The future of health is digital

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1 Dated: XX/XX/XXXX Name: XXXXXXXX XXXXXXXXXXX Birth Date: XX/XX/XXXX Date of scan: XX/XX/XXXX Examination of the anatomical volume: The following structures are reviewed and evaluated for bilateral symmetry, configuration, cortical outline, medullary space, and patent sinuses/airways. Evaluation of the CBCT anatomical volume presented is intended as an overall review for pathology and it is recommended to use intraoral radiographs for assessment of caries and periodontal disease, as those are best imaged by conventional radiographs. Image findings: Clinical Concern: CBCT data evaluation for orthodontic purposes. Paranasal sinuses: Mild to moderate mucosal thickening is observed in the visualized portions of right and left maxillary sinuses. Patency of right osteomeatal complex is also compromised. Dimensions of right maxillary sinus seem to be smaller when compared to the contra-lateral side.floor of right maxillary sinus si above the floor of right nasal cavity. Nasal cavity: Deviation of nasal septum towards left is observed and a small nasal spur is observed projecting towards left. Right concha bullosa is observed. Dimensions of left inferior turbinates seem to be larger when compared to the contra-lateral side. Airway: Mild reduction in pharyngeal airspace is observed in the visualized portions of airway due to retruded soft palate/ tongue mass. Temporomandibular joints: Mild flattening of anterior surface of right and left condyles is observed. Surface irregularitis and small osteophyte formation is suspected at right condyle. Cortical thickening at anetrior surfac eof left condyle is noted. Cortical boundaries of glenoid fossa and articular eminence are within normal limits. Osseous structures: No abnormalities detected in the visualized portions Dental findings: Maxillary and mandibular third molars are in various stages of development and eruption. Maxillary and mandibular second molars are partially erupted and have not reached the occlusal plane. Maxillary first premolars are at crestal level and permanent canines are unerupted. Crowns of unerupted maxillary permanent canines lie buccal to apical ends of adjacent lateral incisors, bilaterally, pushing them mesially and palatally. Palatal placement of crowns of maxillary first premolars noted bilaterally. Non-delineated pattern of trabeculae noted in maxillary right posterior ridge. Low density lesion is noted associated with apices of teeth #23, 24 and 25. The lytic lesion seems to be surrounded by high density expansile region extending from apices of teeth #22 through #27.

2 Impressions: 1. Mild to moderate maxillary sinusitis. Hypoplstic right maxillary sinus. Possibility of monostatic fibrous dysplasia can t be ruled out by radiographic appearance at maxillary right posterior region. Advised correlation with previous history and clinical symptoms and comparison with previous radiographs to establish definitive diagnosis. Advised specialist consultation. 2. Deviated nasal septum 3. Dimensions of pharyngeal airspace seems to be within normal limits/ slightly altered radiographically. Advised further evaluation and treatment in case of presence of any clinical symptoms of sleep apnea/ obstructive airway syndrome. 4. Mild osseous changes at TMJs. Advised MRI imaging in case patient has any TMJ related pain symptoms, to rule out soft tissue and capsular ligament inflammation. 5. Unerupted/ at crestal level upper and lower third molars 6. Unerupted maxillary permanent canines and first premolars bilaterally 7. Lesion at mandibular anterior region is suspected of a. Central ossifying fibroma b. Fibrous dysplasia with traumatic bone cyst Advised correlation with previous history and clinical symptoms and comparison with previous radiographs and histopathological analysis (if clinical conditions indicate)to establish definitive diagnosis. Summary: The submitted CBCT anatomical image volume has been evaluated. Radiographic observations have been identified and reported. Further clinical evaluation is advised and possible treatment may be indicated. This is a consultative report only and is not intended to be a definitive diagnosis or treatment plan. Pertinent Images: Reformatted panoramic view

3 Cross-sectional views of maxillary right posterior ridge Cross-sectional views of tooth #5 and #6

4 3 D virtual model showing orientation of tooth #5 and #6 3 D virtual model showing orientation of tooth #11 and #12

5 Cross-sectional views of tooth #11 and #12 Cross-sectional views of tooth #22-23

6 Cross-sectional views of tooth #24-25 Cross-sectional views of tooth #26-27

7 3 D virtual model showing orientation of lesion at mandibular anterior region Axial view-lesion at mandibular anterior region

8 Cross-sectional views of right and left TMJs Mucosal thickening in maxillary sinuses-coronal view

9 Deviated nasal septum-coronal view Central sagittal sections showing pharyngeal airspace Thank you for the referral of this patient and the opportunity to serve your practice. Dr. Vandana Kumar, DDS, MDS, MS Diplomate Oral and maxillofacial Radiology

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