History of the present illness

This is a 48-year-old black male who first presented four months ago to his dentist for a routine dental cleaning where swelling of the right posterior maxillary gingiva was noticed. The patient was placed on antibiotics which were not helpful and the swelling continued to get larger. The patient was referred to an endodontist and later to an oral surgeon who biopsied the area. The lesion was expansile and was described to be three quarter inch wide. Patient complained of minor discomfort. Teeth #s 1-4 were non-responsive to vitality test but were intact and firmly seated with no evidence of caries or periodontal disease. Periapical radiographs revealed a predominantly radiopaque lesion with cotton wool appearance (Figure 1); it was diffuse with no clear margins.

Figure 1 This is a periapical radiograph composite, all demonstrating diffuse radiopaque lesion of the alveolar bone in area of teeth #s 1-4.