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179 Cards in this Set
- Front
- Back
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Anomaly
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oddity; inconsistency or deviation from the norm
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Congenital
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A condition that is present at birth by either heredity or environmental influences.
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Acquired
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not congenital in that it develops after birth and may be environmental in nature
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Dyostosis
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defective ossification of fetal cartilages
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Dysplasia
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ill formed abnormality of development
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Dystrophy
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disturbance in bone growth and modeling resulting from a disturbance in osseous nutrition or metabolism
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Types of Dental Anomalies
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-number of teeth
-size of teeth -eruption or position of teeth -morphology (form) of teeth |
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Number of teeth
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-hyperdontia or supernumerary teeth
-mesiodens - hypodontia - oligodontia - anodontia |
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Size of teeth
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- Macrodontia
- Microdontia |
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Eruption or Position of Teeth
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- impaction
- transposition - ankylosis - ectopia |
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Morphology (form) of teeth
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-Gemination
-Twinning -Fusion -Concrescence -Taurodontism -Dens Invagination -Dens Evagination -Dilaceration |
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Number of Teeth
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-hyperdontia: too many teeth aka supernumerary teeth
-mesiodens: most common single supernumerary tooth -premolar: most common in mandible (peridens) - "fourth" molar (paramolar/distodens) -hypodontia: missing one or a few teeth -oligodontia: missing numeroud teeth (more than 6) -anodontia: missing all of the teeth |
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Diseases with Supernumerary teeth
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-Gardner's syndrome
-Cleidocranial Dysplasia |
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Most common single missing tooth:
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-max incisor
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Most common missing teeth:
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-third molars
-second premolars -maxillary lateral -mandibular incisors |
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Ectodermal Dysplasia
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-autosomal dominant disorder where at least two ectodermal structures are missing such as hair, nails, sweat glands, skin and teeth
-may be seen with down syndrome, cleft lip/palate, hemifacial microsomia, radiation to the jaws in a child |
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Macrodontia
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-true generalized (could be with pituitary gigantism)
-relatively generalized -single tooth - teeth are larger than normal -usually affects only one tooth may occur with: -vascular abnormalities (hemangioma) -hemihypertrophy of the face -pituitary gigantism (generalized) may cause: - crowding -impactions -malocclusion could be confused with fusion, gemination and positioning errors |
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Microdontia
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- a tooth or several teeth that are smaller than normal and may have an abnormal form
most commonly localized -max incisors- peg lateral -third molars may be syndromic -congenital heart disease -progeria (rapid aging in childhood and failure to grow) -down syndrome |
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Size of teeth Rule out
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-positioning errors (too far forward) x-ray too far forward
-supernumerary teeth -irradiation o the jaws causing dwarfing of the teeth |
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Impaction
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-teeth incased in bone or soft tissue
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Transposition
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neighboring teeth trade positions
-most common in permanent canine and 1st premolar -easily identified -teeth altered prosthetically |
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Ankylosis
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tooth becomes fused withthe bone and fails to erupt properly
-common in primary teeth -fusion to bone caused by trauma (avulsion), infection, absence of permanent tooth -can cause the tooth to look submerged -loss of lamina dura and PDL -difficult to extract |
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Ectopia
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displaced or incorrectly positioned tooth/follical
-abnormal position of tooth/follicle -most common in permanent incisors and canines |
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Impactions
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-tooth that fails to erupt
-evident radiographically -canines and molars most common |
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Fusion
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-missing tooth when teeth are counted- two teeth fused into one and joined by dentin
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Gemination
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-normal number of teeth when counted- tooth bud tries to divide, twinning
-clefting or invagination of the crown -single pulp chamber may be enlarged or partially divided -normal number of teeth -most common in primary teeth but also in permanent teeth -most common in incisor and canines, rarely in premolar -complete division of tooth bud = twinning -can be confused with fusion- remember to count teeth |
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Fusion (synodontia)
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-dentin fused together
-two pulp chambers -no PDL space between, one less tooth in arch differentiate from: gemination macrodontia concrescence |
