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Case 125362

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Disease / syndrome / tumor / condition

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panoramic only

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Canaray 125362

1. Rarefying osteitis at tooth 45: oral surgery referral recommended

A large zone of rarefying osteitis is present in the periapical region of tooth 45. The tooth exhibits a history of endodontic access. This rarefying osteitis extends inferiorly to the inferior mandibular border, and also extends anteriorly into the periapical region of tooth 44. The rarefying osteitis appears to have secondarily infected the dysplastic bone in the mid-fourth quadrant. It is possible that sequestration of some of this bone may occur. Therefore, preparation should be made for possible future surgical debridement of this region. Referral to an oral surgeon for further management is recommended.

2. Fibrous dysplasia in anterior mandible

A broad zone of fibrous dysplasia is present in the anterior mandible. This fibrous dysplasia extends from the periapical region of tooth 35 to the periapical region of tooth 45. Localized expansion of the mandibular body has occurred in this region. The dentition has not been affected by the fibrous dysplasia . The rarefying osteitis originating at tooth 45 has secondarily infected this fibrous dysplasia.

Axial views of mandibular arch

These axial cross sectional images demonstrate the expansion of the mandibular body by the fibrous dysplasia, as well as the rarefying osteitis in the periapical regions of teeth 44 and 45, which extends into the region of fibrous dysplasia.

Buccolingual views of mid-fourth quadrant

These buccolingual cross-sectional images demonstrate the endodontic access of tooth 45, the periapical epicenter of the lesion originating at tooth 45, the extension of the rarefying osteitis into the region of fibrous dysplasia, and the buccolingual expansion of the mandibular body by the fibrous dysplasia.

Mesiodistal views of mid-fourth quadrant

These mesiodistal cross sectional images demonstrate the broad zone of rarefying osteitis that is present in the periapical regions of the roots of teeth 44 and 45. It is possible that tooth 44 has been secondarily infected by the lesion, and is not the source of any pathology. Note the extension of the rarefying osteitis to the inferior mandibular border, as well as the irregular shape of the lesion and absence of a corticated periphery. Tooth 46 has not been affected.

Right mandibular nerve inferior and buccal to tooth 48

The right inferior alveolar nerve canal courses inferiorly and buccally to the root of the mesioangularly impacted tooth 48. The nerve is not in contact with the tooth and is not compressed. No damage has occurred to the distal surface of tooth 47.

Left mandibular nerve inferior and buccal to tooth 38

The left inferior alveolar nerve canal courses inferiorly and buccally to the root of the mesioangularly impacted tooth 38. The nerve is not in contact with the root of tooth 38, and is not compressed. No damage has occurred to the distal surface of tooth 37.