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Referral details

Case 246084

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Referral category

Impacted / delayed / malpositioned / extra teeth

Region of interest

2nd Quadrant, Impacted #25,26,27 and 28

Referral reason

[Only visible to logged-in users]

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Canaray 246084

1. Possible ameloblastic fibro-odontoma causing impaction of teeth 26, 27, and 28

A predominantly radiolucent multilocular entity is present in the pericoronal regions of teeth 26, 27, and 28. This entity is continuous with the alveolar crest, and contains multiple small calcifications with densities that are similar to dental or bone structures. This entity has a thinly corticated periphery. The eruption of teeth 26, 27, and 28 has been prevented by this entity. Based on the pericoronal position of the lesion, the age of the patient and the presence of calcified internal structures, the most likely diagnosis is an ameloblastic fibro-odontome, which can be confirmed via biopsy.

Supernumerary tooth (s) contributing to impaction of tooth 25

A small inverted and distoangularly impacted supernumerary tooth (s) is present in the buccal aspect of the alveolar process at site 25. This supernumerary tooth exhibits microdont morphology and is positioned buccal to the crown of the impacted tooth 25. The position of this supernumerary tooth is contributing to the impaction of tooth 25. The periodontal ligament space and follicle surrounding the crown of the tooth appear normal radiographically. These findings suggest that the tooth is not ankylosed. Extraction of this supernumerary tooth is required in order to facilitate the orthodontic repositioning of tooth 25. The supernumerary tooth can be surgically accessed from the from the buccal and crestal aspects of the alveolar process at site 25.

Axial views of supernumerary tooth (s)

These axial cross-sectional images demonstrate the normal appearance of the periodontal ligament space surrounding the root of the supernumerary tooth (s). The follicle surrounding the crown of the tooth appears normal. These findings suggest that the tooth is not ankylosed.

Impacted tooth 25

The root of tooth 25 has been palatally displaced by the impacted tooth 26. The crown of tooth 25 is oriented in buccoversion and the tooth has rotated about its long axis. The crown of tooth 25 is positioned distal and slightly palatal to the coronal two thirds of the roots of tooth 24. The position of the impacted tooth 26 and the supernumerary tooth (s) have contributed to the displacement and impaction of tooth 25. Tooth 25 has not caused root resorption on the adjacent permanent teeth. However, tooth 24 has been displaced and has rotated about its long axis. The root of tooth 25 is 80% formed. There are no signs of ankylosis on this tooth. The crown of tooth 25 can be surgically accessed from the palatal aspect of the alveolar process at site 25. This tooth can also be surgically accessed from the buccal aspect of the alveolar process at site 25, once the supernumerary tooth (s) has been extracted.

Axial views of tooth 25

These axial cross-sectional images demonstrate the normal appearance of the periodontal ligament space surrounding the developing root of tooth 25. The crown of the tooth has partially erupted through the alveolar crest. The residual follicle surrounding the crown of the tooth appears normal. These findings suggest that the tooth is not ankylosed.

Impacted tooth 26 contributing to impaction of teeth 25 and 27

Tooth 26 is slightly distoangularly oriented in the posterior left maxilla. The roots of the tooth are positioned in the left maxillary sinus and the palatal root abuts the left lateral wall of the nasal fossa. The position of this tooth has contributed to the displacement and impaction of tooth 25 and the impaction of tooth 27. Tooth 26 has not caused root resorption on the adjacent permanent teeth. Moderate external resorption is present on the buccal roots of the tooth. The periodontal ligament space cannot be visualized surrounding the roots of tooth 26. These findings suggest that the tooth is ankylosed. The follicle surrounding the crown of the tooth appears normal and has caused dehiscence of the overlying buccal cortical plate. The crown of tooth 26 can be surgically accessed from the buccal aspect of the alveolar process between teeth 25 and 27.

Axial views of tooth 26

These axial cross-sectional images demonstrate that the periodontal ligament space cannot be fully visualized surrounding the roots of tooth 26. Moderate external resorption is present on the buccal roots of tooth 26. These findings suggest that the tooth is ankylosed. The follicle surrounding the crown of the tooth appears normal and has caused dehiscence of the overlying buccal cortical plate. Note the positions of the roots of the tooth within the left maxillary sinus.