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Concrescence
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-teeth fused by cementum
-max molars most often involved -true concrescence- occurs during development by space restriction -acquired concrescence- local trauma, excessive occlusal force or local infection after development Radiograph shows -no alveolar bone or PDL between teeth -roots connected by cementum -PDL and lamina dura surround roots of both teeth -hypercementosis surrounding roots of both teeth Differential Diagnosis: superimposed teeth fusion hypercementosis CAUTION FOR EXTRACTIONS |
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Taurodontism
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-molars are shaped like a "bull"
-large "trunk"- extension of pulp -short roots -normal crown -noted on radiographs only -may see with Down's Syndrome or Amelogenesis Imperfecta |
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Dilaceration
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-extreme root or tooth curvature
-noted radiographically -most common in maxillary premolars and incisors -result of mechanical trauma or developmental -B/L placed roots appear circular (bull's eye) Differential Diagnosis: -fused roots -sclerosing osteitis -dense bone island |
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Functions of bone
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-Support
-Protection -Environment for hemopoiesis -Reservoir for calcium in the body (99% of body calcium is in the skeletal structure) |
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Types of Bone (Frequency of Remodeling)
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Normal bone is constantly remodeled:
-Cortical bone - 5-10% of mass replaced per year -Trabecular bone - 20% of mass replaced per year |
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Radiographic Presentation of Systemic Diseases
(Generalized manifestations in the jaws) |
-Change in size & shape of the bone
-Change in the number, size, and orientation of trabeculae - Change in the trabecular pattern -Altered thickness & density of cortical structures -Increase/Decrease in bone density - Generalized radiolucency/radiopacity |
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Radiographic Presentation of Systemic Diseases
(Adult dentition NOT affected by systemic conditions) |
-Decrease in bone density = the teeth stand out & cortical structures appear thin
-Increase in bone density = loss of contrast between mandibular cortex & cancellous bone, IAN more distinct |
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Radiographic Presentation of Systemic Diseases
(Dental alterations during tooth formation) |
-Accelerated or delayed eruption
-Hypoplasia --> underdevelopment or incomplete development of a tissue or organ -Hypocalcification -Loss of distinct lamina dura --> loss of attenuation of lamina dura or a thickening of it |
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Diseases of Defective Calcifications
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-Osteoporosis
-Hypophosphatasia -Renal Osteodystrophy -Rickets & Osteomalacia -Hypophosphatemia -Osteopetrosis |
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Langerhans Cell Diseases
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Malignant:
-Letterer Siwe Disease -Hand Schuller Christian Disease Non-Malignant -Eosinophilic Granuloma |
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Endocrine Disturbances
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-Hyperadrenalism
-Hyperparathyroidism -Hypoparathyroidism -Hypothyroidism & Myxedema -Acromegaly |
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Blood Dyscrasias
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-Agranulocytosis
-Anemias -Thalassemia -Leukemia |
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Systemic & Malignant Neoplasms
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-Lymphoma
-Multiple Myeloma -Metastatic lesion to the Jaws |
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Dens in Dente
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-invagination
-may result in necrosis and rarefying osteitis- lateral incisors, max centrals, premolars and canines |
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Dens Evaginatus (Leong's premolar)
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-folding outward of the enamel organ
-Evagination- enamel covered tubercle may chip resulting in oral communication -most common in lateral incisors and premolars |
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Enamel Pearl
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-small globule of enamel that forms on the roots of molars
-apical to the CEJ, often in the furcation -usually not clinically detectable -differential dx: calculus, pulp stone |
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Talon Cusp
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-accessory cusp located on the lingual surface of maxillary or mandibular incisor
-pathogenesis: developmental anomaly, frequently in cleft palate syndrome |
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Turner's Hypoplasia
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-local hypoplastic defect in the crown of a permanent tooth
-caused by infectious or mechanical trauma -alteration in normal contours of affected tooth -differential dx: high dose of therapeutic radiation, caries |
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Other Systemic Diseases
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Scleroderma
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Hutchinson's Teeth (congenital syphilis)
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-keratin deposits on cornea
-disease of the inner ear -mulberry molars -screw driver incisors |
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Osteoporosis
(Definition & at risk population) |
Generalized decrease in bone mass:
-Changes in architecture & volume of trabecular bone -Changes in the size & thickness of trabeculae Population at risk: postmenopausal, thin, Caucasian women |
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Osteoporosis
(Secondary Osteoporosis) |
-Results from nutritional deficiencies, hormonal imbalance (i.e. too much thyroid or excessive medication for hypothyroid), inactivity, or corticosteroid or heparin therapy
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Osteoporosis
(Radiographic Features) |
-May cause a fracture:
*Distal radius, proximal femur, ribs, hip & vertebrae *May notice loss of height or back pain -Generalized radiolucency of jaw when compared to teeth -Sparse trabecular bone -"Pitting" of cortical bone -Thinning of cortical boundaries -Thin lamina dura |
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Hypophosphatasia
(Definition) |
