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Radiographic Pathology

You make the diagnosis!

An asymptomatic 54 yo male patient

presented for routine dental care

Upon examination, displacement of the

maxillary anterior teeth was noted and

#9 was +/- on vitality testing

An occlusal radiograph was obtained

Idiopathic Osteosclerosis

Asymptomatic lesion discovered on routine

radiographs, no odontogenic infection

Radiopaque, no expansion

Premolar/molar region, mand > max

Margins may be sharp or blend with

adjacent bone

Dense bone microscopically

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Condensing Osteitis

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1988 1997

2004 2009

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2010 2014

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Periapical Cyst Most common odontogenic cyst

Arises due to inflammatory stimulus

with proliferation of rests of Malassez

Typically asymptomatic, but may

become tender

Periapical Cyst Radiographically present as a round

to ovoid radiolucency

Apex of non-vital tooth

Less commonly between teeth –

lateral radicular cyst

Most are < 1.5 cm in diameter

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Periapical Cyst Enucleation, with either extraction or

endodontic therapy of the involved

tooth

If the lesion is not removed, a residual

cyst may result

Recurrence is unlikely

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Dentigerous Cyst

Second most common odontogenic cyst

By definition, a cyst that forms around the crown of an impacted tooth

A developmental cyst (not an inflammatory cyst)

Arises from reduced enamel epithelium

Dentigerous Cyst

Usually detected in young adults

Asymptomatic unless secondarily

infected

Most common sites – mand 3rd molars,

max canine, max 3rds

Pericoronal radiolucency, resorption of

adjacent tooth roots (up to 50%)

Dentigerous Cyst

Treatment consists of enucleation

Prognosis is excellent – minimal tendency to recur

Tissue should be submitted for microscopic examination to rule out OKC, ameloblastoma or other odontogenic lesions

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Dentigerous Cyst

In the absence of surgical removal,

the patient must be informed as to

possible sequelae, other diagnostic

considerations and the importance of

periodic radiographic follow-up

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05/2000 09/2007

09/22/04 09/07/05

12/15/98 06/30/03

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Summary

Look for response to conservative therapy

Inform the patient (parent or guardian)

regarding differential diagnosis and the

role of biopsy in establishing the final

diagnosis

Clinical and radiographic follow-up are

essential to good patient management

Indications for cbCT

All cbCTs must be justified on individual

basis with potential benefits outweighing

potential risks (EUR 1996, US 2001);

selective use

European Commission; Cone beam CT for

dental and maxillofacial radiology (EB

guidelines) 2012 http://www.sedentexct.eu/files/radiation_protection_172.pdf

Indications (or not) for cbCT

Oral surgery:

Impactions, implants, pathology if conventional

imaging inadequate; limited volume preferred

Cleft palate analysis

Endodontics:

Selected cases; multi-rooted teeth, complicating

factors (resorption, fx) or adjacent vital anatomic

structures, esp. prior to surgery; not for routine

assessment of PA pathology

Indications (or not) for cbCT

Periodontics:

Implants; limited cases for intrabony

lesions/furcation involvement; not for routine

assessment of bone support

Orthodontics:

Complex cases of skeletal abnormality, may

require large volume studies for combined

ortho/surgical cases; not for routine diagnosis

Questions?