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Cases

Image Challenge

August 2016

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A 65-year-old male complains of food impaction in the lower left mandibular region. Clinical examination reveals a fixed partial denture. Bitewing radiographs show an increased density of the bone under the pontic (green arrows). Identify the abnormality and provide your diagnosis.

 

CORRECT.

There is a well-defined radiopaque entity noted at the crest of the edentulous alveolar ridge. Occasionally, irritation from the pontic could produce excessive bone formation, which would appear as a radiopaque entity under the pontic. Hence the entity noted in the bitewing is termed a subpontic hyperostosis. 

 

INCORRECT.

Mandibular tori are located on the lingual aspect; on radiographs they appear to superimpose over the roots of the premolar and molar teeth. However, in the bitewing radiographs shown, the radiopaque entity noted is below the pontic.

 

August 2016 References

Koenig. Diagnostic Imaging: Oral and Maxillofacial. 1st Edition. Amirsys.

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

 

July 2016

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A 58-year-old female’s routine panoramic interpretation showed a well-defined radiolucency in the interradicular region (between #28 and 29). The lesion is well corticated, round to ovoid in shape. No evidence of root resorption or expansion is noted. Clinical examination proved that teeth are vital. Identify the abnormality and provide your diagnosis.

 

INCORRECT.

Radiographically there is no evidence of loss of lamina dura and PDL space. Both lamina dura and PDL appears to be WNL. Coronally, no evidence of pulpal involvement is observed on the radiographs. Clinical examination should reveal teeth to be nonvital.

 

CORRECT.

Based on the location and radiographic presentation, this fits the description of lateral periodontal cyst. The clinical exam should reveal vital teeth. Lateral periodontal cysts typically are noted in mandible, canine- premolar region. They are more prevalent in 5th or 6th decade. Lateral periodontal cyst if they are multiple they are termed as botryoid type. 

 

INCORRECT.

They are usually asymptomatic and are usually noted as an incidental finding. The radiographic appearance shows relatively smaller number of trabeculae in the cancellous bone. Periodic radiographic follow-up should shows no change.

July 2016 References

Koenig. Diagnostic Imaging: Oral and Maxillofacial. 1st Edition. Amirsys.

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

 

June 2016

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A 40-year-old female was referred by an oral surgeon to obtain a panoramic radiograph. Her chief complaint is mild discomfort in the lower left region. A cropped panoramic is displayed. A moderately well-defined radiolucency associated with an impacted tooth #17 (green arrow) is noted. What abnormality is depicted on this panoramic image?

 

INCORRECT.

Ameloblastic fibromas are benign mixed tumors. Generally they tend to occur at relatively younger age (average 15 years). Based on the age it can be ruled out.

 

INCORRECT.

Normal follicular space is in between 2-3 mm. If the follicular space is more than 3 mm and less than 5 mm one should consider hyperplastic follicle. Based on the radiographic presentation, it doesn’t fit the profile.

 

 

CORRECT.

The involved tooth demonstrates more than 5 mm of the follicular space, which is suggestive of a dentigerous cyst. One more key characteristic feature to observe on the radiograph is the epicenter of the lesion, located superior to the impacted tooth. The extent of the lesion appears to extend from CEJ to CEJ.

June 2016 References

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