(Figure 1 - Orthopantomograph)
The patient was advised to have a CBCT taken to determine the risks of surgical removal of these teeth. A report mentioned the following relevant features:
There is a 17 mm vertical x 18 mm medio lateral x 24 mm AP corticated soft tissue mass in the right maxillary sinus. This is intimately involved with a displaced UR8.
There is thinning of the lateral wall of the right maxillary sinus. The vertical dimension is actually in excess of 28 mm and this mass involves the crowns of both UR8 and UR7.
18 – the apices of this tooth are dilacerated and engage the lateral wall of the right maxillary sinus. They abut the pterygoid palatine fossa.
The roots of UR7 engage both the floor of the maxillary sinus and the floor of the right nasal cavity (palatal root),
The roots of UR7 lie between the roots of UR6. There is apical root resorption of the distobuccal root of UR6 by this arrangement - blunting of the palatal root of UR6 is also noted.
UR5 is two rooted.
UL8 has dilacerated roots and engages the floor of the left maxillary sinus.
UL4 is rotated and 25 is missing.
Both LR8 and LR7 show a ‘kissing molar‘ arrangement with follicular expansion measuring up to 5 mm.
LR8 – the roots engage the lingual cortex and are dilacerated.
LR7 – the roots engage the inferior cortex. The roots of LR7 displace the right ID canal lingually.
Both LL7 and LL8 also show a‘ kissing molar‘ arrangement, again with follicular expansion in a similar pattern to the contra lateral side
The right ID canal takes a lingual course through the ramus of mandible, it then runs lateral to and inferior to the expanded follicle before being displaced lingually by the crown and root structure of LR7. It is intimately involved with the apices of LR7, rounding its apex to emerge as the right mental foramen.
The left ID canal takes a lingual course through the ramus of mandible before being displaced inferior by the follicle of the kissing molar arrangement. It then swings lingually to be in direct contact with the roots of LL7 before rounding the apices to emerge as the left mental foramen.
The apices of both LL7 and LR7 project as far forward as the ‘mental foramena‘.
The patient underwent a biopsy and marsupialisation under local anaesthetic of the cystic lesion in the lower left quadrant. This was confirmed as a dentigerous cyst and histopathology report can be found in text box 1 . Surgical clinical photographs can be seen