Radiopaque Lesions Short Notes Question And Answers

Radiopaque Lesions Essay Questions

Question 1. Discuss in detail the differential diagnosis of radiopaque lesions of the jaw.
Answer:

True Periapical Radiopacities:

• Lesions present in the periapical region.
• Condensing osteitis
• Periapical idiopathic osteosclerosis
• Periapical cement osseous dysplasia
• Hypercementosis
• Odontome
• Foreign bodies.

Read And Learn More: Oral Medicine and Radiology Question And Answers

Condensing osteitis (Focal sclerosing osteomyelitis):

• Sclerosis of bone induced by inflammation or infection that most occurs as a pulp-periapical lesion.
• The mandibular first molar is commonly involved.
• Dense diffuse radiopacity is seen near the periapical region of a nonvital tooth.

Periapical idiopathic osteosclerosis (Enostosis):

• Localized growth of compact bone extending from the inner surface of cortical bone
• Few mm-2 cm in diameter.
• Dense small isolated well-defined radiopacity is usually not contacting the teeth.
• Trabeculae blend with those of adjacent bone.

Periapical cement osseous dysplasia:

• Reactive fibro-osseous lesion derived from the periodontal ligament.
• Mature stage: Dense radiopacity surrounded by a radiolucent halo.
• Affinity to occur in the mandibular anterior region.
• The associated teeth are vital.

Hypercementosis:

• Excessive deposition of cementum on all portions of the roots or at the root apex.
• Occur due to periapical inflammation.
• Systemic diseases like Paget’s disease are associated with hypercementosis.
• Bulbous root surrounded by an intact periodontal ligament space and the lamina dura.

Odontome: It is a developmental hematoma.

• Compound composite odontoid: A radio-lucent halo surrounds a radiopaque mass containing many denticles or small radiopacities resembling teeth. It is frequently seen in the maxillary anterior region.
• Complex composite odontoid: Irregular calcified mass seen as dense radiopacity surrounded by a radiolucent halo. Its occurrence is common in the mandibular posterior region.

Foreign bodies: Extruded radiopaque restorative materials from the root canal-treated teeth.

False Periapical Radiopacities: Structures not present in the periapical region, but the image is projected in the periapical region.

• Unerupted, impacted, supernumerary teeth: Radiopaque structure with central radiolucency representing the pulp chamber.
• Exostosis: Osseous hyperplasia of cortical and cancellous bone on the surface of the alveolar process.
• Torus palatinus is seen in the midline of the posterior hard palate as a dense radiopaque shadow superimposed over the periapical area of maxillary molar teeth.
• Torus mandibularis is seen bilaterally on the lingual aspect of the mandibular premolars as a dense radiopaque shadow.

Ectopic Calcifications (or) Soft Tissue Calcifications

• Sialolith is a calcareous deposit in the major or minor salivary gland and is seen as small radiopacities.
• A calcified lymph node is a linear radiopaque mass, well-contoured, and well-defined.
• Antrolith is calcareous deposits in the maxillary antrum
• Rhinolith is a calcareous deposit in the nasal cavity seen as concentric rings of radiopacity.

Generalized Radiopacities of the Jaw:

• Paget’s disease
• Osteopetrosis
• Florid cement osseous dysplasia
• Diffuse sclerosing osteomyelitis.

Paget’s Disease:

• It is an osteodystrophy where physiological bone remodeling is affected.
• In the advanced stage, excess bone deposi¬tion is seen as fluffy balls called cotton-wool appearance.

Osteopetrosis:

• Bone disease occurs as a result of the failure of bone resorption due to non-functional osteoclasts. As a result of the increased bone density, and trabeculae the marrow spaces are obliterated.
• Multiple unerupted teeth are seen in the orthopantomograph, due to the presence of dense bone.

Florid Cement Osseous Dysplasia:

• Reactive fibro-osseous lesion
• Multiple lesions involving all four quadrants of tooth-bearing regions of the maxilla and mandible
• Diffuse radiopaque mass is seen in OPG called as cotton-wool appearance.

Diffuse Sclerosing Osteomyelitis: It is a reactive bone lesion. There is a proliferative response of bone to low-grade infection and resembles a cotton-wool appearance.

Radiopaque Lesions Short Notes

Question 1. Enumerate the anatomical radiopacities of the jaw.
Answer:

Anatomical Radiopacities Common to Both the Jaws

• Enamel
• Dentine
• Lamina dura
• Alveolar crest
• Trabeculations of alveolar bone.

Normal Anatomical Radiopaque Landmarks of the Maxilla:

• Nasal septum
• The floor of the nasal fossa
• Anterior nasal spine
• Nasolabial fold
• The floor of the maxillary sinus
• Y line of Ennis
• Zygomatic process of maxilla
• Maxillary tuberosity
• Pterygoid hamulus
• Coronoid process of the mandible.

