Radiology · patient case question
What does Patient B's finding suggest?
Patient case: Two findings that should be recognised and left alone — or investigated
Patient: Two patients
Chief Complaint: Both attend for routine examination.
Background: A, 55-year-old male: asymptomatic. An identical finding is visible on a panoramic taken eleven years ago and has not changed. B, 30-year-old female: several extractions performed three years ago.
Findings: A: a well-defined, densely CORTICATED radiolucency at the angle of the mandible lying BELOW the mandibular canal, between the canal and the inferior border. B: the extraction sockets remain clearly visible as dense sclerotic outlines that have not remodelled into the surrounding trabecular pattern.
Show answer and explanation
Correct answer: D. Socket sclerosis, which warrants evaluation for an underlying systemic disorder
- A. Retained root fragments have the shape and density of a root and retain a visible periodontal ligament space around them, rather than reproducing the outline of the whole socket.
- B. Chronic osteomyelitis produces an ill-defined, moth-eaten radiolucency with sequestra and periosteal reaction, and it is symptomatic. This is a well-defined sclerotic finding in an asymptomatic patient.
- C. Normal socket healing shows the outline progressively fading as woven bone is replaced, with the trabecular pattern becoming continuous with the surrounding bone by roughly six to twelve months. A socket still sharply visible at three years is not normal healing.
- D. CORRECT. SOCKET SCLEROSIS is failure of the extraction socket to remodel: the lamina dura persists and the socket fills with dense sclerotic bone that remains visible for years. It matters because of what it is associated with — chronic RENAL disease and renal osteodystrophy in particular, and also sickle cell disease and other systemic disorders of bone metabolism. Multiple sclerotic sockets discovered incidentally in a patient with no known diagnosis warrant medical referral rather than dental treatment.
Note: Socket sclerosis belongs to a small group of incidental radiographic findings whose value lies in what they point to systemically rather than in any dental treatment they require. Note it, ask about renal disease and haemoglobinopathy, and refer.