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Radiographic Differential Diagnosis 2009
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Radiographic Differential Diagnosis 2009

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Oral Diagnosis II

Oral Diagnosis II
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Radiographic Differential Diagnosis 2009 Radiographic Differential Diagnosis 2009 Presentation Transcript

  • Classification - Anatomical- Radiolucent; Radiopaque. - Pathological - Radiolucent – unilocular/multilocular - Radiopaque - Mixed ------ Solitary / Multiple.
  • Classification-pathological Radiolucent – Contacting tooth - Not contacting tooth Mixed – Contacting tooth - Not contacting tooth Radiopaque – Contacting tooth - Not contacting tooth
  • Classification-pathological Radiolucent – Contacting tooth 1. Periapical - Usually sequelae of pulpitis. Periapical granuloma; Radicular cyst; Abcess; Osteomyelitis, Periapical cementoma. 2. Pericoronal Follicular spaces; Dentigerous cysts; Ameloblastoma; Adeno ameloblastoma.
  • Periapical-radiolucent Periapical granuloma – well circumscribed, rounded - around apex. May’ve thin radiopaque border. Tooth may have deep caries/restorations. Tooth-non-vital.
  • Periapical-radiolucent Radicular cyst – involve apex of perm.tooth. Untreated cyst slowly enlarge, expand and thin cortex – crackling sound (crepitus). If infected, all painful symptoms of an abscess develops.
  • Periapical-radiolucent C/c & a/c Dento alveolar abscess: Small/large radiolucencies. May have cortical expansion. Associated tooth- non vital. Teeth with a/c abscess –pain to percussion (high to bite on ) - Pd’l abcess originating in deep pd’l pkt – PA radiolucency + intra bony pkt; pulp vital usually.
  • Periapical abscess
  • Periapical-radiolucent Osteomyelitis: Seen seldom in maxilla (due to rich bld supply). Non vital pulp, sensitive to percussion,h/o assoc.a/c or c/c PA abscess. Borders –poorly defined and ragged. Sinus tract – if present, appears as a radiolucency from PA radiolucency through the cortical plate opening on the skin / mucosa. Is sequestrum seen (segment of dead bone) & large enough, it appears radiopaque within a radiolucency.
  • Osteomyelitis (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:94-8)
  • Periapical-radiolucent - PACOD (Periapical cementoma): Its early stage- round well defined borders, assoc. with vital tooth. Usually in MND incisors; asymptomatic. If a pulpo periapical lesion – non vital pulp.
  • Periapical-radiolucent Periapical Cemental Dysplasia
  • Pericoronal - radiolucent Follicular space: Surrounding crowns of unerupted teeth. Homogenous radiolucent halo with a thin outer radiopaque border, that is continuous with LD. Normal follicular spaces usually decrease in size with age.
  • Pericoronal - radiolucent Dentigerous cyst: Mostly MNDlr 3rd M, Mx- C, MND- PM, Mx- 3rd M. . Ameloblastoma – Infiltrate bone
  • Pericoronal - radiolucent Adeno ameloblastoma – (AOT)- Benign & non-invasive. It differs from ameloblastoma. AOT-slow growing tr, doesn’t infiltrate bone. Displace teeth but no root resorption. Antr maxilla. Expand cortical plate, produces clinical swelling, no soft tissue invasion.
  • Radiolucencies- not contacting teeth - Inter radicular - Solitary cyst – like - Multilocular - Solitary, ragged, poorly defined borders - Multiple separate - Generalized rarefaction
  • Radiolucencies- not contacting teeth Inter radicular radiolucencies: That occur b/w roots of teeth. Pd’l pkts: Pd’l bone loss (H/V) appear on films. Occurs closer to involved tooth contacting its surface. Confirmed diagnosis by placing a pd’l probe into the defect.
  • Radiolucencies- not contacting teeth Furcation involvement: Seen in advanced Pd’l disease. Produces furcation involvement. Usually seen in MNDlr M, where bifurcation is devoid of bone & shows a radiolucency. Usually a probe can be introd. into bifurc area from the B/L aspect. LD remains intact in furcation in normal furcation.
  • Radiolucencies- not contacting teeth  Lat. Radicular cyst: Assoc with non vital pulp.(near to lat. accessory canal opening). If infec. pain, swelling occur on offending tooth; sensitive to percussion
  • Radiolucencies- not contacting teeth Primordial cyst: Cyst like radiolucencies, not contacting tooth. May occur in a region where a tooth may’ve failed to develop. Odontogenic trs: Usually Odontomas. Freq seen as inter radicular radiolucencies. In its radiolucent stage- cyst like with a well defined border. Odontomas
  • Radiolucencies- not contacting teeth Globulomaxillary cyst: Asymptomatic. If large, expands cortical plate buccally; if sec. infected, pain. Inverted tear shaped radiolucency.
  • Radiolucencies- not contacting teeth Incisive canal cyst: Cyst like radiolucency. Mx CI. Often – antr nasal spine is seen over the supr portion of the cyst as a radiopaque shadow, thus producing a Heart- shaped radiolucency.
