History of the present illness

This is a 23-year-old Asian male referred by his general dentist for a deeply impacted tooth # 32 associated with a very large, scalloped and multilocular radiolucency starting from tooth #28 and extending superiorly into the high ramus (Figure 1). This lesion was not expansile or symptomatic in any other way. It was discovered on routine dental examination. The radiolucency shows evidence of cortical bone perforation in the areas of teeth #s 28-30 and the angle of the mandible. Teeth #s 29 & 30 show evidence of root resorption. All associated teeth were vital.

Figure 1 This is a CBCT panoramic view taken at the first clinical presentation. The radiograph demonstrates a very large scalloped radiolucency with slight multilocularity. It starts anteriorly from tooth #28 and progresses posteriorly to the high ramus. Note the root resorption involving teeth #s 29 & 30. Also note the cortical bone perforation apical and between teeth #s 28 & 30. Cortcal perforation is also noted at the angle of the mandible.