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Case 258719

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Dental implants

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Canaray 258719

1. Possible osteomeylitis apical to implant 45

A large focus of rarefying osteitis surrounds the apical half of the implant placed at site 45. This lesion extends inferiorly to surround the right inferior alveolar nerve canal and abut the inferior border of the mandibular alveolar process. This lesion extends into the regions apical to teeth 45 and 46M. However, no direct contact is noted with these teeth. The buccal cortical plate at the level of the inferior alveolar nerve canal exhibits a dehiscence adjacent to the lesion. The periphery of the lesion exhibits a border of sclerotic bone and small fragments of sequestered bone are retained in the inferior aspect of the lesion, which may suggest the presence of localized osteomyelitis. Extraction of implant 45 is indicated, and biopsy of the periapical bone in this region is recommended to ensure that the bone loss is secondary to an inflammatory issue with the implant osteotomy, rather than an unrelated lytic bone reaction.

Additional views of lesion associated with implant 45

These cross-sectional images demonstrate the size and extension of the lesion associated with the implant placed at site 45.

2. Widened PDL space on tooth 46M

The periapical periodontal ligament space on the mesial root of tooth 46 is widened. This may represent an early sign of endodontic pathology. Moderate horizontal periodontal bone loss is present on the mesial and lingual surfaces of the mesial root. The remaining periradicular bone appears normal. There are no signs of a root fracture. Tooth 46 exhibit shortened roots and a high crown-to-root ratio. This may adversely affect the longevity of this tooth.

Periodontal bone loss

Mild periodontal bone loss is present on the imaged teeth.

3. Multiple buccal abrasion

Buccal abrasion is present on teeth 14, 15, 43, and 44, at the level of the cementonenamel junction.