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Case 57440

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Troublesome / painful / cracked tooth (Endodontic)

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Canaray 57440

1. Iatrogenic damage to tooth 24 by fixation screw

Tooth 24 exhibits a history of iatrogenic damage by the fixation screw for the overlying fixation plate. The buccal surface of the buccal root of tooth 24 has been perforated. The perforation extends to the depth of the pulp chamber. Tooth 24 has likely been devitalized. This is the source of the buccal draining fistula adjacent to tooth 24. Tooth 24 requires endodontic treatment or extraction.

Axial views of tooth 24

These axial cross-sectional images demonstrate the extension of the fixation screw through the mesiobuccal aspect of the root of tooth 24 at the midroot level. Note the impingement of the screw upon the root canal system of the tooth, as well as the loss of the buccal cortical plate adjacent to the tooth in the region of the perforation.

Buccolingual views of tooth 24

These buccolingual cross-sectional images demonstrate the impingement of the fixation screw upon the root of tooth 24. A localized zone of internal resorption appears to be present in the buccal root canal of tooth 24 adjacent to the fixation screw.

Mesiodistal views of tooth 24

These mesiodistal cross-sectional images demonstrate the rarefying osteitis that is present on the mesiobuccal aspect of the root of tooth 24 at the site of root impingement by the fixation screw. The internal resorption that is present in the apical third of the buccal root canal of the tooth adjacent to the fixation screw is also evident in these images.

2. Widened PDL space on tooth 23

The periodontal ligament space surrounding the apical region of tooth 23 is widened. This may be a variant of normal anatomy or an early sign of endodontic pathology. Vitality testing is required to confirm the interpretation.

3. Normally seated titanium mesh

The titanium mesh that overlies the lateral wall of the left maxillary sinus is normally seated, and has not had any effects on the underlying tissues.