108 radiograph interpretation

Re: 108 radiograph interpretation

Rob Davis — Fri, 15 May 2015 08:43:14 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Rob Davis"]

[quote user="Evelyn Barbour-Hill"]By the way, the mesial root of 109 seems to have some damage too.[/quote]

I read this as artifact too (neither appear definitively in both views).

[/quote]

Well, maybe, but the 109 mesial is only a bisecting-angle in the top picture, and the 108 distal is only a bisecting-angle in the lower picture. A fracture will be hidden in a foreshortened image.

[/quote]

Fair point.

Re: 108 radiograph interpretation

Evelyn Barbour-Hill — Thu, 14 May 2015 18:09:19 GMT

[quote user="Rob Davis"]

[quote user="Evelyn Barbour-Hill"]By the way, the mesial root of 109 seems to have some damage too.[/quote]

I read this as artifact too (neither appear definitively in both views).

[/quote]

Well, maybe, but the 109 mesial is only a bisecting-angle in the top picture, and the 108 distal is only a bisecting-angle in the lower picture. A fracture will be hidden in a foreshortened image.

Re: 108 radiograph interpretation

Rob Davis — Thu, 14 May 2015 16:28:21 GMT

[quote user="Evelyn Barbour-Hill"]It's definitely abnormal and in the context very likely to be significant.[/quote]

I agree it looks abnormal, but am less confident about its significance, hence the posting.

[quote user="Evelyn Barbour-Hill"]There is a transverse slightly diagonal line across the distal root near the apex which must surely be a fracture (unless it's artefact, but I doubt that.)[/quote]

I suspected this was artifactual when looking at the original film, but looking at it again in the enlarged photograph, you may be right.

[quote user="Evelyn Barbour-Hill"]By the way, the mesial root of 109 seems to have some damage too.[/quote]

I read this as artifact too (neither appear definitively in both views).

It is actually a colleague's case which was referred to her as an ophthalmology case. There is some suspicion of neoplasia, so I believe this is being investigated first. The tooth in question is currently still in situ, but if I get to extract it I will post an update in due course.

Many thanks for the contributions.

Re: 108 radiograph interpretation

Evelyn Barbour-Hill — Thu, 14 May 2015 15:10:10 GMT

It's definitely abnormal and in the context very likely to be significant.

There is a transverse slightly diagonal line across the distal root near the apex which must surely be a fracture (unless it's artefact, but I doubt that.)

Considerably widened periodontal space around the apex, apparently communicating with a large oval or leaf-shaped radiolucent area overlying the whole thing.

One might argue that the root canal is wider than those of neighbouring teeth, but it's debatable.

Diagnosis root fracture, endodontic disease, periapical infection.

Occam's Razor suggests one should consider it to be connected with the retrobulbar abscess. In the circumstances you wouldn't, I think, want to be messing around with endodontic treatment and extraction would be well justified.

By the way, the mesial root of 109 seems to have some damage too.

Re: 108 radiograph interpretation

Bob Russell — Thu, 14 May 2015 15:05:49 GMT

Looked again and not so sure it is all correct at the caudal root tip.

Backing off a bit from saying it is OK!

Re: 108 radiograph interpretation

Bob Russell — Thu, 14 May 2015 15:02:36 GMT

Probably get a red star from Evelyn but the lamina dura looks intact so I would be cautious in reading pathology from the radiographs!

Re: 108 radiograph interpretation

Martin Atkinson — Thu, 14 May 2015 14:16:43 GMT

I'm sure someone who is better at looking at dental radiographs will be along soon and shoot down my terminology as well but the caudal root of what I assume is the carnassial looks as though there is a gas shadow around it which would be suspicious of alveolar disease but I can't see a tract from that. Anyway, would that be far enough caudal to cause a retrobulbar problem though?, IME usually they cause malar abscesses.