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Case 12690

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Troublesome / painful / cracked tooth (Endodontic)

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Canaray 12690

1. Benign or low-grade malignant tumor at site 48

A well-defined multilocular radiolucent entity with irregularly shaped variably corticated borders is present in the former socket of tooth 48. The lingual cortex has been expanded and perforated by the entity, and a soft tissue mass is present at the crest of the alveolar process. The distal surface of the root of tooth 47 exhibits external resorption, but this may have been present prior to the extraction of tooth 48.

These radiographic findings are suggestive of an aggressive benign tumor, or a low-grade malignancy, such as a mucoepidermoid carcinoma. A biopsy is recommended.

Axial slices of posterior 4th quadrant

These axial cross-sectional images demonstrate the perforation of the buccal and lingual cortices of mandibular alveolar process by the entity. Note the extension of the entity around the root surfaces of tooth 47, particularly around the buccal and lingual surfaces of the tooth into the furcation. The mandibular nerve has been inferiorly displaced. The superior boundary of the entity in the anterior ramus has not been captured in this scan.

2. External resorption on tooth 47

These orthogonal cross-sectional views demonstrate the external resorption on the distal root surface of tooth 47. The shape of this resorption is suggestive of a prior history of root resorption secondary to the position of the impacted tooth 48, rather than resorption due to the presence of the current entity at site 48.