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Image Challenge


March 2016

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A 19-year-old female presented to the Oral Medicine and Diagnostic Clinic. Radiographs were obtained and the panoramic radiograph showed a well-defined, round, radiopaque supernumerary tooth distal to the third molar. What is the likely diagnosis?

 

INCORRECT.

A mesiodens is a supernumerary tooth that develops between the maxillary central incisors.

 

 

CORRECT.

Supernumerary teeth are supplemental teeth, which may or may not be morphologically normal, that develop in addition to the normal set of teeth. They are result of excess dental lamina in development. Those that occur in the molar region are called distodens.

 

INCORRECT.

A peridense is a supernumerary tooth that develops in the premolar region.

March 2016 References

White, Stuart C., and Michael J. Pharoah. Oral Radiology: Principles and Interpretation, 7th Edition. Mosby, 2014. VitalBook file.

 


February 2016

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A 63-year-old male presented to the Oral Medicine and Diagnostic Clinic. Radiographs were obtained and the pan showed generalized enlarged roots that were well-defined and radiopaque. There is an intact PDL space surrounding the roots of the teeth. What is the likely diagnosis?

 

INCORRECT.

Dense Bone Islands present asymptomatically and are most often found in the mandible of the premolar region. The periphery of the lesion is often well defined but may also blend in to the trabeculae of the surrounding bone. There is no radiolucent boarder to these lesions.

 

 

CORRECT.

Hypercementosis is defined by an excessive deposition of cementum on the roots of the teeth, and presents without any clinical signs or symptoms. Radiographically hypercementosis demonstrates an excessive buildup of cementum on all or parts of the roots of the teeth. Most notably, the lamina dura and PDL space continue to encompass the expanded tooth.

 

INCORRECT.

Benign cementoblastoma is characterized by formation of slow growing cementum or cementum like tissue tissue attached to the apex of the tooth. On radiograph it is seen as well-defined radiopaque with cortical border and radiolucent band inside the tumor. The apex of the affected tooth is often resorbed. Based on this radiograph, there is no evidence of root resorption.

 

INCORRECT.

Periapical osseous dysplasia initially presents as a radio lucent lesion at the apex of the tooth. In later stages, the later lesion becomes radiopaque. This mature lesion is surrounded by thick sclerotic boarder with a retained radiolucent periphery. These lesions are most often found in the lower anterior region of the mouth.

February 2016 References

White, Stuart C., and Michael J. Pharoah. Oral Radiology: Principles and Interpretation, 7th Edition. Mosby, 2014. VitalBook file.

 


January 2016

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A 40-year-old African American woman was referred to evaluate the radiopaque entity surrounded by radiolucent structure centered over the apex of tooth #30 (circle). Upon vitality testing, both teeth were vital and no history of pain or sensitivity.

 

INCORRECT.

Benign cementoblastoma is characterized by formation of slow growing cementum or cementum like tissue tissue attached to the apex of the tooth. On radiograph it is seen as well defined radiopaque with cortical border and radiolucent band inside the tumor. The apex of the affected tooth is often resorbed. Based on this radiograph, there is no evidence of root resorption.

 

 

CORRECT.

Periapical osseous dysplasia is as result of reactive process where normal cancellous bone is replaced with fibrous tissue and cementum. It predominantly appears in mandibular anterior teeth. There are three different stages of the lesion: early stage radiolucent at the apex of the involved tooth with loss of lamina dura. Mixed stage radiopaque tissue surrounded by radiolucent structure. Mature stage, radiopaque structure with or without thin radiolucent margin at periphery. No treatment is indicated, but diagnosis is critical so it's not confused with other periapical disease.

 

INCORRECT.

Periapical rarefying osteitis is seen on the radiograph as a radiolucent lesion in the periapical area. The affected tooth should have a large carious lesion, spread into the apical region and the tooth is non-vital tooth. Based on the radiographic exam, there is no evidence of dental caries.

January 2016 References

White, Stuart C., and Michael J. Pharoah. Oral Radiology: Principles and Interpretation, 7th Edition. Mosby, 2014. VitalBook file.