Radiology of inflammatory lesions of the jaws

1. Radiology of inflammatory
lesions of the jaws
Dr. Ghaida’ AlJamal, BDS., MS., Dip (ABOMR(

2.  Most common pathologic conditions of jaws
 Body responds to chemical, physical, or
microbiologic injury with inflammation

3. Homeostasis
 Balance of osteoclastic bone resorption and
osteoblastic bone production
 Mediators of inflammation tip this balance to
favor either bone resorption or bone
formation

4. Periapical inflammatory lesion
 Source is necrotic pulp
 Lesion restricted to the region of the tooth

5. Example

6. Osteomyelitis
 Infection spreads in bone marrow
 Lesion is no longer contained

7. Example

8. Periodontal lesions & pericoronitis
 Lesion extended into overlying soft tissues
 Arises in the tissues surrounding the crown of
the PE tooth

9. Radiographic features
 Location
 Periphery
 Internal structure
 Effects on surrounding structures

10. Periapical inflammatory lesions
 Acute apical periodontitis
 Chronic apical periodontitis
 Periapical abscess
 Periapical granuloma

11. Periapical inflammatory lesions
Rarefying oseitis/sclerosing osteitis

12. Periapical inflammatory lesions
 Def: local response of bone around apex of
tooth that occurs 2° to necrosis of pulp or
destruction of PA tissues by extensive
periodontal disease

13. Caries acute
Necrotic pulp apical periodontitis
Trauma chronic
Periapical abcess
Periapical granuloma
Osteomyelitis
Periapical cyst

14. Clinical features
 Asymptomatic …….severe pain w, w/o
facial swelling, fever, lymphadenopathy

15. Radiographic features
 Location
 Apex of involved tooth
 Cervically up the tooth root

16. Radiographic features
 Periphery
 Ill defined
 Well defined

17. Radiographic features
 Internal structure
 Early …..no changes
 Loss of bone density (widening of PDL at
apex)
 Larger diameter involvement
 Mixture of sclerosis and rarefaction

22. Differential diagnosis
 Periapical cemental dysplasia
 Enostosis, osteosclerosis

25.  Small, radiolucent periapical lesions with well
defined periphery…….
granuloma or cyst

26. Differential diagnosis
 Surgical scar
 Mets & leukemia

28. Pericoronitis
 Inflammation of the tissues surrounding the
crown of a partially erupted tooth

29. Radiographic features
No changes……
localized rarefaction and sclerosis……..
osteomyelitis

30. Radiographic features
Enlargement of follicular space with ill defined
periphery and gradual transition of the normal
trabecular pattern

31. Radiographic features
Surrounding bone rarefaction or
sclerosis
Periosteal new bone formation

32. Differential diagnosis
 Enostosis
 FD
 Oseosarcoma
 SCC

33. Osteomyelitis
 Inflammation of bone (marrow, cortex,
cancellous portion & periosteum)
 Source: pyogenic
hematogenous

34. Osteomyelitis
Hallmark is sequestra
It is a segment of bone that has become
necrotic because of ischemic injury caused by
inflammation

35. Acute Osteomyelitis
 Predominantly neutrophils
 From non vital teeth most commonly

36. Radiographic features
 Very early ……no change
 Ill defined periphery
 Decrease in density
 Loss of sharpness of trabeculae

37. Radiographic features
 Maxilla is rare
 Bone destruction area of radiolucency
 Sclerotic regions
 Sequestra maybe present….

38. Radiographic features
 Cortical bone may be resorbed
 Bone formation (involucrum)….
 Onion-skin appearance (proliferative
periostitis
 Effects on teeth &lamina dura….

39. Differential diagnosis
 FD
 Malignancies (OS, SCC)
 LCH
 Lymphoma, luekemia

40. Chronic Osteomyelitis
 De novo
 Or sequela of inadequately treated acute
Osteomyelitis

41. Diffuse sclerosing osteomyelitis
 Bone metabolism shifts toward increased
bone formation…..
 Symptoms are less severe ….

42. Radiographic features
 Posterior mandible most commonly
 Periphery better defined…..
 Regions of greater and lesser radiopacity…
 More chronic lesions are exceedingly
radiopaque…

43. Radiographic features
 Sequestrum….
 Periosteal new bone (similar to onion skin)
 Outer contour of mandible altered
 External resorption, LD less apparent, PDL enlarged
 May develop draining fistula

46. Differential diagnosis
 FD
 Paget disease of bone
 OS
 LCH, leukemia, lymphoma

47. Osteoradionecrosis
Inflammatory condition of bone that occurs after
bone has been exposed to therapeutic doses
of radiation

48. Osteoradionecrosis
 Radiation causes damage to bone w hypoxia,
hypocellularity and hypovascularity
 Delayed or lack of healing….

49. Clinical and radiographic features
 Posterior mandible…
 Bone exposure…
 Pathologic fracture
 Pain or no pain

50. Radiographic features
 Similar to chronic osteomyelitis
 Ill defined periphery
 More bone formation sclerotic
appearance…

51. Radiographic features
 Scattered regions of radiolucency w, w/o
central sequestra
 Uncommon inflammatory new bone….
 Rare bone formation on outer cortex

52. Differential diagnosis
 Malignant neoplasm
 Chronic osteomyelitis (history)