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Clinical Cases

Clinical Cases. Gurminder Sidhu BDS, DDS, MS, Diplomate of ABOMR Director of Radiology services Dept. of Dental Practice. CASE 1. 30 year old female presented for regular dental check up. On Radiographic examination You find…. CASE 1.

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Clinical Cases

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  1. Clinical Cases Gurminder Sidhu BDS, DDS, MS, Diplomate of ABOMR Director of Radiology services Dept. of Dental Practice

  2. CASE 1 • 30 year old female presented for regular dental check up. On Radiographic examination You find…

  3. CASE 1 • On the anterior mandibular periapical radiograph there is a well defined radiolucent area with sclerotic borders present at the root apices of mandibular central and lateral incisors. It is well defined and localized. Is not causing the displacement or resorption of adjacent teeth. There is no gross carious lesion or sign of trauma in the area. The appearance is consistent with periapical cemento-osseous dysplasia.

  4. CASE 1 Can have three stages radiolucent, mixed or completely radiopaque. Common in middle aged women specially Afro-American. Associated teeth are vital. Periapical Cemento-osseous dysplasia.

  5. Periapical Cemento-osseous dysplasia. Mixed radiolucent and radiopaque stage with simple bone cyst arising within the lesions of cemento-osseous dysplasia.

  6. Patient presented with pain in the lower left posterior area. On the left posterior periapical radiograph there is a radiolucent area associated with the root of mandibular left second premolar. The area is well defined, corticated. No displacement of adjacent teeth or resorption of the root is seen. The associated tooth has a big carious lesion and horizontal bone loss. The C:R ration is 1:1. Evidence of calculus in the general area is seen. CASE 2

  7. The appearance is consistent with radicular cyst. CASE 2

  8. The radiolucent area associated with periapical region of mandibular left second molar is irregular and the appearance is consistent with rarifying osteitis. This is the probable cause for pain. CASE 2

  9. Radicular cyst Rarefying osteitis Rarefying osteitis

  10. Case 3 • Patient presented for the replacement of #19. On the left posterior Accuitomo image there is a radiolucent area associated with the mid root region of mandibular left second premolar. The area is irregular. No displacement of adjacent teeth or resorption of the root is seen. No pulp canal is evident.

  11. CASE 4 • 86 year old patient with a history of prostate cancer presents for routine dental exam. A well defined radiolucent area with thick corticated border is noted on the posterior right mandible below the inferior alveolar canal.

  12. Anatomy Mylohyoid ridge Submandibular salivary gland fossa

  13. CASE 5 • Patient presented for routine dental exam. On mandibular right premolar periapical radiograph there is a well defined, corticated and unilocular radiolucent area in between the roots of canine and 1st premolar. The periodontal ligament space is intact on canine and premolar. The lesion is not causing expansion, displacement or resorption of the adjacent teeth

  14. Lateral periodontal cyst

  15. Case 6 • Patient presented for routine dental exam. On mandibular left canine periapical radiograph there is a well defined, corticated and unilocular radiolucent area in between the roots of lateral incisor and canine. The periodontal ligament space is intact on these teeth. Slight displacement of the adjacent teeth is noted. The lesion is not causing expansion or resorption of the adjacent teeth

  16. CASE 7 • 48 year old patient presented with slow growing (past 6 months) facial swelling of right side. Pt. does not complain of pain or discomfort. On radiographic examination there is a well defined and corticated radiolucent area associated with the crown of mandibular right 3rd molar. The radiolucent area extends from the apices of 1st molar to neck of coronoid and condylar process. It has caused thinning of the lower border of the mandible. 3rd molar has been displaced apically.

  17. Dentigerous cyst: The epicenter of dentigerous cyst is coronal to the crown of the involved tooth. The cyst is attached at CEJ but when it enlarges the tooth appears to be within the cyst. Dentigerous cyst is completely radiolucent and is well defined and corticated. It can resorb and displace adjacent teeth. Usually displace the associated tooth in an apical direction. 3rd molars may be displaced to the condylar or coronoid process or to the inferior border of the mandible.

  18. Enlarged follicle

  19. CASE 8

  20. CASE 9 • On clinical exam of a 38 year old male a small well defined swelling posterior to the palatine papilla is noted. On radiographic exam there is a well defined and corticated radiolucent area in the region of incisive foramen.

