Dentomaxillofacial Radiology (2006) 35, 65-66
© 2006 British Institute of Radiology
doi: 10.1259/dmfr/58382124
Multiple radiographic projections in diagnosis of uncommon unerupted tooth
The radiographic examination together with the clinical evaluation of patients is essential for a correct diagnosis in order to determine the precise location of unerupted teeth. The conventional radiograph image is the first choice of imaging examination, but this modality presents a limitation because it does not visualize the third dimension.1 Thus, only two dimensions are registered on the film and an overlapping of the anatomical structures becomes inevitable, making the diagnosis difficult. It is necessary to take images from different angles before surgical treatment, mainly in cases in which proximity to important structures is observed, in order to avoid unnecessary surgical access and achieve better surgical planning.2 Recently, a case that is a great example of what is described above was observed at the authors' radiological clinic.
A case is presented of a patient who was referred to the authors' radiological clinic for a panoramic radiograph to localize an unerupted tooth. Radiographically, it was possible to observe the presence of an unerupted third molar projected inside the right maxillary sinus (Figure 1
). In addition, a lateral cephalometric radiograph, Hirtz axial and posteroanterior (PA) to the maxillary sinus images were performed. In the lateral cephalometric radiograph, the presence of a tooth was also observed, as though it were located inside the maxillary sinus (Figure 2). However, in the PA (Figure 3) and axial projection (Figure 4), it was observed that the tooth was clearly shown to be in a close relationship only with the posterior wall of the maxillary sinus and was not located inside it, but in the corresponding space of the infratemporal fossa.
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Figure 1 The panoramic radiographic image shows the unerupted tooth projected inside the right maxillary sinus
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Figure 2 In this lateral view an unerupted tooth can be seen as though it were inside the maxillary sinus
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Figure 3 Posteroanterior of the maxillary sinus clearly shows only the close relationship with the posterior wall of the maxillary sinus
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Figure 4 The axial projection shows the maxillary unerupted tooth in the corresponding space of the infratemporal fossa
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The complication rate associated with the removal of third molars is approximately 7–10% and the risk of haemorrhage is 0.2–1.4%.3 A surgical procedure to remove teeth located in the infratemporal fossa is difficult, not only because of access, but also because of the structures located around it. In addition, post-operative infections in this area could spread to the base of skull, the deep tissue spaces of the neck and the submasseteric space.4 Therefore, radiographic complementation is essential because it facilitates the correct interpretation of the image and establishes the correct relationship between the anatomical structures.
Flávia Maria de Moraes Ramos1,
Mauro Guilherme de Barros Quirino Martins1,
Solange Maria de Almeida1,
Pedro Duarte Novaes2 and
Francisco Haiter-Neto1
1 Oral Radiology, Department of Oral Diagnosis Brazil;
2 Histology and Embryology Department of Morphology School of Dentistry State University of Campinas Piracicaba, SP Brazil
References
- Sawamura T, Minowa K, Nakamura M. Impacted teeth in the maxilla: usefulness of 3 D dental-CT for preoperative evaluation. Eur J Radiol 2003; 47: 221–226.[Medline]
- Dawson K, MacMillan A, Wiesenfeld D. Removal of a maxillary third molar from the infratemporal fossa by a temporal approach and the aid of image-intensifying cineradiography. J Oral Maxillofac Surg 1993; 51: 1395–1397.[Medline]
- Moghadam HG, Caminiti MF. Life threatening hemorrhage after extraction of third molars: case report and management protocol. J Can Dent Assoc 2002; 68: 670–674.
- Gallagher J, Marley J. Infratemporal and submasseteric infection following extraction of a non-infected maxillary third molar. Br Dent J 2003; 194: 307–309.[Medline]
