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Case 138412

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Wisdom Teeth

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Canaray 138412

2. Dense bone island apical to tooth 47D

There is an irregularly shaped region of dense, cortical bone located periapical to the distal root of tooth 47. There are no effects on the surrounding structures. These findings suggest the presence of a dense bone island, which is an unrelated incidental finding.

1. Osteomyelitis in posterior right mandible

A large, irregularly shaped defect is observed at the edentulous site 48, which is consistent with the reported history of tooth extraction. At the time of image acquisition, there is minimal evidence of reparative bone formation, which is unusual given that the extraction was reportedly performed 2 months prior to imaging.

The crestal portion of the buccal cortex overlying the distal aspect of this site appears detached from the alveolar process, which is consistent with sequestrum formation. Lamellar periosteal bone formation is also observed along the buccal surface of the alveolar process at site 48, and the lingual surface of the mandibular body apical to tooth 47.

These findings suggest a developing focus of osteomyelitis, which is the likely source of the patient's symptoms. Local surgical debridement may be considered.

Additional orthogonal views of the posterior right mandible: without the nerve overlay

The same cross-sectional images are provided without the nerve overlay so as to provide better visualization of the cortices of the nerve canal. Although the base of the residual socket at site 48 appears within close proximity to the right inferior alveolar nerve canal, its cortices remain intact.

3. Possible lymphadenopathy

The level Ib lymph nodes on the right side appear slightly enlarged, which could represent lymphadenopathy. Clinical correlation is recommended.

4. Thin lingual bone overlying implant 46D

The lingual cortical bone overlying the apex of the implant at the distal aspect of site 46 is thin and may be partially dehiscent. The remainder of the implant appears to be embedded in bone. This is unlikely to be the source of the patient's symptoms.

5. Apex of implant 46M extends slightly beyond lingual cortex

The apex of the implant placed at the mesial aspect of site 46 extends slightly beyond the lingual cortical plate. The remainder of the implant appears to be embedded in bone. This is unlikely to be the source of the patient's symptoms.