  21. CASE 10 • On clinical exam of a 32 year old male a small well defined swelling posterior to the palatine papilla is noted. On radiographic exam there is a well defined and corticated radiolucent area in the region of incisive foramen.

  22. CASE 11 • 7 year old child is brought to your clinic by his mother with the chief complain “lower right back tooth is missing”. On radiographic examination a well defined, corticated radiolucent area is noted coronal to mandibular first molar area. The tooth is displaced apically and lower border of the mandible is thinned.

  23. CASE 12 • On routine examination of 11 year old patient a well defined corticated radiolucent lesion is noted. The lesion shows some radiopacities and is present associated with 3rd molar. The tooth is apically displaced.

  24. CASE 13 • On routine dental exam a well defined, corticated radiolucent lesion is noted in the mandibular left posterior area in the region of 2nd molar. The margins are scalloped and it is causing displacement of 2nd molar.

  25. OKC

  26. OKC

  27. Axial CT The Encyclopedia of Medical Imaging Volume VI:2

  28. CASE 15 • 45 year old male presents with the chief concern of “I want an implant in lower right area for the missing tooth” On radiographic evaluation a multilocular, well defined, well corticated radiolucent area is noted extending from the apical area of # 30 to # 27. Displacement of the root of # 27 is noted. On clinical exam there is a hard swelling in this area and overlying tissue appears normal.

  29. Ameloblastoma 3% 2% 10% 60% 15% 10%

  30. Ameloblastoma

  31. Ameloblastoma

  32. Mural Ameloblastoma

  33. CASE 16 • 18 year old female presents with the chief complain of swelling and tenderness in anterior maxilla.

  34. CASE 17 • 38 year old male presents with the chief complain of swelling in anterior mandible.

  35. CASE 18 • 5 year old child is brought to your office by his mother. On clinical exam there is bilateral painless enlargement of the face. Enlargement of submandibular lymph nodes.

  36. Basal cell nevus syndrome

  37. CASE 19 • Chief complaint: 19-year-old male presented with a 3-month history of an enlarging lower left jaw mass. Physical examination revealed a firm, non-tender, fixed mass located in the body of the left mandible posteriorly and extending up in the ramus. The overlying skin appeared normal and mobile. Oral cavity examination showed a firm expansion of the left madibular vestibule.

  38. CASE 20 • 60 year old male presents with rapidly increasing swelling in the upper right quadrant. On radiographic evaluation there is ill defined radiolucent area present in the region canine and premolar. No cortication or reaction in surrounding bone is seen.

  39. CASE 21 35 year old male presented with rapidly growing swelling in mandibular posterior area. On clinical exam the teeth in the area are loose and overlying mucosa is erythematous with small area of ulceration. Pt. complains of pain in the area.

  40. CASE 22 • 60 year old male presents with C/C of pain in left posterior area in mandible.

  41. Case 23 • Patient presented for the replacement of #19. On the left posterior Accuitomo image there is a radiolucent area associated with the mid root region of mandibular left second premolar. The area is irregular. No displacement of adjacent teeth or resorption of the root is seen. No pulp canal is evident.

  42. CASE 24 • Pt. presents in emergency clinic with the chief concern of loose upper tooth. On radiographic examination there is an ill defined enlargement of PDL unilaterally. Periphery shows infiltrative border. No reaction in surrounding bone is noted. On evaluating medical history it is noted that pt. is undergoing treatment for leukemia.

  43. CASE 25 • 23 year old pt. presents with swelling, dull pain, gingivitis. History of multiple extractions over the last 6 months. Teeth have become progressively loose then been extracted.

  44. CASE 26 54 year old male presents with the chief complaint of loose teeth. On radiographic examination there is a radiolucent area present in the mandibular right premolar-molar area.

  45. CASE 27 • 45 year old female presents with the chief complain that her teeth are progressively becoming loose. On radiographic evaluation there is generalized widening of PDL.

  46. CASE 28 58 year old female complains of pain of 2 years duration. Pain is not relieved by any pain medication. Intra-oral examination WNL.

  47. Osteomyelitis

  48. Osteomyelitis

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