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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
#46 and #47
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1. Lytic bone loss in right posterior mandible suggestive of malignancy
An ill-defined area of bone loss is present around the roots of teeth 46 and 47, and mild sclerosis of the surrounding trabecular bone is noted. The periodontal ligament spaces around the roots of teeth 46 and 47 are widened, and the lamina dura is partially effaced. The right mandibular nerve canal is unaffected.
Given the purported history of breast cancer and the presence of soft tissue swelling adjacent to tooth 46, this radiographic appearance is most suggestive of a malignant process. The possibility of breast metastases should be considered. Medical referral is required.
Orthogonal views of tooth 47
These orthogonal cross-sectional images demonstrate widening of the periodontal ligament space around the roots of tooth 47, as well as partial loss of the lamina dura. This pattern of bone loss does not appear to be endodontic in origin.
Orthogonal views of tooth 46
These orthogonal cross-sectional images demonstrate diffuse bone loss within the furcal and apical regions of tooth 46, as well as periodontal ligament space widening around the roots. The slightly sclerotic appearance of the residual trabecular bone is evident.
2. Retained root fragment at site 48
A root fragment is retained within the alveolar process at site 48. No pathology surrounds this retained fragment, which suggests that it is a non-significant finding that does not require treatment.