Mandibular idiopathic osteosclerosis mimicking inferior alveolar nerve conflict
a case report highlighting the role of CBCT imaging
DOI:
https://doi.org/10.61872/sdj-2026-02-04PMID:
42454527Keywords:
Idiopathic osteosclerosis, third molar, radiopaque lesion, inferior alveolar nerveAbstract
A 28-year-old patient was referred to the Oral Surgery and Implantology Unit at Geneva University Hospitals for extraction of the mandibular third molars following multiple episodes of pericoronitis. A two-dimensional panoramic radiograph (PAN) showed a subtle radiopaque image apparently superimposed on the roots of the third molar, projected over the course of the inferior alveolar canal, suggesting of a close relationship between the inferior alveolar nerve (IAN) and the apices of tooth 38 evoking a nerve conflict.
To further assess this apparent anatomical relationship, a three-dimensional cone-beam computed tomography (CBCT) scan was performed. The CBCT demonstrated no direct contact between the mandibular third molar and the inferior alveolar nerve canal. Instead, it revealed a well-defined radiopaque lesion adjacent to the nerve canal, separate from the tooth roots, consistent with idiopathic osteosclerosis.
This case highlights the limitations of two-dimensional imaging in evaluating complex anatomical relationships in the posterior mandible. When panoramic radiography shows equivocal findings due to superimposition and suggests a potential nerve–tooth conflict, three-dimensional imaging is essential for accurate diagnosis and treatment planning.
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Copyright (c) 2026 Qendresa Lubishtani, Mathilde Lombardi, Tommaso Lombardi, Alexandre Perez
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