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Troublesome / painful / cracked tooth (Endodontic)
Region of interest
#47, 46 and 45 area
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1. Osteomyelitis in mid-fourth quadrant
A diffuse zone of bone destruction is present in the mid-fourth quadrant apically to sites 43, 44, 45, and 46. Periosteal bone formation is visible at the inferior border of the mandible adjacent to this region of bone destruction. The residual bone is sclerotic in this region. Small fragments of cortical bone have sequestered from the inferior border of the mandible. This radiographic appearance is suggestive of the presence of osteomyelitis in the mid-fourth quadrant.
Sagittal views of mid-fourth quadrant
These sagittal cross-sectional images demonstrate the extension of the osteomyelitis from the level of the alveolar crest between implants 45 and 46 to the inferior border of the mandible. The diffuse destruction of bone in the mid-fourth quadrant is evident in these images.
Axial views of mid-fourth quadrant
These axial cross-sectional images demonstrate the sclerotic residual bone that is present between the radiolucent zones of bone destruction caused by the osteomeylitis. Sequestra may be present at the inferior border of the mandible.
Coronal views of mid-fourth quadrant
These coronal cross-sectional images demonstrate the extension of the osteomas to the inferior border of the mandible, as well as the periosteal bone reaction that is present on the buccal and inferior surfaces of the mandible.
2. Implant 46 impinges upon mandibular nerve canal
The implant at site 46 impinges upon the superior border of the mandibular nerve canal. This may be a source of the patient's symptoms at this site.
Normal implant 45
The implant at site 45 appears relatively normal radiographically. The osteomyelitis in the fourth quadrant extends around the apical region of implant 45.
3. Rarefying osteitis on tooth 47M
The mesial root of tooth 47 exhibits periapical rarefying osteitis. The distal root of the tooth is not captured in this imaging volume and cannot be evaluated. A gutta percha point has been extruded through the apical foramen of the mesial root of tooth 47. No signs of root fracture are present.