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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
Lower left quad
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1. Benign cyst or tumor adjacent to tooth 37
A well-defined, corticated radiolucency is centered along the lingual aspect of tooth 37 from the level of the root apices to the alveolar crest. The contiguous lingual cortical plate is expanded, thinned, and partially dehiscent, and the roots of tooth 37 have been displaced buccally. The alveolar crest is lost interproximal to teeth 37 and 38. No root resorption is apparent. The left mandibular nerve canal is unaffected. This pattern of bone loss does not appear to be endodontic in origin, and is more suggestive of a benign cyst or cystic tumor. A biopsy of this region is indicated for a definitive diagnosis.
2. Rarefying osteitis on tooth 36M+D
The mesial and distal roots of tooth 36 exhibit periapical rarefying osteitis, which extends along the buccal surface of the roots to the level of the alveolar crest. The area of rarefying osteitis associated with the distal root of tooth 36 communicates with the radiolucent lesion associated with tooth 37, but the epicenters of bone loss appear to be distinct. Vitality testing of tooth 36 is recommended to confirm this interpretation prior to initiating endodontic treatment.
Axial views of posterior 3rd quadrant
These axial cross-sectional images demonstrate distinct epicenters of bone loss associated with teeth 36 and 37. The lingual cortex is expanded and partially dehiscent overlying the radiolucent lesion along the lingual surface of tooth 37, which suggests soft tissue extension of this lesion should be considered.
Buccolingual views of tooth 37
These buccolingual cross-sectional images demonstrate the buccal displacement of the roots of tooth 37, which suggests the radiolucent lesion represents a benign space-occupying entity. Note the slightly granular appearance of the thinned lingual cortical plate adjacent to tooth 37.
Buccolingual views of tooth 36
These buccolingual cross-sectional images demonstrate periapical bone loss associated with the mesial and distal roots of tooth 36, which extends coronally to the level of the furcation.
Mesiodistal views of posterior 3rd quadrant
These mesiodistal cross-sectional images demonstrate communication between the area of periapical rarefying osteitis associated with the distal root of tooth 36 and the extensive radiolucent lesion adjacent to tooth 37. The alveolar crest is lost interproximal to teeth 37 and 38. Teeth 35 and 38 appear normal.