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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Benign cystic or neoplastic lesion at site 24
There is a well-defined, corticated, unilocular entity within the left maxillary alveolar process, between the roots of teeth 23 and 25. Internally, the entity is radiolucent with hints of granular patches. Specifically, there is a well-defined arc-shaped radiopacity near the inferior periphery of the lesion. This arc-shaped radiopacity is fairly distinctive, and may be a sign of the presence of a calcifying odontogenic cyst (also known as a calcifying cystic odontogenic tumor), although the patient is not in the age range that this lesion normally manifests. There has been significant expansion, thinning, and possible dehiscence of the buccal and palatal cortical plates at site 24 and the expanded cortices exhibit a granular pattern. The floor of the left maxillary sinus has been slightly elevated. In addition to a calcifying odontogenic cyst, a long-standing residual cyst with dystrophic calcifications could also be considered in the differential diagnosis. Biopsy and histopathological examinations are recommended to confirm the interpretation.
Orthogonal measurements of lesion in left maxilla
These orthogonal cross-sectional images demonstrate the approximate dimensions of the lesion in the left maxilla.
2. External resorption + possible separated instrument of tooth 25
Smooth external resorption is present on the mesial surface of the root of tooth 25. A linear radiopaque object is present in the coronal half of the palatal root canal of tooth 15. The remainder of the palatal canal is unobturated. This suggests the presence of a separated instrument. Tooth 25 may be the source of the lesion at site 24, or may be secondarily affected by the lesion.
3. Secondarily affected tooth 23
The lesion at site 24 abuts the distal surface of the apical two thirds of the root of tooth 23. Hypercementosis is present on the apical third of the root, which represents a non-significant incidental finding. The remaining periradicular appears normal, which suggests that tooth 23 has been secondarily affected, as opposed to a contributing source of pathology.
4. Retained restorative material at site 27
A granule of restorative material is retained within the alveolar process at site 27. This represents a non-significant incidental finding.