Solitary radiopacities

Question 1

I. EXOSTOSES

Answer 1

Are hamartomous masses of mostly cortical bone, arising from the bone
surface. They may incorporate a small amount of internal cancellous bone

Question 2

Clinical features:
1.Exostosis:
1. size, amount
2. appearance
3. Always covered with
4. gender, age

Answer 2

May attain a large size, may be solitary or multiple.
May be flat, nodular or pedunculated.
mucosa and are bony hard on palpation.
Male predominance and increase frequency with age.

Question 3

1.Exostosis:
a. Most commonly on the
b. Less commonly on the

Answer 3

buccal surfaces of the maxillary alveolar processes, usually in the canine or molar area.

palatal surface of the alveolar bone

Question 4

I. EXOSTOSES
Imaging Features
1. Location.

Answer 4

• The maxillary alveolar process is the most common location. In PAs they are superimposed over the roots of the adjacent teeth.

Question 5

I. EXOSTOSES
2. Periphery.

Answer 5

• Well defined with a curved border.

Question 6

I. EXOSTOSES
Imaging Features
3. Internal structure.
(2)

Answer 6

• Usually is homogeneous and radiopaque.
• Although when large it can have an internal cancellous bone,
  they most often consist only of cortical bone

Question 7

I. EXOSTOSES
4. Effects on adjacent structures.
5. Effects on adjacent teeth.
6. Management

Answer 7

• Continuous with the bone surface.
• No effects.
• No treatment required*

Question 8

Torus

Answer 8

• Is an exostosis that may occur in the midline of the hard
  palate (torus palatinus) or the lingual surface of the
  mandible (torus mandibularis).

Question 9

It has been hypothesized that genetic and environmental
factors may be involved in the development of

Answer 9

torus
mandibularis, with masticatory forces being reported as an
essential factor underlying formation.

Question 10

Torus
Clinical Features
* The torus palatinus: ~–% of the population
* Mandibular tori: ~–% of the population.
* Gender
* Although tori may be discovered at any age, it is rare in
—. They usually develop in young adults before —
years of age, and they may continue to enlarge slowly during
a lifetime.

Answer 10

20
8
Twice as often in women as in men.
children, 30

Question 11

Torus
Clinical Features
* The (3) of tori can vary
broadly.
*Palatal tori:
*These lesions have been described as being
(3)

Answer 11

number, size, and shape
The base is in the palate and the bulk extends downward into the oral cavity.
flat, lobulated or nodular

Question 12

Torus
Clinical Features
*In the mandible, single or multiple tori can develop, and they can be unilateral or bilateral, most often developing in the — region
*Mandibular tori can also vary in size, ranging from an outgrowth that is…
*Normal mucosa covers the bony mass, and the mucosa may be thin and appear pale. Consequently, if traumatized, the mucosa may easily —.
*Patients often are unaware of having tori, and sometimes, patients who do discover them may insist that they

Answer 12

premolar
barely palpable to one that contacts a torus on the opposite side.
ulcerate
have arisen suddenly and have
grown rapidly.

Question 13

Torus
Imaging Features
Location:
* On maxillary periapical or panoramic images, a torus palatinus
appears as a
*On mandibular periapical images, a torus mandibularis appears
as a

Answer 13

well-defined, oval, dense radiopaque structure
superimposed over the crowns and/or roots of the maxillary
premolar and molar dentition

well-defined, oval, radiopaque entity, usually superimposed
on the roots of premolars and molars and occasionally over a
canine or incisor

Question 14

Torus
Effects on adjacent structures.
* Effects on adjacent teeth.
* Management

Answer 14

Tori are continuous with the bone surface from which they are
arising.

Tori have no effects on the teeth.

Tori do not usually require treatment, although removal may be
necessary to accommodate a removable denture.

Question 15

II. Idiopathic osteosclerosis
Disease Mechanism
* A.K.A:
*Are the “—” of exostoses
* Represent localized growths of — bone into the
cancellous bone.
Clinical Features
* —.

Answer 15

Dense bone islands (DBI) or enostosis
internal counterparts
cortical
Asymptomatic

Question 16

II. Idiopathic osteosclerosis
Imaging Features
Location:
*More common in the
*Most often in the — areas
* Their presence does not correlate with the presence or
absence of —.

Answer 16

mandible than in the maxilla
premolar and molar
teeth

Question 17

II. Idiopathic osteosclerosis
Periphery:

Answer 17

• DBIs directly abut adjacent normal bone with a well defined periphery that blends with the trabeculae of the surrounding bone.

