RADIOLOGICAL ASPECTS OF INFLAMMATORY LESIONS

October 1, 2024
| No Comments

TOPIC: RADIOLOGICAL ASPECTS OF INFLAMMATORY LESIONS

🌟 IMPORTANT POINTS TO REMEMBER

🔸Periodontal Ligament Space: Accumulation of inflammatory exudates in the connective tissue of the periodontal ligament causes oedema and this causes widening in the periodontal ligament space. The non-pathological reasons for widening of periodontal ligament space are terminal stage of root formation.

🔸Lamina Dura: Loss or decrease of the visibility of lamina dura has been considered as an indication of local or systemic disease. In moderate-to-severe inflammation cases, a collar-shaped increase in the thickness of the lamina dura at the lateral aspect of the root may be found.

🔸Trabecular Bone: The trabecular bone structure may show rarefaction around the lamina dura or apical radiolucency when there is moderate or severe inflammation.

🔸Cancellous Bone: The orientation of the trabecular pattern of cancellous bone changes in the presence of a root canal infection.

🔸AAP or AAA: The involved tooth is tender to touch, percussion and/or palpation in cases of an acute inflammation in the periodontal ligament space. Widening of periodontal ligament space is caused by oedema.

🔸Periapical Granuloma: Periapical granuloma is a growth of granulation tissue continuous with the periodontal ligament resulting from the death of the pulp. Vitality test of the tooth is negative. Radiographically the lesion is not fully dark but it has a greyish appearance. Shape of lesion is usually circular or ovoid radiolucent area.

🔸Differences Between Cyst and Granuloma: It is accepted that lesions having a diameter smaller than 1.5 cm are apical granulomas and lesions bigger than this are periapical cysts.

🔸Chronic Periapical Abscess: Clinically, there will be a moderate-to-large carious lesion. The lesion may have a radiolucent appearance with ill-defined borders and at this time it can be impossible to differentiate from a periapical granuloma or radicular cyst.

🔸Condensing Osteitis: The patient is asymptomatic in this condition. Lesion is localised and present as an increased band of radio-opacity associated with root of the tooth.

🔸Pericoronitis: Pericoronal flap gets frequently traumatised. The patient usually presents with swelling in the affected area and an inability to open the mouth completely. The most common radiographic feature of pericoronitis of the mandibular third molar is that there is a presence of distal bone loss.

🔸Osteosclerosis: There is presence of compact bone in spongiosa. This is known as osteosclerosis. This radio-opaque lesion can be solitary or multiple.

🔸Periapical scar: The tooth is non-vital and patient presents no symptom. The margin of radiolucency is well-defined and the shape is round.

🔸Osteomyelitis: Osteomyelitis is an inflammation of bone. Osteomyelitis of the maxilla is much less frequent than that of the mandible because the maxillary blood supply is far more extensive. Clinically, patients present with facial swelling, localised pain and tenderness, low-grade fever, draining sinus tracts, suppuration, dental loss and sequestrum formation. The first radiographic evidence of the acute form of osteomyelitis is slight decreased density of the involved bone. Chronic osteomyelitis involves the formation of periosteal bone, which is seen radiographically as a single radio-opaque line or series of radio-opaque lines.

🔸Garre’s Sclerosing Osteomyelitis: It is a chronic non-suppurative sclerosing type of osteomyelitis. Mandible is affected more commonly than the maxilla. Carious molar teeth which are associated with mild pain are found on examination. There is focal area of well-calcified bone proliferation.

📌 MULTIPLE CHOICE QUESTIONS (MCQs)

💡How much mineral loss is required to produce radiographic evidence of disease?

  1. 20–40%
  2. 35–55%
  3. 50–60%
  4. 30–60%

Answer : 4

💡Non-pathological reason for the widening of PDL is

  1. Infection
  2. Trauma
  3. Terminal stage of root formation
  4. Tooth extraction

Answer : 3

💡Irritation-induced focal thickening of periosteum and cortical bone leads to

  1. Pericoronitis
  2. Acute osteomyelitis
  3. Garre’s sclerosing osteomyelitis
  4. All of the above

Answer : 3

💡Periapical lesion having a diameter smaller than 1.5 cm is

  1. Granuloma
  2. Cyst
  3. Abscess
  4. Scar

Answer: 1

💡Chronic focal sclerosing osteomyelitis is another name of

  1. Acute osteomyelitis
  2. Condensing osteitis
  3. Osteosclerosis
  4. Apical periodontitis

Answer: 2

💡Osteomyelitis begins as inflammation of

  1. Cortical bone
  2. Periosteum
  3. Medullary bone
  4. Periosteum and inner bone

Answer : 3

💡Focal sclerosing osteomyelitis is

  1. Due to excessive bone formation
  2. An extremely painful condition
  3. Due to low-grade chronic infection
  4. A common sequela following sequestrum

Answer : 3

💡Periapical cyst is usually preceded by

  1. Periapical granuloma
  2. Periodontal abscess
  3. Periapical abscess
  4. All of the above

Answer: 1

💡Which of the following is more prone to osteomyelitis?

  1. Maxilla
  2. Zygoma
  3. Mandible
  4. Palatine bone

Answer : 3

💡An asymptomatic tooth has deep caries at the occlusal surface. Radio-opaque shows radio-opaque mass at the apex of the tooth. This mass is most likely to be

  1. Cementoma
  2. Condensing osteitis
  3. Chronic apical periodontitis
  4. Acute apical periodontitis

Answer : 2

Oral Medicine and Radiology