Reduced production or defective function of alkaline phosphatase = Defective Bone Matrix
-Enzyme needed for normal osteoid mineralization -Low serum alkaline phosphatase Rare inherited disorder (normally autosomal dominant - homozygous will often die) |
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Hypophosphatasia
(Radiographic Features: Teeth & Jaws) |
Jaw:
-Generalized radiolucency -Thin cortical bone & lamina dura -Poorly calcified alveolar bone appears deficient Primary/permanent teeth: -Thin enamel layer -Large pulp chambers -Large root canals -Hypoplastic -Lost prematurely |
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Hypophosphatasia
(Radiographic Features: Skull) |
-Enlargement of the long bones
-Skull deformities *Poorly calcified (radiolucent) *Premature closure of skull suture *"beaten metal appearance" *Skull is abnormally shaped -Adults - reduction in bone density |
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Renal Osteodystrophy/Renal Rickets
(Chronic Renal Failure) |
-May resemble rickets
-May resemble hyperparathyroidism: *generalized loss of bone density *thinning of bony cortices (all cortical bone is missing) *Rarely - bone density increase *may have brown tumors (radiolucent & has a lot of blood in the biopsy specimen) -Jaw enlargement noted with dialysis: *enlargement of cancellous bone (granular pattern) |
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Renal Osteodystrophy
(Presentation in Children & Adults) |
Children - growth retardation & frequent fractures
Adults - softening & bowing of bones (erosion of the cortex in long bones) |
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Renal Ostedystrophy
(Radiographic Features) |
Jaws:
-Decreased density/rarely an increase -Decrease in the # of internal trabeculae -May have a granular pattern of bone -thin cortical boundaries (indistinct outer cortex) Teeth: -Absence of lamina dura -Susceptible to non vitality -Rarely - Sclerotic bone causes --> lamina dura/corticies less apparent (slightly sclerotic appearance) |
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Renal Osteodystrophy
(Increased Radiolucency & Radiopacity) |
Increased Radiolucency:
-Loss of bone mass -Loss of lamina dura -Sclerotic bone pattern around teeth Increased Radiopacity: -Loss of inferior cortex (IAN jumps out at you) |
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Rickets & Osteomalacia
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-Defect in the normal activity of the metabolites of vitamin D required for resorption of calcium in the intestines
-Non deposition of calcium salts = hypocalcemia -Rickets --> disease in a growing skeleton (infants, children) -Osteomalacia --> disease in a mature skeleton (adult) |
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Rickets
(Radiographic Features: General) |
-Skull may be radiolucent
-Characteristic bowing of the soft weight bearing bones (femur, tibia) -Greenstick fractures |
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Rickets
(Radiographic Features: Jaws) |
-Changes occur after those in the ribs & long bones
-Trabeculae are reduced in density, number & thickness -Radiolucent (teeth may appear to have no support) -Thinning of cortical structures --> inferior border of mandible & IAC |
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Rickets
(Radiographic Features: Teeth) |
-Hypoplasia of developing enamel especially before the age of 3
-Delayed tooth eruption/erupt in unusual order -Lamina dura & cortical boundaries of follicles may be missing/thinned -Teeth may have no roots (like in dentin dysplasia), but the pulp chambers are not demilune shaped |
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Osteomalacia
(Radiographic Features) |
General:
-Thinning of bone corticies -Pseudofractures Jaws: -None -General radiolucency with sparse trabeculae Teeth: -None - teeth are already formed -Long-standing or severe cases may cause thinning of the lamina dura |
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Hypophosphatemia
(aka Vitamin D-resistant rickets or Hypophosphatemic rickets) |
Children
-Reduced growth -Rickets like boney changes *Bowing of the legs *Enlarged epiphyses *Skull changes Adults -Bone pain -Muscle weakness -Vertebral fractures |
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Hypophosphatemia
(Radiographic Features: General & Jaws) |
General:
-Children --> same as rickets -Adults --> long bones have persistent deformities, fractures & pseudofractures - osteoporotic bone Jaw: -Radiolucency (may be extreme) - very porotic -cortical boundaries radiolucent/not apparent -Fewer visible trabeculae or a granular pattern |
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Hypophosphatemia
(Radiographic Features: Teeth) |
-Poorly formed
-Thin enamel caps -Large pulp chamber & canals -Periapical & periodontal abscesses common -Premature loss of teeth -Lamina dura sparse & cortical boundaries thin/absent -Spontaneous peripical rarefying osteitis may result from high pulp horns in close proximity to the DEF (allows ingress of microorganisms) |
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Osteopetrosis
(Aka Albers-Schonberg & Marble bone disease) |
-Abnormal formation of the primary skeleton (defect of osteoclasts)
*Generalized increase in bone mass (less vasculature = increased risk of osteomyelitis) -Failure of normal bone remodeling *Dense, fragile bones *Fracture & infection -Obliteration of the marrow *Compromises hematopoiesis *Compresses cranial nerves - cranial nerve palsies |
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Osteopetrosis
(Radiographic Features: General & Jaws) |
General:
-Increased density (radiopaque) *Bilateral & symmetrical *Homogenous & diffuse -Trabecular patterns & cortices obscured -Bone may be mildly enlarged Jaw: -Increased radiopacity -Internal structure & teeth not visible |
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Osteopetrosis
(Radiographic Features: Teeth) |
-Delayed eruption - both primary & secondary dentition
*Bone density & ankylosis (impaction) -Early tooth loss -Missing teeth -Malformed roots & crowns -Poorly calcified & caries prone -Lamina dura/cortical borders thicker than normal |
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Langerhans Cell Diseases
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Malignant:
-Letterer Siwe Disease --> multiple organs & sites are involved in children under the age of 2 -Hand Schuller Christian Disease --> exopthalmos, polyuria, polydipsia, osteomalacia & multiple skull defects noted in children Non-Malignant: -Eosinophilic Granuloma --> solitary or multiple lesions that affect the bone -Adolescent or young adult -Prognosis is good |
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Letterer Siwe Disease - LCH
(Predilection & Radiographic Features) |
Occurs very young, is rapid & often fatal
