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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
R Mandible 44,45,46,47
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1. Osteomyelitis in posterior fourth quadrant
A detached bone fragment representing the crestal aspect of the lingual cortical plate is present adjacent to the coronal thirds of the roots of teeth 46 and 47. The definition of the periradicular bone on the lingual surfaces of the involved teeth adjacent to the detached bone fragment has been lost. These imaging findings are suggestive of the presence of osteomyelitis and sequestrated mandibular lingual cortex. Considering the patient's history of bisphosphonate medication, The appearance is suggestive of mediation-related osteonecrosis of the jaw. This interpretation is substantiated by the clinically noted signs of infection and the presence of exposed bone. The coronal location of the lesion, suggest a periodontal origin. Bone curettage and removal of the sequestrated bone are recommended. Continuous follow up is recommended to monitor the healing.
Teeth 46 and 47 appear normal otherwise. No signs of apical pathology or root fractures are present on these teeth.
Normal tooth 44
Tooth 44 appears normal radiographically. The periodontal ligament space is of uniform width surrounding the root of the tooth and the lamina dura is intact. There are no signs of periapical or periradicular pathology on the tooth. No signs of a root fracture are present.
Normal tooth 45
Tooth 45 appears normal radiographically. The periodontal ligament space is of uniform width surrounding the root of the tooth and the lamina dura is intact. There are no signs of periapical or periradicular pathology on the tooth. No signs of a root fracture are present.
2. Lingual mandibular tori
Lingual tori composed of cortical bone are present along the alveolar process of the mandible adjacent to the canine-premolar regions. This is a non-significant incidental finding.
3. Possible calcification of the left carotid bifurcation
Calcification is present in the left neck just lateral to the greater horn of the hyoid bone. This appearance may suggest the presence of calcification at the bifurcation of the left carotid artery.
4. Calcified stylohyoid ligament
The left stylohyoid ligament is partially calcified. This is an incidental finding with no significance.