Question 18

II. Idiopathic osteosclerosis
Internal structure:

Answer 18

• The internal pattern of DBIs can vary from a ground glass-like pattern
  to one that is uniformly radiopaque

Question 19

II. Idiopathic osteosclerosis
Effects on adjacent structures:

Answer 19

• There are no effects on adjacent structures.

Question 20

Idiopathic osteosclerosis or dense bone island
Effects on adjacent teeth:

Answer 20

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.

Question 21

Idiopathic osteosclerosis or dense bone island
Differential Interpretation
* When a DBI is located at a root apex, it may resemble
* Dense bone islands may also have similarities to

Answer 21

periapical sclerosing osteitis.
periapical cemento-osseous dysplasia, or hypercementosis or cementoblastoma.

Question 22

Idiopathic osteosclerosis or dense bone island
Management

Answer 22

DBI does not require treatment. If multiple DBIs are present,
the patient’s family history should be reviewed for the
presence of colonic polyps.

Question 23

V. Osteoma
Disease Mechanism
* It is unclear whether osteomas are …
*Radiologic appearances similar to (3)
* Osteomas develop from the periosteum and
may occur either

Answer 23

hamartomas or neoplasms.

dense bone islands, exostosis, and tori.

externally on a bone surface
or within the paranasal sinuses (most
commonly frontal sinuses or ethmoidal air cells)

Question 24

IV. Osteoma
Clinical Features
* Can occur at any age but are most commonly — years.
* Can be…
* The osteomas are attached to the cortex of the jaw by a…
* When osteomas develop on a bone surface, a patient may perceive a…

Answer 24

> 40
solitary or multiples, occurring on a single bone or on numerous bones.
pedicle or along a wide base.
hard swelling. The swelling is painless until its size or position interferes with function.

Question 25

• Structurally, osteomas can be divided into three types:

Answer 25

lesions composed of
cortical bone (also called ivory osteomas); lesions composed of cancellous bone;
and lesions composed of a combination of both.

Question 26

IV. Osteoma
Imaging Features
1. Location.
* The — is more commonly
involved than the —.
* Most frequently on the…

Answer 26

mandible, maxilla

medial
surface of the ramus or on the
inferior border of the mandible.

Question 27

IV. Osteoma
2. Periphery.

Answer 27

• Have a well-defined borders.

Question 28

IV. Osteoma
3. Internal structure.
(2)

Answer 28

• Osteomas composed solely of cortical bone are
  uniformly radiopaque
• Osteomas containing cancellous bone show
  internal trabecular structure.

Question 29

IV. Osteoma
4. Effects on surrounding structures.

Answer 29

• Large lesions can displace adjacent soft tissues,
  such as the muscles of mastication, and cause jaw
  dysfunction

Question 30

IV. Osteoma
Differential Interpretation
*A small osteoma may be similar in
appearance to large

Answer 30

hyperostosis or
torus.

Question 31

IV. Osteoma
Management

Answer 31

• Unless the osteoma interferes with
  normal function or presents a
  cosmetic problem, this lesion may not
  require treatment. In such cases, the
  osteoma should be kept under
  observation. Resection of osteomas is
  possible but may be difficult if the
  osteoma is of the cortical (ivory) type.

Question 32

Gardner syndrome
Disease Mechanism
- Multiple — (usually appearance in the second decade of life) are a feature of Gardner syndrome, as are multiple dense bone
islands, epidermoid cysts, and subcutaneous desmoid tumors.
- Characterized by the development of multiple —
- Increased frequency of — may also occur in Gardner syndrome.

Answer 32

osteomas
colonic polyps (higher risk for developing colon cancer)
supernumerary and impacted teeth, and odontomas

Question 33

Gardner syndrome
Management
(2)

Answer 33

• Early diagnosis.
• Multiple osteomas + family history of colorectal cancer = Physician referral for examination of intestinal polyposis and management.

Question 34

V. ODONTOMA
Disease Mechanism
* Is a hamartoma that is characterized by the production of…

Answer 34

mature enamel, dentin, cementum, and pulp tissue.

Question 35

• Complex odontoma:

Answer 35

A nondescript and heterogeneous mass
of the dental hard tissues.

Question 36

• Compound odontoma:

Answer 36

Multiple well-formed teeth
(denticles) referred to as a compound odontoma.

Question 37

• Dilated odontoma:

Answer 37

may also be a severe expression of a
dens in dente.

Question 38

V. ODONTOMA
Clinical Features
- Very common and often they interfere with the …
- Most form while the dentition is developing in the — decade of life.
- Left unidentified or untreated, odontomas will not increase in —.
- Compound odontomas are about — as common as the complex type.
- In very rare circumstances, a compound odontoma may …

Answer 38

eruption of permanent
teeth (may be found during investigations of retained or delayed eruption)
2nd
size
twice
erupt into the mouth.

