INBDE Bootcamp High-Yield Oral Radiology (Bone Lesions) | Bootcamp.

com
Structure Radiograph Key Facts

Radiolucent, well-defined, unilocular

Periapical cyst or granuloma Etiology:

● Infection or inflammation of the pulp

Radiographic appearance:
● Well-defined, unilocular radiolucency
● Associated with apex
● Round and symmetrical

Clinical presentation:
● Painless (in acute exacerbations)
● Non-vital teeth
● +/- history of swelling
● History of carious lesions, restorations, or trauma

Traumatic bone cyst Etiology:

● Trauma to jaw (not a true cyst)

Radiographic appearance:
● Well-defined, unilocular radiolucency
● Located in body of mandible, apical to several teeth
● Scalloped corticated border around roots

Clinical presentation:
● Painless
● Vital teeth
● No swelling
● Typically an incidental finding

Nasopalatine duct cyst Etiology:

● Developmental, arising from epithelial remnants

Radiographic appearance:
● Well-defined, unilocular radiolucency
● Located on midline of anterior maxilla
● Heart shaped

Clinical presentation:
● Painless
● Bony hard swelling typically on the incisive papilla
 INBDE Bootcamp High-Yield Oral Radiology (Bone Lesions) | Bootcamp.com
Structure Radiograph Key Facts

Radiolucent, well-defined, unilocular

Dentigerous cyst Etiology:

● Developmental, arising from epithelial remnants

Radiographic appearance:
● Well-defined, unilocular radiolucency
● Often located in posterior mandible or third molar region
● Associated with an impacted or unerupted tooth
● Spans CEJ to CEJ
● No root resorption but can displace teeth

Clinical presentation:
● If left untreated, can cause facial swelling

Residual cyst Etiology:

● Epithelial cells left behind after an extraction

Radiographic appearance:
● Well-defined, unilocular radiolucency
● Located in an edentulous space

Clinical presentation:
● Painless

Stafne bone defect Etiology:

● Developmental anomaly, depression in the bone (not a true
cyst)

Radiographic appearance:
● Well-defined, unilocular radiolucency
● Below the inferior alveolar nerve

Clinical presentation:
● Painless
● Incidental finding
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Radiolucent, well-defined, multilocular

Central giant cell granuloma Etiology:

● Abnormal reaction of bone to stimuli

Radiographic appearance:
● Well-defined, uni or multilocular radiolucency
● Often located in anterior mandible that crosses midline

Clinical presentation:
● Painless
● Vital teeth
● Slow growing, bony hard swelling
● +/- history of trauma
● Expansile

Odontogenic myxoma Etiology:

● Uncontrolled cell growth

Radiographic appearance:
● Well-defined, multilocular radiolucency
● Often located in posterior mandible or third molar region
● “Honeycomb” or “tennis racket” appearance
● Wispy trabeculae
● Destructive, causes root resorption

Clinical presentation:
● Painless
● Slow growing, bony hard swelling
● Expansile

Odontogenic keratocyst Etiology:

● Developmental, arising from epithelial remnants

Radiographic appearance:
● Well-defined, multilocular radiolucency
● Often located in posterior mandible
● Scalloped borders
● Locally invasive and destructive

Clinical presentation:
● Painless, slow growing, bony hard swelling
● Associated with nevoid basal cell carcinoma syndrome
● Risk of recurrence
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Radiolucent, well-defined, multilocular

Ameloblastoma Etiology:
● Uncontrolled cell growth

Radiographic appearance:
● Well-defined, uni or multilocular radiolucency
● Often located in the posterior mandible
● “Soap bubble” appearance
● Expansile
● Locally destructive and invasive
● Tooth displacement and/or root resorption

Clinical presentation:
● Painless
● Vital teeth
● Slow growing, bony hard swelling

Radiolucent, ill-defined

Acute osteomyelitis Etiology:

● Infection of bone attributed to bacterial invasion from dental
infections, procedures, trauma, blood, or other structures

Radiographic appearance:
● Ill-defined, non-corticated radiolucency
● Diffuse boundary
● May also have no radiographic findings

