PMC3890650_01
Intraoperative situation with exposed necrotic bone lingual and crestal in the region of former tooth 47 (white arrow). Inflammatory reaction within the necrotic region is also leading to local sugillations and bleedings as mucosal integrity seems to be disturbed. Crowned tooth 46 was removed within the operation.
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F1
On clinical investigation exposed bone surrounded by gingival inflammatory reaction was observed in the region of former tooth 47 (Figure 1).
Pre- and postoperative panoramic radiographs. Preoperative radiograph (a) is showing a persistent extraction socket and hypersclerosis of the mandibular bone in the region 46/47 after extraction of 47 in January 2013. Postoperative panoramic radiograph (b) revealing a reduction of the mandibular bone height after repeated osteotomy and adequate ossification of the former extraction sockets.
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F2
Panoramic radiograph revealed a persistent extraction socket of 47 (Figure 2a). The patient was followed up weekly and received a second operative intervention at the beginning of April 2013 which improved the clinical situation (Figures 2b and 5).
Drug regime since Crohn's disease was diagnosed in 2000.
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F3
The patient was treated with varying doses of steroids together with 5-aminosalicylic (5-ASA) between 2000 and 2008 (Figure 3).
Magnetic Resonance Imaging (MRI), t2 weighted, showing increased signalling in the jaw within the region of teeth 44 until 47 as well as in the ipsi- and contralateral lymph nodes (left side with white arrow). Additionally, perimandibular soft tissue swelling is detectable on the affected side.
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F4
In March 2013, the patient was treated after previous MR-imaging revealed increased signalling in the jaw in the area of teeth 44 until 48 and additionally confirmed prominent lymph nodes on both sides of the submandibular region (Figure 4).
Postoperative situation in October 2013 showing recovery of the affected side after extraction of tooth 46 and repeated osteotomy.
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F5
The patient was followed up weekly and received a second operative intervention at the beginning of April 2013 which improved the clinical situation (Figures 2b and 5).