JAVMA Diagnostic Imaging In Veterinary Dental Practice 2010-2019 Flashcards
What is your description of this lesion?
What are your differentials?
(A), notice the permeative bone loss (arrows).
(B), there is near-total loss of attachment (arrows), extrusion of the right mandibular canine tooth, and a sunburst-like periosteal reaction at the interdental space of the right mandibular third premolar tooth and right mandibular canine tooth.
(C), there is evidence of endosteal scalloping to the level of the mandibular third premolar tooth (arrows)
Differentials osteomyelitis, nonodontogenic tumors (eg, squamous cell carcinoma), and odontogenic tumors (eg, ameloblastoma).
This was a case of osteomyelitis.
What species is this?
What pathology is present?
Rabbit (has Peg teeth)
Malocclusion of incisors and molars,
(A), notice the incisor, premolar, and molar malocclusion (black arrowheads), the apical tooth elongation (black arrows), and the soft tissue swelling (white arrow).
(B), notice the apical elongation of the mandibular second molar teeth (black arrows), the buccal and lingual sharp points (white arrows), and the large, expansile lesion involving the left maxilla dorsal to the left third maxillary molar (white arrowheads). Also notice the slight lateral displacement of the left globe.
(C), notice the rim of the expansile lesion in proximity to the orbit (black arrow).
What abnormailty is pictured here?
Dens Invaginatus (allegedly)
notice the radiopaque structures at the mesial aspect of the crowns consistent with dens invaginatus (black arrows).
Radiolucent areas surrounding the root apices that are associated with loss of the lamina dura and ascend coronally along the roots of the teeth, consistent with combined endodontic-periodontal lesions, are evident (white arrows).
On the right side, notice the alveolar bone loss at the dorsal aspect of the mandibular canal (white arrowhead), creating a communication between the affected tooth’s alveolus and the mandibular canal
Oral examination revealed moderate gingivitis and calculus with irregularly shaped crowns of the right mandibular first molar tooth, the right maxillary fourth premolar tooth, and the right maxillary first molar tooth. On the areas of the irregular crowns, the teeth had a brown discoloration that appeared as a hard leathery surface. Use of a dental explorer to evaluate these areas revealed soft, adherent dentin
What are your diagnoses?
Dental caries with secondary endodontic disease
What is being depicted by the explorer?
If the pulp was never directly exposed, what could be routes of endodontic infection?
What is seen radiographically on these teeth?
Intact tertiary dentin
anachoresis, or leakage of bacteria through dentinal tubules
104/204 - widened pulp chamber compared to mandibular canines, periapical lucencies and root resorption on 104
108 was extracted by the rDVM 7 weeks prior.
Are retaned root tips or endodontic disease likely based on these radiographs?
What would the next steps be?
No
CT and Biopsy
Turned out to be a carcinoma, and caudal maxillectomy performed
This dog was adopted at 3 months old and had known distemper asa a puppy.
What is seen?
(A) fused roots of the right mandibular second premolar tooth (black arrowhead) and the convergent roots of the third premolar tooth (white arrow).
A cyst surrounds the mesial part of the crown of the fourth premolar tooth; the cyst has well-corticated margins except on its rostroventral aspect (white arrowhead). Notice the irregularities of the alveolar margin between the mandibular right third premolar and first molar teeth (black arrow), which could correspond to the resorbing distal root of the right mandibular deciduous third premolar tooth.
The tips of the crown of the right mandibular second and third premolar teeth appear less radiopaque than typical, consistent with enamel hypoplasia.
(B), notice the abnormally narrow and small roots of the right mandibular first molar tooth (black arrows) and the convergent roots of the second molar tooth (white arrow). The irregular surface and decreased radiopacity of the crown of the first molar tooth are consistent with enamel hypoplasia
This is a 4month old yorkie that has pain following trauma
What additional imaging would you perform, what abnormalities can be identified?
Dental rads or CT.
Wide space between tooth bud of M1 on lateroblique. apparently there are radiolucent line through cortex of mandible on V/D.
What is the most likely etiology of the draining tract given the location and CT findings?
Endodontic disease of M1
What are differentials for this radiographic appearance?
Why is biopsy of cystic structures important?
Primary differential was dentigerous cyst, but other conditions that could potentially cause aggressive bony destruction, including neoplastic conditions (eg, acanthomatous ameloblastoma) that have a cystic structure, osteomyelitis, and other cystic processes
Biopsy is important because this tuned out to be a SCC.
What treatment is indicated for the abnormalities seen in this rad?
External replacement root resorption of P4 - unless intraoral no treatment indicated
Areas of likely osteosclerosis.
“Radiopacities not associated with a tooth root are most likely osteosclerosis and of no clinical importance”
“In the absence of clinical or radiographic signs of endodontic or periodontal disease, these lesions are most likely incidental findings and do not require further treatment”
This dog was presented for sneezing episodes 1 week after being kicked by a horse. identify the fractured bones and what would be a reasonable repair modality?
multiple comminuted depression fractures of the left maxilla and the dorsomedial aspect of the right maxilla, right and left nasal bones, and rostral portions of the left and right frontal bones, resulting in many variably sized osseous fragments within the left and right nasal cavities
Dorsal midline approach and bone plating
horse
horse
horse
horse
What are possible differentials in this pug with decreased airflow through the left nostril and left sided nasal discharge?
nasal neoplasia, inflammation (eg, lymphocytic plasmacytic rhinitis), foreign body, and fungal infection.
nasal discharge can also result from periapical disease such as a dental abscess or oronasal fistula.
Ended up being a tooth in the nose - maxillary premolar within a histopathologicall identified gingival inclusion cyst. Suggest it was jammed in by minor trauma secondary to advanced periodontal dz
What is this pattern of bone loss called? What is it associated with?
