7a Radiograph Findings by xV43uA2v


									Subject: radiograph finding

DR: REMA 3zzam
lec: 7 diagnosis
date: 15/11/2011

      When to request a radiograph (RG)??
      And what projection of the RG??
      And what help to expect the radiograph??
      Because there is certain limitation….

      ***When to order RG like any diagnostic test??
      **If after doing full history taking and conducting examination and still
      couldn`t reach the definite diagnosis …

      Provisional diagnosis (clinical, preliminary): 2tash5ee9 2lmabd2ee
      definite diagnosis: 2tash5ee9 2lmo2kad

      **if we reach the definite diagnosis but we need to set the detailed tx
      plane e.g you planed for RCT but you need RG to see if you need
      apextomy if there is a periapical cyst OR not…. Or to do RCT or

      ** To distinguish peripheral or central bony lesion e.g biogenic
      granuloma central (intra bony lesion): there is radiographic finding
      (radio-opaque, radio-lucent, or mixed).
      Peripheral (extra bony lesion): soft tissue lesion.. there isn't radiographic

      ** To investigate for asymptomatic lesion as proximal caries .. pt don't
      have pain or food impaction .. to see caries not detectable clinically ..

** Or before constructing CD or partial denture, you should do
panorama to see if there is remaining root or residual cyst that not
produce symptoms..

** To follow up, take preoperative RG for RCT then after 6 months of
RCT to see if the lesion is improved or getting worse..

*** Certain condition can be detected by radiograph other cant:
1- Proximal caries can be detected but occlusal caries not..
Occlusal caries that appear in radiograph can be detected clinically ..

2- Periodontitis but not gingivitis.. to assist the severity of the disease

3- Missing tooth or teeth without history of extraction to see if the tooth
embedded in the bone or not formed…

4- Pulp condition but not pulpitis (pulpitis is diagnosed by clinical
complain of pt and vitality test)..

5- Pulp condition like stones or calcification or sclerosis or certain
condition made the pulp chamber larger….

6- Assessment of root before RCT or extraction, or using this tooth as
abutment, curved root or ankylosed root, external resorption..

7 – Intra bony lesion cyst or tumor or bone disease as osteomylitis:
inflammation of bone and bone marrow, Paget disease, osteoporosis,

8- Bone manifestation: systemic disease that might effect bone as sickle
cell anemia, thalasemia.. the bone changing here widening and expansion
in the marrow spaces … in anemia bone make compensatory reaction by
being hyperactive to create more RBC…

9- Hyperparathyroidism HPT: bone changes that appear in RG is
radiolucent bone because PTH hormone cause leaching out of Ca from

bone including jaw..

10- Scleroderma: C.T disease cause fibers of C.T of the skin, mucosa and
internal organs.. changes: concavity at muscle attachment .. and
generalized widening of all teeth , become double the width of normal
without periodontitis ..

***Caries: the preferable view to detect caries …
this pic shows recurrent caries and proximal caries that may not detect
clinically or appears grayish discolored under the marginal ridge..(refer to
slide to get the pic)

*** Periapical (refer to slide): here caries within enamel and
interproximal caries..

***Periodontitis: can be assessed by bitewing RG to see the alveolar

Panorama is used to general assessment for bone and periodontal space
if there is pocketing and bone loss 5 mm and more we take OPG
if less than that the panorama not helpful

Refer to the slide ( this is for young pt with good oral hygiene and he has
mobility in 6s and centrals .. this is aggressive juvenile periodontitis

*** Wisdom: take panorama
this is pt 18 or 20 has no canine >>> in RG it shows impacted canine
and its surrounded by dentigerous cyst (attached to the neck of the tooth
at CEJ and this is the main characteristic for dentigerous cyst)

*** Before Extraction: to assist num and shape of root, dicelaration
(sharp bend of the root) this thing complicate the extraction..

*** Hypercementosis (excess cement is deposited on the root surface..
***Concrosion (fusion of the cementum of 2 adjacent teeth with loss of
interseptal bone so if you take a head so you will extract 2 teeth instead of

*** Before RCT see too see the condition of the pulp not pulpitis, to see
if there is sclerosis, internal resorption, num and shape of the root canal
and periapical bone ..

