radiographic interpretation

Question 1

Are the majority of jaw lesions radiopaque or radiolucent and why is this?

Answer 1

Radiolucent
This is due to losing the radiodensity of the bone

Question 2

What is the first step in diagnosing a jaw lesion?

Answer 2

Anatomical
Artefactual
Pathological

Question 3

What should be described when diagnosing a jaw lesion?

Answer 3

Site
Size
Shape
Margins
Internal structure
Effect on normal anatomy
Number

Question 4

How should site of a jaw lesion be described?

Answer 4

Alveolar bone or basal bone
Relationship to other structures
Where it is in relation to other structures

Question 5

How should the shape of a jaw lesion be described?

Answer 5

General shape - rounded scalloped or irregular
Locularity - unilocular, pseudolocular or multilocular

Question 6

How should the margins of a jaw lesion be described?

Answer 6

Well-defined or non well-defined
Corticated or non-corticated
If poorly defined does it blend into normal anatomy, if ragged or moth-eaten

Question 7

What does corticated margins suggest?

Answer 7

A benign lesion

Question 8

When can corticated and non-corticated margins not be applied?

Answer 8

To radiopacities

Question 9

How should the internal structure be described in jaw lesions?

Answer 9

In general - entirely radiolucent, radiolucent with some internal radiopacity or radiopaque
Radiopaque - homogenous or heterogenous
Description of internal radiopacities - amount, bony septae and particularly structures involved

Question 10

Give 4 reasons for radiolucencies

Answer 10

Resorption of bone
Decreased mineralisation of bone
Decreased thickness of bone
Replacement of bone with abnormal, less-mineralised tissue

Question 11

Give 4 reasons for radiopacities

Answer 11

Increased thickness of bone
Osteosclerosis of bone
Presence of abnormal tissue
Mineralisation of normally non-mineralised tissue

Question 12

How should effect on adjacent bone be described?

Answer 12

Displacement of cortices
Perforation of cortices
Sclerosis of trabecular bone

Question 13

How should effect on inferior alveolar canal/maxillary sinus/nasal cavity be described?

Answer 13

Any effect of displacement, erosion or compression

Question 14

How should the effect on teeth from jaw lesions be described?

Answer 14

Any displacement/impaction
Resorption
Loss of lamina dura
Widening of PDL space
Hypercementosis

Question 15

How should the number of jaw lesions be described?

Answer 15

If single, bilateral or multiple
Suspect a syndrome if multiple (>2) lesions

Question 16

How may infected cysts mimic malignancy?

Answer 16

They can lose their well-defined, corticated margins - poorly defined margins or moth-eaten appearance
Check for clinical features of secondary infection

Question 17

How is the term radiolucent relative?

Answer 17

When lesions expand into the maxillary sinus they will be surrounded by air and so are radiopaque in comparison to their surroundings

Question 18

Give 5 examples of common radiopacities

Answer 18

Idiopathic osteosclerosis
Sclerosing osteitis
Hypercementosis
Buried retained roots
Unerupted teeth including supernumeraries

Question 19

What is idiopathic osteosclerosis?

Answer 19

A localised area of increased bone density of unknown cause
No association with inflammatory neoplastic or dysplasia
Asymoptomatic

Question 20

Why is idiopathic osteosclerosis relevant to orthodontics?

Answer 20

Will be harder to move teeth through the dense bone

Question 21

What is the incidence of idiopathic osteosclerosis?

Answer 21

Affects 6% of the population
Typically presents in adolescence and stops growing in adulthood
Most common in premolar-molar region or mandible

Question 22

How does idiopathic osteosclerosis present radiographically?

Answer 22

Well defined radiopacity - often homogenous with no radiolucent margin
Variable shape
Usually <2mm
Teeth not displaced
No affect on the PDL spaces of teeth

Question 23

What is sclerosing osteitis?

Answer 23

Localised area of increased bone density in response to inflamation
Inflammation often low-grade and chronic
May have concurrent symptoms due to source of inflammation

Question 24

What is the other name for sclerosing osteitis?

Answer 24

Condensing osteitis

Question 25

How does sclerosing osteitis present radiographically?

Answer 25

Well-defined or poorly-defined radiopacity
Variable shape
Directly associated with source of inflammation eg - apex of necrotic tooth, infected cysts

Question 26

How can you differentiate idiopathic osteitis and sclerosing osteitis?

Answer 26

Look for a source of inflammation and check for signs and symptoms of teeth through sensibility testing

Question 27

What is hypercementosis?

Answer 27

Excessive deposition of cementum around root
Non-neoplastic and asymptomatic
Tooth is vital (unless necrotic for another reason)

Question 28

What is the cause of hypercementosis?

Answer 28

Unknown but more common in certain conditions
eg - Paget’s disease of bone and acromegaly

Question 29

What is the clinical relevance of hypercementosis?

Answer 29

Makes extractions more difficult

Question 30

How does hypercementosis present radiographically?

Answer 30

Can involve single or multiple teeth
Involves either entirety of root or just a section
Homogenous radiopacity continuous with root surface - radiodensity subtly different to dentine of root
PDL space of tooth extends around periphery
Margins well-defined and often smooth (but can be irregular)

Question 31

When should retained roots be extracted?

Answer 31

If infected, symptomatic or hampering treatment eg - implant placement

Question 32

How may buried retained roots become unclear on radiographs?

Answer 32

If any inflammation - due to external root resorption or sclerosing osteitis of adjacent bone
May appear as a diffuse radiopacity