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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
Quad 3, 37
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1. Generalized cortical thinning and porosity in left posterior mandible
The cortical bone within the left posterior mandible is relatively thin, and multiple small foci of porosity are present along the endosteal surface. No frank cortical defects are noted adjacent to these areas of porosity. This appearance is suggestive of osteopenia, which may be age-related or secondary to an underlying pathological process.
2. Lytic bone loss at site 38 suggestive of malignancy
An ill-defined area of lytic bone loss is present within the alveolar process in the edentulous 38 site. The alveolar crest and lingual cortical plate are partially effaced, and the cortex of the left mandibular nerve canal is poorly visualized as is courses through this region. Given the prior diagnosis of multiple myeloma and the purported paresthesia of the left lower lip, this appearance is suggestive of a malignant process. Medical referral is indicated for further assessment and management.
Orthogonal views of tooth 37
These orthogonal cross-sectional images demonstrate partial effacement of the lamina dura along the distal aspect of the distal root of tooth 37 due to the proximity of the area of lytic bone loss at site 38. Periradicular bone loss is also evident along the lingual aspect of the distal root of tooth 37. However, this tooth appears normal otherwise, and no signs of endodontic pathology are present. The patient's symptoms do not appear to be odontogenic in origin.
Orthogonal views of tooth 36
These orthogonal cross-sectional images demonstrate the intact lamina dura around the roots of tooth 36. No signs of periapical or periradicular pathology are evident.
3. Osseous defect apical to tooth 34
A prominent focus of trabecular bone loss is present within the left mandibular body apical to tooth 34. The apical lamina dura of tooth 34 remains intact, which suggests this bone loss is not endodontic in origin. The overlying buccal and lingual cortical plates are slightly thinned, but remain intact. This area may reflect an additional site of malignant involvement, and should be assessed further with medical imaging.