Use of Cone Beam Computed Tomography in Endodontics
Figure 8
On conventional intraoral periapical radiography periapical mucositis (PM) presents as a relatively radiopaque, soft-tissue, dome-shaped lesion localized to the apex of a maxillary posterior tooth and projecting into the floor of the maxillary sinus. Most are indistinguishable from mucosal lesions of intrinsic sinus origin such as antral mucosal pseudocysts (see Figure 9). While clinically asymptomatic, they are usually associated with necrotic or failing root canal-filled teeth. PM is a localized mucosal thickening of the sinus membrane, secondary to a breach of periradicular inflammation, and will resolve after successful endodontic treatment. This patient gave a history of persistent left side pain over the maxillary molar region of 4-month duration. Treatment for sinusitis did not relieve the symptoms. Panoramic and intraoral dental radiology did not reveal a cause. Coronal CBCT imaging (a) demonstrates acute sinusitis bilaterally with 50% to 70% opacification and previous uncinectomy and antrostomy (as evidenced by the loss of the superior medial wall of the right sinus) of the right sinus, whereas the left sinus shows thickened mucosal lining with a dome-shaped soft tissue lesion overlying the roots of the restored left maxillary first molar tooth. 5 mm reformatted panoramic (b) and 1 mm cross-sectional (c) reconstructions of the maxillary left first molar show periapical lesional penetration and communication with the floor of the sinus in this region. Data acquired on an iCAT, Imaging Sciences International, Hatfield, PA USA at 0.3 mm resolution and reformatted using InVivo Dental, Anatomage, San Jose, CA.
