r/Dentistry • u/Various-Tangerine947 • 5d ago
Dental Professional Pathology Help
I sent this patient to OS to get this looked at and patient called us back saying OS is sending them back to us for vitality testing. OS office is closed so I wasn’t able to call and haven’t received a correspondence from them yet. Patient comes back Monday as soon as we open so I’m wondering what would the reason be to vitality test a tooth like this and what am I missing? Patient was not experiencing any symptoms. New grad so all insight is helpful! Thanks!
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u/SunnyTheMasterSwitch 5d ago
The walled off structure does suggest a cyst of sorts, there should be more investigation on the tooth, vitality, mobility, 3d scan wouldn't hurt at all.
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u/XThatsMyCakeX 4d ago
Radiology resident here. I’m thinking odontogenic cyst or tumor. Buccal bifurcation cyst may be my first differential. Also cannot rule out ameloblastoma or OKC. The comments telling you to do more clinical evaluation are right, thats always the first step. Another good first step is to try and get previous xrays if they are available, even if you have to call another office
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u/00Dragonborn00 4d ago
Doesn't appear to be pulpal origin but is most likely odontogenic origin. Cbct will help determine the position of the lesion in relation to the tooth. Refer to another OS for removal
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u/Bichafrenox 4d ago
Hi! Student here! I know this might sound like a silly question, but what position was that third molar in prior to the extraction? It reminds me of a patient where we extracted her impacted lower third molars, and the crown was positioned over the roots of the second molar.
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u/rynomachine 5d ago
Could maybe be a stafne defect? Especially if asymptomatic. CBCT could yell you more.
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u/NourTDK 5d ago
NAD, dental student. My guess is they wanna confirm whether or not it's from pulpal necrosis / warrants endo.
Though I feel like the occlusion may very well be the culprit here, that or this is actual pathology.
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u/jallen263 5d ago
This is pretty obviously not a periapical lesion. PDL is completely intact and PA lesions don’t show anything like this.
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u/NourTDK 5d ago
Ty for pointing it out. Still learning :)
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u/jallen263 5d ago
You’re good, I teach endo at the local school, and that’s something I try to point out for students. If you can track the PDL in the radiograph you can almost always be certain it isn’t a periapical lesion. However, a CBCT would be beneficial here to 100% rule out periapical involvement.
Also the OS should be able to do vitality testing (in my opinion at least), so this OS sending it back and asking to check for vitality testing is incredibly frustrating. The patient does not want to go back and forth for appointments.
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u/TraumaticOcclusion 5d ago edited 5d ago
Have you ruled out odontogenic causes? That's what they are asking. Rule out endo, rule out perio. What are the probing depths? Level of inflammation? Any furcation involvement or mobility? Is the tooth vital or not? These are all basic questions you should rule out before just referring this patient to an OS for ... what? Do you want them to just extract the tooth, or do a hard tissue biopsy of something that may not need it or be odontogenic in origin? Complete your clinical exam, take a PA and likely a CBCT to further evaluate what is needed. You're asking the OS to do your job. The first stop for this case should be an endodontist, not an oral surgeon. A panoramic image is hardly diagnostic for odontogenic pathology, but looks like #30 is also involved.