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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Sequestered bone palatal to teeth 24 and 25
A sequestrum has formed in the alveolar process in the region palatal to teeth 24 and 25. This sequestrum has been infected, and drains through the alveolar crest at the palatal aspect of the alveolar process. The sequestrum is likely forming secondary to low vascularity within the dense bone that is present in the mid-second quadrant. The palatal root of tooth 24 appears to have been secondarily infected.
2. Fibrous dysplasia in left maxilla
Fibrous dysplasia is present in the mid second quadrant. This localized zone of dysplasia exhibits a high trabecular bone density. The lesion extends into the hard palate and into the lateral region of the nose. Localized expansion that follows the original bone contours is present, which is a hallmark of this entity. The high density of this bone may have resulted in the low vascularity of the area, which predisposes this bone to osteomyelitis. The fibrous dysplasia has not caused any resorption or damage to any of the adjacent teeth.
3. Palatal root of tooth 24 secondarily affected by draining osteomyelitis
The draining osteomyelitis that is present in the mid-second quadrant extends around the palatal root apex of tooth 24. The buccal root of the tooth does not exhibit any pathology. It is possible that tooth 24 has been secondarily infected, and may contain a non-vital palatal root canal. No signs of fracture are present in tooth 24
Normal tooth 25
Tooth 25 appears normal radiographically, and has not been affected by the osteomyelitis that originates within the mid-second quadrant.
4. Fibrous dysplasia in left pterygoid plate and sphenoid base
A localized zone of high density bone dysplasia is present in the left pterygoid plate. Localized expansion of the bone has occurred in this region, which has resulted a narrowed pterygopalatine fossa. The fibrous dysplasia extends into the base of the left sphenoid bone. The neurovascular canals in this region have been locally narrowed. The patient is at risk of neural symptoms with continued narrowing of the canals and foramina in the left sphenoid bone
5. Mild mucositis of left maxillary sinus
The left maxillary sinus exhibits mild mucositis, which represents an incidental finding with no clinical significance.