Radiographic interpretation

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Radiology II
Forth Year

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Radiographic interpretation

  1. 1. Oral & Maxillofacial Radiographic x- ray film interpretation By Dr. Hassan M. Abouelkheir BDS, MSc, PhD
  2. 2. Systematic approach • It should apply to : • A- Entire radiograph. • B- specific Lesions.
  3. 3. 
 A- Entire radiograph
 • 1- type of radiograph: A- Extraoral : - panoramic . - cephalometric. - Oblique lateral. B- Intra-oral: - periapical. - Bite-wing. - Occlusal.
  4. 4. 2- general overview of the entire film i- Teeth: – Number. – Chronologic and development age. – Position. – Condition of crowns(crowns/ restorations). – Condition of the roots(length, fillings, resorption, c/r ratio)
  5. 5. 2- general overview of the Entire film ii- The apical tissues: - Integrity of Lamina dura. - Apical radiolucency or radiopacitiy. iii- The periodontal tissue: - PDL space width. - level & quality of alveolar crest. - vertical or horizontal bone loss. - Furcation involvement. - Calculus deposits.
  6. 6. 2- General overview of the Entire film IV- OTHER STRUCTURES: - BODY & RAMUS OF THE MANDIBLE: - SHAPE & OUTLINE. - THICKNESS OF LOWER BORDER. - TRABECULAE PATTERN. - ANY RADIOLUCENT OR RADIOPAQUE AREAS. - CONDYLAR HEAD.
  7. 7. 1- site: 2- size & shape: 3- outline / edge (periphery). 4- Internal structures (relative radiodensity). 5- Effect on surrounding structures. Specific lesions:
  8. 8. 1- Site (Location): • Maxillary/ Mandibular. • Localized or generalized. • Originating from a point or epicentre relative to surrounding structures e.g; – Above or below ID canal. – In bone or soft tissue. – In or outside a tooth max. ant. – Odontogenic lesions (above ID canal) / non- odontogenic lesions (above/ within or below the canal).
  9. 9. 
 2- size & shape:
 • 2.1-Size: A- measuring dimensions in cm (e.g. 2cm×3cm). B- Describing the boundaries; - Extension from … to… in one dimension. - Extension from … to… in other dimension.
  10. 10. 
 2- size & shape:
 2.2- Shape: • Unilocular. • Multilocular. • Oval. • Round. • Scalloped. • Irregular.
  11. 11. 3- Outline/ edge (periphery): A) Discrete or well defined outlines; – Smooth. – Punched out( no peripheral bone reaction). – Corticated: thick or thin surrounding radiopaque (white) cortex. – Sclerotic: non uniform radiopaque boundary. – Encapsulated: surrounded by radiolucent line partially or completely.
  12. 12. B) Non Discrete or Poorly defined outlines: • blend in with normal anatomy. • Moth- eaten or ragged. 3- Outline/ edge (periphery) cont.:
  13. 13. 4- Internal structures(relative radiodensity): • Uniformly radiolucent. • Mixed lesion . • Radiopaque. • Internal structures; – Ground glass. – Honeycomb. – Cottonwool patches. – Homogenous/ discrete bony septa. – Cementum. – Dental tissue. – No specific pattern.
  14. 14. 5- effects on surrounding structures: 1- Teeth: – Resorption. – Displacement. – Delayed eruption. – Disrupted development. – Loss of lamina Dura. – Increase width of PDL space. – Hypercementosis. – Alteration in size.
  15. 15. 2- surrounding bone: – Expansion Buc./ling./ Other directions . – Displacement. – Raged destruction. – Sclerosis. – Subperiosteal bone formation. – Increase width of ID canal. – Irregular bone remodeling. 5- effects on surrounding structures:
  16. 16. Differential diagnosis 1- Normal anatomical structures. Maxilla / Mandible. 2- Artefactual:e.g overexposure or air shadow. 3- Pathological: a- Radiolucent lesions b- lesions with variable radiopacity (mixed lesions). c- Radiopaque lesions.
  17. 17. Differential Diagnosis of Radiolucent lesions: 1- Normal anatomical structures. Maxilla / Mandible. 2- Artefactual:e.g overexposure or air shadow. 3- Pathological: a- Congenital: abnormal hereditary lesions at birth. b- Developmental. c- Acquired.
  18. 18. C- Acquired lesions 1- Localized infection . 2- Spreading Infection. 3- Trauma . 4- A cyst and cystic like lesions. 5- A tumour or tumor like lesion. 6- A bone Related lesions; - A Giant cell lesion. -An Osseous Dysplasia. - Another lesion.
  19. 19. Localized infection • A- Periapical : • Periapical abcess. • Acute apical periodontitis. • Periapical granuloma • Rarifying osteitis. • Sclerosing osteitis. B- Pericoronitis.
  20. 20. Spreading infection A- Osteomyelitis ( Acute/ chronic). B- Osteoradionecrosis. C- Bisphosphanates related osteonecrosis (BRON).
  21. 21. Trauma • A- teeth 1- Concusion. 2- Laxation. 3- Avulsion. 4- Fracture of teeth. - Enamel (Crack). - Enamel & Dentine (uncomplicated fracture). - E &D (complicated fracture). - Root fracture a- horizontal b- vertical or oblique.
  22. 22. Trauma (cont.) B) bone fracture: 1- mandible: - body. - condyle. - Alveolar process. 2- Maxilla : - Midface: Le Fort I /II/III. - zygomatic fracture.
  23. 23. Cyst & cystic like lesions A) Odontogenic : • Radicular. • Residual. • Lateral Periodontal. • Dentigerous. • Odontogenic Keratocyst. B) Non- Odontogenic -Nasopalatine duct/ incisal canal cyst. - simple bone cyst. - Stafne’s bone cyst
  24. 24. Tumours and Tumour like lesions 1- Benign Odontogenic: - ameloblastoma. - ameloblastic fibroma. - calcyfing odontogenic cyst. - odontogenic fibroma. - odontogenic myxoma. 2- Malignant odontogenic: - odontogenic carcinoma. - odontogenic sarcoma. 3- Non-odontogenic primary bone diseases. 4- Squamous cell carcinoma. 5- Multiple myloma.
  25. 25. Bone Related Lesions 1- Giant cell lesion: -Central giant cell lesion. - Brown tumour of hyperparathyriodism. - cherubism. - Aneurysmal bone cyst. 2- Osseous dysplasia: - periapical cemental dysplasia. - Focal osseous dysplasia. - Florid osseous dysplasia. - Familial gigantiform cementoma. 3- Other lesions: - Ossifying fibroma. - fibrous dysplasia. - simple bone cyst. - Stafne’s bone cyst.
  26. 26. Case 1
  27. 27. Case 2
  28. 28. Case 3
  29. 29. Case 4
  30. 30. Case 5
  31. 31. The End

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