Periapical Radiopacities and Solitary Radiopacities Not Necessarily Contacting Teeth True Periapical Radiopacities

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Oral Diagnosis and Treatment Planning

Periapical Radiopacities and Solitary Radiopacities Not Necessarily Contacting Teeth
True Periapical Radiopacities
Condensing or Sclerosing Osteitis – Chronic Osteitis

  • M>F

  • Age 5-15 and 50-80

  • Usually associated with root of a pulpless tooth, slow course

  • Cystlike radiolucency or radiopacity

Periapical Cementoosseous Dysplasia (Cementoma)

  • Lucent in early stage, Mixed lesion intermediately, Mature lesion is radiopaque

  • More common in blacks, females, age 40-50 (fifth decade)

  • Most common in the mandible especially the apices of anterior teeth (incisors); usually more than one tooth affected

  • Radiopaque with smooth radiolucent border – radiolucency is generally from tissue of odontogenic origin

  • Teeth are vital and asymptomatic

  • Requires no treatment

Idiopathic Osteosclerosis

  • Separate from chronic osteitis based on history or possibility of inflammation

  • Teeth are vital, asymptomatic, with no sinus drainage – overlying mucosa is normal

  • Cause is unknown - indicated when other diseases can be ruled out and tooth is vital

  • Irregular in shape (compared to PCOD which is a well-defined opacity with a lucent border)

Unerupted Succedaneous Teeth

Foreign Bodies


  • Contained within normal periodontal ligament space and lamina dura

Tori and exostoses

  • Adults

  • Palate, lingual mandible, and buccal aspect of alveolar bone

  • May occur as opacity when large

  • Torus palatinus in 25% of population, torus mandibularis in 10%; cause unknown; little significance

Retained Root Tip

Solitary Radiopacities Not Necessarily Contacting Teeth

And False Periapical Radiopacities

Tori, exostoses, and osteomas

Unerupted, impacted and supernumerary teeth

  • Hyperdontia – 8 associated syndromes – know 3

    • Gardener’s Syndrome - Multiple osteomas, fibromas, familial history, epidermoid cyst, POLYPS – lead to malignancy – 50% patients have in GI tract (30% early , 100% later) – (note: GI polyps are also seen in Peutz-Jagers Syndrome – patients have multiple melanin macules) – cotton wool appearance seen radiographically – like Paget’s disease

    • Clido-cranial dysplasia – can touch shoulders in front of body

    • Sturge-Weber Syndrome or Angiometosis – encephalotrigeminal angiometosis - vascular lesions – follow distribution of trigeminal nerve

Retained Roots

Idiopathic Osteosclerosis

Periapical Cementoosseous Dysplasia (PCOD)

  • Also has cotton wool appearance similar to Paget’s disease

Fibrous Dysplasia

  • M=F

  • 10-20 years old – peak 17

  • maxilla:mandible – 4:3

  • 3 types:

    • McCune-Albright Syndrome – FD plus endocrine abnormalities - precocious puberty– female

    • polyostotic (more than one bone)

    • monostotic (one bone)

  • rare in anterior maxilla and symphysis

  • no pain, no parathesia, slow expansion

  • mottled or ground glass appearance

Sclerosing Osteomyelitis

Complex Odontoma

  • (compound – associated with tooth – looks like a washer)

  • Females – 68%

  • 5-20 years old

  • mandible most common

  • molars – 70% first, second, usually supracoronal

  • uniform radiopaque mass

Projected Radiopacities

Ectopic Calcifications

  • Sialoliths of major and minor salivary glands

  • Rhinoliths

  • Antroliths

  • Phlebolith

  • Calcified Lymph Nodes

  • Arterial Calcifications

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