Radiographic Appearance: -The skull shows multiple areas of radiolucency with irregular outlines (may look like multiple myeloma; however, multiple myeloma occurs in adults) -There is saucer-shaped destruction of alveolar process -The teeth become unsuported by bone -There are multiple lesions |
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Eosinophilic Granuloma - LCH (Radiographic Features)
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-Posterior Mandible
-Unilocular or multifocal -Well defined and non-corticated -Radiolucent lesion -"Punched out" or "scooped" appearance -Destruction of bone & lamina dura (may look like a periodontal defect, but should not be in a young child) -Teeth "floating in air" appearance -Loose teeth -Root resorption is rare -Periosteal new bone reaction -Skull lesions have a beveled appearance (button sequestrum - the remaining bone that is still between the lesion --> looks like a lesion within a lesion) |
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Hyperadrenalism: Cushing's Syndrome
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-Many distinctive clinical changes
*moon face -Radiographic appearance: *Generalized osteoporosis *Loss of the lamina dura in isolated areas |
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Hyperparathyroidism
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Radiographic signs may precede the clinical signs
Radiographic Appearance: -There can be generalized or localized manifestations (moth-eaten appearance) |
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Hyperparathyroidism
(Generalized) |
-Osteoporosis of both jaws
-Granular bone pattern -Complete loss of lamina dura -Multiple external resorption of teeth -Teeth appear radiopaque in constrast to the radiolucent jaws -Roots look slightly spiky in appearance in the maxilla AND the mandible (if only in 1 arch, then suspect a malignancy) |
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Hyperparathyroidism
(Localized) |
-A radiolucency with a thin cortex (may be moderately well defined or ill-defined), containing fine strands of opacity of granular structure (brown tumor of hyperparathyroidism)
-No mandibular cortical border (all the bones looks the same) -Marked resorption of teeth in the proximity of the lesion |
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Hypoparathyroidism
(Radiographic Appearance) |
-The skull shows areas of radiopacity in the region of the basal ganglion
-There is increased density of radiopacity in the mandible & maxilla. Rarely there is increased radiolucency. -Hypoplasia of the enamel -Late eruption -Dilaceration -Multiple external resorption -"Beaten metal" appearance in the calvarium |
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Hypothyroidism
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-Fontanelles late closing
-Wormian bones -General osteoporosis -Mandible & maxilla small -Thinning of lamina dura -Delayed eruption -Short roots These signs are only seen in children |
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Acromegaly
(Hyperpituitarism) |
-An example of acromegaly manifesting as excessive growth of the mandible, resulting in a Class III skeletal relationship of the jaws.
-A portion of the lateral skull view demonstrating enlargement of the sella turcica from a pituitary tumor (enlargement more than 1.2-1.7cm indicates a pituitary cyst or tumor) |
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Agranulocytosis
(Primary & Secondary Radiographic Changes) |
1. Primary Radiographic Appearance:
-Osteoporotic bone -Granular pattern of bone -Loss of lamina dura -Slight loss of bone outside the lamina dura 2. Secondary -Due to infection brought about by impairment of the gingival tissues. Radiographic Appearance: -Periodontal disease -Teeth exfoliated Generally caused by neutropenia |
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Anemias
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According to the type of anemia & the age of the patient, radiographic changes may be visible.
In general, the younger the patient, the greater the likelihood of there being changes in the mandible & maxilla. |
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Sickle Cell Anemia
(Radiographic Features: General) |
Extent of bone changes relates to the degree of hyperplasia of the bone marrow (Low O2 tension with sickling of blood cells, body tries to defend itself by making more blood to increase the oxygen. Therefore, you get widening of the bone marrow & may show a more radiolucent appearance)
Thinning of individual cancellous trabeculae & cortices: -Vertebral bodies, long bones & skull & jaws -Long bones show osteoporosis, periosteal new bone & areas of sclerosis |
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Sickle Cell Anemia
(Radiographic Features: Skull) |
-Thinning of the inner & outer tables
-"Hair-on-end" appearance when outer table not visible (5%) -Localized bone sclerosis --> infarction -Osteomyelitis -Growth retardation |
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Sickle Cell Anemia
(Radiographic Features: Jaws) |
Generalized radiolucent appearance:
-Decrease in the volume of trabecular bone (looks like osteoporosis in postmenopausal women, but it's in a child) -Possible thinning of the cortical plates -Mandible & maxilla large bone marrow spaces |
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Thalassemia
(Various Forms) |
-Red blood cells
*Reduce hemoglobin content *Thin *Shorted life span -Thallassemia minor (heterozygous form) *Develops in adults *Radiographic changes usually absent *Middle Eastern or African descent -Thalassemia intermedia -Thalassemia major (homozygous form) *Develops in infants (can be fatal) *Prominent cheekbones & protrusive premaxilla ("rodentlike" face) Bone marrow spaces are much larger than Sickle Cell anemia |
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Thalassemia
(Radiographic Features: General) |
Generalized radiolucency of bones with cortical thinning
-Hyperplasia of ineffective bone marrow (pt looks much smaller than his/her age) -Failure to produce normal RBCs -More exaggerated appearance than other anemias Skull -Thickening of the diploic space - especially frontal region -Generalized granular appearance -"hair-on-end" appearance is possible (more possible in thalassemia than SCA) -Small maxillary sinuses |
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Thalassemia
(Radiographic Features: Jaws) |
-Radiolucent with thinning of cortical borders
-Enlargement of marrow spaces -Trabeculae are large & course -Lamina dura is thin & roots of teeth may be short -Severe cases --> decreased paranasal sinus pneumatization & expansion of the maxilla causing malocclusion (large maxilla is trying to compensate for not enough oxygen) |
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Leukemia
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A malignant disease of the hematopoietic tissue.
