Radiography

Question 1

PA granuloma

Answer 1

Chronic inflammatory infiltrate - lymphocytes, histiocytes, plasma cells

Question 2

PA cyst

Answer 2

SS epithelium from cell rests of Malassez

Round/ovoid unilocular RL at root apex or at lateral aspect

Always associated with non-vital teeth except for residual cysts

Can have root resorption, bony expansion

Question 3

Acute apical abscess

Answer 3

Pulp necrosis
TTP, TTPp
Severe pain, swelling, mobility, elevation, systemic symptoms

Question 4

Condensing osteitis

Answer 4

Diffuse RO dense sclerotic bone around root

Occurs with pulpitis/necrosis
Variable responses to vitality tests or percussion/palpation

Question 5

Osteomyelitis

Answer 5

May have periosteal bone reaction (onion layers)

Subtle decrease in bone trabeculation and increase in RL in acute osteomyelitis

Sequestra, sclerosis and mottled/motheaten look in chronic osteomyelitis

Ill defined, non-corticated borders

Question 6

ORN

Answer 6

Similar to osteomyelitis but periosteal reaction is rare as there are no osteoblasts left after radiotherapy

Pathologic fracture possible

Question 7

MRONJ

Answer 7

Alveolar bone loss or resorption but not due to perio

Change in trabecular pattern to have increased sclerosis and no new bone in extraction sockets

Lamina dura thickening and decrease in PDL space

Question 8

Ameloblastoma

Answer 8

Well defined and corticated RL

Multilocular/unilocular

Honeycomb/soap bubble with thick and curved septae

Question 9

Adenomatoid odontogenic tumour

Answer 9

Unilocular, well circumscribed RL

May have fine, snowflake like calcifications

Question 10

Calcifying epithelial odontogenic tumour

Answer 10

Unilocular, RL or mixed

Question 11

Complex odontome

Answer 11

Encapsulated RL with amorphous RO

Question 12

Compound odontoma

Answer 12

Encapsulated RL with multiple miniature tooth-like structures

Question 13

Ameloblastic fibroma

Answer 13

Well defined
Unilocular to multilocular RL with RO borders

Usually around impacted/unerupted teeth

Question 14

Ameloblastic fibro-odontoma

Answer 14

Well defined
Unilocular mixed RL and RO

Usually around impacted/unerupted teeth

Question 15

Cementoblastoma

Answer 15

Dense RO mass fused with root apex
Surrounded by thin, well-defined RL border

Question 16

Odontogenic myxoma

Answer 16

Multilocular or unilocular RL
Honey comb or soap bubble RL areas with thin wispy trabecular at right angles (tennis racket)

Question 17

Enostoses

Answer 17

Well defined dense RO areas

Question 18

Osteoma

Answer 18

Circumscribed sclerotic masses

Question 19

Dentigerous cyst

Answer 19

Unilocular RL with well defined corticated borders
Pericoronal to impacted tooth, attached to CEJ

Can cause root resorption or displacement of adjacent structures/teeth

Question 20

Odontogenic keratocyst

Answer 20

Well-defined RL with corticated smooth-scalloped margins

Multilocular or unilocular

Expands in AP direction, less likely to cause root resorption, displacement and expansion

Question 21

Lateral periodontal cyst

Answer 21

Small, well-defined unilocular RL between roots of 2 vital teeth

Can be multilocular if its the polycystic variant

Question 22

Nasopalatine duct cyst

Answer 22

Oval/pear/heart shaped unilocular RL

Midline between roots of CI

Question 23

Simple bone cyst

Answer 23

RL with well defined but irregular edges

Interradicular scalloping

Question 24

Stafne bone defect

Answer 24

Sharply circumscribed oval RL beneath IAC

Question 25

Fibrous dysplasia

Answer 25

Expansile lesion Ground glass appearance Blending/diffuse/ill-defined borders RL/mixed/RO but typically RO Anatomic expansion

Question 26

Focal/periapical osseous dysplasia

Answer 26

Early stage: RL like PARL, can be single or multiple, can coalesce Mixed stage: mixed, RL outer rim Late/mature stage: RO with RL rim Possible loss of lamina dura and variable effects on PDL space

Question 27

Florid osseous dysplasia

Answer 27

Usually bilateral and in both jaws Epicenter apical to teeth and above IAC Well defined RL/mixed/RO +/- corticated border Cotton wool appearance May be multilocular

Question 28

Ossifying fibroma

Answer 28

Well defined RL/mixed/RO +/- corticated border, encapsulated with RL rim Concentric growth/expansion, displaces IDN, teeth, can cause root resorption and loss of lamina dura

Question 28

CGCG

Answer 28

Well defined RL, often with thin or missing cortication Can be ill-defined in maxilla Usually anterior mand Fine granular bone or wispy septa Unilocular or multilocular Expands in uneven/undulating pattern, cortical plates may be thinned or destroyed

Question 29

Cherubism

Answer 29

Multifocal bilateral expansile multilocular well-defined and corticated RL, with posterior epicenter and wispy internal septa Massive expansion and tooth displacement towards anterior midline

Question 30

Paget's disease

Answer 30

Multifocal Bone enlarging Cotton wool Hypercementosis

Question 31

Buccal bifurcation cyst

Answer 31

buccal bifurcation of mand 1st molar > 2nd molar may see periosteal reaction

Question 32

Nevoid basal cell carcinoma syndrome

Answer 32

Multiple OKCs

Question 33

SCC

Answer 33

Ill defined, non corticated, irregularly shaped RL Destruction of cortical boundaries, irregular widening of PDL, loss of lamina dura Possible pathologic fractures

Question 34

Osteosarcoma

Answer 34

Ill-defined, non corticated, irregularly shaped RL/mixed/RO Internally granular, sclerotic, cotton ball, wispy or honeycomb shaped Irregular PDL space widening, loss of lamina dura, possible root resorption, destruction of surrounding structures Soft tissue mass effect Periosteal reactions possible (sunray, codmans triangle)

Question 35

Multiple myeloma

Answer 35

Multiple well-defined non-corticated RL "punched out" circular/oval lesions May coalesce to give multilocular appearance Thinning/destruction of surrounding cortical boundaries Loss of lamina dura and follicular crypts

Question 36

Lymphoma/leukemia

Answer 36

Ill-defined non-corticated with infiltrative extensions, usually RL Can be multifocal, usually takes on shape of host bone Can be multilocular if coalescent Destruction of surrounding structures, lamina dura, PDL space widening, loss of cortical crypts, displacement in occlusal direction Uncommonly get periosteal reaction

Question 37

Burkitt Lymphoma

Answer 37

Rapid growth Floating teeth Periosteal reactions

Question 38

Metastasis

Answer 38

Can be bilateral Moderately well to ill defined Non corticated, usually RL Breast and prostate cancer can be RO, stimulating periosteal reaction Destruction of surrounding structures Can widen PDL spaces, cause loss of lamina dura, mimicking PA lesions

Question 39

Langerhans cell disease

Answer 39

Single or multiple Moderately well-defined but non corticated Smooth or irregular Punched out or scooped out appearance with epicenter at midroot Floating tooth Possible periosteal reaction