Oral Hard Tissue Lesions: A Radiographic Diagnostic Decision Tree

Abstract

BACKGROUND: Focusing on history taking and an analytical approach to patient’s radiographs, help to narrow the differential diagnoses.
 AIM: This narrative review article aimed to introduce an updated radiographical diagnostic decision tree for oral hard tissue lesions according to their radiographic features.
 METHODS: General search engines and specialized databases including PubMed, PubMed Central, Scopus, Embase, EBSCO, ScienceDirect, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “jaw diseases,” “maxilla,” “mandible,” “radiolucent,” “radiopaque,” “odontogenic,” “nonodontogenic,” “cysts,” and “tumors.” Related English-language articles published from 1973 to 2020, including reviews, meta-analyses, and original papers (randomized or non-randomized clinical trials; prospective; or retrospective cohort studies), case reports, and case series about oral hard tissue lesions were appraised.
 RESULTS: In this regard, bony lesions have been classified according to their radiographic pattern (radiolucent, mixed, radiopaque, and rarified), position (periapical, pericoronal and interradicular), margins (well and ill-defined), relation to dentition (with and without dental association), and number (solitary and multiple). In total, 50 entities were organized in the form of a decision tree.
 CONCLUSION: In this paper, an updated decision tree was proposed to help dental practitioners to make more accurate diagnoses and better treatment plans on the basis of radiographic characteristics.

Multidisciplinary treatment of radicular cyst caused by delayed trauma in the maxillary central teeth – case report

“…Among such lesions, radicular cysts are the most common type of inflammatory odontogenic cysts and are most frequently seen and more widespread in the maxillary anterior region [2,3]. Possible radiological progress of a radicular cyst starts as a small radiolucent lesion at the root of a non-vital tooth or at the apex of a remaining root, similar to periapical granuloma [4]. Most cysts are asymptomatic but especially infected cysts might cause pain [5].…”

“…Most cysts are asymptomatic but especially infected cysts might cause pain [5]. Additionally, if such lesions reach a certain size, they might cause some symptoms in neighboring teeth, such as repositioning, mobility, expansion or paresthesia [4]. Small cysts are treated with root canal therapy and apical resection.…”