Radiopaque lesions of the jaws

Broken Root Abnormal radiopacities of the teeth radiolucency osteosclerosis Removed Not removed History of extraction, presence of periodontal space, surrounding bone show sclerosis. Associated radiolucency reveal secondary inflammation & its removal is necessary.

Foreign Bodies Amalgam fragments in the site of extraction & area of apical surgery, pieces of Gutta-percha, screw, brackets, pins, broken endodontic instrument

Unerupted or misplaced teeth including supernumeraries

Compound & Complex Odontoma Odontogenic tumor, slow growing with tooth-like structure. Distinguished by dense radiopacity of the enamel & their outline. Compound: Composed of two or more toothlike structures. Complex: is irregular dense radiopaque mass.

Hypercementosis: The formation of excessive amounts of cementum, usually around the apical portion of the root. Unknown etiology, but sometimes seen in Paget's disease of bone .

Conditions of variable opacity affecting bone Developmental Exostoses, including tori (mandibular or palatal) Exostoses are small, irregular overgrowths of bone sometimes developing on the surface of the alveolar bone. They consist primarily of compact bone and produce an ill-defined radiopacity when superimposed over the bulk of the alveolar bone. Location ; midline of the palate (torus palatinus), lingual aspect of Mandibular bicuspid (torus mandibularis).

Chronic Sclerosing Osteomyelitis ( multiple enostosis ) Multiple radiopaque mass of the jaw ( tooth-bearing area & edentulous ). Age ; over 30 years. Signs ; long duration, expand the jaw, painless unless secondary infected. Rad. ; cotton wool appearance , absence of lesion in other bone. fabrication of prosthesis should be avoided. Normal laboratory test.

Paget`s Disease Is a condition of abnormal resorption and apposition of osseous tissue in one or more bones. Age ; over 40 years. Location ; involve many bones of the skeleton. Signs ; enlargement of skull, headaches, loss of vision, deformity of spine & bone of legs. Rad. ; thickening of cranial vault cortex, cotton-wool numerous radiopacities, migration of teeth, loss of lamina dura, hypercementosis & jaw lesions have ground glass appearance .

Osteopetrosis (albers-Schonberg or marble bone disease ) Hereditary present at birth & involve entire skeleton (normal bone formation but absence of bone resorption ). Rad. : bone appear solid radiopaque with little or no bone marrow , loss of lamina dura & healing after extraction is very slowly. Treatment :bone marrow transplants.

dense alveolar bone and embedded, poorly formed teeth.

Caffey`s Disease A largely self-limiting disorder which affects infants(first year of life) , It causes bone changes, soft-tissue swelling, and irritability. Unknown etiology. Radio : radiopaque, enlargement of the lower border of the mandible & thickening of the cortex of the other affected bone. (no therapy).

Thalassemia (Cooley's anemia) Is a hereditary disorder that results in a defect in hemoglobin synthesis. Signs ; yellow skin, weakness, enlargement of liver & spleen with some mongoloid appearance . Radiographically ; thickening & vertical radiopaque trabeculae on the surface of cranium to give a hair on end appearance (start from the inner table of cranial vault extent beyond the outer surface). Jaws are enlarged, with dense, irregular, coarse trabeculae results in malocclusion. The jaws appear radiolucent, with thinning of the cortical borders and enlargement of the marrow spaces. The trabeculae are large and coarse. The lamina dura is thin, and the roots of the teeth may be short. . Maxillary antrum obliterated .

Thalassemia

Osteogenic Sarcoma Malignant tumor of bone. Sign ; rapid growth, migration & loosening of teeth, ulceration, pain & paresthesia. Age ; between 10 – 30 years of age. Radiographic features ; widening of periodontal space radiating radiopaque striae from the cortex of affected bone ( sun-rays appearance ). New bone formation between the periosteum & the cortex form a triangular area called Codman's triangle.

Codman's triangle. Normal widening of periodontal space

Mixed lesions of the jaws

Mixed Lesions of the Jaws Such lesions arise from the following ways ; 1.Radiolucent lesion ( Cementoma & Paget`s disease) may gradually mature into a radiopaque mass & during this process may appear mixed . 2.Radiopaque lesion ( condensing osteitis ) may become infected, suppurate, destroy bone & become mixed . 3.Lesion may begin as a mixed ( Aemeloblastic Odontoma ).

Cementoma stage-II Teeth are vital . Single or multiple circumscribed lesions at the apices of the teeth. Most frequently involve the ant. Mandibular region. Female > Male . No treatment is required.

Multiple circumscribed radiopaque lesion at the apices of the teeth Cementoma stage-III Multiple circumscribed radiopaque lesion at the apices of the teeth

OSSIFING FIBROMA Solitary, expansile lesion, long duration & slow growth, occur at any age ( usually in the young adult) , majority of lesion is radiopaque but in very early stage may appear radiolucent or mixed. Normal blood values (calcium, phosphorus & alkaline phosphatase). D.D: Fibrous Dysplasia &other radiopaque lesions.

Ossifying Fibroma

Ossifying Fibroma

CONDENSING OSTEITIS Most common radiopaque lesion of the jaws, ill -defined or clearly demarcated , less density from the enamel ( to distinguishing from Odontoma ). Etiology; low grade infection or physical stress. Location; most frequently in the bicuspid & molar area of the mandible. Radiolucent in very early stage or mixed . Diagnostic features: Asymptomatic for long history , sudden appearance of pain & suppuration , presence of sequestration in advanced cases ( surgical removal is indicated ).

Polyostatic Fibrous Dysplasia Slow, expansile, radiopaque lesion of vary degree of density ,appear radiolucent at times. Age ; children & young adult. Migration of teeth & loss of lamina dura are common . Diagnostic feature ; presence of endocrine dysfunction& skin pigmentation (Albright`s syndrome) , involve multiple bone of the skeleton.

Cystic Odontoma Odontogenic slow growing tumor . Multiple tooth-like structure surrounded by a radiolucency . Odontomas are located near the alveolar crest , some time undergo secondary inflammation resulting in destruction of surrounding bone.

Cystic Odontoma

Ameloblastic Odontoma Rare, slow growing Odontogenic tumor . Age ; childhood or young adult. Location ; maxilla > mandible. Feature ; irregular radiopacity associated with vary size of radiolucency , opaque mass may be form small foci at the periphery of the lesion .