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Dental Radiology > Maxillofacial Radiology Interpretation > Flashcards

Maxillofacial Radiology Interpretation Flashcards

1
Q

Which radiographs best demonstrate caries? (1)

A
  • Bitewings or long-cone periapical radiographs
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2
Q

When can caries be radiographically detected? What does this mean clinically? (2)

A
  • When there has been 30-40% demineralization, so that the lesion can be differentiated from normal dentine and enamel - Because of this limitation, the carious lesion is larger (up to 25%) than that seen on radiographs
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3
Q

What can be useful when identifying early lesions? (1)

A
  • Magnification
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4
Q

Describe earliest radiographic Proximal surface caries (3)

A
  • Enamel caries seen as a triangular radiolucency - Just below the contact point - Apex pointing towards the amelo-dentinal junction
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5
Q

What happens when radiographic Proximal caries reaches the ADJ? (1)

A
  • When caries reaches the ADJ, it spreads along the junction, often forming a second radiolucent triangle, with its apex pointing towards the pulp
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6
Q

When is radiographic occlusal caries difficult to diagnose?

A
  • If the lesion is restricted to enamel
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7
Q

What is often the first indication of radiographic Occlusal caries? (2)

A
  • A thin radiolucent line at the ADJ, with intact enamel - As the lesion progresses it becomes easier to detect
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8
Q

How is Smooth surface caries detected? (1)

A
  • Should be visible clinically, but a radiograph can provide confirmation
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9
Q

How and where is root caries usually diagnosed? What can mimic root caries on a radiograph? (2)

A
  • Radiographs may reveal root surface caries that is not evident clinically, usually this is interproximally - Cervical burnout can mimic root caries, except that in cervical burnout there is still an image of the root edge
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10
Q

How does recurrent caries appear radiographically? What can obscure recurrent caries? (2)

A
  • Appears as a zone of increased radiolucency along the margins of a restoration - Radiopaque materials such as metals can obscure recurrent caries, and radiolucent lining materials can make detection difficult
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11
Q

What do radiographic signs of periapical periodontitis depend on? What is the earliest sign? (2)

A
  • Depends on the time course of the disease process - The earliest sign is usually widening of the apical periodontal ligament, followed by loss of lamina dura
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12
Q

What is rarefying osteitis? (1)

A
  • Bone resorption
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13
Q

What is sclerosing osteitis? (1)

A
  • Bone formation
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14
Q

What does the body promote in an attempt to heal from chronic apical periodontitis? How does this appear radiographically? (2)

A
  • Stimulates the formation of granulation tissue - This appears as a well-defined radiolucency surrounding the apex of a non-vital tooth
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15
Q

What is the most likely diagnosis of a well defined radiolucency surrounding the apex of a non-vital tooth with >1cm diameter? (1)

A
  • Radicular cyst
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16
Q

What can occur intermittently with Periapical Granulomas? (1)

A
  • Acute exacerbations of chronic lesions can occur intermittently
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17
Q

Give three possible pathological conditions resulting from Periapical Periodontitis? (3)

A
  • Root resorption - Radicular cyst formation - Osteomyelitis
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18
Q

Why are radiographs useful in Periodontal Disease? (3)

A
  • No radiographic signs of gingivitis - Useful to demonstrate the form of bone loss in chronic periodontal disease - As well as any local factors such as calculus or overhanging restorations
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19
Q

Where is the alveolar crest normally seen in a healthy individual? (1)

A
  • Within 1.5mm of the amelo-cemental junction
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20
Q

Describe the three radiographic patterns of bone loss (3)

A
  • Early: erosion of the interdental crest - Later: ‘horizontal’ loss of bone generalized and localised - ‘Complex’: osseous defects
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21
Q

Describe ‘Juvenile’ Periodontitis (1)

A
  • Localised, aggressive
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22
Q

Describe Rapidly Progressive Periodontitis (1)

A
  • Generalised, aggressive
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23
Q

What is Papillon-Lefevre associated with? (1)

A
  • Genetic disorders
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24
Q

Give three ways that dental anomalies can occur (3)

A
  • Anomalies of tooth number - Anomalies of tooth form - Anomalies of tooth structure
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25
Q

Give examples of anomalies of tooth number (2)

A
  • Missing teeth: hypodontia, anodontia - Extra teeth: supernumerary, mesiodens, supplemental
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26
Q

What happens when there is a Germination dental anomaly? (1)

A
  • Two teeth joined together but arising from a single tooth germ
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27
Q

What happens when there is a Fusion dental anomaly? (1)

