solitary opacities Flashcards
exostoses
Are hamartomous masses of mostly cortical bone, arising from the bone surface. They may incorporate a small amount of internal cancellous bone.
Exostosis locations?
a. Most commonly on?
b. Less commonly on?
a. Most commonly on the buccal surfaces of the maxillary alveolar processes, usually in the canine or molar area.
b. Less commonly on the palatal surface of the alveolar bone
exotosis
1. size, number?
2. shapes?
3. Always covered with? palpation?
4. gender? age?
- May attain a large size, may be solitary or multiple.
- May be flat, nodular or pedunculated.
- Always covered with mucosa and are bony hard on palpation.
- Male predominance and increase frequency with age
EXOSTOSES Imaging Features
1. Location. .
2. Periphery.
- Location:
* The maxillary alveolar process is the most common location. In PAs they are superimposed over the roots of the adjacent teeth. - Periphery:
* Well defined with a curved border.
exotosis
exotosis
EXOSTOSES imaging features
3. Internal structure.
4. Effects on adjacent structures.
5. Effects on adjacent teeth.
6. Management
- Internal structure.
* Usually is homogeneous and radiopaque.
* Although when large it can have an internal cancellous bone, they most often consist only of cortical bone. - Effects on adjacent structures.
* Continuous with the bone surface. - Effects on adjacent teeth.
* No effects. - Management
* No treatment required
exotosis with cancellous interior
exotoses at alveolar crest
exotoses
subpontic hyperostosis
Torus
Is an exostosis that may occur in the midline of the hard palate (torus palatinus) or the lingual surface of the mandible (torus mandibularis).
possible etiologies for tori
*It has been hypothesized that genetic and environmental factors may be involved in the development of torus mandibularis, with masticatory forces being reported as an essential factor underlying formation
Torus Clinical Features
* The torus palatinus: % population
* Mandibular tori: % population
* gender
* Age and developement
- The torus palatinus: ~20% of the population
- Mandibular tori: ~8% of the population.
- Twice as often in women as in men.
- Although tori may be discovered at any age, it is rare in children. They usually develop in young adults before 30 years of age, and they may continue to enlarge slowly during a lifetime
Torus
Clinical Features
* The number, size, and shape of tori?
*Palatal tori?
*These lesions have been described as being?
- The number, size, and shape of tori can vary
broadly.
*Palatal tori: The base is in the palate and the
bulk extends downward into the oral cavity.
*These lesions have been described as being
flat, lobulated or nodula
tori
tori and exotosis
Torus
Clinical Features
*In the mandible, single or multiple? unilateral or bilateral? most common location?
*Mandibular tori can also vary in?
* what covers the bony mass? may appear? Consequently?
*Patients unaware of having tori? may believe?
*In the mandible, single or multiple tori can develop, and they can be unilateral or bilateral, most often developing in the premolar region
*Mandibular tori can also vary in size, ranging from an outgrowth that is barely palpable to one that contacts a torus on the opposite side.
*Normal mucosa covers the bony mass, and the mucosa may be thin and appear pale. Consequently, if traumatized, the mucosa may easily ulcerate.
*Patients often are unaware of having tori, and sometimes, patients who do discover them may insist that they have arisen suddenly and have grown rapidly.
Torus Imaging Features
Location:
* On maxillary periapical or panoramic images?
*On mandibular periapical images?
- On maxillary periapical or panoramic images, a torus palatinus appears as a well-defined, oval, dense radiopaque structure superimposed over the crowns and/or roots of the maxillary premolar and molar dentition
*On mandibular periapical images, a torus mandibularis appears as a well-defined, oval, radiopaque entity, usually superimposed on the roots of premolars and molars and occasionally over a canine or incisor
torus palatinus
torus mandibularis
torus palatinus
torus mandibularis
film bent, not a torus
torus palatinus
Torus
Effects on adjacent structures?
* Effects on adjacent teeth?
* Management?
Effects on adjacent structures:
Tori are continuous with the bone surface from which they are arising.
* Effects on adjacent teeth:
Tori have no effects on the teeth.
* Management:
Tori do not usually require treatment, although removal may be necessary to accommodate a removable denture.
Idiopathic osteosclerosis
Disease Mechanism
Clinical Features
Disease Mechanism
* A.K.A: Dense bone islands (DBI) or enostosis
*Are the “internal counterparts” of exostoses
* Represent localized growths of cortical bone into the
cancellous bone.
Clinical Features: Asymptomatic.
idiopathic osteosclerosis
Idiopathic osteosclerosis Imaging Features
Location:
*More common in?
*Most often where?
* Their presence does not correlate with?
*More common in the mandible than in the maxilla
*Most often in the premolar and molar areas
* Their presence does not correlate with the presence or absence of teeth.
idiopathic ostesclerosis
Idiopathic osteosclerosis
Periphery:
Internal structure:
Effects on adjacent structures:
.
Periphery:
* DBIs directly abut adjacent normal bone with a well defined the periphery that blends with the trabeculae of the surrounding bone.
Internal structure:
* The internal pattern of DBIs can vary from a ground glass-like pattern to one that is uniformly radiopaque
Effects on adjacent structures:
* There are no effects on adjacent structures.
idiopathic osteosclerosis
Idiopathic osteosclerosis or dense bone island
Effects on adjacent teeth:
Effects on adjacent teeth:
A DBI located periapical to a tooth root can (but rare) induce external root resorption
In all circumstances, the tooth pulp is vital, and the root resorption appears to be self-limiting. A visible periodontal ligament space may be visible between the resorbed tooth root and the DBI
idiopathic osteosclerosis dif dx
- When a DBI is located at a root apex, it may resemble periapical sclerosing osteitis.
- Dense bone islands may also have similarities to periapical cemento-osseous dysplasia, or hypercementosis or cementoblastoma.