Radiopaque Lesions Of The Jaws In Dentistry

Radiopaque Lesions Of The Jaws In Dentistry

Enumerate and differentiate various radiopaque lesions of the jaws.
Answer.

Radiopaque Lesions of Jaws

• Abnormalities of teeth
  • Unerupted and misplaced teeth including supernumeraries
  • Odontomas, i.e. compound and complex
  • Root remnants
  • Hypercementosis
• Conditions which affect the bone
  • Developmental: Exostosis including tori i.e. either mandibular or palatal.
  • Inflmmatory
    • Low grade chronic infection: Sclerosing osteitis
    • Osteomyelitis: Sequestra, involucrum formation
  • Tumors odontogenic (Late stages)
    • Calcifying epithelial odontogenic tumor
    • Adenomatoid odontogenic tumor
    • Calcifying odontogenic cyst
  • Non-odontogenic tumor
    • Benign: Osteoma, chondroma
    • Malignant: Osteosarcoma, Osteogenic secondary metastasis
  • Fibro-cemento-osseous lesions
    • Fibrous dysplasia
    • Periapical cemental dysplasia
    • Gigantiform cementoma
    • Benign cementoblastoma
    • Cemento-ossifying firoma
  • Others
    • Paget’s disease
    • Osteopetrosis
• Superimposed soft tissue calcifications
  • Salivary calculi
  • Calcified lymph node
  • Calcified vessels
  • Phleboliths
  • Calcified acne scars
• Foreign bodies
  • Intrabony
  • Within the soft tissue
  • On or overlying the skin

Differential Diagnosis of Radiopaque Lesions of Jaws

Odontomas i.e. Compound and Complex

• Difference between compound and complex type: Compound consists of more than one fragment and is more commonly seen in maxillary canine region while complex has one solid mass and is commonly seen in mandibular molar region.
• Cementifying or Ossifying firoma: Association of odontoma is with unerupted molar teeth and is more radiopaque as compared to firoma. It also occurs at younger age as compared to firoma.
• Adenomatoid odontogenic tumor: It is rarely as opaque as complex type and is seen in association with the maxillary canines.
• Periapical cemental dysplasia: It is smaller than complex type and is limited to mandibular anterior region. Periapical cemental dysplasia are multiple lesions and has wider, uneven sclerotic border while odontomas have well defied cortical border and usually the sof tissue capsule is more uniform and is bettr defied.
• Calcifying epithelial odontogenic tumor: It is rare, less opaque and develops in midline.
• Fibrous dysplasia: It is mottled or have smoky pattern with poorly defied borders.

Hypercementosis

• Any radiopaque structure which is seen in the vicinity of the root like enostosis, mature cemental dysplasia.
• Multirooted teeth and dilacerated root
• Main differentiating characteristic is presence of periodontal membrane space around hypercementosis.

Exostosis Including Tori i.e. either Palatal or Mandibular

It can be diffrentiated from periapical radiopacity by taking another radiograph with diffrent horizontal angulation of the central ray.

Condensing osteitis

• Hypercementosis: It is seen as a integral part of malformed root and associated with an intact lamina dura and periodontal ligament space. Associated tooth is vital.
• Periapical cemental dysplasia: It is associated with vital teeth and the lesion is separated from the surrounding bone by a radiolucent border.
• Osteosclerosis: It is associated with an edentulous area.

Calcifying Epithelial odontogenic Tumor

• Adenomatoid odontogenic tumor: This is common in anterior maxilla as compared to calcifying epithelial odontogenic tumor which is common in mandibular molar – premolar region.
• Calcifying odontogenic cyst: On aspiration viscous granular yellow colored flid is seen.
• Central odontogenic firoma: Histologically, firoblasts are prominent and abundant.

Adenomatoid Odontogenic Tumor

• Calcifying odontogenic cyst: It is diffilt to diffrentiate from extrafollicular type of adenomatoid odontogenic tumor. It occurs in older age group mainly in premolar area.
• Calcifying epithelial odontogenic tumor: It is found commonly in mandibular posterior region.

Osteoma

• Solid odontome: It shows presence of sof tissue capsule.
• Fibrous dysplasia: No clearly defied borders are present. It does not reveal same homogeneous density as in osteoma.
• Osteosarcoma: There is bony enlargement along with typical sunray appearance.
• Ossifying firoma: Presence ofbony enlargement with dense radiopaque mass.

Chondroma

• Osteogenic sarcoma: It shows typical sunray appearance.
• Fibrous dysplasia: This can be diffrentiated histologically and radiographically it has ground-glass appearance.
• Osteoblastic metastatic carcinoma: There will be presence of primary tumor.
• From radiographic point of view it is not possible to identify chondroma inthe jaws. Anarea ofbone destruction without the characteristics of the cyst, occurring in region of condyle or coronoid process is considered as possible of being cartilaginous in origin.

Gigantiform cementoma

• Paget’s disease: Radiolucent capsule is absent. There are increased serum alkaline phosphatase levels. This affcts nearly all bones of skeleton. It affcts entire mandible while gigantiform cementoma is centered above inferior alveolar canal.
• Osteopetrosis: There is profuse thickening of skull base or calvarium and diffuse bone radiopacities. It will lead to enlargement of bone but this will not happen in gigantiform cementoma.
• Chronic sclerosing osteomyelitis: Region of cementum may appear similar o that of sequestrum, CT imaging aids in diffrentiation.

Benign cementoblastoma

• Periapical cemental dysplasia: No expansion of jaws, females are more commonly affcted and radiolucent band is not uniform in fist molar region, cementoblastoma has a more rounded shape than cemental dysplasia.
• Periapical sclerosing osteitis: It does not have sof tissue capsule.
• Hypercementosis: It does not have sof tissue capsule and is surrounded by periodontal ligament space which is much thinner than sof tissue capsule of cementoblastoma. There is no root resorption or jaw expansion.

Paget’s disease

• Florid osseous dysplasia: Hypercementosis is present but it is only confied to the jaw bones. In Paget’s disease when jaw bones are involved, it affcts complete jaw. This may have cotton wool pattrn , but the lesions are centered above inferior alveolar canal and commonly have radiolucent capsule.
• Tori: Lesion is small and is confied to jaw bones.
• Osteoma: Lesion is small and is confied to jaw bones.

Osteopetrosis

• Polyostotic firous dysplasia: It involves part of a bone rather than complete bone.
• Paget’s disease: It involves skull, pelvis, vertebrae, femur, maxilla and mandible. There is marked elevation of serum alkaline phosphatase levels.

Salivary calculi

• Phleboliths: There will be no sialadenitis and these are more or less rounded and consist of laminations or central dark areas.
• Calcified submandibular lymph node: If there is presence of pain, it is suggestive of sialolith. Calcified lymph node appears to be cauliflower shaped.

Phleboliths

Sialolith: It occur singly, if multiple sialoliths are present , they are oriented in a single line while phleboliths are multiple and have more random clustered distribution and is associated with vascular lesion.

Calcified Lymph Node

• Sialoliths: It is painful and have smooth outline. Patient may have symptoms related to submandibular salivary gland. Sialography aid in diffrentiation.
• Phlebolith: These are smaller and have concentric radiopaque and radiolucent rings, its shape may mimic a portion of blood vessel.