Patient Presentation

A 12yo African American male presented to the Howard University, College of Dentistry, Department of Orthodontics, for evaluation. The patient showed a skeletal and dental class III occlusion with generalized anterior spacing. The facial profile displayed profound convexity while his frontal analysis displayed symmetry in all planes (vertical and transverse). His cephalometric analysis confirmed the skeletal anomaly (class III), with proclined upper incisors. The patient was referred to Dr. Martin D. Levin for endodontic evaluation and possible CBCT.

Clinical Description

Right side of maxilla: Lesion can be palpated on the palatal surface between teeth #s 6 and 7. Lesion is elevated- approximately 3 mm of elevation and approximately 23 mm x 7 mm in surface dimension, is ovoid, circumscribed, well defined, with no variation in color, and fluctuant under pressure; no pain upon palpation and non-symptomatic. Palatal bone plate cannot be palpated between teeth #s 6 and 7.

There was no pain upon percussion, vitality test were within normal limits to cold and EPT; no changes in tooth color.

Radiographic description of lesion

  • Location: maxillary right anterior alveolus, between roots from CEJ to the apex of teeth #s 6 and 7
  • Radiodensity: low density
  • Size: Approx. 18.0 mm x 15.0 mm
  • Shape: unilocular/ovoid
  • Borders: partially  well-defined mesial to canine between #6-#7, non-corticated; poorly defined between distal teeth #s 7 and 8
  • Internal architecture: uniform low density
  • Effect on surrounding tissues: lesion has locally destroyed buccal and palatal cortical plates of the right anterior side of maxilla with 6 mm of expansion of buccal and palatal plates in the area between teeth #s 6 and 7; no lamina dura observed in associated tooth roots adjacent to lesion; roots of tooth #6 and #7 are displaced mesially and distally respectively; thickening of the membrane of the floor of the maxillary sinus (3-5 mm within the field of view)  Maxillary Sinuses show uniform, 3 mm–5 mm thickening of the mucous membrane of the floor within the image volume

Impression of Maxillary Anterior Lesion and Recommendations

Maxillary right: features consistent with a lateral periodontal cyst, keratocystic odontogenic tumor, or central giant cell granuloma; referral to oral and maxillofacial surgeon for evaluation and possible treatment of maxillary right alveolar lesion (including biopsy) between teeth #s 6 and 7

 

Attending Resident: Rina Gonzalez-Albazzaz, DMD
Consulting Orthodontist: Sana Augustus, DDS
Consulting Radiologist: Barry Pass, DDS, PhD
Consulting Endodontist: Martin D. Levin, DMD