radiographic interpretation of a lesion
TRANSCRIPT
RADIOGRAPHIC INTERPRETATION
J.RAHUL RAGHAVENDER
CRI
• Radiographs are often obtained as part of a complete examination.
• Appropriate radiographic interpretation is used along with clinical information and other tests to formulate a differential diagnosis.
Normal radiographic anatomy
• ENAMEL
Most radiopaque structure
• DENTIN
Slightly lighter than enamel
• PULP CAVITY
Radiolucent lines within the tooth
• ALVEOLAR CREST
Gingival margin of the alveolar process appear as a radiopaque line
• PDL SPACE
Narrow radiolucent line around tooth surface
• LAMINA DURA
Radiopaque line representing tooth socket
Periapical radiograph interpretation of a lesion
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Interpretation is an orderly process
Normal variation Abnormal
Developmental abnormalities
Acquired abnormalities
Cyst Benign neoplasia
Vascular anomaly
MetabolicInflammatorylesion
Malignant neoplasia
Bone dysplasia
Trauma
Describing the Lesion
• 1. Size
• 2. Shape
• 3. Location
• 4. Density
• 5. Borders
• 6. Internal Architecture
• 7. Effect on adjacent structures
1. Size
• Measure the lesion with a ruler. If you must estimate, use surrounding structures as your guide
• Measure in two dimensions, width and height in mm or cm, as appropriate
2. Shape
• Regular
Round
Triangular
Rhomboid, etc.
• Irregular shape
3. Location
• Is the lesion localized or generalized?
• Unilateral or bilateral
• Where is the lesion in relation to other structures and anatomic landmarks?
• Use terms such as:
Mesial, Distal
Inferior, Superior
Posterior, Anterior
• If the epicenter of the lesion is above the mandibular canal, the likelihood is that the lesion is odontogenic in origin.
• Epicentre- below mandibular canal, non odontogenic(likely)
• Cartilaginous lesions are found nearer the condyles.
• If the epicenter of the lesion is in the sinus, it probably is not odontogenic in origin.
4. Density
• Is the lesion Radiopaque, Radiolucent,orMixed Density
• Remember that opacity is relative to the adjacent structures.
• If the lesion is of mixed density, describe the appearance
5. Borders
• Well or poorly demarcated
• Punched out (muliple myeloma)
• Corticated (osteomyelitis)
• Sclerotic (wide, uneven opaque border)
• Hyperostotic (increased density of trabeculation)
6. Internal architecture
• Is the lesion uniform?
• Internal structures such as septae or loculations
• Use terms such as: soap bubble ,honey comb , cotton wool, ground glass, wispy, orange peel, etc.
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7. Effect on adjacent structures
Is the lesion causing:
• Displacement ( such as teeth, maxillary sinus, inferior alveolar canal, etc.)
• Scalloping
• Root resorption
• Destruction
• Remodelling
• Expansion(any benign lesion)
• Epicentre above crown of teeth-follicular cysts-teeth apically
• Lesion-ramus of mandible-cherubism-anterior direction
• Widening of PDL, broken lamina dura-periapical abscess
• Reactive bone-periphery of lesion-benign slow growth