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Flashcards in Final Sweep Deck (93):
1

Contrast Resolution

• Contrast resolution is defined as the ability to detect subtle changes in grayscale and distinguish this from background noise in the image

2

• Spatial Resolution

• Spatial resolution is defined as the ability of an imaging system to record separate structures that are positioned close together.

3

RaySumorRayCasting.

• Any multi-planar image can be "thickened" by increasing the number of adjacent voxels included in the display.
• Creates an image that represents a specific volume of the patient.

This mode can be used to generate simulated projections such as lateral cephalometric images

4

The size of these voxels determines the
----- of the image.

resolution

5

 A cyst is lined by

epithelium

6

Cyst 3 parts

cortex, epithelium, lumen

7

Cyst Periphery:
 Well-------

defined

▪ Corticated -Smooth
▪ Non-corticated -Regular border

8

Cyst  Effect on surrounding structures:

 Displacement
 Root resorption
 Expansion

9

 Without resistance, the cyst grows in a ------
fashion resulting in a ------ shape
 Within bone, its shape is influenced by the

concentric

spherical

resistance of
adjacent hard tissue

10

ODONTOGENIC cysts

Periapical Cyst Residual Cyst Lateral Periodontal Cyst Buccal Bifurcation Cyst Dentigerous Cyst

OKC, CEOC*

11

NON ODONTOGENIC cysts

Naopalatine cyst Nasolabial Cyst Dermoid Cyst Simple Bone Cyst Aneurysmal Bone Cyst

12

Radicular/periapical cyst

Epithelial cells in PDL are stimulated by inflammatory process
 C/F:
 Nonvital teeth
 May cause swelling
 Maybe asymptomatic

13

Periapical cyst - If large, may cause

tooth displacement
and root resorption

14

Residual cyst

Is a cyst that develops after incomplete removal of original cyst
 Usually asymptomatic
 In some cases, expansion may be
noted

15

Residual cysts found more in
More in -------
 Periapical region of an -------
 ------- margin
 Radiolucent
 May cause tooth displacement and root
resorption

mandible

edentulous area


Corticated

16

Manage residual cyst -  ------- or ------, or both if the cyst is large.

marsupialization

Removal

17

Buccal Bifurcation cyst

Age:

First two decades

18

Buccal Bifurcation cyst

 Lack of or a delay in eruption of a
--------

mandibular first or second molar

19

Buccal Bifurcation cyst

 ------ cusp tips may be protruding
through the mucosa, higher than the ------- cusps.

Lingual

buccal

20

Buccal bifurcation cyst -  Periphery:

May be well-defined,
corticated.
 Sometimes, periphery is not very obvious, and the radiolucency may be superimposed over the image of the roots of the molar.

21

Buccal bifurcation cyst - Management:

conservative curettage, or nothing. Can resolve independently

22

Dentigerous cyst

Forms around the crown of an unerupted tooth
 C/F
 Swelling
 Facial asymmetry  Missing teeth

23

Dentigerous cyst - Usually in ----------
 Well-defined, corticated
 Radiolucent
 Displace and resorb roots
 May cause expansion

mand third molar or max canine

24

Dentigerous cyst - ------ removal, which may include the tooth as well.  Large cysts may be treated by ------

Surgical

marsupialization before
removal

25

Lateral periodontal cyst

Arise from epithelial rests in periodontium lateral to the tooth root
 Asymptomatic and usually less than 1 cm in diameter
 Well-defined, unilocular radiolucency. Large cysts may displace adjacent teeth and cause expansion

26

Lateral perio cyst - management

 Excisional biopsy or simple enucleation

27

Botyroid odontogenic cysts BOC

multilocular, otherwise a lot like a lateral perio cyst

28

Nasopalatine canal cysts

 Arises from ----- remnants of
nasopalatine duct
 Mostly -----
 May cause swelling posterior to incisive
papilla


epithelial

asymptomatic

29

 May cause the roots of central incisors to
diverge and may also resorb roots

Nasopalatine canal cyst

30

Simple bone cyst

Traumatic bone cyst
 Is a cavity in the bone lined with -----------
 First two ------ of life
 ------- in most cases

connective tissue


decades

Asymptomatic

31

Simple bone cyst - Mostly in ----- mandible
 ------ borders, that
blend into surrounding bone
 Boundary is well defined in the -------
 ----- between roots of teeth

Usually ------
 Usually no effect on surrounding
structures

posterior

Well-defined to ill-defined

alv
processes around teeth

Scallops

unilocular

32

Simple bone cyst - management

Conservative opening into the lesion and curettage of the lining to initiate bleeding and subsequent healing.
 Spontaneous healing has been reported

33

The sensitivity of a test refers to

how many cases of a disease a particular test can find

34

 The specificity of a test refers to

how accurately it diagnoses a particular disease without giving false-positive results

35

An advanced lesion affects both

enamel and dentin.

