Figure 1. Panoramic radiograph at presentation demonstrating a large unilocular radiolucency with irregular borders at the apex of tooth # 31. The latter has a small filling and was 3+ mobile at presentation. It was also vital. 



History of the present illness
This is a 39-year-old white female who present in September 2006 to the Oral surgery clinic at the University of Washington complaining of pain in her lower right jaw. She was referred by her general dentist who on a routine panoramic radiograph found a radiolucent lesion at the apex of tooth #31 involving the body of the mandible and extending posteriorly into the ramus (Fig 1). Tooth # 31 was vital and was loose. The patient reported feeling pain in this area in early June 2006. That was followed by tooth #31 gradually becoming loose. The tooth was extracted and the area was biopsied.