Radiology of lesions

Radiolucent lesions

A. Periapical radiolucency

B. Pericoronal radiolucency (impacted teeth)

AOT
Ameloblastoma – UL/ML – resorbed roots
Ameloblastic fibroma – UL/ML – well circumscribed sclerotic margin, maxilla
CCOT
CEOT
Dentigerous cyst – from neck of crown CEJ, resorbs adjacent roots
KCOT – UL/ML – Anterior posterior direction, radiopaque margin, no roots resorbed

C. Unilocular radiolucency

Dentigerous cyst – UL/ML – from neck of crown CEJ, resorbs adjacent roots
Eruption cyst
Hemangioma
Histiocytosis X – well defined, non corticated, punched out no jaw expansion, no root resorption, therefore floating teeth
Lateral periodontal cyst – usually between canine and premolar
Nasopalatine duct cyst – heart shaped, midline, symmetrical, sclerotic border, >8mm in diameter
Paradental cyst – distal to partially impacted mandibular 8s
Periapical abscess or granuloma
Pleomorphic adenoma – “ball in hand”
Radicular cyst – root divergence, resorption
Scar – dense fibrous tissue in RCT treated tooth

D. Unilocular radiolucency with ragged and poorly defined borders

Burkitt’s lymphoma
Chronic dentoalveolar abscess
Chronic osteitis
Chronic osteomyelitis – moth eaten appearance
Ewing’s sarcoma – onion skin periosteal reaction. Biopsy to differentiate from Garre’s osteomyelitis
Fibrous dysplasia – early, loss of lamina dura, ground glass, expands bone
MNTI
Metastatic tumors of the jaw – moth eaten
Osteogenic sarcoma – osteolytic type
Primary lymphoma of bone – do biopsy
Squamous cell carcinoma

E. Multilocular lesions

Aneurysmal bone cyst – empty intrabony cavity, expands between roots of teeth
Ameloblastoma – UL/ML – resorbed roots
Ameloblastic fibroma – UL/ML– well circumscribed sclerotic margin, maxilla
Ameloblastic carcinoma
Central hemangioma of bone
Cherubism – soap bubble appearance, bilateral
Dentigerous cyst – UL/ML – from neck of crown CEJ, resorbs adjacent roots
Giant cell granuloma – wispy trabeculae
Giant cell lesion of hyperparathyroidism – pepper pot skull, Brown’s tumor
KCOT – UL/ML – Anterior posterior direction, radiopaque margin, no roots resorbed
Odontogenic myxoma – tennis racket appearance

F. Multiple separate radiolucency

COD – early
Histiocytosis X – well defined, non corticated, punched out no jaw expansion, no root resorption, therefore floating teeth
KCOT – UL/ML – Anterior posterior direction, radiopaque margin, no roots resorbed
Metastatic tumors of the jaw – moth eaten
Multiple myeloma – punched out, non corticated radiolucency

A. Periapical radiopacity

Cementoblastoma – well defined, “golf ball” at apex, 2-3 cm, radiolucent halo
COD – late, multifocal
Condensing osteitis/focal sclerosing osteitis – in long standing periapical inflammation
Odontoma
Hypercementosis

B. Discrete and diffuse multifocal radiopacities

C. Generalized radiopacity

AOT – small radiopaque foci in radiolucent lesion
CCOT – “salt and pepper” appearance
Cementoblastoma – well defined, “golf ball” at apex, 2-3 cm, radiolucent halo
CEOT – “driven snow” appearance
COD – early radiolucent, late cottonwool appearance
Cherubism – soap bubble appearance, bilateral
Chronic osteomyelitis – moth eaten appearance
Ewing’s sarcoma – onion skin periosteal reaction
Fibrous dysplasia – early radiolucent, ground glass, late cottonwool appearance, loss of lamina dura, expands bone
Florid COD – cottonwool appearance only in 4 quadrants of the jaws
Garre’s osteomyelitis – onion skin appearance
Giant cell lesion of hyperparathyroidism – pepper pot skull, Brown’s tumor
Multiple myeloma – punched out, non corticated radiolucency
Osteopetrosis – cottonwool appearance
Odontogenic myxoma – tennis racket appearance
Osteosarcoma – sunburst appearance
Paget’s disease – cottonwool appearance, bone deformity
Pleomorphic adenoma – “ball in hand”
Sjogren’s syndrome – “cherry blossom” appearance

Cottonwool appearance:

Moth eaten appearance: