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Case 142210

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Troublesome / painful / cracked tooth (Endodontic)

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Canaray 142210

1. Mixed radiolucent/radiopaque lesion interproximal to teeth 15/16

A well-defined, corticated radiolucency with multiple scattered internal radiopaque foci is present within the right posterior maxilla interproximal to teeth 15 and 16. This lesion extends along the buccal aspect of the mesiobuccal root of tooth 16, but the periapical region appears normal. The buccal and palatal cortical plates are intact, and the contiguous sinus floor is elevated but also remains intact. The alveolar crest is lost between teeth 15 and 16, and the roots of these teeth are splayed. No root resorption has occurred to the adjacent teeth.

These findings suggest the presence of a benign odontogenic neoplasm capable of producing a calcified matrix, such as a calcifying epithelial odontogenic tumor. However, biopsy with histopathologic correlation is necessary for a definitive diagnosis.

Orthogonal views of tooth 16

These orthogonal cross-sectional images demonstrate effacement of the lamina dura along the mesiobuccal root of tooth 16 adjacent to the mixed radiopaque/radiolucent lesion in the right maxilla. The periapical region of tooth 16 appears normal, which suggests this tooth is not endodontically compromised. The roots of tooth 16 are displaced distopalatally, but no resorption is noted.

Orthogonal views of tooth 15

These orthogonal cross-sectional images demonstrate the intact lamina dura along the distal aspect of tooth 15. The root of tooth 15 is tipped mesially, but no resorption has occurred. The periapical region appears normal.

Impacted tooth 18

Tooth 18 is vertically impacted and the crown is positioned distal to the coronal half of the distobuccal and palatal roots of tooth 17. The follicle appears normal and the periodontal ligament space is visible. No signs of ankylosis are present, and no resorption has occurred to tooth 17.