Clinical presentation:
● Pain
● Vital teeth
● Rapidly progressive swelling
● History of trauma, surgery or infection
● Erythema, edema, and drainage
● Tooth mobility
● +/- history of fever or lymphadenopathy
● Restricted mouth opening, pain, and pus
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Radiolucent, ill-defined

Osteosarcoma Etiology
● Uncontrolled cell growth

Radiographic appearance:
● Ill-defined radiolucency
● “Sunburst” appearance
● Potential opacities within the lesion
● Rapidly growing

Clinical presentation:
● Pain
● Paresthesia
● Mobile teeth
● Overlying mucosa is disrupted

Metastatic carcinoma Etiology:

● Metastasis from primary cancer site to the jaw

Radiographic appearance:
● Ill-defined radiolucency
● Destructive
● Rapidly growing

Clinical presentation:
● Pain
● Paresthesia
● Mobile teeth
● Telangiectasias
● History of previous cancer or evidence of recurrence
or metastasis
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Mixed radiolucent/radiopaque

Chronic osteomyelitis Etiology:

● Long standing infection and inflammation of the jaw due to
dental infections, procedures, trauma, systemic infections,
compromised immunity, or poor blood supply

Radiographic appearance:
● Mixed radiolucent-radiopaque
● “Onion peel” appearance
● Sequestrum of bone

Clinical presentation:
● +/- Pain
● Swelling or cervical lymphadenopathy
● History of acute episodes, trauma, or infection
● Tooth mobility
● Purulence or bad taste

Adenomatoid odontogenic Etiology:

tumor ● Uncontrolled cell growth

Radiographic appearance:
● Well-corticated, mixed radiolucent-radiopaque
● Often located in anterior maxilla or canine/premolar
region

Clinical presentation:
● Painless
● Slow growing, bony hard swelling
● Retained primary tooth
● Unerupted permanent teeth

Periapical cemento-osseous Etiology:

dysplasia ● Disturbance in normal bone remodeling process in which
normal bone is replaced by fibrous bone

Radiographic appearance:
● Mixed radiolucent-radiopaque
● Often located in periapical mandibular incisor region

Clinical presentation:
● Painless
● Vital teeth
● No swelling
● Typically occurs in African American adult females
over the age of 30
● Typically an incidental finding
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Mixed radiolucent/radiopaque

Focal cemento-osseous Etiology:

dysplasia ● Disturbance in normal bone remodeling process in which
normal bone is replaced by fibrous bone

Radiographic appearance:
● Mixed radiolucent-radiopaque
● Often located in posterior mandible

Clinical presentation:
● Painless
● Vital teeth
● +/- swelling

Complex odontoma Etiology:

● Uncontrolled cell growth

Radiographic appearance:
● Mixed radiolucent-radiopaque
● Ill-formed mass resembles tooth density
● Often located in the maxilla

Clinical presentation:
● Painless
● Slow growing, bony hard swelling
● Unerupted or impacted teeth

Compound odontoma Etiology:

● Uncontrolled cell growth

Radiographic appearance:
● Mixed radiolucent-radiopaque
● Multiple, small tooth-like structures
● Tooth-bearing areas of the jaw

Clinical presentation:
● Painless
● Slow growing, bony hard swelling
● Unerupted or impacted teeth
● Typically an incidental finding
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Mixed radiolucent/radiopaque

Calcifying odontogenic cyst Etiology:

● Developmental, arising from epithelial remnants

Radiographic appearance:
● Mixed radiolucent-radiopaque
● Associated with impacted teeth

Clinical presentation:
● Painless
● Slow growing, bony hard swelling
● Expansile

Ossifying fibroma Etiology:

● Uncontrolled fibrous tissue growth

Radiographic appearance:
● Mixed radiolucent/radiopaque
● Expansile

Clinical presentation:
● Painless
● Vital-teeth
● Slow-growing, bony hard swelling

Calcifying epithelial Etiology:

odontogenic tumor (CEOT), ● Uncontrolled cell growth
Pindborg’s tumor
Radiographic appearance:
● Mixed radiolucent/radiopaque
● Radiopaque flecks
● Often located in posterior mandible
● Associated with unerupted or impacted teeth
● Expansile

Clinical presentation:
● Painless
● Slow-growing, bony hard swelling
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Radiopaque

