radio densities Flashcards
What can radio opacities on a radiograph be due to
- Artfacts
- Normal anatomy
- Dental tissue
- Bone
- Soft tissue
- Foreign body
What causes something to appear more radiopaque
Increase in tissue or object in the line of the x ray beam
or
Increase in density
What can lead to increased thickness in bone
- Developmental
- Inflammatory
- Neoplastic
What can lead to increased density of bone
- Inflammatory
- Dysplasia
Give examples of artefacts that may be seen on a radiograph
- Copper dot
- Foreign objects
- Cervical spine shadow
- Ghost shadow of the mandible
Why might a copped dot be seen on a radiogrpah
Due to the film being placed back to front
Give examples of normal anatomy that appears radio opaque on a radiograph
- Zygomatic buttress
- Coronoid process
- Lower lip
- Nose
Give examples of abnormalities of the teeth that can appear radio opaque
- Retained root
- Unerupted or ectopic tooth
- Super numeracy
- Abnormality of tooth development
- Odontome
- Hypercementosis
What is dens in dente
Invagination of tooth stricture
What is dens in dente also called
Dens invaginatus
Where is dens in dente commonly found orally
In the maxillary lateral incisor
What are pulp stones
Calcifications in the pulp tissue
What is an enamel pearl
An extra growth of enamel usually in the furcation of molar teeth
What is hypercementosis
Excessive deposition of cementum on roots usually asymptomatic
How does hypercementosis appear on a radiograph
Outline is usually smooth
slightly more radiolucent than dentine
What are odontomes
Abnormal growth of normal dental tissues
Name the 2 types of odontomes
- Compound odontomes
- Complex
Describe compound odotnomes
Made up of lots of little denticles that look like a collection od small malformed teeth
Describe complex odontomes
Does not have normal ordering of tooth tissue
What can tumours of the jaw be split into
Odontogenic
Non odontogenic
Give examples of odonotgenic tumours
- Odontomes (complex and compound)
- Cmentoblastoma
- Calcifying epithelial odontgenic tumour
Give examples of odonotgenic tumours
- Odontomes (complex and compound)
- Cementoblastoma
- Calcifying epithelial odontgenic tumour
What can non odonotgenic tumours be split into
- Benign
- Malignant
Give examples of Benign non odonotgenic tumours
Osteoma
Chondroma
Give examples of malignant non odonotgenic tumours
Osteogenic sarcoma
Osteogenic secondary
Describe cementoblastomas
Benign neoplasms that are rare
Where do cementoblastomas occur
More common in mandibular premolar molar region
Describe how cementoblastomas maty appear on a radiograph
Circular radio opacity at the apex of the tooth
Radiolucent periphery and sclerotic margins outside the lesion
Root resorption may be seen
Describe calcifying epithelial odontogenic tumours
Benign rare tumours that affect the mandible more than maxilla
What are calcifying epithelial odontogenic tumours associated with
Unerupted teeth often the lower 8s
Describe how calcifying epithelial odontogenic tumours may appear on a radiograph
2/3 are mixed density
Usually, scalloped margin
Give examples of soft tissues that can appear radio opaque on a radiograph
Maxillary antrum
When might the maxillary antrum appear radio opaque
Due to inflammatory changes causing thicjenign of the paranasal sinus mucosa
Describe how the maxillary antrum may appear on a radiogrpah
Well defined non corticated band of soft tissue opacity
Parallels the bony outlien of the antrum
Cortical line of antrul floor and walls are in tact
How might a benign antral cyst/ retention pseudocyst present on a radiogrpah
Well defined non corticated smooth doem shaped opacity
Antral wall will be intact
Give examples of imaging features of the maxillary antrum that indicate further investigation
- Bone erosion
- Corticated border of the soft tissue
- Displacement of astral boundary
State red flag clinical symptoms in regards to the maxillary antrum
Epistaxis
Unilateral nasal obstruction
dys- or paresthesia;
facial swelling
Give examples of soft tissue calcifications that may appear radiodense
- Pulp stones
- Ligaments
- Lymphoid tissue/ tonsils
- Salivary glands
- Blood vessels
- Antrum
- Nose
- Skin
- Muscles/ subcutaneous tissues
Give examples of normal bone variation that may appear radio dense on a radiogrpah
Dense bone islands
Idiopathic osteonecrosis
Give an example of a developmental bony defect that can appear radio dense on a radiogrpah
Tori
Give examples of inflammatory / infections of the bone that can led to radio dense areas on a radiogrpah
- Sclerosing osteitis
- Osteomyelitis
- ORN
- MRONJ
Give examples of bony dysplasias that may appear radio dense on a radiograph
– Cemento-osseous dysplasia – Fibrous dysplasia
What is Sclerosingosteitis
A periapcal low grade chronic infection
What is Osteomyelitis
Spreading, progressive inflammation in response to
infection
What is Osteoradionecrosis
Radiation-induced damage resulting in bone necrosis.
What does MRONJ stand for
Medication-related osteonecrosis of the jaws
What is Sclerosing Osteitis a reaction to
Proliferative reaction following plural necrosis
What are some imaging features of Sclerosing Osteitis
Non vital tooth
Deep caries or large restoration
Widening of apical periodontal ligament space
Sclerotic bone surrounding the apex
Where is Osteomyelitis seen more frequently
Mandible over maxilla
List some radiographic features of Osteomyelitis
- Moth eaten poorly defined areas
- Subperiosteal bone formation
- Sequestra of necrotic bone
- Sclerosis of surrounding bone
What is Periostitis
Inflammation of the periosteum can be due to Subperiosteal bone deposition
What happens in Periostitis
Bone layers can form parallel to each other to the cortical surface
What is ORN
Radiation induced damage to bone leadign to necrosis
How does ORN presen clinically
With presence of exposed bone
List some radiographic features of ORN
- Similar to osteomyelitis but without perosteal recant
List some radiographic features of ORN
- Similar to osteomyelitis but without perosteal reaction (Periostitis)
- Bone sequestra
- Pathological fracture
- Can resemble bone destruction by malignant neoplasm
List some radiographic features of MRONJ
- similar to osteomyelitis and ORN
- Moth-eaten area; bony sequestra
- Reduced periosteal reaction
- Widening of the periodontal ligament spaces
Where do Periosteal osteomas arise
on the bone surface as a pedunculated mass
Usually asymptomatic and solitary
How do Periosteal osteomas appear on a radiograph
Well-defined radiopacity with a smooth outline
What are Multiple jaw osteomas a feature of
Gardner syndrome
Describe cemento ossifying fibroma
Composed of fibrocellular tissue and mineralising material
List the radiographic features of cement ossifying fibroma
- Round well defined expansile
- Mixed density
Describe osteogenic sarcomas
Rapidly destructive bone malignancyvery rare in jaw
List the radiographic appearance of osteogenic sarcomas
- Non specific can present as widening of the periodontal membrane space
- Classically has sunray appearance
What is pagets disease
An idiopathic disease of the elderly causing abnormal maintenance of bone
Can lead to brittle bone and increased risk of fracture and osteogenic sarcoma
What does the radiographic appearance of apogees disease depend on
The stage of the disease eg initial osteolytic of later bone deposition
Talk through the radiographic appearance of the skull vault in early pagets disease
Osteoporosis
circumscripta: scalloped, well-defined zones of osteoporosis
Talk through the radiographic appearance of the skull vault in late pagets disease
Cotton wool patches of sclerotic bone in earlier osteoporotic zones
