Case of the month – periapical lesions
CBCT scanner: instrumentarium OP300
CBCT imaging protocol: 60x60x80mm, 0.2 voxel
Effective dose: 0.04 mSv
Clinical information: implants planned in upper aesthetic zone.
Findings: paranasal sinuses – minimal mucosal thickening noted in the right maxillary sinus with some calcifications. A small mucous attention cyst is noted on the floor of the left sinus.
Maxilla: presence of a periapical lesion on UR2 with severe external resorption. The lesion is causing thinning on both buccal and palatal cortices. The crown to root ratio of the tooth is unfavourable.
Periapical lesion with endodontic surgery and retrograde obturation are noted on UR1 with presence of a bone defect superior to the tooth extending posteriorly to communicate with the incisive canal.
Impressions and recommendations
Prognosis of UR2 is poor with need for extraction, enucleation of the cyst and biopsy.
Prognosis of UR1 is also noted with presence of a periapical lesion and another most probably inflammatory lesion involving the incisive canal. Extraction of the tooth and enucleation of both lesions and biopsy is recommended as well.
Mucous retention cysts and mucositis in the maxillary sinuses are common findings, the calcifications are consistent with antrolith, no further evaluation needed.
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