Question 39

Gender
- Compound odontoma:
- Complex:

Answer 39

equal in men and women
60% in women

Question 40

ODONTOMA
Imaging Features
Location:
(2)

Answer 40

• The majority of compound odontomas (62%) occur in the anterior maxilla
• 70% of complex odontomas are found in the mandibular first and second molar area

Question 41

ODONTOMA
Periphery:

Answer 41

• The borders of odontomas are well defined, with an irregular periphery, surrounded by a radiolucent rim and
  have a cortical border.

Question 42

ODONTOMA
Internal structure.
- Compound odontoma:
- Complex odontomas contain
- A dilated odontoma has a

Answer 42

Radiopaque (toothlike structures or denticles ).

an irregular, but somewhat more homogeneous mass of calcified tissue. The
density of the mineralized matrix within these lesions may vary, reflecting differences in the amount and type
of hard tissue that has been formed.

single calcified structure with a more radiolucent central portion that has an
overall form similar to a doughnut

Question 43

ODONTOMA
Effects on surrounding structures.
Effects on adjacent teeth.
Management

Answer 43

• Large odontomas may cause expansion of bone, but with maintenance of the cortical boundary.
• Odontomas can interfere with the normal eruption of teeth, and most (70%) are associated with impacted.
• Odontomas are removed by simple excision. They do not recur and are not locally invasive.

Question 44

VI. Fibrous dysplasia
(monostotic)
- Is a — dysplasia

Disease Mechanism
(3)

Answer 44

bone

• Altered bone metabolism
• Cancellous bone is replaced by
  fibrous connective tissue containing
  varying amounts of immature,
  abnormal bone.
• Compared with normal bone, there
  are more trabeculae per unit volume

Question 45

Fibrous dysplasia
(monostotic)
Clinical Features
- Most commonly affects the skeleton —
- The most common sites include the (5)
- Discover in — individuals (approximately from 12 years of age)
- The lesions usually become — when skeletal growth ceases.
- Lesions may become active during…
- Does not have — predilection
- Most of the times is mild and asymptomatic. However, patients with jaw involvement may
first complain of
- If craniofacial lesions involve the skull base, the bone changes may impinge on

Answer 45

unilaterally
ribs, femur, tibia, maxilla, and mandible.
young
static
pregnancy or with the use of oral contraceptives.
sex
unilateral facial swelling or an enlarging deformity of the alveolar process.
neural foramina

Question 46

Fibrous dysplasia (monostotic)
Imaging Features
Location:

Answer 46

• Maxilla:Mandible (2:1) and frequently seen in the more posterior regions.

Question 47

Fibrous dysplasia (monostotic)
Imaging Features
Periphery:
(2)

Answer 47

• Commonly poorly defined, with a gradual and broad transition between the
  dysplastic and normal bone.
• Occasionally the boundary between the dysplastic and normal bone can appear
  better defined and even corticated, especially in young lesions

Question 48

Fibrous dysplasia
(monostotic)
Internal structure
(2)

Answer 48

• The internal density may be radiolucent, radiopaque, or a
  mixture of both compared with normal bone.
  *Granular appearance (ground-glass), a pattern resembling the
  surface of an orange, a wispy arrangement (cotton wool), an
  amorphous pattern or pattern similar to a fingerprint.

Question 49

Fibrous dysplasia
(monostotic)
Effects on surrounding structures:
* If the lesion is small, it may…
* Expansion and intact thinned-outer cortex, affecting the bone more…
* May expand into the — by displacing its cortical boundary
* Usually do not affect the dentition. However, it can…
* The lamina dura disappears because this bone also is changed into the…
* Fibrous dysplasia appears to be unique in its ability to displace the…

Answer 49

have no effect on surrounding structures.
evenly along its length.
sinus
displace teeth or interfere with normal eruption.
abnormal bone pattern. A very narrow PDL space is seen.

inferior alveolar nerve canal in a superior direction.

Question 50

Fibrous dysplasia (monostotic)
Management:
*Growth from stimulation of a lesion during surgical intervention in — patients have been reported.
*— imaging can be used baseline study for future comparisons.
*Occasional monitoring of the lesion or ask the patient to report any changes (with most lesions, growth is complete
at skeletal maturation).
*— treatment and — surgery may be limited or delayed.
*— changes are unusual but have been reported, especially if therapeutic radiation has been administered.
*In female — changes (pregnancy or oral contraceptives) may stimulate growth

Answer 50

young
CT
Orthodontic, cosmetic
Sarcomatous
hormonal