-Sometimes there are no detectable changes -The skull may show patches of radiolucency -Generalized osteoporosis of both jaws -Destruction of the crest of the alveolus, leaving an irregular surface (flame-like; (or asymmetric widening around the tooth roots) -Loss of lamina dura & surrounding bone -Loss of crypts (loss of the bony/follicular space that the tooth is is) |
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Lymphoma
(Radiographic Appearance) |
-Osteolytic lesions
-Diffuse radiolucency in the alveolar bone (loss of the cortical border of the maxillary sinus) -May see a dome shaped mass. Big Clue = displacement of the teeth |
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Multiple Myeloma
(Clinial Features) |
Aka Myeloma aka Plasmacytoma
-Malignant neoplasm of plasma cells -Most common malignancy of bone in adults -Plasmacytoma = single lesions -Multiple myeloma = multiple lesions -Fatal systemic malignancy -Orally --> may have no radiographic findings but complain of pain, swelling, hemorrhage, paresthesia & dysesthesia -These pts do not live past 5 or 6 years. |
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Multiple Myeloma
(Radiogrphic Features) |
-Well defined & noncorticated
-Radiolucent -Multiple "punched out" lesions -Borders can be ragged & infiltrative -Periapical PDL lesions mimic inflammatory periapical disease -Teeth may appear to be "too opaque" in the osteopenic background -Loss/thinning of cortical boundaries (non-corticated) -"Sunburst" periosteal reaction rare. |
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Metastatic Tumors
(Radiographic Features) |
-Irregular radiolucency with diffuse borders --> Moth eaten appearance
-Generally seen in the mandible -Posterior mandible is the most common site -Can stimulate a periosteal reaction --> sunray appearance -Non uniform widening of the PDL -Teeth may appear to be floating in air -Destroys cortical boundaries |
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Most common cancers tha tmetastasize to the jaws:
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Breast (31%), Lung (18%), & Kidney (15%)
Breast & Prostate cancer can appear more sclerotic |
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Scleroderma
(Definition) |
Aka Progressive Systemic Sclerosis
-Generalized connective tissue disease (collagen production is missing) -Patient may not look like he/she has any facial expression (have Reynaud's phenomenon) |
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Scleroderma
(Radiographic Features: Jaws) |
Pattern of mandibular erosions at muscle attachments (angles, coronoid process, digastric region & condyles)
-Bilateral & symmetric -Smooth & sharply defined -Progressive with disease |
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Scleroderma
(Radiographic Features: Teeth) |
Increased width of the PDL (Will be SYMMETRIC)
-Noted in 2/3s of patients -Twice as thick as normal -Anterior & posterior teeth affected -Teeth are not mobile & gingival attachments are intact -Lamina dura remains normal |
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Scleroderma
(Limited Symptoms) |
CREST:
C-Calcinosis --> calcium deposits in the skin R-Raynaud's phenomenon --> spasm of blood vessels in response to cold or stress E-Esophageal dysfunction --> acid reflux & decrease in motility of esophagus S-Sclerodactyly --> thickening & tightening of the skin on the fingers & hands T-Telanglectasias --> dilation of capillaries causing red marks on surface of skin |
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3 Systemic/Metabolic Diseases with a "beaten metal" appearance:
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Crouzon's disease
Hypophosphatasia Hypoparathyroidism |
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Abnormalities of Form
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-Amelogenesis Imperfecta
-Dentinogenesis Imperfecta -Dentin Dysplasia -Regional Odontodysplasia |
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Amelogenesis Imperfecta
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-Hereditary defect of enamel
-an ectodermal disturbance -enamel hypoplasia due to an incomplete or defective formation of the enamel matrix of primary and permanent teeth -tendency toward impaction -normal dentin structure -resistance to caries -Four general types (White & Pharoah) hypoplastic hypomaturation hypocalcification hypomaturation/hypocalcification |
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Dentinogenesis Imperfecta
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-hereditary opalescent dentin
-hereditary condition affecting primary and permanent dentition where dentin is defective -more prevalent than amelogenesis imperfecta -three types -DEJ is smooth bulbous crowns -constricted necks -shortened roots -imperfect formation of dentin sometimes assocaited with OSTEOGENESIS IMPERFECTA |
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Dentinogenesis Imperfecta Type 1
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-with osteogenesis imperfecta, blue sclera multiple fractures and scars
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Dentinogenesis Imperfecta Type 2
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-does not occur in association with osteogenesis imperfecta. Most frequently referred to as hereditary opalescent dentin
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Dentin Dysplasia
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-rare occurence
-rootless teeth -autosomal dominant -two types type 1 and type 2 |
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Type 1 Dentin Dysplasia
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-short roots, conical in shape and sometimes known as "rootless teeth",
-Molar will have a shallow W shape, 20% assoc with periapical lesions -four variations |
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Type 2 Dentin Dysplasia
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-Coronal
-normally shaped roots, normal length, pulp chambers become flame or thistle shaped with multiple pulp stones |
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Regional Odontodysplasia
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-large pulp chambers
-thin enamel -hypocalcified, thin dentin -usually restricted to a region such as a single quadrant -also known as "ghost teeth" |
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Nonodontogenic anomalies of the jaws
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-stafne bone defect
-exostosis/enostosis -TMJ Abnormalities -incisive canal cyst -cleft palate -max sinus anomalies -craniofacial developmental disturbances of the face and skull |
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Coloboma
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a hole in one of the structures of the eye- congenital defect most commonly of the iris (keyhole)
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Brachycephalic
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someone who has a short, broad head
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Hypertelorism
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abnormal increase between two organs/parts of the body- eyes
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wormian bones
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extra small, irregular pieces of bone that occur within a suture of the cranium
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synostosis
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abnormal fusion of neighboring skeletal bones making one larger bone
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Oxycephaly
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congenital abnormality of the skull that leads to a cone shape appearance of the head. Caused by premature closure of the lambdoid and coronal sutures
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Trigonocephaly
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congenital abnormality of the skull that leads to a triangular appearance of the head. Caused by premature closure of the lambdoid and coronal sutures.