Impacted tooth 27

Tooth 27 is vertically impacted. The position of the impacted tooth 26 and the supernumerary tooth (s) have contributed to the impaction of tooth 27. Tooth 27 has not caused root resorption to the adjacent permanent teeth. The distobuccal and palatal roots of tooth 27 exhibit prominent dilacerations, which is likely the main contributing factor to the impaction of this tooth. These roots are positioned within the left maxillary sinus. The mesiobuccal root exhibits resorption or a fracture. The periodontal ligament space cannot be fully visualized surrounding the roots of the tooth, which suggests the presence of ankylosis. The follicle surrounding the crown of the tooth appears normal and communicates with the follicle surrounding the crown of tooth 28. The crown of tooth 27 can be surgically accessed from the from the buccal aspect of the alveolar process, between teeth 26 and 28.

Axial views of tooth 27

These axial cross-sectional images demonstrate that the periodontal ligament space cannot be fully visualized surrounding the roots of tooth 27. External resorption or a root fracture is present on the mesiobuccal root of tooth 27. These findings suggest the presence of ankylosis. The follicle surrounding the crown of the tooth appears normal. Note the positions of the distobuccal and palatal roots within the left maxillary sinus.

2. Retained root fragment at site 27DB

A small root fragment is retained within the distobuccal aspect of the alveolar process, in the superior portion of site 27. No pathology is present on the retained root fragment. This root fragment may represent the fractured or partially resorbed and displaced root fragment of tooth 27MB.

Mildly malformed tooth 28 contributing to impaction of tooth 27

Tooth 28 is slightly distoangularly oriented. The crown of tooth 28 is positioned distal and slightly inferior to the crown of the impacted tooth 27. The position of tooth 28 may be contributing to the impaction of tooth 27. The mesial aspect of the crown of tooth 28 appears slightly malformed in the region adjacent to the crown of tooth 28. The root of tooth 28 has not yet commenced development. The follicle surrounding the crown of the tooth appears normal and communicates with the follicle surrounding the crown of tooth 27. Tooth 28 can be surgically accessed from the from the buccal or palatal aspects of the alveolar process at site 28.

Axial views of tooth 28

These axial cross-sectional images demonstrate the normal appearance of the follicle surrounding the crown of tooth 28. Note the mild malformation on the mesial aspect of the crown of tooth 28.

Displaced + rotated tooth 24

The palatal root of tooth 24 has been mesially displaced by the impacted tooth 25. Tooth 24 has rotated about its long axis. There is no evidence of root resorption on tooth 24. The root apex of tooth 25 is positioned palatal to the palatal root apex of tooth 25. The supernumerary tooth (s) is positioned distobuccal to the coronal half of the buccal root of tooth 24.

Axial views of posterior 2nd quadrant

These axial cross-sectional images demonstrate impaction of teeth 25, 26, and 27 within the posterior 2nd quadrant. The buccal position of the supernumerary tooth (s) relative to tooth 25 is also evident in these images. There are no signs of ankylosis on the teeth 25, 28, and the supernumerary tooth (s). Ankylosis appears to be present on teeth 26 and 27.

Mesiodistal views of posterior 2nd quadrant

These mesiodistal cross-sectional images demonstrate the orientations of the impacted teeth 25, 26, 27, and the supernumerary tooth (s) in the posterior 2nd quadrant. External resorption is present on tooth 26MB+DB. External resorption or a fragment is present on tooth 27MB. There is no evidence of root resorption on teeth 24, 25, or 28. Note the positions of the roots of teeth 26MB+DB and 27DB+P within the left maxillary sinus.

Possible future impaction of tooth 38

Tooth 38 is partially captured in this imaging volume. The tooth is developing in a horizontal orientation, which suggests the possibility of future impaction. The follicle surrounding the crown of the tooth appears normal and has caused dehiscence overlying the overlying alveolar crest. No further comments can be made based on this limited field of view.