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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
Sites #46,47,48, right ramus, right TMJ
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1. Osteomyelitis in right posterior mandible
An ill-defined area of lytic bone loss involves the lingual aspect of the right mandibular body within the premolar-molar region. The lingual cortical plate is partially sequestered in this region. Bone loss extends to abut the right mandibular nerve canal, and generalized sclerosis of the trabecular bone around the roots of the adjacent teeth is noted. A residual extraction socket remains at site 47, and apical periodontal ligament space widening is noted on tooth 46.
This radiographic appearance is consistent with the presence of osteomyelitis in the right posterior mandible. Communication between this area of osteomyelitis with the right mandibular nerve canal should be noted if a debridement procedure is planned.
2. Persistent extraction socket at site 47
Granular bone formation is noted around the periphery of the extraction socket at site 47, but foci of sequestered bone are noted within the central portion of the socket. The base of the extraction socket communicates with the right mandibular nerve canal. No evidence of retained root fragments are noted. Note that site 48 has healed normally.
3. Widened PDL space on tooth 46M+D
The mesial and distal roots of tooth 46 exhibit apical periodontal ligament space widening. This may reflect early endodontic pathology or be secondary to occlusal trauma. Vitality testing is indicated.
4. Caries on tooth 28O
The occlusal surface of tooth 28 exhibits carious decay.
5. Caries on tooth 38O
Occlusal caries are present on tooth 38.
6. Lingual mandibular tori
Lingual tori composed of cortical bone are present in the alveolar process of the mandible. This is a non-significant incidental finding.