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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
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1. Secondarily affected tooth 37M
The area of rarefying osteitis and periradicular bone loss arising from tooth 36 extends distobuccally, and abuts the buccal surface of the mesial root of tooth 37. The periapical region of tooth 37 appears normal, which suggests the endodontic status of this tooth is unlikely to be compromised.
2. Rarefying osteitis on tooth 36: Possible osteoradionecrosis
A broad, ill-defined area of rarefying osteitis is present around the periapical region of tooth 36. This bone loss extends circumferentially around the distal root, and has caused dehiscence of the buccal cortical plate. This appearance suggests the presence of persistent endodontic pathology. Small foci of sequestered bone appear to be present within this region of rarefying osteitis. Given the purported history of radiotherapy to the head and neck region, the possibility that this reflects an area of osteoradionecrosis should be considered.
Normal tooth 35
The periapical and periradicular bone associated with tooth 35 appears normal. The lamina dura appears to remain intact around the root circumference. No signs of endodontic pathology are noted.
3. Possible rarefying osteitis on tooth 34
A focal area of low density trabecular bone is evident adjacent to the distal aspect of the root apex of tooth 34. The lamina dura is not clearly visible in this area. The possibility that this reflects an area of rarefying osteitis should be considered. Vitality testing is indicated.
4. External resorption on tooth 33Bu
The buccal surface of tooth 33 exhibits external resorption involving the coronal third of the root. No direct pulpal communication is noted, and there is no evidence of periapical pathology on this tooth.
5. Rarefying osteitis on tooth 32: Possible osteoradionecrosis
An ill-defined area of rarefying osteitis is present at the apex of tooth 32, and the buccal cortical plate is lost overlying the root of this tooth. Periradicular bone loss is evident along the mesial aspect of tooth 32, which extends to the alveolar crest. This suggests that tooth 32 is devitalized. Foci of sequestered bone appear to be present within this area of lytic bone loss, which suggests that this may reflect an additional focus of osteoradionecrosis.
6. Secondarily affected tooth 31
The area of bone loss associated with tooth 32 abuts the distal surface of the root of tooth 31. The periapical region of tooth 31 appears normal at this time, which suggests the endodontic status of this tooth is unlikely to be compromised.
7. Vertical bone loss on tooth 44Li
Vertical bone loss is present on the lingual surface of tooth 44. This bone loss is limited to the coronal third of the root, and is likely periodontal in origin.
8. Generalized cervical abrasion
Generalized buccal abrasion is present at the level of the cementoenamel junction. The mandibular incisors exhibit circumferential cervical abrasion.