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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
3rd quadrant region of 36
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1. Osteomyelitis in left posterior mandible
A broad zone of lytic bone loss is present within the left posterior mandibular alveolar process and body, which involves the edentulous 35, 36, and 37 region. The alveolar crest is lost, and the buccal and lingual cortices are dehiscent and partially sequestered. Multiple sequestra are dispersed through the residual trabecular bone in this region. A lamellar periosteal reaction extends along the buccal, inferior, and lingual surfaces of the mandible. The presence of a defect through the periosteal bone formation along the inferior mandibular border suggests a draining sinus tract is present. The left mandibular nerve canal courses through this area of lytic bone loss, and the canal cortices are partially effaced. These radiographic findings are consistent with the presence of osteomyelitis. A history of anti-resorptive therapy would suggest the presence of bisphosphonate related osteonecrosis of the jaws (BRONJ).
2. Widened PDL space on tooth 34
The periapical periodontal ligament space of tooth 34 is widened. Periosteal bone formation extends along the buccal cortical plate adjacent to the root apex of tooth 34. This suggests the area of osteomyelitis related to bisphosphonate therapy may extend to involve tooth 34.
Axial views of posterior 3rd quadrant
These axial cross-sectional images demonstrate the extensive area of bone loss within the left posterior mandibular alveolar process and body, which involves the edentulous 35, 36, and 37 region. Multiple sequestra are present within the residual buccal and lingual cortices and trabecular bone.
Buccolingual views of posterior 3rd quadrant
These buccolingual cross-sectional images demonstrate dehiscence of the buccal and lingual cortices and loss of the alveolar crest within the left posterior mandible. The cortices of the left mandibular nerve canal are effaced. Periosteal bone formation is noted along the buccal, inferior, and lingual cortical plates.
Mesiodistal views of posterior 3rd quadrant
These mesiodistal cross-sectional images demonstrate bone loss within the left posterior mandibular alveolar process and body. Sequestra are evident within this area of lytic bone loss. Note loss of the cortex of the left mandibular nerve canal through this area of osteomyelitis may serve as a complicating factor for regional debridement. A lamellar periosteal reaction is visible along the inferior border of the mandible, and a draining sinus tract appears to extend through this area of periosteal bone formation.
Periodontal bone loss
Generalized mild horizontal periodontal bone loss is present. A vertical periodontal defect is present on the mesial surface of the mesially tipped tooth 27, and moderate bone loss extends into the furcal region of this tooth.
3. Rarefying osteitis on tooth 12
Tooth 12 exhibits periapical rarefying osteitis. The cortical plates are intact. This may represent a healing post-treatment appearance or a persistent periapical lesion.
4. Vertical bone loss on tooth 12P
Vertical bone loss extends along the palatal surface of tooth 12 from the alveolar crest to the apical third of the root. This bone loss is likely periodontal in nature.
5. Palatine tonsilloliths
Tonsilloliths are present in the palatine tonsils. This is an incidental finding with no clinical significance due to the spontaneous exfoliation of tonsilloliths.
6. Calcified cornu of thyroid cartilage
The right cornu of the thyroid cartilage is partially calcified. This is an incidental finding with no clinical significance.