radiographic interpretation Flashcards
Are the majority of jaw lesions radiopaque or radiolucent and why is this?
Radiolucent
This is due to losing the radiodensity of the bone
What is the first step in diagnosing a jaw lesion?
Anatomical
Artefactual
Pathological
What should be described when diagnosing a jaw lesion?
Site
Size
Shape
Margins
Internal structure
Effect on normal anatomy
Number
How should site of a jaw lesion be described?
Alveolar bone or basal bone
Relationship to other structures
Where it is in relation to other structures
How should the shape of a jaw lesion be described?
General shape - rounded scalloped or irregular
Locularity - unilocular, pseudolocular or multilocular
How should the margins of a jaw lesion be described?
Well-defined or non well-defined
Corticated or non-corticated
If poorly defined does it blend into normal anatomy, if ragged or moth-eaten
What does corticated margins suggest?
A benign lesion
When can corticated and non-corticated margins not be applied?
To radiopacities
How should the internal structure be described in jaw lesions?
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
Give 4 reasons for radiolucencies
Resorption of bone
Decreased mineralisation of bone
Decreased thickness of bone
Replacement of bone with abnormal, less-mineralised tissue
Give 4 reasons for radiopacities
Increased thickness of bone
Osteosclerosis of bone
Presence of abnormal tissue
Mineralisation of normally non-mineralised tissue
How should effect on adjacent bone be described?
Displacement of cortices
Perforation of cortices
Sclerosis of trabecular bone
How should effect on inferior alveolar canal/maxillary sinus/nasal cavity be described?
Any effect of displacement, erosion or compression
How should the effect on teeth from jaw lesions be described?
Any displacement/impaction
Resorption
Loss of lamina dura
Widening of PDL space
Hypercementosis
How should the number of jaw lesions be described?
If single, bilateral or multiple
Suspect a syndrome if multiple (>2) lesions
How may infected cysts mimic malignancy?
They can lose their well-defined, corticated margins - poorly defined margins or moth-eaten appearance
Check for clinical features of secondary infection
How is the term radiolucent relative?
When lesions expand into the maxillary sinus they will be surrounded by air and so are radiopaque in comparison to their surroundings
Give 5 examples of common radiopacities
Idiopathic osteosclerosis
Sclerosing osteitis
Hypercementosis
Buried retained roots
Unerupted teeth including supernumeraries
What is idiopathic osteosclerosis?
A localised area of increased bone density of unknown cause
No association with inflammatory neoplastic or dysplasia
Asymoptomatic
Why is idiopathic osteosclerosis relevant to orthodontics?
Will be harder to move teeth through the dense bone
What is the incidence of idiopathic osteosclerosis?
Affects 6% of the population
Typically presents in adolescence and stops growing in adulthood
Most common in premolar-molar region or mandible
How does idiopathic osteosclerosis present radiographically?
Well defined radiopacity - often homogenous with no radiolucent margin
Variable shape
Usually <2mm
Teeth not displaced
No affect on the PDL spaces of teeth
What is sclerosing osteitis?
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
What is the other name for sclerosing osteitis?
Condensing osteitis
How does sclerosing osteitis present radiographically?
Well-defined or poorly-defined radiopacity
Variable shape
Directly associated with source of inflammation eg - apex of necrotic tooth, infected cysts
How can you differentiate idiopathic osteitis and sclerosing osteitis?
Look for a source of inflammation and check for signs and symptoms of teeth through sensibility testing
What is hypercementosis?
Excessive deposition of cementum around root
Non-neoplastic and asymptomatic
Tooth is vital (unless necrotic for another reason)
What is the cause of hypercementosis?
Unknown but more common in certain conditions
eg - Paget’s disease of bone and acromegaly
What is the clinical relevance of hypercementosis?
Makes extractions more difficult
How does hypercementosis present radiographically?
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)
When should retained roots be extracted?
If infected, symptomatic or hampering treatment eg - implant placement
How may buried retained roots become unclear on radiographs?
If any inflammation - due to external root resorption or sclerosing osteitis of adjacent bone
May appear as a diffuse radiopacity
