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Case 187002

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Right maxillary sinus

Referral reason

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Canaray 187002

1. Air-fluid level + diplaced and non-integrated bone graft in right maxillary sinus: rule out sinusitis

An air-fluid level is evident in the right maxillary sinus, and a large focus of bone graft material with homogeneous density is observed along the sinus floor. These findings suggest acute inflammatory changes involving the soft tissue lining of the maxillary sinus, which could infer the possibility of sinusitis.

The presence of air -fluid level and displaced graft material suggest that the Schneiderian membrane is compromised. It should be noted that sinusitis is a clinical diagnosis, and radiologic findings are often non-specific. A referral to an ENT specialist may be considered if the patient exhibits any relevant signs and symptoms suggestive of recurrent sinusitis.

Healed left maxillary sinus lift

The bone graft material associated with the previous left maxillary sinus lift has healed normally and exhibits a uniform density that is slightly higher than the remainder of the trabecular bone within the left posterior maxilla. The implant at site 26 extends to the bone graft and appears integrated to the graft material.

2. Apex of implant 24 extends through sinus floor

The apex of the implant placed at site 24 extends beyond the floor of the maxillary sinus and is partially extend to the sinus lift bone graft at this site. The remainder of the implant appears to be embedded in the bone graft at this site.

3. Healing extraction socket at site 16

Granular bone is present within the extraction socket at site 16, which indicates healing. The density of this granular bone is lower than that of the surrounding trabecular bone. Note the floor of the maxillary sinus is thin and may be dehiscent overlying the base of the socket.

4. Rarefying osteitis at tooth 27MB

The mesiobuccal root of tooth 27 exhibits periapical rarefying osteitis. The existing obturation in the mesiobuccal root is fairly centrally positioned, and no additional canals appear to be present. This rarefying osteitis has slightly elevated the overlying maxillary sinus floor, but it remains intact. The overall radiographic appearance is suggestive of a persistent endodontic pathology or healing scar tissue in the mesiobuccal root. The distobuccal and palatal roots of tooth 27 appear adequately obturated, and do not exhibit any periapical pathology. No signs of fracture are present.

5. Healed buccal bone graft in anterior maxilla

The buccal bone graft in the anterior maxilla has healed normally, and has a density that is similar to that of the adjacent trabecular bone.

6. Low density bone at implant 36

A small zone of low density granular bone apical to the implant 36 suggests a history of previous periapical pathology in this region, which appears to be healing normally, or a over-drilling at this site. However, periodic radiographic follow up and clinical correlation are recommended.

7. Retained radiopaque fragment at site 26

A small retained fragment of radiopaque restorative or endodontic material is present within the floor of the maxillary sinus at site 26. This is a non-significant incidental finding.

Generalized periodontal bone loss

There is generalized mild to moderate horizontal bone loss involving the imaged dentition. Furcation involvement is present at tooth 46 and 47