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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Recurrent odontogenic keratocyst in left posterior mandible
A well-defined, corticated radiolucency is present within the left posterior mandible. This radiolucency extends from the periapical region of site 36, along the buccal aspect of the root apices of tooth 37, and tracks along the distobuccal surface of the distal root of tooth 37 to the level of the alveolar crest. The buccal cortical plate is lost adjacent to site 36, which may at least partially reflect a post-surgical defect. The left mandibular nerve canal is lingually positioned within the mandibular body and the overlying lingual cortex is partially lost, an appearance that is also consistent with the prior surgical intervention. While granular bone formation is present at the anteroinferior and posteroinferior aspects of this radiolucency, which suggests partial healing has occurred, the majority of the defect does not demonstrate any evidence of healing bone formation. This radiographic appearance is highly suggestive of a recurrent odontogenic keratocyst in the left posterior mandible. The possibility of secondary infection due to communication with the oral cavity should be considered. A biopsy and histopathologic evaluation of the region is indicated.
2. Retained root fragment at site 36D
A small root fragment is present at the distal aspect of site 36. This root fragment abuts the persistent radiolucent defect in the left posterior mandible. Removal may be considered.
No signs of periapical pathology or resorption on tooth 37
The periapical region of tooth 37 appears normal. No signs of root resorption are radiographically evident. The radiolucency originating at site 36 courses along the buccal aspect of the root apices of tooth 37, then along the distobuccal surface of the distal root of tooth 37 to the alveolar crest. Removal of tooth 37 may be required if this radiolucency is a histopathologically proven recurrent odontogenic keratocyst.