Where is the odontogenic swelling stemming from?

A 52-year- old man presented with moderate discomfort and definitive fluctuant swelling on the buccal aspect of his maxillary left quadrant.

As one can visualize from this intake periapical film not information could be evaluated from the image. We went ahead and proceed to take another periapical image along with a bitewing view.

As dental clinicians we are often challenged by the need for proper images, either from the appropriate angle or often with the proper exposure and development of the image. There are then technical errors we often encounter with digital or solution developed variables.

Now where do you suspect the odontogenic swelling was stemming from?

Finding the ontogentic swelling …

1. We exposed our own periapical digital film and a somewhat compromised bitewing as he presented with some significant buccal swelling.

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  Digital film

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  Digital film

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  CBCT coronal view

2. Here the CBCT coronal view displays a slight periapical lesion lesion stemming from the MB root from #14. (Note the thickening of the sinus floor)

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  Anatomic view

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  Axial CBCT view

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  Final digital radiograph

3. Interestingly, I was somewhat intrigued that this anatomic view displays the fenestration of the DB root end. The axial CBCT view displays the lack of cortical osseous tissue on the buccal aspect of the DB root end of #14. Here displays the final digital radiograph after his subjective symptoms had resolved.

The images that we additionally captured where then augmented with a CBCT scan of the area. Upon evaluation of the scan images, we where able to more completely understand the source of his mucco-gingival swelling, stemming from the necrotic fenestrated DB root end.