Periapical lesions for clinical dentistry along with normal anatomical landmrks in jaw bones

1. DR BASAVRAJ
 PROF&HEAD,
 DEPT. OF OMR
 DIRDS, FRDKT, PUNJAB

2. DRBASAVARAJ
 BDS &MDS: KLE UNIVRSITY, BELGAUM, KARNATAK
 AREA OF INTEREST:ORAL MUCOSAL DISEASES,ORAL
CANCERAND PRECANCER,TMJ, FORENSIC ODONTOLOGY,

3. BDS/ MDS; KLE VK DC- BELGAUM/ KARNTAKA

4. Radiographic
interpretations
BONY LESIONS

5. TERMS;

6. BONY LESIONS
1. RADIOLUCENT
CONTACTING TOOTH
• Periapical
• Pericoronal
 NON-CONTACTING TOOTH
• Interradicular
• Solitary, cystlike
• Multilocular
• Solitary- ragged, poorly defined borders.
• Multiple, separate
• Generalized rarefaction

7. 2. RADIOLUCENT & RADIOPAQUE
CONTACTING TOOTH
• Periapical
• Pericoronal
NON-TOOTH CONTACT
3. RADIOPAQUE
CONTACTING TOOTH
• periapical
NON-TOOTH CONTACT
• Solitary
• Multiple, separate
• Generalized opacification

11. STRUCTURES
PECULIAR TO THE
MANDIBLE

12. 1. Mandibular foramen
2. Mandibular canal
3. Mental foramen
4. Lingual foramen
5. Airway shadow
6. Submandibular fossa
7. Mental fossa
8. Midline symphysis
9. Medial sigmoid depression
10.Pseudocyst of the condyle
11.Anterior buccal mandibular depression
12.Cortical plate mandibular defect

19. Pseudocyst of
condyle

20. Stafne bone cyst

21. STRUCTURES
PECULIAR TO THE
MAXILLA

22. 1.Intermaxillary suture
2.Incisive foramen, incisive canal & superior foramina of incisive
canal
3.Nasal cavity
4.Naris
5.Nasolacrimal duct or canal
6.Maxillary sinus
7.Greater palatine foramen

25. STRUCTURES
COMMON TO BOTH
JAWS

26. 1.Pulp chamber and root canal
2.Periodontal ligament space
3.Marrow space
4.Nutrient canal
5.Developing tooth crypt

27. Nutrient canals

31. PERIAPICAL
RADIOLUCENCIES

32. PERIAPICAL RADIOLUCENCIES
• True lesions: Lesions that are truly in contact with the apex of a
tooth[Image cannot be shifted from the apex by additional
Radiographs.
• False Lesions: Anatomical cavities/lytic lesions that do not contact
the apex of a tooth[Image can be shifted from the apex by
additional Radiograph.

33. True Periapical Lesions
(radiolucent- lesions)
o Pulpo-periapical lesions
o Odontogenic Tumors:
• Cementomas
• periapical cemental Dysplasia
o Periodontal diseases
o Malignant tumors
o Developmental cysts[incisive canal, mid palatine, median mandibular]
o Traumatic bone cyst

34. Pulpo-periapical Lesions
• Periapical Abscess
• Periapical Granuloma
• Periapical Cyst
• Periapical Scar
• Sugrical Defect
• Ostomyelitis
• Hyperplasia of maxillary sinus

35. Periapical Abscess
NOTE: involved with vital tooth and
carious lesion.

37. DIFFERENTIAL DIAGNOSIS
Clinical
o Gingival abscess
o Periodontal abscess
o Pericoronal abscess
o Mucormycosis
Radiographically
o Periapical granuloma
o Periapical cyst
o Mental foramen
o Pseudocyst (stafne bone cyst)

39. P. A. GRANULOMA;defination
◦An attempt of periapical tissue to neutrilise
and confine toxic products escaping from root
canal
◦ C/F:
◦ Deep Caries
◦ Large Restoration
◦ Fracture/ Discoloured Tooth
◦ Nonvital Tooth

40. Periapical Granuloma
NOTE:
 Grossly decayed tooth
 Long-standing lesion
 Non-vital tooth

41.  Well circumscribed
 Rounded around apex
RADIOGRAPHIC DIFFERENTIAL DIAGNOSIS
o Periapical abscess
o Periapical cyst
o Osteomylitis
o Normal anatomical landmark.