36

A severe lesion involves

both the enamel and dentin and may clinically appear as a hole in the tooth.

37

Occlusal classification

Incipient: Cannot be seen on a dental radiograph and must be detected clinically.
 Moderate: Caries extends into dentin and is seen as a very thin radiolucent line under the enamel. Little if any radiographic change is noted in the enamel.
 Severe: Caries extends into dentin and is seen as a large radiolucency. Severe occlusal caries is apparent clinically and appears as a hole in a tooth.

38

Adumbration

(Cervical Burnout)

Between CEJ and alveolar crest  Diffuse radiolucency
 Ill-defined borders
 Presence of the edge of root
 Clinical evaluation

39

 Metallic restorations often hide

recurrent caries

40

FIBRO-OSSEOUS LESIONS
 Normal bone is replaced by

fibrous connective and abnormal osseous tissues
 Cementum-like material may also be present

41

OSSEOUS DYSPLASIAS

 Idiopathic
 4th to 5th decades of life
 Females (9:1)
 African Americans and Asians  Mandible
 Generally asymptomatic but symptoms may include: Expansion/facial swelling
 Pain
 Types are categorized by location:  Focal
 Periapical  Florid
 No treatment necessary  Teeth are vital!
 Residual lesions and florid cases may require surgical removal

42

OSSIFYING FIBROMA

 Benign neoplasm of mesodermal mesenchymal tissue 3rd to 4th decades of life
Females (70%)
 Caucasians
 Mandible
 Generally asymptomatic but symptoms may include:
 Expansion/facial asymmetry  Tooth displacement
 Pain
 Surgical removal
 Enucleation and/or curettage  Resection
 Recurrence rate is about 12%

43

JUVENILE OSSIFYING FIBROMA

 More aggressive, expansile, rapidly growing, non-encapsulated form of ossifying fibroma
1st to 2nd decades of life
No gender predilection
Two subtypes based on histologic pattern of mineralization: Psammomatoidmaxilla
Trabecularparanasalsinus regions
 Recurrence rate is about 30% to 58%

44

CENTRAL GIANT CELL GRANULOMA

 Benign neoplasm-like reactive lesion with an unknown stimulus  Any age, but 60% before the 3rd decade of life
 Older patients should be evaluated for hyperparathyroidism
 Females (2:1)
 Mandible
 Can be asymptomatic but usually discovered due to painless facial swelling (expansion)  Other symptoms may include:
 Tenderness/pain
 Paresthesia
 Cortical plate perforation with color change or ulceration of mucosa  Tooth displacement
Surgical removal
 Enucleation and/or curettage
 Resection
 Corticosteroid injections
 Recurrence has been reported (more common in aggressive and/or maxillary lesions)
 11% to 50%

45

CHERUBISM

 Benign congenital disease with genetic etiology (SH3BP2 gene, etc.)  Causes bilateral enlargement of bones
 Often maxilla and mandible
1st decade of life
 Mild cases  2nd decade of life

46

OSTEITIS DEFORMANS (PAGET’S DISEASE)

 Skeletal disorder involving bone remodeling possibly of genetic origin (SQSTM1 gene, NF-kB gene, etc.)  Causes osteoclastic driven bone resorption followed by osteoblastic driven apposition of poor quality bone
 Enlargement of affected bones (pelvis, skull, spine, jaws, etc.)
 Maxilla

47

ANEURYSMAL BONE CYST

 Benign neoplasm-like reactive lesion with proliferative vascular response to an unknown stimulus

48

LANGERHANS CELL HISTIOCYTOSIS

 Group of aggressive idiopathic lesions characterized by abnormal proliferation of immune cells (namely Langerhans cells)
Affects skeleton and organs
 Bony lesionsskull, femur, jaws, ribs, vertebrae, pelvis, long bones
 50% of all bony lesions occur in the skull and facial bones  10%-20% in the jaws
 Mandible

49

Closer to sensor for pan

things scrunch down, lower

50

Further from sensor for pan

things stretch out longitudinally, higher

51

 Crestal cortices

 Within 0.5mm to 2mm below CEJs Vary in length and thickness

52

PERIAPICAL RAREFYING OSTEITIS

Region of decreased bone density
 At apex or lateral to apex
 Widening of apical PDL space
(early)
Loss of apical lamina dura
Varies in size
 Gradual transition to bone with normal trabeculation
 Radiolucency may be surrounded by osteosclerosis