Osteoma Etiology:
● Uncontrolled growth of bone

Radiographic appearance:
● Radiopaque
● Can have radiolucencies within

Clinical presentation:
● Painless
● Vital teeth
● Slow growing, bony hard swelling
● Expansile
● History of Gardner syndrome

Fibrous dysplasia Etiology:

● Genetic mutation causing normal bone to be replaced by
fibrous bone

Radiographic appearance:
● Radiopaque
● “Ground glass” appearance
● Often located in the posterior
● Smudgy with diffuse, blending borders
● Loss of lamina dura
● Increased trabeculation

Clinical presentation:
● Painless
● Vital teeth
● Slow growing, bony hard swelling
● Normal intact mucosa
● Associated with McCune-Albright syndrome

Cementoblastoma Etiology:
● Uncontrolled cell growth

Radiographic appearance:
● Radiopaque mass with thin radiolucent border
● Commonly associated with mandibular first molars
● Attached to root
● Root resorption

Clinical presentation:
● Pain
● Vital teeth
● Slow growing, bony hard swelling
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Radiopaque

Condensing osteitis Etiology:

● Fibro-osseous response of bone to chronic inflammation
or infectious

Radiographic appearance:
● Radiopaque
● Irregular sclerosis adjacent to the apex of a root

Clinical presentation:
● +/- Pain
● Involved with both vital and non-vital teeth
● No swelling

Hypercementosis Etiology:
● Excessive deposition of cementum

Radiographic appearance:
● Radiopaque
● Bulbous, enlarged roots
● Thickened cementum

Clinical presentation:
● Not painful
● Vital tooth
● No swelling

Idiopathic osteosclerosis Etiology:

(dense bone island) ● Benign growth of bone with no exact reason

Radiographic appearance:
● Radiopaque
● Often located in posterior mandible
● Not associated with teeth

Clinical presentation:
● Not painful
● Vital teeth
● No signs or symptoms
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Systemic Diseases

Sickle cell disease Etiology:

● Genetic blood disorder

Radiographic appearance:
● Interproximal alveolar bone “step ladder” pattern
● Large trabecular spaces
● Increased medullary spaces
● Thinning of inferior mandibular border
● Thickening of lamina dura
● “Hair-on-end” striations on skull in cephalometric
radiograph

Clinical presentation:
● Systemic features: low hemoglobin levels, fatigue,
weakness, shortness of breath

Multiple myeloma Etiology:

● Uncontrolled growth of blood cells

Radiographic appearance:
● Multiple “punched out” osteolytic lesions

Clinical presentation:
● Pain and paresthesia
● Systemic features: anemia, bleeding, infection, and
fracture

Paget’s disease Etiology:

● Chronic abnormal bone remodeling

Radiographic appearance:
● Sclerotic and radiolucent areas
● Widespread and multifocal
● “Cotton wool” appearance
● Tooth displacement

Clinical presentation:
● Pain
● Swelling
● Systemic features: bone pain, headaches, altered vision
or hearing, and increased alkaline phosphatase levels
 INBDE Bootcamp Radiographic Bone Lesions | Bootcamp.com
Structure Radiograph Key Facts

Systemic Diseases

Hyperparathyroidism Etiology:
● Excessive production and secretion of parathyroid
hormone

Radiographic appearance:
● Multiple radiolucent foci
● Loss of lamina dura
● Giant cell lesions aka “Brown tumors”

Clinical presentation:
● Systemic features: kidney stones, metastatic calcification,
osteoporosis, neurologic problems, arrhythmias, elevated
PTH and alkaline phosphatase

Cherubism Etiology:
● Genetic disorder resulting in abnormal development and
growth of the jawbones

Radiographic appearance:
● Uni- or multilocular radiolucencies
● Often located in posterior mandible but also frequently in
maxilla
● “Soap bubble” appearance
● Thin cortical bone
● Displacement of teeth

Clinical presentation:
● Painless
● Bilateral, symmetrical jaw expansion
● Premature exfoliation of primary teeth

Langerhans cell histiocytosis Etiology:

● Abnormal proliferation of immune cells

Radiographic appearance:
● Non-corticated radiolucencies
● Osseous lytic lesions with “punched out” appearance
● “Floating teeth”

Clinical presentation:
● Tooth mobility
● +/- erythematous skin or mucosal lesions