  • Radiolucencies- not contacting teeth Malignancies: May begin in inter septal bone and usually present as radiolucencies with poorly marginated borders. If they involve PDL early in their development, charact. pds a band like widening image of PDL. Lat’l PDL cyst: More in Mndlr C & PM. Adjacent teeth’ve vital pulps. Round/oval, well defined, often with sclerotic border. .
  • Radiolucencies- not contacting teeth  Median mandibular cyst: Occurs in symphyseal region of L/jaw. If the adj teeth are non-vital, it is usually a radicular cyst.
  • Radiolucencies- not contacting teeth Solitary cyst like: Post extraction socket: sometimes show cyst like radiolucency after extn. H/o extn exists. Residual cyst: Is a radicular/ another cyst that’as remained after its assoc: tooth has been lost. Usually over 20 yrs & more in Mx.
  • Radiolucencies- not contacting teeth  Lingual MNDlr bone defect (Stafne’s cyst): Invagination in the median surface of MND, Usually 3rd M, angle area. Located infr to MNDlr canal in 3rd molar area. Asymptomatic, Unilocular/multilocular, lined by cortex
  • Radiolucencies- not contacting teeth Odontogenic Keratocyst (OKC):Usually in 2nd & 3rd decades. Findings suggestive of OKC: 1. Cyst like radiolucency in MNDlr 3rd M region/ ramus. 2. A diameter of > 3 cm. 3. Unilocular cyst like radiolucency with scalloped margins. 4. Multilocular cyst. 5. Odorless, creamy or caseous contents on aspiration.
  • Radiolucencies- not contacting teeth OKC
  • Radiolucencies- not contacting teeth Primordial cyst: B/w 10 & 30 yrs. MNDlr 3rd M. Seldom produces cortical expansion. Usually in areas where a tooth failed to develop.
  • Radiolucencies- not contacting teeth Ameloblastoma: Asymptomatic initially. Expands, perforates cortical plates. Feels firm if it is of solid type. Cystic type is soft & fluctuant and straw colored fluid can be aspirated in some cases.
  • Radiolucencies- not contacting teeth Multilocular type: Terms – Soap bubble, honey comb and tennis racket – used to describe the various radiographic images of multilocular lesions.
  • Radiolucencies- not contacting teeth Soap bubble appearance
  • Radiolucencies- not contacting teeth Ameloblastoma: Multilocular type may be of soap bubble/honey comb variety.
  • Radiolucencies- not contacting teeth Solitary radiolucencies with ragged & poorly defined borders: Chronic osteitis & osteomyelitis: Inflammation of bone caused by pathogenic micro org, called Osteitis, when just alveolar bone is affected. If basal bone of jaws is involved, this process is Osteomyelitis.
  • Osteomyelitis (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:94-8)
  • Radiolucencies- not contacting teeth Multiple separate, well defined radiolucencies: - Multiple cysts/granulomas
  • Radiolucencies- not contacting teeth Gen: rarefactions of jaw bones: -Hyperparathyroidism: -Osteoporosis:
  • Radiolucencies- not contacting teeth Osteoporosis
  • Mixed lesions – contacting tooth Mixed lesions assoc: with teeth: 1. Peri apical mixed lesions. 2. Pericoronal mixed lesions. Peri apical mixed lesions: Calcifying crown of developing tooth:
  • Mixed lesions – contacting tooth Calcifying crowns of - developing teeth
  • Mixed lesions – contacting tooth Calcified material with in an intermediate stage odontoma
  • Mixed lesions – contacting tooth Pericoronal mixed lesions: Odontoma – intermediate stage.
  • Mixed lesions – not contacting tooth 1. Healing surgical site: h/o Surgery. 2. C/c Osteomyelitis:
  • Osteomyelitis (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:94-8)
  • Radiopacities Contacting tooth – Periapical radiopacities Not contacting tooth – - Solitary - Multiple separate - Generalized opacification
  • Radiopacities contacting tooth Periapical radiopacities: 1. Condensing or sclerosing osteitis: Sclerosis of bone induced by an inflamm. or infec. that most often occurs as a pulpo periapical lesion. Non-vital teeth. Usually in MND – 1st M & PM.
  • Radiopacities contacting tooth 2. Mature periapical cemental dysplasia
  • Radiopacities contacting tooth Periapical Cemental Dysplasia
  • Solitary radiopacities not contacting tooth True intra bony radiopacities: a. Tori. b. Unerupted, impacted & supernumerary teeth. c. Retained roots. d. Focal & diffuse sclerosing osteomyelitis
  • Multiple separate radiopacities not contacting tooth 1. Tori & exostoses 2. Multiple retained roots Mandibular tori
  • Multiple separate radiopacities not contacting tooth 3. Multiple hypercementosis 4. Multiple embedded/impacted teeth Hypercementosis
  • Generalized radiopacities D/d of Gen. radiopacities of jaw bones:  Osteopetrosis  Normal variations in form & density.
  • Generalized radiopacities Dense radiographic images of the jaw bones may be seen in patients who have heavy jaw bones or are over weight. -----------------------