53

OSSEOUS DYSPLASIA

 Lesions formed by replacement of normal bone by fibrous and abnormal bony tissues
 Radiolucent, mixed density, and radiopaque stages

54

PERIAPICAL CONDENSING OSTEITIS

 Region of increased bone density in response to inflammation

55

Anytime you see expansion of cortical boundaries, it is a

benign lesion

56

For
• Adult

– Posterior bitewings, and selected periapicals
or panoramic radiograph
– A full-mouth series is preferred when the patient has evidence of disease or history of extensive treatment

57

Enostosis
Idiopathic Osteosclerosis

 Localized growths of compact bone that extend from the endosteal (inner) surface of cortical bone into the cancellous bone
 Seen more in Mandibular premolar-molar region

58

Odontogenic Keratocystic tumor
 Arises from cell rest of --------
 The ------ of OKC appears to have an
inherent growth potential
 The epithelium is -------
 The cyst contains a -----

dental lamina


epithelium

keratinized

cheesy material

59

Odontogenic keratocystic tumor
Most common location is -------
 May surround the crown of an unerupted tooth
 Well-defined, corticated and may have scalloped border
Tend to grow in an ------ direction in the body of mandible with minimal expansion
 In ------, considerable expansion may occur
 Can displace and resorb roots, but to a lesser extent than dentigerous cysts
 Unilocular or multilocular radiolucency

post body of mandible

antero-posterior

upper ramus

60

BASAL CELL NEVUS SYNDROME(NBCCS)
 ----- syndrome
 Autosomal -----
 mutations in the------ gene found on chromosome arm 9q
 Abnormalities of the --------
 Diagnosis is made in the presence of 2 major or 1 major and 2 minor criteria

Gorlin-Goltz

dominant

PTCH (Patched)

skin, skeletal ,CNS and genitourinary system

61

Ameloblastoma
 More in -----
 Age: 20-50yrs
 Grow ----
 ----- of bone

men

slowly

Thinning

Molar\ramus region in mandible  Well-defined, corticated
 Unilocular/multilocular
 Extensive root resorption
 Expansion and displacement

62

Recurrent ameloblastoma
 ------ with very coarse ------ cortical margins

Multilocular

sclerotic

63

Adenamatoid Odontogenic Tumor
 More in ------
 5-50 yrs
 ----- growing swelling
Maxillary ------
 ----- borders
 ----- in 75% , rest completely ------
 Displacement, expansion, root resorption

females

Slow

canine

Well-defined

Radiopacities, radiolucent

64

Calcifying Epithelial Odontogenic Tumor (CEOT)

 More in ------ in ------- region
 52% associated with -----------
 Well-defined/diffuse borders
 Radiolucent with -------- close to teeth
 Displacement, expansion, root resorption

 Pindborg tumor  More in men
 Wide age range  Jaw expansion

mandible, premolar-molar

unerupted teeth

radiopacities

65

Odontoma
Compound: -----
 Complex: ---------
 Well-defined, corticated
 Compound: multiple tooth-like structures
 Complex: Irregular mass of calcified tissue
 Prevents tooth eruption

Ant. Maxilla

mand first and second molar
region

66

Ameloblastic fibroma/ fibro-odontoma
 5-20 yrs
 slow-growing
 tooth displacement
 May be associated with -----
------- region of mandible
 Well-defined, corticated
 Unilocular/multilocular
 Associated teeth may not erupt or pushed apically

missing teeth

Premolar-molar

67

Odontogenic Myxoma
 More in ------
 10-30 yrs
 Associated with -------
 High recurrence
More in ------- region of mandible
 Well-defined
 Usually Multilocular, with ------
 Displaces adjacent teeth, root resorption rare

females

missing teeth

premolar-molar

fine septa

68

Benign Cementoblastoma
 More in ----
 12-65 yrs
 -----, eventually may displace teeth
 Tooth may maybe painful
More in mand ----- teeth
 Well-defined radiopacity with -------
 -------- of involved teeth
 Resorption of roots

males

Slow growing
premolar-molar

radiolucent
halo

Obscures the outline

69

Neurofibroma
 Usually in the -----
 Potential for malignant
change
 Multiple lesions
 ------
May occur in the ---------
 Usually are ------ and may be
 Usually ------
 Enlargement of -----

young

Pain and Paresthesia

mandibular canal, in the cancellous bone, below the periosteum.

sharply defined, corticated

unilocular

canal

70

Neurofibromatosis
 ------'s disease
-------- spots on the skin
 Multiple peripheral -------
 Other dysplastic abnormalities of the skin, nervous system, bones, endocrine organs, and blood vessels.

