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Case 101224

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Referral category

Wisdom Teeth

Region of interest

48

Referral reason

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1 Files Info

Canaray 101224

1. Osteomyelitis at the extraction site 48

An area of lytic bone loss is present within the right posterior mandible at the extraction site 48, which extends from the alveolar crest to the adjacent area of the superior border of the mandibular canal. The buccal cortical plate is partially sequestered in this region. A focal area of periosteal bone formation is present along the dehiscent buccal cortical plate. The superior cortex of the right mandibular nerve canal is partially effaced as a result of the proximity of the apex of the extraction socket of tooth 48. This radiographic appearance is consistent with osteomyelitis associated with the extraction socket at site 48.

Axial views of the posterior 4th quadrant

These axial cross-sectional images demonstrate the mild buccolingual extension of the lytic bone loss at the alveolar process at site 48. The buccal cortical bone has been sequestrated and perforated. The linear periosteal proliferation is evident along the buccal cortical bone at this region.

Buccolingual views of posterior 4th quadrant

These buccolingual cross-sectional images demonstrate the perforation and sequestration on the buccal surfaces of the alveolar process adjacent to the lytic lesion associated with the extraction site 48. Note the periosteal reaction and a large sequestrum at the buccal cortex, which support the diagnosis of osteomyelitis.

Mesiodistal view of posterior 4th quadrant

These mesiodistal cross-sectional images demonstrate the non-healed socket at site 48 as well as the mesial and distal extension of the lytic bone loss secondary to the osteomyelitis associated with the extraction socket at site 48.

Mesiodistal views of the cystic lesion without nerve tracking

These mesiodistal cross-sectional images demonstrate that the superior border of the canal is partially effaced adjacent to the apex of the socket of tooth 48, which may explain the patient's symptom of a mild hypersensitivity of the nerve.

2. Rarefying osteitis on tooth 47M

There is rarefying osteitis located periapical to the mesial root of the endodontically-treated tooth 47. The existing obturations in the mesiobuccal, mesiolingual, and distal canals of this tooth extend to their radiographic apices. The remaining periradicular bone appears normal and there are no signs of root perforation or fracture. The extruded endodontic sealer beyond the roots apices is a non-significant incidental finding. These findings suggest the presence of persistent endodontic pathology or post-treatment healing scar tissue involving the mesial root of tooth 47. Periodic radiographic follow up and clinical correlation are indicated.