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Case 135576

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Referral category

Disease / syndrome / tumor / condition

Region of interest

tooth #46-48 region

Referral reason

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1 Files Info

Canaray 135576

1. Sequestered osseous fragment at site 47/48 secondary to antiresorptive therapy

The lingual aspect of the crestal bone at site 47/48 is sequestered from the remainder of the alveolar process. This fragment measures approximately 16.0mm long and 4.8mm high. A well-defined area of low bone density is evident underlying this sequestered region of bone, but the remainder of the body of the mandible appears normal. In conjunction with the purported clinical presentation of exposed bone in this region and a history of antiresorptive therapy, this appearance is consistent with bisphosphonate-related osteonecrosis of the jaw (BRONJ).

Mesiodistal views of posterior 4th quadrant

These mesiodistal cross-sectional images demonstrate a normal appearance of the right mandibular nerve canal. Tooth 46 also appears normal radiographically. The sequestered osseous fragment along the lingual aspect of the alveolar crest is evident.

Buccolingual views of sites 47/48

These buccolingual cross-sectional images demonstrate the extent of the area of low bone density underlying the sequestered region of crestal bone at sites 47/48. This region of relative radiolucency does not extend to abut the mandibular nerve canal.

Axial views of posterior 4th quadrant

These axial cross-sectional images demonstrate the lingual position of the sequestered fragment of bone distal to tooth 46.

Normal tooth 46

Tooth 46 appears normal radiographically. No signs of periodontal or endodontic pathology are noted at this time.