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Stafne Bone Defect
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-group of concavities on mandibular lingual surface- submandibular gland fossa most common
-described by Stafne in 1942 -caused by growth of salivary gland -rarely-medial surface of ascending ramus from parotid gland -unknown etiology-Pressure resorption & fatty tissue growth |
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Exostoses/Enostoses/Tori
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-limited boen hyperplasia
-maxillary tori are most common (20%) -mand tori (8%)>exostoses -exostoses seen mostly in the maxilla usually along the facial/buccal surfaces -composed of compact bone -enostoses= internal counterparts to exostoses |
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TMJ Abnormalities
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-condylar agenesis
-condylar hyperplasia -bifid condyle |
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Incisive Canal Cyst
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-classic heart shaped appearance
-if larger than 6mm then it is suspicious for cyst |
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Incisive Canal Cyst
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-classic heart shaped appearance
-if larger than 6mm then it is suspicious for cyst |
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Maxillary sinus anomalies
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-sinus pneumatization-expansion of the sinus into edentulous spaces
-sinus hypoplasia -sinus agenesis-sinus never forms |
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Maxillary sinus anomalies
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-sinus pneumatization-expansion of the sinus into edentulous spaces
-sinus hypoplasia -sinus agenesis-sinus never forms |
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Sutures
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-a baby's brain grows 70% of it's adult size by age one
-premature closure makes the head shape irregular and can lead to mental retardation, blindness and hearing loss |
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Sutures
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-a baby's brain grows 70% of it's adult size by age one
-premature closure makes the head shape irregular and can lead to mental retardation, blindness and hearing loss |
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Cleidocranial Dysplasia
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-a congenital hereditary condition
-abnormalities of skull, teeth, jaws, clavicle and some longbones -skull has a flat appearance -partially or totally missing clavicle -retention of decidous teeth -delay in eruption of permanent teeth -supernumerary teeth -multiple impactions -dentigerous cysts may develop -large head with frontal and parietal blossing -high arched palate -small sinuses- maxillary micrognathia -hearing loss |
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Cleidocranial Dysplasia
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-a congenital hereditary condition
-abnormalities of skull, teeth, jaws, clavicle and some longbones -skull has a flat appearance -partially or totally missing clavicle -retention of decidous teeth -delay in eruption of permanent teeth -supernumerary teeth -multiple impactions -dentigerous cysts may develop -large head with frontal and parietal blossing -high arched palate -small sinuses- maxillary micrognathia -hearing loss |
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Craniofacial Dysplasia -Crouzan's Syndrome
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-early closure of all cranial sutures (radiographic absence of sutures)
-"frontal bossing" bulging of frontal bone -hypertelorism (eyes are wide apart) -"beaten metal" appearance- cranial markings which look like digital impressions seen in the cranial vault -normal mental capacity |
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Craniofacial Dysplasia -Crouzan's Syndrome
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-early closure of all cranial sutures (radiographic absence of sutures)
-"frontal bossing" bulging of frontal bone -hypertelorism (eyes are wide apart) -"beaten metal" appearance- cranial markings which look like digital impressions seen in the cranial vault -normal mental capacity |
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Mandibulofacial Dysplasia
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-treacher collins syndrome
-underdevelopment of the mid-facial region -coloboma of the eyes -malformation of the external ear -atypical hair growth -macrostomia -radiographic findings -hypoplasia of the facial bones especially the zygoma -facial clefts and other skeletal deformities |
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Bone Dysplasias
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-Fibrous Dysplasia: monostotic and polystotic
-Cemento-Osseous Dysplasia: Periapical cemento-osseous dysplasia, florid cemento-osseous dyplasia |
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Fibrous Dysplasia Radiographic Features
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-Located 2:1 predilection for the maxilla, more common in posterior region
-ill defined periphery with gradual blending of normal and abnormal trabeculation bone, ground glass, Peau de Orange, Cotton Wool -internal structure is widely variable, can be radiolucent, radiopaque and mixed density -expansion causes cortical effacement, or superior displacement of IAN canal |
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Fibrous Dysplasia Management
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-radiographic diagnosis
-serial follow-up and monitoring -Static Growth when growth of bone stops, radiation therapy and hormonal changes may cause static nature to revert to growing again -Associated Aneurysmal Bone Cysts and Giant Cell Granuloma |
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Periapical Cemental Dysplasias Radiographic Features
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- location: periapical epicenter of growth
-well defined radiolucent periphery, radiopaque or mixed lesions, varying radiolucent border, band of reactive sclerosis -internal structure is varied -loss of normal lamina dura |
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Periapical Cemental Dysplasia management
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-radiographic and clinical diagnosis
-no treatment |
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Florid Osseous Dysplasia radiographic features
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-located bilateral and present in both jaws