Refer to the slide to see the periapical lesion which is chronic in nature,
this is radiolucent lesion that is well defined with corticated border so this
feature is applied to chronic lesion which expanded slowly so the bone
have the chance to be sclerotic at the margin so this is applied to
periapical granuloma or periapical cyst not periapical abscess..

Now another photo:
there is a tooth which we free of caries with wide periapical lesion and
the tooth not vital, there is dicelaration of the root, but this not cause the
problem, there is a dense in dentine that cause that causes un detectible
pulp exposure m3 2nha ma feha caries .. and had bebyen 2hmeat RG
before RCT or extraction..

***Cyst: might be odontogenic (derived from odontogenic epithelium
which is remnants of the epithelium that derived after the formation of the
tooth germ..)
OR ymken tkoon non odontogenic..

In this slide (refer to the slide) what is this do u think odontogenic or non
odontogenic??? It is non odontogenic, why?? Because it is inferior to the
ID l2noo el teeth bttkon above the ID, now describe the lesion: this is
radiolucent, well defined, has sclerotic margin, in the posterior of the
mandible just Anterior to the angle of the mandible.. fe lesion 25dna
btmyez bnfs this feature .. lo 25dna biopsy men hoon benlagee salivary
gland tissue ..(this is stafne’s bone cyst ).. bykoon 3na extra lumen from
the mandibular salivary gland at this site .. it is incidental finding has no
symptoms ..

Refer to slid,, hoon 3na radicular cyst, dentigerous cyst ..
Another cyst.. lateral periodontal cyst .. lesh 7kena this provisional
diagnosis ?? Because it is small radiolucent with sclerotic margin appears
between the two premolars but we still need to confirm l2no 3na other

Another slid.. 3na hoon impacted tooth which displaced apically w hay
yemken tkoon large dentigerous cyst..

D/D of the radiolucent area that related to impacted tooth:
* Dentigerous cyst
*Ameloblastoma (unisystic, related to impacted tooth)
*ymken tkoon ameloblastic fibroma
*Adinomatied odontogenic cyst (bkone feha calcification)

Tumors: according to the slides this is a poly cystic lesion and this is
feature of ameloblastoma it has sun papillaries appearance, at the angle
and extend to the ramus , typically ameloblastoma is follicular..

This pic (refer to the slide) pt who don’t have the canine yet..
the canine appear impacted and there is something preventing the canine
eruption,, because of these small radiopaque masses and surrounded by
radiolucent occlusal rim (these are compound odontome) because you
have small rounded masses which is one the commonest tumor
preventing the teeth from eruption..

Inflammatory bone condition starting from simply widening of the PDL
which start 3adatan apically
 hla2 ymken ykon 3na periapical abscess it is not simply widening of the
PDL we have resorption of the periapical alveolar bone..

hal2 had 2l mander kteer r7 nshfoo bl lower molar
condensation of bone it is become radiopaque w kman 3na widening of
the PDL condensing osteitis which is a type of chronic osteomylitis and
the tooth which have this condition is not vital and it is asymptomatic ..

  but the acute osteomylitis there is resorbtion, and it is pain full and is
  tender, ymken ykon 3na expansion, paresthesia of the area, systemic
manifestation: fever, acute osteomylitis it is resorpative lesion it appear as
muff eaten, irregular radiolucency in bt there is opacity these are necrotic
       bone that is called sequestrum in case of acute osteomylitis,

acute osteomylitis appear in RG as malignant lesion which is irregular not
                        have distinctive border..

    Refer to the slide here these are the two mandibular central incisor
 radiolucency.. this may be a periapical lesion or abscess, these teeth are
caries free .. so we should do the vitality test, if these teeth are founded to
 be normally vital .. is there another diagnosis ?? After 6 month we take
another RG and we found this and there was a little of radiopaque nodule
        within radiolucent, this is periapical cemental dysplasia it is
asymptomatic >> not affect the vitality of teeth, mainly in lower anterior
    and the tooth not mobile …………………………………………..

                                   The End

Done By: Bara’ah Al-Shboul


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