COM Sept. 2016

Small and unilocular radiolucency between teeth #s 27 & 28

Contributed by Dr. Graig Erickson
Everett, WA

Case Summary and Diagnostic Information

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This is a 39-year-old female who presented with pain and mild swelling in the superior third of the root between teeth #s 27 & 28.

History of present Illness

This is a 39-year-old female who presented with pain and mild swelling in the superior third of the root between teeth #s 27 & 28 (Figure 1). Clinically, the area was mildly swollen and was greyish in color. The color was bluish when a flap was raised (Figure 2). There was mild tooth resorption, especially in tooth #27. The radiographic images show a unilocular radiolucency between teeth #s 27 and 28 involving the superior third of the roots. This lesion had been present for more than three months and the surrounding teeth were solidly seated with no evidence of mobility or being pushed apart.

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Figure 1  This radiograph was taken at the first clinical presentation. The figure shows a well-demarcated, small radiolucency between teeth #s 27 and 28 in the superior third of the root.

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Figure 2  This photograph was taken at surgery after the raising of a flap exposing the alveolar bone between teeth #s 27 & 28. Note the blue-colored intact bone.

Past Medical History

This patient has no known health issues.

Clinical and Radiographic Findings

The patient first noticed the swelling between teeth #s 27 & 28, three months ago. The patient reported a mild swelling pressure/pain in the area but no obvious tooth movement. Radiographic findings showed a small and well demarcated radiolucency between these two teeth.

Treatment

Under local anesthesia, a full thickness surgical flap was raised. The bone in the area was bluish in color with alveolar bone still present on the facial part of the buccal plate. An elevator was used to make a window to access the lesion, which was removed by enucleation. Once the lesion was removed the surrounding alveolar bone was curetted and thoroughly irrigated. The gross appearance of the content of the radiolucency was soft and dark brown with a liver-like appearance, indicating high vascularity (Figure 3).
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Figure 3 This is the photograph of the gross specimen removed from the area depicted in Figure 1. The lesion was completely curetted in one piece. The soft tissue specimen is dark brown with a liver-like color grossly.

Incisional and excisional biopsy

Histologic examination reveals vascular granulation tissue with many giant cells surrounded by a rim of bony trabeculae (Figure 4). The granulation tissue is cellular and vascular. It contains many giant cells of variable shapes and sizes and haphazardly arranged (Figure 5). The granulation tissue also contains large aggregates of extravasated erythrocytes.

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Figure 4 Low-power (X100) H & E stained section revealing a highly vascular granulation tissue surrounded by a rim of viable bone. The granulation tissue is cellular and contains many multinucleated giant cells.

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Figure 5 Higher-power (X200) H & E stained section revealing a closer look at the vascular granulation tissue with many multinucleated giant cells.

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