-more common in the mandible when involving a single jaw, more common in the mandible when involving a single jaw -periphery is florid, well defined -internally radiolucent, or radiopaque or mixed -prominent radiolucencies may represent Simple Bone Cyst -displacement of buccal and lingual cortical plate, IAN canal, and antral floor. |
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Florid Osseous Dysplasia Management
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-Generally no treatment
-propensity for secondary infection |
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Cemento-ossifying fibroma radiographic features
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-located bilaterally and present in both jaws, more common in the mandible when involving a single jaw
-periphery is well defined, radiolucent rim may be present, sclerotic zone of peripheral bone -internal structure is mixed radiolucent-radiopaque, dependent upon the form of the internal calcified material -displaces surrounding structures such as buccal and lingual cortical plates, IAN canal and antral floor. |
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Cemento-ossifying fibroma management
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-favorable prognosis with enucleation or resection
-unlikely recurrence |
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Central Giant Cell Granuloma radiographic features
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-location: epicenter anterior to the first molar in the mandible, epicenter anterior to the canine in the maxilla
-periphery is well defined and generally non-corticated in the mandible, or ill defined malignant appearing borders in the maxilla -internal structure: radiolucent, when present wispy septa are characteristic of the lesion. If well developed may appear multilocular -displacement and resorption of teeth, marked expansion of cortical boundaries |
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Central Giant Cell Granuloma management
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-computed tomography
-enucleation and curettage -resection -serial follow-up |
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Aneurysmal bone cyst radiographic features
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-location: 3:2 predilection for the mandible, predominantly within the molar and ramus regions
-periphery is well defined, circular hydraulic character -internal structure: multilocular with septation similar to the pattern of central giant cell granuloma -extreme expansion, displacement and resorption of teeth |
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Aneurysmal bone cyst management
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- surgical curettage
-resection -serial follow up |
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Cherubism radiographic features
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-located bilaterally often effecting both jaws, epicenter is always in the posterior aspect of the jaws, growth in an anterior direction
-periphery is well defined sometimes corticated -internal structure is prominent multilocular pattern with fine granular bone and wispy septa characteristic of central giant cell granuloma -marked expansion of cortical boundaries, teeth displaced anteriorly |
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Cherubism managment
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-treatment delayed until bone growth static
-cosmetic surgical procedures -surgical exposure and orthodontics |
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Paget's Disease radiographic features
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-located in pelvis, femur, skull, vertebrae and infrequently the skull, 2:1 predilection for the maxilla
-Effects entire bone, ill defined, malignant appearing borders in the maxilla -internal structure: early radiolucent, mixed, late radiopaque -bony enlargement, associated hypercementosis -increased bone density involving the entire bone, bony enlargement |
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Paget's Disease Management
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-medical pharmacology: calcitonin, sodium etidronate, bisphosphonates
-orthopedic surgery -delayed healing of extraction sites with a higher incidence of osteomyelitis -osteogenic sarcoma |
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Langerhans'Cell Histiocytosis radiographic features
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- alveolar and intra-osseous lesions
-location: alveolar lesions: multi-focal, intra-osseous: solitary, mandibular predilection, posterior region of the jaws more common -periphery is eosinophilic granuloma(EG) and moderately to well defined without cortication, alveolar: epicenter of bone destruction mid-root, circular pattern, intra-osseous: varied -internal structure: radiolucent -bone destruction, teeth "floating in space", periosteal reaction similar to the periosteal reaction in inflammatory lesions, pathologic migration not displacement of teeth, minor root resorption |
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Langerhans' Cell Histiocytosis management
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-complete radiographic work up
-Localized lesions: surgical curettage, limited radiation therapy -Disseminated disease: chemotherapy |
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Interpretation Principles
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1. Importance of recognizing normal anatomy
2. The independence of radiographic signs to imaging modalities 3. The principle of symmetry 4. Radiographic signs: terminology & description 5. Categorization of disease and/or abnormalities |
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Viewing Sequence
(Global) |
-Assess symmetry of form & density
-Follow cortical boundaries -Count teeth |
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Viewing Sequence
(Local) |
-Assess periodontal ligament space & lamina dura
-Evaluate root form & canal structure -Assess crowns for caries or abnormality |
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Systematic approach includes:
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-Patient information (age, gender, race)
-History -Symptoms -Clinical examination -Existing diagnostic radiographs -New image selection if needed |
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Radiolucent Lesions
(Terminology) |
-Corticated Unilocular Radiolucency
-Non-corticated Unilocular Radiolucency -Multilocular Radiolucent Lesion -Multifocal Confluent Radiolucencies -Moth-Eaten Radiolucencies |
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Radiopaque Lesions
(Terminology) |
-Focal Opacity
-Target Lesion -Multifocal Confluent Radiopacities -Irregular, Ill-definied Radiopacities -Ground Glass Radiopacities -Mixed Density Radiopacities -Soft Tissue Opacities |
