Suspected Langerhans Cell Histiocytosis on Pre-Implant Evaluation

A 48-year-old male with multiple missing, mobile, and supra-erupted teeth, along with moderate to advanced periodontal disease, was referred with all-on-x procedures planned. The radiologist identified well-defined destruction of much of the alveolar process around the maxillary and mandibular left posterior teeth, with scooped-out and floating-tooth appearances. While perio-endo inflammatory lesions are likely contributors, the radiologist noted that Langerhans Cell Histiocytosis, such as eosinophilic granuloma, should be ruled out with biopsy, especially since several affected teeth lacked coronal destruction or restoration. The radiologist noted that this condition is uncommon and would require surgical treatment and possible radiation therapy, chemotherapy, or intralesional corticosteroids before implant treatment could be considered. Radiographically, this could be fairly easily mistaken for aggressive periodontal disease, potentially leading to inappropriate treatment.