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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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Volume rendering of tooth 48
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1. Possible bisphosphonate-induced osteonecrosis lingual to tooth 47
A defect is present in the lingual cortical plate in the region mesiolingual to tooth 47. This defect is irregularly shaped, and likely represents the site of spontaneous bone sequestration. The adjacent bone does not exhibit any signs of sclerosis, which is typical of bisphosphonate-induced osteonecrosis. The lamina dura remains intact around the roots of teeth 46 and 47. Neither tooth is the source of any pathology. Small fragments of sequestered bone appear to be present in the lingual aspect of the alveolar process adjacent to tooth 47.
Axial views of posterior fourth quadrant
These axial cross-sectional images demonstrate the absence of any sclerotic bone formation in the region adjacent to the irregularly shaped bone defect, which is not typically seen in cases of osteomyelitis, but is a feature of osteonecrosis. The intact lamina dura around the roots of teeth 46 and 47 is evident in these images. No significant widening of the periodontal ligament spaces of the tooth has occurred.
Buccolingual views of posterior 4th quadrant
The buccolingual cross-sectional images demonstrate the irregular shape of the defect in the lingual cortical plate adjacent to tooth 47.
Buccolingual views of posterior fourth quadrant
These buccolingual cross-sectional images demonstrate the normal appearance of the buccal cortical plate in the posterior fourth quadrant, as well as the well defined defect in the lingual cortical plate adjacent to tooth 47.
Right mandibular nerve lingual to tooth 48
The right inferior alveolar nerve canal courses lingually to the apical halves of the roots of tooth 48. The nerve is mildly compressed by the roots of the tooth. The residual follicle surrounding the crown of the tooth is slightly hyperplastic, and has marsupialized through the alveolar crest at site 48. Tooth 48 has not had any effects on the surrounding structures.