What is the most likely differnetial?
Geographic bone loss - regular margins, uniform bone loss. Geographic patterns of bone loss are usually associated with slow-growing neoplastic or nonneoplastic lesions
Neoplasia
ended up being a poorly differentiated sarcoma.
This is a slow growing mass present for 3 years time. now it is bothering the dog.
What is the most likely diagnosis?
CAA
Osteosarcoma
Osteoma
SCC
osteoma, long period of growth, not displacing teeth, no aggressive bony changes on rads.
horse
horse
What were the most likely diagnoses?
What could not be ruled out?
POF, FFH, possibly early CAA
Couldn’t rule out malignant neoplasia, but no aggressive bony changes appreciated.
ended up being a POF
5 years before presentation, this cat was diagnosed with a UCF of 204 with no pulp exposure. no rads were taken.
oops
how useful are these shots?
questionable to me.
horses with septic OA of the TMJ. Did a condylectomy… that’s cool!
What is your diagnosis?
What might be the origin of this lesion?
Chronic apical periodontitis
Possibly bacterial invasion via dentinal tubules secondary to distal abrasion,
as no complicated fracture was detected.
What are differentials for this large lucency?
commment on the radiographic fill of the RCT
chronic apical periodontitis, periapical abscess, periapical granuloma, radicular cyst
biopsy has stratified squamous epithelium in the lining of the cavity so concluded it was a radicular cyst
Apical third shows numerous voids - underfilled at the apex and underextended.
Also tooth had no restoration and the Gutta Percha was exposed.
This is an otter fake out. The right side of the mouth is normal on gross exam, and there is a CCF of the 304 and 308.
What are the apparent lucencies in the rad of the right side?
Mental Foramina
What do you reckon this is?
Badness.
Multilobular tumor of bone
What are the authors suspicions about the origin of this problem?
What is the difference between impacted teeth and embedded teeth?
Trauma
An embedded tooth has not erupted, usually because of the lack of eruptive forces, and is typically completely covered with bone,
Impacted tooth is located or wedged against another tooth, bone, or soft tissue that acts as a physical barrier so that complete eruption is unlikely.
Horse
Horse
supernumerary teeth
Which class of lesion periodontal endodontic lesion is this on M1?
What is the prognosis for maintenance of this tooth?
Class II Perio-endo
prognosis is poor for retention, recommend XSS
This is a dog presented for trauma secondary to an altercation with a horse.
What 3 diagnoses can be applied to the canine tooth?
non vital tooth
lateral luxation
root fracture.
Which class of perio-endo lesion is this?
Class I - primarily endo
What could differentials be for this lesion?
odontogenic cyst, odontogenic tumor, neoplastic tumor.
histopath didn’t definitively identify it.
This dog had M2 extracted 2 months prior to referral. What’s your diagnosis?
osteonecrosis of the jaw (Same rad appears in one
This dog had acute respiratory distress. Think it’s the tooth?
Nope. Nasal tumor of glandular epithelium (adenocarcinoma).
What do you think will happen with these teeth if they aren’t treated?
They will become nonvital and endodontically affected.
They called this a class I dens invaginatus
Type 1 lesions are those with a minimal enamel lined invagination confined to the crown and not extending beyond the level of the external cemento`enamel junction
Type II lesions, the invagination is also enamel-lined; it extends into the pulp chamber but remains within the pulp cavity with no communication with the periodontal ligament.
Type IIIA lesion extends through the root and communicates laterally with the periodontal ligament through a pseudoforamen without direct communication with the pulp, and a
Type IIIB lesion passes through the root and communicates with the periodontal ligament at the apical foramen (usually with no communication with pulp).
A keratinizing odontogenic cyst was biopsied from this region previously. What characteristics are consistent with cyst recurrence?
The formation of a well-defined corticated border (characterized by a fairly uniform, thin, radiopaque line) and geographic bone loss were consistent with a slowly expansile growth.3,4
This capuchin monkey had his canine crowns shortened 7 months prior to referral for facial abscesses and lymphadenopathy.
exposed pulp, non vital teeth, abscesses. sigh.
Yep, bad things happen when your face is eaten off…
What abnormality is seen here?
sialolith in the parotid duct
What is the name for the, dense bone sometimes associated with chronic endodontic infections?
sclerosing osteitis
What’s going on here??? This tooth has a friend!
Awww… isn’t it cute?
SN tooth
Any time it’s a cystic lesion in a young cat, think of a…
FIOT!
here’s an easy one
BAM - CCF
And another.
Is it impacted or embedded?
Impacted - horizontal inclination represents a barrier to eruption. embedded is just that it lacks eruptive forces
Here’s a wierd one…
Fun Fact…. Historically, elastic bands were intentionally used to extract teeth in people with coagulation abnormalities and in patients with a high risk of osteonecrosis because of bisphosphonate treatment; however, this method fell out of favor owing to the potential for several complications.
What’s going on here?
more impacted/embedded/unerupted teeth!
This dog was referred for perio.
look what we found!
some non vital teeth. No real explanation found.
Nasal tumor aside, what is seen on the maxillary first molars?
What could be an etiology given this dog had no advanced periodontal disease or fractures to these teeth?
advanced Caries!
Why do you think this kitty has a gingival issue in the 203/204 diastema after trauma to it’s chin?
What are treatment options?
Root fracture
Could XSS OR Wire and splint!!!
This was a wierd presentation
2 different lesions in the same mouth
Histopath gave wierd answers compared to rads… .biopsy of P3 region - osteosarcoma
biopsy of incisor region - POF
horse TMJ fracture
Look at this banana sauce craziness…
I can’t believe it’s not cancer - neither could they. biopsied twice from multiple locations - osteomyelitis
