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Referral details

Case 53362

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Referral category

Troublesome / painful / cracked tooth (Endodontic)

Region of interest

38+21

Referral reason

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Canaray 53362

1. Fractured root 21

Tooth 21 exhibits a root fracture on its mesial surface at the level of the endodontic post. Localized vertical bone loss is present on the mesiopalatal surface of the coronal third of the root adjacent to this fracture.

Axial views of tooth 21

These axial cross-sectional images demonstrate the localized bone loss on the mesiopalatal surface of the coronal third of the root of tooth 21, adjacent to the displaced root fracture.

Buccolingual views of tooth 21

The localized bone loss on the mesiopalatal surface of the root of tooth 21 is evident in these images.

Mesiodistal views of tooth 21

These mesiodistal cross-sectional images demonstrate the displaced fracture on the mesial surface of the coronal third of the root of tooth 21.

2. Osteomyelitis in posterior third quadrant

Two sequestered fragments of bone are present in the region of the extraction socket at site 38. The sequestered bone fragments are likely secondarily infected and may be the source of the inflammation in this region. A broad zone of bone loss is present in the posterior third quadrant, particularly at the buccal aspect of the alveolar process in the anterior inferior ramus.

This pattern of rarefying osteitis is suggestive of the presence of osteomyelitis, which may be secondary to the history of radiation treatment, and may therefore represent osteoradionecrosis.

Axial views of posterior third quadrant

These axial cross-sectional images demonstrate the lytic bone destruction by the osteomyelitis in the posterior third quadrant. Note the presence of multiple sequestra in the crestal regions of the alveolar process.

Coronal views of third quadrant

The osteomyelitis that is present in the posterior third quadrant extends through the buccal cortex of the left inferior ramus and is most prominent at the buccal aspect of the alveolar process in the posterior left mandibular body. The inferior alveolar nerve canal has not been affected.

Sagittal views of posterior third quadrant

These sagittal cross-sectional images demonstrate the extensive bone loss that is present in the posterior left mandible

3. Fractured tooth 26DB

A fracture is present on the distal surface of the distobuccal root of tooth 26. Localized bone loss surrounds this fracture fragment. The mesiobuccal and palatal roots of the tooth appear normal.

4. Caries on tooth 46D

Recurrent caries are present on the distal surface of tooth 46.