A
  • Two teeth joined due to the fusion of two tooth germs
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28
Q

What is Concrescence? (2)

A
  • Condition where the cementum overlying the roots of at least two teeth join together - The cause can sometimes be attributed to trauma or crowding of teeth
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29
Q

What is Dens Invaginatus? (1)

A
  • Infolding of the outer surface of a tooth into the interior
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30
Q

What is Dilaceration? (1)

A
  • Sharp bend in the root direction, usually due to previous trauma
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31
Q

What is Taurodontism? (1)

A
  • Enlarged pulp chambers, short roots (cow teeth), usually of no clinical significance
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32
Q

What is Amelogenesis Imperfecta? (2)

A
  • Inherited condition affecting enamel formation, which is thin, pitted or grooved. - Up to 14 variants identified
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33
Q

What is Dentinogenesis Imperfecta? (2)

A
  • Ingerited condition affecting dentine formation, which is discoloured and soft. - Can occur with Osteogenesis Imperfecta
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34
Q

What are Odontomes? (1)

A
  • Benign odontogenic tumours (WHO) forming dental hard tissues, compound or complex
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35
Q

What size is the follicular space usually and what does a change in size suggest? (2)

A
  • The follicular space is usually no greater than 3mm
  • More than this suggests cystic change, especially if root formation is complete
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36
Q

Where are pericoronal radiolucent lesions usually seen? (2)

A
  • Usually seen around the crown of normally erupting teeth
  • The follicular space
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37
Q

What is the most common pathologic pericoronal radiolucency in the jaws? (1)

A
  • The dentigerous (follicular/eruption) cyst
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38
Q

What other lesions may present in the same way as dentigerous (follicular/eruption) cysts? (2)

A
  • Keratocysts
  • Ameloblastomas
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39
Q

What diagnosis does it suggest if there is calcification within a pericoronal radiolucency? (3)

A
  • Adenomatoid Odontogenic Tumour
  • Pindborg tumour
  • Calcifying Odontogenic Cyst
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40
Q

Why are radilucent lesions with indistinct borders so important? What can mimic this? (2)

A
  • Can indicate a sinister condition
  • Periodontal disease can mimic more sinister conditions but usually the bone loss seen with ‘perio’ is general as opposed to the local loss seen with malignancy
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41
Q

What is crucial when differentiating various radiolucent lesions with indistinct borders? And what is the general rule? (2)

A
  • Clinical findings
  • As a general rule, bone loss with an indistinct border is a sign of serious disease
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42
Q

What is important when identifying sinister pathology? Give an example(2)

A
  • Remember normal radiographic anatomy, bony outlines, check these landmarks are present on viewing films
  • E.g. Maxillary Sinus Carcinoma – always look for the ‘four white lines’ on OPGs, if one or more is absent then sinister pathology has to be considered
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43
Q

What possibility must be considered when looking at an opaque lesion on a radiograph? (2)

A
  • That an opaque lesion is not actually bone, may be the adjacent soft tissues
  • e.g. salivary calculus
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44
Q

What can an opcity at the end of a root be? (2)

A
  • A sign of non-vitality – sclerosing osteitis
  • Cemental lesions also need to be considered, affected teeth are usually vital
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45
Q

What is Gardener’s Syndrome? (3)

A
  • Clinically appears as multiple jaw osteomas with or without supernumberary teeth and odontomes
  • Patients with Gardener’s syndrome also develop multiple polyps in the bowel, these usually undergo malignant change by the age of 40
  • Early detection can be life-saving
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46
Q

What is the most likely radiographic diagnosis from a Tubular shaped opacity extending from the styloid process? (2)

A
  • Calcification of the stylohyoid ligament
  • Very common and of little clinical significance
47
Q

What is the most likely radiographic diagnosis from large well defined rounded opacities, sometimes multiple, in the cervical region? (2)

A
  • Usually indicate calcification of lymph nodes.
  • Very common incidental finding, not significant
48
Q

What is a Phlebolith? (1)

A

A phlebolith is a small local, usually rounded, calcification within a vein

49
Q

How do Phleboliths present on a radiograph? (2)

A
  • Multiple small opacities made up of concentric rings
  • Seen in vascular lesions
50
Q

What is the most likely radiographic diagnosis from a rounded single opacity projected over or just below the mandibular angle? (3)

A
  • Calculus in the submandibular gland
  • Expect a history of pain/swelling with meals
  • Occlusal views helpful
51
Q

What is the most likely radiographic diagnosis from a well defined dome-shaped opacity in the lower half of the maxillary sinuses? (3)

