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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
15, 16, 17
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1. Osteosarcoma in right maxilla
An ill-defined pattern of lytic bone destruction and disorganized bone formation is present within the right maxillary alveolar process, which extends from the midline to the tuberosity and from the alveolar crest to the sinus floor. The right maxillary sinus is opacified, which suggests the presence of an associated soft tissue mass extending into the antral cavity. The buccal and palatal cortical plates and alveolar crest are partially dehiscent, and a diffuse area of spiculated periosteal bone formation is evident along the buccal aspect of the maxilla. Irregular periodontal ligament space widening is present around the contiguous teeth, and tooth 18 exhibits external resorption.
This radiographic appearance is consistent with a bone-forming malignancy. An osteosarcoma is the most likely interpretation. Biopsy is required for a definitive diagnosis.
Axial views of right maxilla
These axial cross-sectional images demonstrate the presence of irregular and diffuse bone formation within the right maxilla, which has resulted in a spiculated periosteal reaction that extends from sites 13 to 16. Lytic bone loss and periodontal ligament space widening is evident around the teeth, and tooth 18 exhibits external resorption. The right maxillary sinus is opacified and small fenestrations are evident within the antral walls.
Mesiodistal views of right maxilla
These mesiodistal cross-sectional images demonstrate the complete opacification of the right maxillary sinus. The sinus floor is thinned and appears to be partially dehiscent apical to tooth 14 and site 15. A focal area of air-like density at site 15 suggests secondary infection may be present.
Buccolingual views of right maxilla
These buccolingual cross-sectional images demonstrate the presence of a spiculated periosteal reaction along the buccal aspect of the right maxilla. This appearance of lytic bone loss combined with an irregular pattern of bone formation is highly suggestive of an osteosarcoma.
Impacted tooth 28
Tooth 28 is vertically impacted relative to the long axis of tooth 27, and the crown is oriented in mild buccoversion. The crown of tooth 28 is positioned distal to the coronal half of the distobuccal root of tooth 27. The follicle appears normal. The root apices of tooth 28 abut the sinus floor. No resorption has occurred to tooth 27.
Impacted teeth 38 and 48
A small amount of the impacted teeth 38 and 48 are captured in this imaging volume. No pathology is visible based on this limited field of view.