Enlargement of the -----
 ------ between the body and the
ramus
 Deformity of the ------ head
 Lengthening of the ----- neck
 Enlargement of the --------------
 May affect eruption of molars

von Recklinghausen

Café au lait

nerve tumors

coronoid notch

Obtuse angle

condylar, condylar

mandibular canal and mental and mandibular foramina

71

Gardner’s syndrome

Familial multiple polyposis
 Multiple ------
 ------- cysts, ------ fibromas
 Polyps of small and large --------
 Multiple -------

osteomas and enostosis

Cutaneous sebaceous

subcutaneous

intestine

supernumerary teeth

72

Central Hemangioma
 Congenital anomaly
 Proliferation of ---------
 More in young ------
 Mandible: Often within the -------
 Borders: May be well-defined with or without cortication

blood vessels

females

canal

73

Central Hemangioma
 Congenital anomaly
 Proliferation of ---------
 More in young ------
 Mandible: Often within the -------
 Borders: May be well-defined with or without cortication

blood vessels

females

canal

74

Water's projection for

sinuses - namely frontal.

75

Submentovertex projection for

zygomatic arch viewing

76

MDCT

• Superior soft tissue characterization compared to CBCT
• Ability to use contrast medium

77

Radiographic features of malignant lesions

• Poorly defined
• Non-corticated, irregular margin
• Non-space occupying
• Irregular widening of PDL
• Non-resorption of teeth (usually)
• Destruction of anatomical structures • Teeth floating in space

78

Non-aggressive
– Geographic with

narrow transition zone

79

Aggressive

– ‰Moth-eaten: areas of destruction with ragged borders
– Permeative: Ill-defined lesion

80

Periosteal Reactions
Non-aggressive

– Solid/continuous

81

Periosteal Reactions
Aggressive

– ‰Onion-skinning/ multilamellar
– S‰piculated (Hair-onEnd/Starburst) – Codman’s triangle

82

SOFT-TISSUE COMPONENT
• Presence of a soft-tissue component with a bone lesion suggests a

malignant process.
• Frank destruction of cortex.
• Soft-tissue component may displace adjacent
fat planes.
• Tumors that often have a soft-tissue component are osteosarcoma, Ewing sarcoma, and lymphoma

83

Carcinoma
• A malignant neoplasm made up of

epithelial cells.

84

Osteosarcoma

• Primary malignant tumor of bone. The most common malignancy of bone tissue.
• 20-40 years old.
• Pain and swelling of the involved bone, loose teeth, paresthesia, bleeding, nasal obstruction.
• Widening of the periadontal ligament space.

85

Osteolytic -

no neoplastic bone formation: poorly defined
“moth-eaten’ radiolucency, loosening of associated teeth

86

• Mixed –

patches of neoplastic bone formed: poorly defined radiolucent area with variable internal radiopacity.

87

• Osteosclerotic-

neoplastic bone formation: often formation of sub-periosteal bone orientated at right angles to the original cortex, producing the so-called “sun-ray” appearance, loosening of associated teeth, distortion of the alveolar ridge.

88

Multiple Myeloma

• Canceroftheplasmacells.
• Mostcommonmalignancyofboneinadults.>30 years.
• Symptomsandsignsincludepain,swelling, paresthesia, soft tissue mass and tooth mobility.
• Multiplepunched-outroundradiolucenciesinthe skull and jaws (more often in the mandible).
• Lesionmarginsareusuallywell-definedbutnot corticated

89

Lymphoma
• Malignant neoplasms of cells of

Generalised ------ with loss of the ------ and the inferior dental canal and involvement of the cortex.

lymphoid origin.

osteopenia

lamina dura

90

Leukemia
• Bilaterally

ill-defined, patchy radiolucent areas

91

Leukemia

• Effect seen more often in areas of developing teeth
• Developingteethin their crypts and teeth undergoing eruption may be displaced in an occlusal direction

92

Langerhans cell histiocytosis

• CausedbytheabnormalproliferationofLangerhans cells.

Punchedoutlesions
• TeethFloatinginSpace.

93

Threeclinicalforms of langerhans cell histiocytosis
– Eosinophilic granuloma: -----
– Hand-Schuller-Christian disease: --------.
– Leterrer-Siwe disease: -------

localized (most often in older children and young adults).

chronic, wide-spread

acute, wide-spread (children under than 3 years old).