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5 Soft Tissue Radiopacities
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-Calcified lymph nodes
-Siololiths -Tonsilloliths (most common calcification) -Phleboliths (calcified blood clots) -Calcified carotid atheromas |
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Radiographic Signs: Developmental & Congenital
(Dental Anomalies) |
-Variations in number
-Variations in size -Variations in form -Variations in position |
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Radiographic Signs of Trauma
(Recent Trauma to Dentition) |
-Radiolucent fracture line
-Radiopaque fracture overlap -Widened PDL space -Tooth displacement |
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Radiographic Signs: Developmental & Congenital
(Anomalies of the Jaws) |
-TMJ Abnormalities
-Cleft Palate -Maxillary Sinus Anomalies -Craniofacial Developmental Disturbances of the Face & Skull |
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Radiographic Signs of Trauma
(Old Trauma to Dentition) |
-Open apex
-Large pulp canal -Pulpal obliteration/calcification -Root resorption -Periodontal defect/periapical change |
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Radiographic Signs of Trauma
(Mandible & Maxillary Sinus) |
Mandible:
-Oblique fracture (or oblique projection geometry) seen as 2 cortical fracture lines -Disruption in plane of occlusion (step deformity) Maxillary Sinus -Clouding -Air-fluid levels |
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Radiographic Signs of Inflammation
(Acute Inflammation) |
-No radiographic evidence
-Clinical signs & symptoms only sometimes -Inadequate time for changes in calcified content -Widening of periodontal ligament space -Increased radiolucency |
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Radiographic Signs of Inflammation
(Chronic Inflammation) |
-Increased radiolucency
-Increased radiopacity -Mixture of increased radiolucency & radiopacity -Same density, but change in bony pattern -Sequestration, fistula, pathological fracture -"onion skin" appearance, often with thickening |
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Radiographic Signs
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1. Radiographic density
2. Margin characteristics 3. Shape 4. Location & distribution 5. Size 6. Internal architecture 7. Effect on surrounding tissue |
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Radiographic Signs
(Density) |
Benign
-Radiolucent -Mixed radiolucent/radiopaque -Septations, loculations -Radiopaque Malignant -->Always radiolucent, except: -Metastases (Breast cancer & prostate cancer) -Osteogenic sarcoma |
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Radiographic Signs
(Margins) |
Benign:
-Well-defined (narrow zone of transition because of a slow growing, benign process) -Smooth, regular -Corticated Malignant: -Ill-defined (wide zone of transition) -Ragged -Moth-eaten |
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Radiographic Signs
(Shape) |
-Round
-Oval -Undulated -Unilocular -Multilocular -Soap bubble Rule of thumb: if you can discern the shape of a lesion, then it's probably benign (Malignant = irregular shapes) |
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Radiographic Signs
(Internal Architecture/Location & Distribution) |
-Localized or generalized?
-Unilateral or bilateral? -One bone or multiple bones (monostotic vs. polyosteotic) Position: -Soft tissues or the jaws? -Where is the epicenter of the lesion? -Some lesions tend to be in certain locations |
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Radiographic Signs
(Epicenter Coronal to a tooth) |
If the epicenter is coronal to a tooth, the lesion is probably composed or odontogenic epithelium
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Radiographic Signs
(Epicenter Above the mandibular canal) |
If the epicenter is above the IAN canal, the likelihood is greater that it is composed of odontogenic tissue
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Radiographic Signs
(Epicenter Below the mandibular canal) |
If the epicenter is below the IAN canal, it is unlikely to be of odontogenic origin
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Radiographic Signs
(Epicenter Within the mandibular canal) |
If the epicenter is within the IAN canal, it is likely to be of neural or vascular origin
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Radiographic Signs
(Epicenter Within the antrum) |
If the epicenter is within the maxillary antrum, the lesion is not of odontogenic tissue, as opposed to a lesion that has grown into the antrum from the alveolar process of the maxilla.
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Radiographic Signs
(Epicenter Associated with the Condyle) |
The probability of cartilaginous lesions & osteochondromas occurring is greater in the condylar region
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Radiographic Signs
(Effect on surrounding tissues: Cortical Bone) |
Benign:
-Expansion -Thinning -Aggressive benign may erode Malignant: -Erosion -Destruction |
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Radiographic Signs
(Effect on surrounding tissues: Maxillary Sinus) |
Benign:
-Displacement Malignant: -Erosion -Destruction |
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Radiographic Signs
(Effect on surrounding tissues: Mandibular Canal) |
Benign
-Displacement mandibular canal -No neuro-sensory deficits Malignant: -Invasion & destruction of canal -Anesthesia, paresthesia |
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Radiographic Signs
(Effect on surrounding tissues: Tooth Position) |
Benign:
-Displacement -May prevent eruption Malignant: -"Floating teeth" |
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Radiographic Signs
(Effect on surrounding tissues: Tooth Roots) |
Localized root destruction usually is associated with pressure resorption from slowly growing lesions or benign neoplasms such as ameloblastoma
Benign: -Horizontal or near horizontal Malignant: -More variable -Sometimes no root resorption -Spiked roots (vertical root resorption) |
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Radiographic Signs
(Effect on surrounding tissues: Periodontal Ligament Space & Lamina Dura) |
Asymmetric widening of the periodontal ligament space & loss of lamina dura can be a sign of a MALIGNANT tumor, such as:
-Osteosarcoma -Chondrosarcoma -Lymphoma Can also be caused by: -Scleroderma -Vertical root fracture -Orthodontic movement |
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Radiographic Signs of Systemic & Metabolic Disease
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-Generalized radiolucency or radiodensity
-Change in trabecular pattern -Loss or attenuation of lamina dura or thickening -Loss of alveolar crest (or thickening) -Change in eruption pattern of teeth |
