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
• 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.
                        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.
Periapical Cemento-
osseous dysplasia. Mixed
radiolucent and
radiopaque stage with
simple bone cyst arising
within the lesions of
cemento-osseous
dysplasia.
                               CASE 2
• 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
• The appearance
  is consistent with
  radicular cyst.
                         CASE 2
• 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.
Radicular cyst

                 Rarefying osteitis




                 Rarefying osteitis
                               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.
                   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.
Anatomy



  Mylohyoid ridge




                    Submandibular salivary gland fossa
                      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
Lateral periodontal cyst
                       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
                              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.
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.
Enlarged follicle
CASE 8
                   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.
                  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.
                          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.
                     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.
                  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.
OKC
OKC
                Axial CT




The Encyclopedia of Medical Imaging Volume VI:2
                         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.
Ameloblastoma


       10% 3% 2%




        60% 15%10%
Ameloblastoma
Ameloblastoma
Mural Ameloblastoma
                  CASE 16
• 18 year old
  female
  presents with
  the chief
  complain of
  swelling and
  tenderness in
  anterior
  maxilla.
                CASE 17




• 38 year old male presents with the chief
  complain of swelling in anterior mandible.
                          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.
Basal cell nevus syndrome
                              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.
                 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.
                      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.
                   CASE 22
• 60 year old
  male presents
  with C/C of
  pain in left
  posterior area
  in mandible.
                             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.
                       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.
                    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.
                 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.
                         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.
                  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.
Osteomyelitis
Osteomyelitis
                        CASE 29
82 year old patient
 with a history of
 breast cancer
 presents for routine
 dental exam.
CASE 29