A
  • Usually represent harmless polyps
  • There may be a history of allergy or upper respiratory infection
  • Common incidental finding on OPT
52
Q

What is the most likely radiographic diagnosis from an opacity seen in the region of the carotid artery? (2)

A
  • Could represent atheroma
  • May serve as a warning sign for similar disease elsewhere
53
Q

What is an Atheroma? (2)

A
  • Atheroma is an accumulation and swelling in artery walls made up of (mostly) macrophage cells, or debris, and containing lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.
  • Atheroma occurs in atherosclerosis, which is one of the three subtypes of arteriosclerosis (which are atherosclerosis, Monckeberg’s arteriosclerosis and arteriolosclerosis).
54
Q

What is Fibrous Dysplasia?

A
  • A benign development anomaly where normal bone is replaced with fibrous bone tissue
55
Q

How does the radiographic appearance of Fibrous Dysplasia vary?

A
  • Radiographic appearance varies with age
56
Q

What do early fibrous dysplasia lesions tend to look like radiographically?

A
  • Early lesions tend to be radiolucent with well defined borders
57
Q

What is the classic radiographic appearance of Fibrous Dysplasia?

A
  • As lesion matures more bone is laid down leading to a mottled radiopacity so called ‘orange peel’ pattern
58
Q

What do the borders of fibrous dysplasia lesions look like radiographically?

A
  • The borders of the lesion then blend into the adjacent normal bone
59
Q

What may happen to the bone in fibrous dysplasia?

A
  • Bony expansion may occur
60
Q

What can happen to the sinus in Fibrous Dysplasia and why? Which sinus?

A
  • Lesions in the maxilla can occlude the sinus
61
Q

What can Fibrous Dysplasia do to the teeth?

A
  • Teeth may be titled or bodily displaced
62
Q

What can Fibrous Dysplasia do to the roots and developing teeth?

A
  • Root resorption can occur as can destruction of developing teeth
63
Q

Which disease looks similar to Fibrous Dysplasia and how do you differentiate between the two?

A
  • May look similar to Paget’s disease but active Fibrous Dysplasia is uncommon in middle/old age and Fibrous Dysplasia is usually unilateral unlike Paget’s
64
Q

What is Cherubism?

A
  • Rare inherited fibro-osseous disease of the jaws
65
Q

When does Cherubism develop?

A
  • Develops in infancy
66
Q

What does Cherubism usually present as? And then what follows?

A
  • Usually presents as a painless bilateral enlargement of the lower face
67
Q

In Cherubism, what develops and where? Where does this expand to?

A
  • Enlargement of the maxilla gradually
  • Cyst-like radiolucencies develop at the posterior aspect of the mandible, bilaterally
  • These will expand into the rami and body
68
Q

Describe the lesions in Cherubism

A
  • The lesions are well defined and produce bone expansion rather than cortical perforation
69
Q

What happens to the tooth buds in Cherubism?

A
  • Tooth buds will be displaced or destroyed especially the 2nd and 3rd molars
70
Q

What can happen to the erupted primary teeth in Cherubism?

A
  • Erupted primary teeth may be shed early
71
Q

What is Paget’s disease characterised by?

A

Characterised by abnormal resorption and deposition of osseous tissue in bone(s)

72
Q

At what age does Paget’s disease usually occur?

A
  • A disease of later middle and old age
73
Q

What part of the body is Paget’s disease common in?

A
  • Common in the skull
74
Q

Which jaw does Paget’s Disease affect more?

A
  • Affects the maxilla more than the mandible
75
Q

What part of the bone is usually involved in Paget’s disease?

A
  • Usually involves all of the bone affected
76
Q

What happens to the affected bone in Paget’s Disease?

A
  • Affected bones enlarge, teeth can be moved
77
Q

What may also develop in Paget’s Disease, other than bone enlargement?

A
  • Osteomyelitis and sarcoma may develop
78
Q

How does the jaw appear in the early stages of Paget’s Disease? What may be seen in the skull?

A
  • In the early stages the jaw bone has a laminated structure. Osteoporosis circumscripta may be seen in the skull
79
Q

What can be visible ‘striking’ in Paget’s Disease? Later, how can the bone look radiographically?

A
  • Bony expansion can be striking
  • Later ‘cotton wool’ areas develop
80
Q

How can the roots of teeth be affected in Paget’s Disease?

A
  • Hypercementosis may eventually affect the roots
81
Q

What can frank bony destruction indicate in Paget’s Disease?

A
  • Frank bony destruction may indicate the development of osteogenic sarcoma
82
Q

Describe Osteopetrosis, including its effects on bone, teeth and cortical structure.