Normal Anatomical Radiopaque Landmarks of Mandible:

• External oblique ridge
• Internal oblique ridge
• Mental ridge
• Genial tubercle
• Two thin radiopaque lines on either side of the inferior alveolar canal
• The inferior border of the mandible.

Question 2. Enumerate the various conditions causing radiopacities in enamel, dentin, and pulp.
Answer: Restorative materials which appear radiopaque:

• Silver amalgam
• Gold
• Gutta-percha
• Stainless steel pins
• Silver points
• Calcium hydroxide
• Orthodontic appliance.

Talon’s cusp: Hyperplasia of cingulum of maxillary or mandibular incisors. The radiopaque image of the talon’s cusp is superimposed on the crown of the involved incisor.

Pulp stone: Foci of calcification in the pulp chamber, seen a round or ovoid radiopacity occupying the pulp chamber.

Question 3. Name the characteristic radiographic appearance of jaw lesions.
Answer:

 

Question 4. Differential diagnosis of multiple separate radiopacities of jaws.
Answer:

• Multiple impacted teeth/retained teeth:
  • Osteopetrosis—delayed eruption of teeth due to bone sclerosis.
• Multiple impacted supernumerary teeth are seen in:
  • Cleidocranial hypostasis
  • Gardner’s syndrome
• Multiple exostoses: Multiple osseous hyperplasia in the buccal and lingual cortical bones of both jaws seen as multiple separate radiopacities.
• Multiple hypercementosis: Club-shaped root apex due to excess cementum deposi¬tion is seen in many teeth in Paget’s disease, a hyperpituitarism.

Radiopaque Lesions Multiple Choice Questions

Question 1. Ground glass appearance in fibrous dysplasia is due to.

1. Numerous small trabeculations
2. Multiple bony islands
3. Immature woven bones
4. Wide marrow space

Answer: 1. Numerous small trabeculations

Question 2. The club-shaped root with dense radiopacity seen within the periodontal ligament space is due to.

1. Hyperostosis
2. Hypercementosis
3. Enostosis
4. Cementicles

Answer: 2. Hypercementosis

Question 3. Generalized hypercementosis can occur in.

1. Fibrous dysplasia
2. Hyperparathyroidism
3. Rickets
4. Paget’s disease

(Note: Generalized hypercementosis occur in Paget’s disease and hyperpituitarism).

Answer: 4. Paget’s disease

Question 4. Focal hypercementosis can occur as a result of.

1. Primary periodontal infection
2. Secondary periodontal infection
3. Periapical infection
4. Root caries

Answer: 3. Periapical infection

Question 5. Which of the following developmental anomaly resembles a tooth-like structure?

1. Complex composite odontoma
2. Peg laterals
3. Disto molar
4. Compound composite odontome

(Note: Compound composite odontoma is common in the anterior maxillary region and complex composite odontome is common in the posterior mandibular region, appearing as an irregular dense radiopacity surrounded by radiolucent halo).

Answer: 4. Compound composite odontome

Question 6. Well-defined radiopacity in the maxillary antrum is likely to be.

1. Phlebolith
2. Antral septum
3. Antrolith
4. Roots of maxillary molars

Answer: 3. Antrolith

Radiopaque Lesions Viva Voce

Question 1. Differential diagnosis of cotton wool appearance.
Answer:

• Paget’s disease
• Diffuse sclerosing osteomyelitis
• Florid osseous dysplasia.

Question 2. The radiographic appearance of fibrous dysplasia.
Answer:

• Initially osteolytic stage—Completely radio-lucent
• Intermediate stage—Radiopaque flecks in radiolucency (salt and pepper appearance)
• Advanced stage—Dense radiopacity with many small closely arranged trabeculations seen as stippled or ground glass appearance or Peau d orange appearance.

Question 3. Name the solitary radiopacities not necessarily contacting the teeth.
Answer:

• Exostosis (palatine torus and torus mandibularis)
• Idiopathic osteosclerosis or enostosis
• Unerupted/impacted/supernumerary teeth.

Question 4. What is onion skin appearance?
Answer:

• It represents the laminar periosteal bone reaction commonly seen in malignant lesions of jaws
• Alternating layers of radiolucency and radiopacity seen as onion peel or onion skin appearance.
• This type of periosteal reaction with multiple layers of new bone on the buccal aspect of the mandible is also seen in Garre’s osteomyelitis.

Question 5. What is a target lesion?
Answer: Target lesion refers to a well-defined, localized radiopaque area surrounded by a radiolucent halo, for example, Benign cementoblastoma.

Radiopaque Lesions Highlights

• Radiopacity refers to the portion of the image that appears white or light. Dense structures or structures with high atomic numbers absorb the X-rays and hence reduce the amount of radiation reaching the receptor resulting in a radiopaque image. Bone, enamel, dentin, cementum, and lamina dura are a few examples of radiopaque structures.
• Dental restorative materials like amalgam, root canal obturating materials, metal and ceramic crowns, posts, and acrylic resins appear radiopaque.