More radiographic interpretation

Question 1

What pathologies could come under radiographic jaw lesions?

Answer 1

Cysts
Benign neoplasms
Cancers
Developmental abnormalities
Reactive lesions
Genetic conditions

Question 2

What differential diagnosis are there for suspected lesions on a radiograph?

Answer 2

Anatomical
Artefactual
Pathological

Question 3

What information should you give when describing a radiographic lesion?

Answer 3

Site
Size
Shape
Margins
Internal structure
Effect on adjacent anatomy

Question 4

What information should be given about the SITE of a radiographic lesion?

Answer 4

Specific location (which bone is it on)
Notable relationships with other structures (teeth, canals)
Where it is in position to other structures (close to max. sinus)

Question 5

What information should be given about the SIZE of a radiographic lesion?

Answer 5

Measurement mesio-distally by supero-inferiorly
Describe boundaries (extends between 34 and 38)
Volumetric analysis from CBCT

Question 6

What information should be given about the SHAPE of a radiographic lesion?

Answer 6

General - rounded, scalloped, irregular
Locularity - uni-ocular, pseudolocular, multiocular

Question 7

What information should be given about the MARGINS of a radiographic lesion?

Answer 7

Well defined and corticated/non-corticated
Poorly defined and blending in/ragged

Question 8

What is the significance of a radiographic lesion with a moth-eaten/ragged margin?

Answer 8

Suggests malignancy, corticated border indicates benign.

Question 9

What information should be given about the INTERNAL STRUCTURE of a radiographic lesion?

Answer 9

Entirely radiolucent or,
Radiolucent with some internal radiopacity or,
Radiopaque

Internal radiopacities can be described by amount, bony profile, and particular structure.

Question 10

What makes jaw lesions radiolucent?

Answer 10

Resorption of bone
Less mineralization in bone
Less thickness in bone
Replacement of bone with abnormal tissue

Question 11

What makes jaw lesions radiopaque?

Answer 11

Increased thickness of bone
Osteosclerosis of the bone
Presence of abnormal tissue
Mineralization of normally non-mineralized tissues.

Question 12

How can radiographic jaw lesions impact adjacent anatomy?

Answer 12

Some pathologies have characteristic growth
patterns related to their ability to affect adjacent
structures

Aggressive pathologies tend to grow quickly & be
more destructive

Displacement of structures, impaction of teeth, loss of lamina dura, widening of the PDL, erosion of structures.

Question 13

Describe the lesion presented below.

Exclude size for the purposes of this card.

Answer 13

Site: Alveolar bone region of 46, above the right IAC

Shape: Uniocular and rounded

Margins: Well defined and corticated

Internal structure: Entirely radiolucent

Tooth involvement: None, but close to 45

Effects: Non visible

Number: Single

Question 14

Describe the lesion presented below.

Exclude size for the purposes of this card.

Answer 14

Site: Right ramus and post. body of mandible, above IAC

Shape: Pseudolocular and scalloped

Margins: Well defined and corticated

Tooth involvement: Yes, displaced 48 and 47

Effects: Displaced teeth and IAC, thinned inferior cortex of mandible

Number: Single

Question 15

Describe the lesion presented below.

Answer 15

Site: Alveolar bone of 46, above IAC

Shape: Oblong but irregular

Margins: Well defined and smooth

Internal structure: Homogeneously radiopaque

Tooth involvement: Yes involves apicies and furcation of 46

Effects: None

Number: Single

Question 16

Other than anatomical/artefactual reasons, what can cause periapical radiolucency?

Answer 16

Periapical granuloma
Periapical abscess
Radicular cysts
Perio-endo lesion
Cemento-psseous dysplasia
Surgical defect
Fiberous healing defect
Ameloblastoma

Question 17

How can infected cysts mimic radiographic features of malignancy?

Answer 17

They can loose their well defined corticated margins, and this should be confirmed with clinical features.

Question 18

What do radiographic jaw lesions contain?

Answer 18

Air, fluid, or non-mineralised tissue. They may not appear radiolucent relative to the adjacent tissues.

Question 19

What is idiopathic osteosclerosis?

Answer 19

Localised area of increased bone density of unknown cause.

No assoication with pathological process.

Asymptomatic, and generally an incidental finding.

Stops growing by adulthood.

Question 20

What are the radiographic features of idiopathic osteoclerosis?

Answer 20

Well defined
No radiolucent margin
Usually less than 2cm wide
Often homegenous, but can have slightly radiolucent areas

Question 21

What is sclerosing osteitis?

Answer 21

Localused area of increased bone density, in response to inflammation

Also known as condensing osteitis

Directly associated with source of infection (apex of necrotic tooth, infected cyst etc.

Question 22

What are the radiographic features of sclerosing osteitis?

Answer 22

Well defined or poorly defined radiopacity
Variable shape
Visibly linked with source of inflammation

Question 23

What is hypercementosis?

Answer 23

Excessive deposition of cementum around the root of a tooth.

Cause unknown, but more common in Paget’s Disease and Acromegaly.

Makes extraction of the tooth more challenging.

Question 24

Describe the radiographic presentation of hypercementosis?

Answer 24

Single or multiple teeth involved

Homogeneous radiopacity continuous with the root surface, with subtle difference in density when compared to root dentine.

PDL Space extends around periphery.

Often well defined and smooth margins, but can be irregular.

Question 25

What are buried retained roots?

Answer 25

Remnants of incomplete extractions or heavily broken down teeth.

Management only needed if infected, symptomatic, or hampering treatment such as implants.

May appear as diffuse radiopacity due to ERR or sclerosing osteitis of adjacent bone.

Question 26

Identify the abnormality found around the apex of the 43.

Answer 26

Retained/sunken root.

Question 27

Identify the blue and purple abnormalities indicated in this image.

Answer 27

Blue = Supernumerary tooth
Purple = Sclerosing osteitis or Idiopathic osteosclerosis.