Oral Diagnosis II Forth Year

1. Classification
- Anatomical- Radiolucent; Radiopaque.
- Pathological
- Radiolucent – unilocular/multilocular
- Radiopaque
- Mixed
------ Solitary / Multiple.

2. Classification-pathological
Radiolucent – Contacting tooth
- Not contacting tooth
Mixed – Contacting tooth
- Not contacting tooth
Radiopaque – Contacting tooth
- Not contacting tooth

3. 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.

4. Periapical-radiolucent
Periapical granuloma – well circumscribed, rounded -
around apex. May’ve thin radiopaque border. Tooth may
have deep caries/restorations. Tooth-non-vital.

5. 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.

6. 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.

7. Periapical abscess

8. 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.

9. Osteomyelitis
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:94-8)

10. 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.

11. Periapical-radiolucent
Periapical Cemental Dysplasia

12. 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.

13. Pericoronal - radiolucent
Dentigerous cyst: Mostly MNDlr 3rd M, Mx- C, MND- PM,
Mx- 3rd M.
.
Ameloblastoma – Infiltrate bone

14. 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.

15. Radiolucencies- not contacting teeth
- Inter radicular
- Solitary cyst – like
- Multilocular
- Solitary, ragged, poorly defined borders
- Multiple separate
- Generalized rarefaction

16. 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.

17. 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.

18. 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

19. 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

20. Radiolucencies- not contacting teeth
Globulomaxillary cyst: Asymptomatic. If large, expands cortical plate
buccally; if sec. infected, pain. Inverted tear shaped radiolucency.

21. 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.

22. 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.
.

23. 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.

24. 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.

25. 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

26. 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.

27. Radiolucencies- not contacting teeth
OKC

28. 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.

29. 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.

30. Radiolucencies- not contacting teeth
Multilocular type:
Terms – Soap bubble, honey comb and tennis
racket – used to describe the various
radiographic images of multilocular lesions.

31. Radiolucencies- not contacting teeth
Soap bubble appearance

32. Radiolucencies- not contacting teeth
Ameloblastoma: Multilocular type may be of soap bubble/honey comb
variety.

33. 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.

34. Osteomyelitis
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:94-8)

35. Radiolucencies- not contacting teeth
Multiple separate, well defined
radiolucencies:
- Multiple cysts/granulomas

36. Radiolucencies- not contacting teeth
Gen: rarefactions of jaw bones:
-Hyperparathyroidism:
-Osteoporosis:

37. Radiolucencies- not contacting teeth
Osteoporosis

38. 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:

39. Mixed lesions – contacting tooth
Calcifying crowns of -
developing teeth

40. Mixed lesions – contacting tooth
Calcified material with in an intermediate stage odontoma

41. Mixed lesions – contacting tooth
Pericoronal mixed lesions:
Odontoma – intermediate stage.

42. Mixed lesions – not contacting tooth
1. Healing surgical site: h/o Surgery.
2. C/c Osteomyelitis:

43. Osteomyelitis
(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:94-8)

44. Radiopacities
Contacting tooth – Periapical radiopacities
Not contacting tooth –
- Solitary
- Multiple separate
- Generalized opacification

45. 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.

46. Radiopacities contacting tooth
2. Mature periapical cemental dysplasia

47. Radiopacities contacting tooth
Periapical Cemental Dysplasia

48. Solitary radiopacities not contacting tooth
True intra bony radiopacities:
a. Tori.
b. Unerupted, impacted & supernumerary
teeth.
c. Retained roots.
d. Focal & diffuse sclerosing osteomyelitis

49. Multiple separate radiopacities not contacting tooth
1. Tori & exostoses
2. Multiple retained roots
Mandibular tori

50. Multiple separate radiopacities not contacting tooth
3. Multiple hypercementosis
4. Multiple embedded/impacted teeth
Hypercementosis

51. Generalized radiopacities
D/d of Gen. radiopacities of jaw bones:
 Osteopetrosis
 Normal variations in form & density.

52. Generalized radiopacities
Dense radiographic images of the jaw bones
may be seen in patients who have heavy
jaw bones or are over weight.
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