A

All bones show greatly increased density

  • There may be delayed eruption and early loss of teeth
  • This cortical structures such as the lamina dura and the mandibular canal walls may be totally obscured by the dense bone
83
Q

What is Hyperparathyroidism due to?

A
  • Due to excess circulation of PTH hormone
84
Q

What does hyperparathyroidism usually stimulate?

A
  • PTH stimulates osteoclasts to mobilise calcium from the skeleton
85
Q

What percentage of body calcium is in the skeleton and what impact does this have?

A

99% of body calcium is in the skeleton, hence the profound impact on the bones

86
Q

What happens to the skeleton in Hyperparathyroidism?

A

The skeleton becomes demineralised, so the bones look radiolucent

87
Q

Where should you look for evidence of Hyperparathyroidism radiographically?

A
  • Look for demineralisation of the inferior border of the mandible and sinus outlines
  • Loss of lamina dura may occur
88
Q

What kind of lesions may develop in the jaws in Hyperparathyroidism?

A
  • Variably defined radiolucent lesions may develop in the jaws ‘brown tumours’
89
Q

What is Hyperpituitarism due to?

A
  • Due to excessive production of growth hormone by the anterior lobe of the pituitary
90
Q

What does Hyperpituitarism cause in childhood?

A
  • In childhood this causes ‘giantism’
91
Q

What does Hyperpituitarism cause in adults and what does it affect?

A
  • In adults it is called acromegaly and the excessive growth does not affect all bones
92
Q

How does adult onset Acromegaly affect the jaws?

A
  • Acromegaly leads to increased length of the ramu sand body of the mandible resulting in a class III skeletal jaw relationship
93
Q

What can a lateral skull view reveal in Hyperpituitarism?

A
  • A lateral skull view may, but not always reveal ‘ballooning’ of sella turcica
94
Q

Enlargement of what – is very common in Acromegaly?

A
  • Enlargement of the paranasal sinuses, especially the frontal, is very common
95
Q

What can happen to the skull in adults with Acromegaly?

A
  • In acromegaly the outer table of the skull may be quite thickened
96
Q

What is sickle cell anaemia and what does it cause?

A
  • A chronic haemolytic blood disorder
  • Abnormal red blood cells rapidly destroyed
97
Q

What happens to bone marrow in Sickle Cell Anaemia?

A
  • This results in compensatory hyperplasia of the bone marrow
98
Q

What are the radiographic findings in Sickle Cell Anaemia? What accounts for this?

A

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  • Expansion of the bone marrow at the expense of spongy bone accounts for the radiographic findings
99
Q

What does marrow hyperplasia lead to?

A
  • Marrow hyperplasia leads to thinning of cancellous trabeculae and cortices
100
Q

What appearance is seen in the skull in 5% of Sickle Cell Anaemia patients?

A
  • May see widened diploic space in the skull and ‘hair-on-end’ appearance in 5%
101
Q

What does bony artifaction in Sickle Cell Anaemia lead to?

A
  • Bony infarction leads to areas of sclerosis
102
Q

Describe the jaws in sickle cell anaemia

A
  • Jaws look osteoporotic, thin cortices
103
Q

What is the ‘stepladder’ pattern in Sicle Cell Anaemia?

A
  • In between teeth, the bony trabeculae are coarse – so called ‘stepladder’ pattern
104
Q

What is evident in this radiograph?

A
  • Missing RHS hard palate
  • Missing both RHS and LHS floor of maxillary sinus
  • Missing RHS posterior border of maxillary sinus
105
Q

What is evident in this radiograph?

A
  • Missing RHS floor of the maxillary sinus
106
Q

What is evident in this radiograph?

What is the differential diagnosis?

A
  • Tubular shaped opacity, extending
    from the styloid process
  • Calcification of the stylohyoid
    ligament
107
Q

What is evident in this radiograph?

Diagnosis?

A
  • Large well defined opacities
  • Calcification of lymph node
108
Q

What disease is shown by these radiographs?

A

Fibrous Dysplasia

109
Q

What disease is shown by these pictures and radiographs?

A

Cherubism

110
Q

What disease is shown by these radiographs?

A

Paget’s Disease

111
Q

What disease is shown by these radiographs?

A

Osteoporosis

112
Q

What disease is shown by these radiographs?

A

Hyperparathyroidism

113
Q

What disease is shwon by these pictures and radiographs?

A

Hyperpituitarism

114
Q

What is evident in these radiograph?

A

Sickle Cell Anaemia

Dental Radiology (9 decks)

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