42. ◦ Inflammatory Odontogenic Cyst
◦ Originate From P.A. Granuloma
◦ C /F
C/F:
Deep Caries
◦ Large Restoration
◦ Fracture/ Discoloured Tooth
◦ Nonvital Tooth
◦ Common In Maxilla
◦ Max Anteriors[60%]
Radicular Cyst/periapical cyst:

43. Periapical Cyst

44. DIFFERENTIAL DIAGNOSIS
o Chronic periapical abscess/ granuloma
o Cementoma
o Developmental lateral periodontal cyst
o Lateral radicular cyst
o Residual cyst

45. ABSCESS GRANULOMA CYST
DURATION Acute/ Chronic Chronic Chronic
TOOTH VITALITY vital Non vital Non vital
PERCURSSION Positive Negative Negative
SIZE <0.5cm <1cm >1 cm in diameter
MARGINS & BORDERS Irregular
Diffuse
Well-circumscribed
Sclerotic
Well-circumscribed
corticated

46. A- Normal B-Apical periodontitis c-Apical
periodontitits
D- PERIAPICAL ABCESS E- PERIAPICAL GRANULOMA F- PERIAPICAL CYST

47. Periapical Scar
Dense Fibrous Tissue seen at the apex of endodontically treated tooth.
RADIOGRAPHIC FEATURES:
 Well-defined small radiolucency
 Radiolucency is smaller than Cyst/ Granuloma
 Involved tooth treated endodontically
 Most common in mand. anterior teeth

48. SURGICAL DEFECT
A surgical defect in the bone is an area that fails to fill with osseous tissue
after surgery
H/O Endodontic Surgery
RADIOGRAPHIC FEATURES
Radiolucent image over the apex of resected root enodontically treated tooth
 Well-defined borders

49. OSTEOMYELITIS
 Inflammation of bone involving all three components, periosteum, cortex, and marrow
space
 Chronic osteomyelitis presents periapical radiolucency
 Involved tooth contains non-vital pulp
 Sensitive to percussion
 Borders are poorly defined/ ragged

50. ACUTE OSTEOMYELITIS
Similar to an acute primary
alveolar abscess.
No bone resorption.
CHRONIC OSTEOMYELITIS
Represents a low-grade infection of the bone
If untreated, massive destruction.
Shows 4 distinct radiographic pictures
Completely radiolucent
Mixed radiolucent and radiopaque
Completely radiopaque
Proliferative periostitis

54. Proliferative periostitis

55. DIFFERENTIAL DIAGNOSIS
Chronic alveolar abscess
An infected malignant tumor
 Paget’s disease
Eosinophilic granuloma

56. Hyperplasiaof maxillary sinus
 These appear as gray shadows that may be dome-shaped in the maxillary sinus floor
or a gray radiopacity that appears as a cap over the adjacent troublesome root.
 DIFFERENTIAL DIAGNOSIS
o Benign mucosal cyst
o Buccal exostosis
o Polyps of maxillary sinus
o Malignant tumors
o Antral exostoses

58. PERIAPICAL CEMENTO OSSEOUS DYSPLASIA [Early / osteolytic
/fibroblastic stage
 It is a reactive fibro-osseous lesion arising from the versatile periodontal ligaments.
 Following stages of development
o Early stage (osteolytic or fibroblastic): radiolucent
o Intermediate stage (as lesions mature) : radiolucent area containing radiopaque foci
o Final stage (mature lesion): completely calcified and appears as a well-defined,
solid, homogenous radiopacity surrounded by thin radiolucent borders.

63. DIFFERENTIAL DIAGNOSIS
 Anatomic radiolucency
 Pulpoperiapical radiolucency
 Traumatic bone cyst
 Focal cementoosseous dysplasia
 Cementoossififying fibroma
 Cementoblastoma
 Malignancy

64. CYSTIC LESIONS
Traumatic Bone Cyst Incisive canal cyst

65. TRAUMATIC BONE CYST
 Other names
o Hemorrhagic cyst,
o simple bone cyst,
o solitary bone cyst,
o blood cyst
 False cyst; does not have an epithelial lining
 CLINICAL FEATURES
 Mean age 25 yrs
 Mandibular premolar or molar common
 H/O trauma may be elicited
 Teeth involved are vital

66. RADIOGRAPHIC FEATURES:-
Intact lamina dura
Round/ oval radiolucency at the apex of the tooth
Radiolucency extending superiorly between the roots of premolar /molar
Scalloped border is a characteristic feature
 D/D:
• Radicular cyst
• a rare median mandibular cyst.

70. Incisive canal cyst
[ nasiopalatine cyst]
CLINICAL FEATURES
o .Age 4-6decades
o Common In Males
o Painless Swelling In The Palate
RADIOGRAPHIC FEATURES
 round /Circular Radiolucency At The Apex Of Central
Incisors
 Radiolucency>2cms In Diameter

74. DIFFERENTIAL DIAGNOSIS
Radicular Cyst.: by changing the angle of the radiograph, the cyst moves
away from the apex. not related to the tooth
Mid palatine cyst

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Periapical lesions-radiology