Application of CBCT in orthodontics: Hyper-pneumatized maxillary sinus associated with impacted mesiodens - Case report

Background: The maxillary sinus has a very unique and important relationship with the oral cavity. When this sinus exhibits variations in its normal anatomy and boundaries it gives rise to unprecedented cases, the successful management of which is made possible today due to the application of advanced diagnostic aids like Cone Beam Computed Tomography (CBCT). Case description: This article presents the case of a 22-year-old male patient who sought orthodontic treatment for correction of his malaligned teeth. Pre-treatment orthopantomogram revealed an unerupted mesiodens between the two central incisors, prompting further investigation with CBCT. The CBCT images revealed unusually large maxillary sinuses on both sides with the left sinus reaching the incisive foramen and being in close proximity to the unerupted mesiodens. The imaging and the information from it aided in careful surgical removal of the mesiodens and subsequent orthodontic treatment. Practical implications: CBCT imaging can often present incidental findings some of which can be rare. Awareness about the same can keep the clinician on the lookout for any unusual presentations which may have a bearing on the treatment approach.