior first quadrant
These buccolingual cross-sectional images demonstrate the partial dehiscence and mucositis at the floor of the right maxillary sinus, as well as dehiscence in the buccal cortical plate. The palatal cortical plate is expanded and partially dehiscent overlying the rarefying osteitis at the palatal root apices of teeth 17 and 16.
2. Rarefying osteitis on tooth 17
Tooth 17 exhibits periapical rarefying osteitis involving all of its root apices. The buccal cortical plate and the floor of the maxillary sinus are partially dehiscent overlying the roots of tooth 17. This suggests that tooth 17 is devitalized and may be a contributing source of infection to the possible infected cemental dysplasia at this site.
Axial views of tooth 17
Mesiodistal views of tooth 17
Buccolingual views of tooth 17
3. Rarefying osteitis on tooth 16
Tooth 16 exhibits rarefying osteitis involving the mesiobuccal, distobuccal, and palatal root apices. The overlying sinus floor has been elevated and perforated, and the palatal and buccal cortical plates are dehiscent. This suggests tooth 16 is devitalized secondary to recurrent carious decay at the occlusal aspect of the tooth. This tooth likely contributes to the possible infected cemental dysplasia or osteomyelitis at this region. A focal formation of hypercementosis is present at the distal surface of the distobuccal root, which may support the diagnosis of the presence of cemental dysplasia in this region.
Axial views of tooth 16
Mesiodistal views of tooth 16
Buccolingual views of tooth 16
4. Moderate mucositis in right maxillary sinus
Moderate mucositis is present on the floor of the right maxillary sinus. This is an incidental finding and likely secondary to the infection arising at the periapical areas of teeth 16 and 17 and the associated infected cemental dysplasia.