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Case 151489

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Referral category

Disease / syndrome / tumor / condition

Region of interest

Please assess entire mandible Focus on Quad 4 Likely MRONJ

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1 Files Info

Canaray 151489

1. Sequestering bone fragment in the posterior fourth quadrant

A large sequestrum is forming at the alveolar crest at sites 45 and 46. No periosteal bone formation is visible in this region. This radiographic appearance is consistent with medication-associated osteonecrosis of the jaw. The bone defect extends to the depth of the inferior alveolar nerve canal, and multiple small sequestra are also visible within the alveolar process in the region superior to the canal. Tooth 44 appears normal radiographically, and has not been affected by the osteonecrosis.

Mesiodistal views of posterior fourth quadrant

These sagittal cross-sectional images demonstrate the sequestering bone that is present at the alveolar crest at sites 45 and 46, as well as the radiolucent zone of bone loss surrounding the sequestrum. Note the absence of any significant sclerosis or periosteal bone formation

Axial views of posterior fourth quadrant

These axial cross-sectional images demonstrate the defects are present in the buccal and lingual cortical plates at the alveolar crest at site 46. Note the absence of any periosteal bone formation in the region adjacent to the sequestering bone.

2. Dense bone at site 47

The bone at site 47 has a granular appearance, and has a density that is significantly higher than that of the adjacent trabecular bone. This bone has not had any effects on the surrounding structures, and is a non-significant incidental finding.

Mild horizontal periodontal bone loss around anterior mandibular teeth

Mild horizontal periodontal bone loss is present around the anterior mandibular teeth. These teeth do not exhibit any endodontic pathology.

3. Small dense bone island at site 18

A small dense bone island is present at site 18. This dense bone island has not had any effect on the surrounding structures, and is a non-significant incidental finding.