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Case 218872

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Troublesome / painful / cracked tooth (Endodontic)

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Canaray 218872

1. Iatrogenic mandibular fracture + developing osteomyelitis at site 47

An irregularly shaped fracture plane is evident within the right mandible. This fracture plane extends from the alveolar crest to the inferior border of the mandible along the buccal cortex at the extraction site 47, and appears to communicate with the oral mucosa through the extraction socket. An extraction defect is evident at site 47, which is surrounded by a periphery of sclerotic bone. Granular bone is evident along the walls of this residual socket, which suggests incomplete healing. The alveolar crest has not been re-established, and the buccal cortical plate appears partially dehiscent and a small sequestrum is present within the socket. The lingual cortical plate remains intact at the time of image acquisition. Granular bone is also evident along the buccal and inferior cortices, which is organized in a lamellar pattern. These findings suggest the presence of periosteal bone formation.

These features are consistent with a developing osteomyelitis likely secondary to the iatrogenic fracture of the mandible at site 47.

Mesiodistal views of posterior right mandible: without the nerve overlay

These mesiodistal cross-sectional images are provided without the nerve overlay so as to provide better visualization of the cortices of the nerve canal. Note the borders of the canal appear sclerotic and might be partially lost along the inferior surface of the extraction socket at site 47. Also note a small sequestrum at the buccal cortical plate, both osseous defect and sclerotic bone at site 47, as well as periosteal reaction on the inferior border of the mandible, which support the diagnosis of osteomyelitis.