Radiographic Interpretation Flashcards
What abnormalities are less commonly seen on radiographs?
- jaw lesions
- cysts
- tumours
- benign neoplasms
- developmental abnormalities
- supernumeraries
- foreign bodies
What abnormalities are commonly seen on radiographs?
- caries
- periodontal bone loss
- periapical granulmas
- impacted teeth
- missing teeth
- skeletal relationships
- monitoring root canal treatment
- monitoring traumatised teeth
Are the majority of lesions radiolucent or radiopaque?
radiolucent
What are the three options in the first step of differential diagnosis pf any lesion radiographically?
- anatomical
- artifactual
- pathological
What are the 7 sections that should be included in a lesion description?
- site
- size
- shape
- margins
- internal structure
- effect on adjacent anatomy
- number
When describing the site of a lesion, what should be included?
- where is it?
- alveolar bone or basal bone
- mandible or maxilla or other
- is there a notable relationship to structures?
- teeth
- whole tooth
- root
- apex
- follicle
- inferior alveolar canal
- nasopalatine canal
- teeth
- what is its position relative to structures
- inferior alveolar canal
- below are unlikely odontogenic
- maxillary sinus floor
- above are unlikely to be odontogenic
- inferior alveolar canal
When describing the size of a lesion, what should be included?
- measurement of dimensions
- description of boundaries
When describing the shape of a lesion, what should be included?
- general
- rounded
- scalloped
- irregular
- jocularity
- unilocular
- pseudolocular
- multilocular
When describing the margins of a lesion, what should be included?
- well defined
- corticated
- suggested benign
- non-corticated
- corticated
- poorly defined
- blending into adjacent normal anatomy
- moth eaten
- suggests malignancy
When describing the internal structure of a lesion, what should be included?
- entirely radiolucent
- radiolucent with some internal radiopacity
- radiopaque
- homogenous
- heterogeneous
- amount
- scant
- multiple
- dispersed
- bony septae
- thin or coarse
- prominent or faint
- straight or curved
- particular structure
- enamel and dentine radiodensity
What can make jaw lesions radiolucent?
- resorption of bone
- reduced mineralisation of bone
- reduced thickness of bone
- replacement of bone with abnormal tissue
What can make jaw lesions radiopaque?
- increased thickness of bone
- osteosclerosis of bone
- presence of abnormal tissue
- mineralisation on non-mineralised tissue
When describing involvement of a tooth in a jaw lesion, what should be included?
- position
- apices
- at the side of the root
- around the crown
- around the entire tooth
When describing the effect of a jaw lesion on adjacent anatomy, what should be included?
- bone
- displacement of cortices
- perforation of cortices
- sclerosis of trabecular bone
- inferior alveolar canal/maxillary sinus/nasal
- displacement
- erosion
- compression
- teeth
- displacement/impaction
- resorption
- loss of lamina dura
- widening of PDL space
- hypercementosis
When describing the number of jaw lesions, what should be included?
- majority occur alone
- some pathologies occur bilaterally
- if multiple lesions present, suspect syndrome
What are the potential causes of a periapical radiolucency?
- periapical granuloma
- periapical abscess
- radicular cyst
- perio-endo lesion
- cemento-osseous dysplasia (early stage)
- surgical defect (after peri-radicular surgery)
- fibrous healing defect (resolution of lesion)
- ameloblastoma occurring next to tooth §
What must be used along side radiographs to diagnose a periapical radiolucency?
- clinical signs and symptoms
- condition of tooth, treatment history
- periodontal condition
- patient demographic
When might a benign cyst mimic a malignancy radiographically?
- infection
- can lose well-defined, corticated margins
- clinical features of secondary infection
- pain
- soft tissue swelling, redness, hotness
- purulent exudate
Most lesions appear radiolucent, when which structure is affected does the lesion become radiopaque and why?
- expansion into maxillary sinus
- lesion surrounded by air
What are 5 important points to note when attempting to diagnose jaw lesions?
- infected cysts can lose their well-defined, corticated margins
- most jaw lesions will inevitable be near a tooth, it does not mean a tooth is associated
- early lesions are small regardless of pathology
- the term radiolucent is relative
- be flexible with pathology presentations
In what way might jaw lesions present differently from the textbook definition?
- any cyst can become symptomatic
- infected/inflamed
- well-defined corticated margins can be lost
- lesion infected or inflamed
- external root resorption can occur
- most lesions is abutting a tooth for long
- internal ‘dystrophic’ calcification
- can form in any chronic cyst
- especially if inflamed
What radiopacities might be picked up incidentally on a radiograph?
- idiopathic osteosclerosis
- sclerosis osteitis
- hypercementosis
- buried retained roots
- unerupted teeth, including supernumeraries
What is idiopathic osteosclerosis?
- localised area of increased bone density with an unknown cause
- no association with inflammatory process
- asymptomatic
- potential relevance to orthodontist
- challenging to move tooth through
- increased risk of root resorption
- may be called dense bone island or enostosis
- most common in premolar-molar region of the mandible
What is the radiographic presentation os idiopathic osteosclerosis?
- well defined radiopacity
- often homogenous
- slightly radiolucent internal areas
- no radiolucent margin
- often homogenous
- variable shape
- round
- elliptical
- irregular
- usually <2cm in size
- not associated with teeth
- often appears next to teeth
- teeth not displaced
- no effect on PDL
What is sclerosis osteitis?
- localised area of increased bony density in response to inflammation
- low grade, chronic inflammation
- may have concurrent symptoms
- usually from source of inflammation - no expansion or displacement
- adjacent structures
- can also be called condensing osteitis
What is the radiographic presentation of sclerosis osteitis?
- well-defined or poorly defined
- variable shape
- directly associated with source of inflammation
- apex of necrotic tooth
- infected cyst
How can idiopathic osteosclerosis and sclerosing osteitis be told apart?
if there is a source of inflammation, it is sclerosing osteitis, if not it is idiopathic osteosclerosis
What is hypercementosis?
- excessive deposition of cementum around the root
- non-neoplastic and asymptomatic
- tooth vital
- necrosis due to another reason
- cause unknown
- more common in certain conditions
- Paget’s disease
- acromegaly
- more common in certain conditions
- extractions more challenging
How does hypercementosis present radiographically?
- single or multiple teeth involved
- entirety of root
- section of root
- 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
- can be irregular
Why might retained roots occur and how are they managed?
- remnants of failed extractions or heavily broken-down teeth
- management only required if infected, symptomatic or hampering treatment (e.g. implant placement)
How do retained roots present radiographically?
- can become unclear in case of inflammation
- external root resorption
- sclerosis osteitis of adjacent bone
- diffuse radiopacity
