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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Nasopalatine duct cyst
A well-defined and corticated cystic entity is present in the anterior maxilla. The entity extends between the apices of teeth 13 and 24 and involves the full thickness of the alveolar process. The entity also extends superiorly from the midroot level of the involved teeth to the elevated floor of the nasal cavity. The floor of the nasal cavity has been significantly elevated to the level of the base of the right and left inferior nasal conchae. The inferior aspect of this cystic entity is continuous with the inferior half of the nasopalatine canal. The buccal and palatal cortical plates exhibit thinning, significant hydraulic expansion, and discontinuities. The buccal cortical plate overlying the periapical area of tooth 22 is dehiscent. These imaging findings are suggestive of the presence of a long standing nasopalatine duct cyst. Biopsy with histopathologic correlation is recommended to confirm this interpretation.
Orthogonal measurements of lesion in anterior maxilla
These orthogonal cross-sectional images demonstrate the approximate dimensions of the lesion in the anterior maxilla.
2. Linear foreign body within the cystic entity
A liner radiopaque foreign body is present around the apex of tooth 22. The appearance may suggest the presence of a gutta percha point that was inserted through the buccal dehiscence. This represents an incidental finding of no clinical significance.
3. Secondarily affected tooth 22
The cystic entity surrounds the apical half of the root of tooth 22. There are no signs of root resorption or displacement on tooth 22. It is not possible to assess the periapical region of the tooth for endodontic pathology. The remaining periradicular bone appears normal. There are no signs of a root fracture.
4. Secondarily affected tooth 23
The cystic entity extends along the palatal surface of the apical half of the root of tooth 23. Tooth 23 has been displaced in a buccal direction. There are no signs of root resorption, periapical pathology, or root fracture on tooth 23.
5. Secondarily affected tooth 24
The cystic entity extends along the palatal surface of the apical third of the root of tooth 24. There are no signs of root resorption or displacement on tooth 24. The presence of periapical pathology cannot be assessed. The remaining periradicular bone appears normal. There are no signs of a root fracture.
6. Periapical rarefying osteitis on tooth 13
Periapical rarefying osteitis is present on tooth 13. The buccal cortical plate overlying this region has been slightly thinned, but remains intact. The cystic entity extends in close proximity to the mesiopalatal exhibits of the apical third of the root of tooth 13. However, no direct communication is noted. The remaining periradicular bone appears normal. There are no signs of a root fracture.
7. Multiple buccal abrasions
Buccal abrasion is present on teeth 14, 15, 24, and 25, at the level of the cementonenamel junction.
Periodontal bone loss
Moderate horizontal periodontal bone loss is present at the buccal surfaces of teeth 23, 24 and 25. Moderate vertical periodontal bone loss is present at the lingual surface of tooth 15, and the mesial and distal surfaces of tooth 16.
8. Mucous retention cyst in left maxillary sinus
A mucous retention cyst is present on the floor of the left maxillary sinus. This represents a non-significant incidental finding.