S.

M Notes

Oral & Maxillofacial Radiology

SYNDROMES/SYSTEMIC......................................................................................................................................................................... 2
CHERUBISM...................................................................................................................................................................................................... 2
NEVOID BASAL CELL CARCINOMA SYNDROME (NBCCS)...........................................................................................................................................3
FIBRO-OSSEOUS LESIONS....................................................................................................................................................................... 4
FIBROUS DYSPLASIA............................................................................................................................................................................................ 4
OSSIFYING FIBROMA........................................................................................................................................................................................... 5
OSSEOUS DYSPLASIA...........................................................................................................................................................................................6
ODONTOMA..................................................................................................................................................................................................... 8
OTHER RADIOPAQUE LESIONS OF THE JAWS........................................................................................................................................... 9
ANTRAL PSEUDOCYST......................................................................................................................................................................................... 9
CEMENTOBLASTOMA........................................................................................................................................................................................ 10
SCLEROSING OSTEITIS/CONDENSING OSTEITIS.......................................................................................................................................................11
DENSE BONE ISLAND (DBI)............................................................................................................................................................................... 11
RADIOLUCENT LESIONS OF THE JAWS................................................................................................................................................... 12
LATERAL PERIODONTAL CYST..............................................................................................................................................................................12
DENTIGEROUS CYST.......................................................................................................................................................................................... 13
KERATOCYSTIC ODONTOGENIC TUMOR (KCOT).....................................................................................................................................................14
AMELOBLASTOMA............................................................................................................................................................................................ 15
ODONTOGENIC MYXOMA.................................................................................................................................................................................. 16
NASOPALATINE DUCT CYST................................................................................................................................................................................ 17
PSEUDOCYSTS...................................................................................................................................................................................... 18
SIMPLE BONE CYST (TRAUMATIC BONE CYST).......................................................................................................................................................18
LINGUAL BONE DEFECT (STAFNE DEFECT).............................................................................................................................................................19
PERIAPICAL RADIOLUCENCY OF INFLAMMATORY ORIGIN (PRIO)...............................................................................................................................19
VARIOUS RADIOGRAPHS...................................................................................................................................................................... 20
DIFFERENTIAL DIAGNOSIS FLOWCHARTS.............................................................................................................................................. 26
A VERY LARGE TABLE............................................................................................................................................................................ 47
 Syndromes/Systemic

Cherubism
= Rare Autosomal Dominant condition

Clinical Features - Develops in early childhood

- Bilateral expansion/swalling of the cheeks
- “Heavenly Gaze”
- Self Resolves around time of skeletal maturity

Radiographic
Features

Site Bilateral and affects both the maxilla and mandible

- Always in the posterior body and ramus of mandible and the tuberosity
of the maxilla
Shape Well defined, corticated multiple lesions
Size
Shade RL with a multilocular pattern and internal septae
Surroundings Significant bony expansion with substantial displacement of the medial and
lateral surfaces of the ramus
- Medial displacement may block the airway
Adjacent teeth
- Destroys developing tooth buds
- Significant tooth displacement (towards the midline usually)
Density
Displacement Displacement of the Maxillary sinus floor
Diameter
Differential Dx
Tx Delay Tx until the lesions stop growing

Nevoid Basal Cell Carcinoma Syndrome (NBCCS)

= AKA Gorlin-Goltz Syndrome

Page | 2
Clinical Features Variable phenotypes including:
- Multiple Basal Cell Carcinoma of the skin, Palmar and planting pitting, Skeletal abnormalities (bifid ribs,
vertebral fusion, polydactyly, temporoparietal bossing), Calcified Falx Cerebri.
- Multiple KCOTs
- BCC most frequent in North Europeans
- Multiple KCOT most frequent in East Asians
- Presents in 20-30s (10 years earlier than single KCOTs)

Radiographic See KCOT, and add a bunch of these in the mandible

Features

Site Multiple lesions, mostly Posterior sextant of Mandible

Shape Well defined, corticated and scalloped border
- May be multilocular
Size
Shade RL, might have internal Septa
Surroundings Grows M-D with minimal B-L expansion
Adjacent teeth
- May displace and resorb roots, but to a much lesser extent vs
ameloblastoma
Density
Displacement
Diameter
Differential Dx
Tx

Page | 3
 Fibro-Osseous Lesions
(Fibrous Dysplasia, Ossifying Fibroma, Osseous Dysplasia, Odontoma)

Fibrous Dysplasia
- Symptomatic regional alteration of bone in which the normal architecture is replaced by fibrous tissue and
nonfunctional trabeculae-like osseous structures; lesions may be monostotic or polyostotic, with or without
associated endocrine disturbances.

Clinical Features Age: most often juveniles and young adults

- singular, slow-growing, painless swelling of either jaw
Location: more common in maxilla than mandible
overgrowth of tissue that occurs centrally in the jaws
may involve impacted or unerupted teeth
disfiguring, may present as facial enlargement of affected side
increased level of serum alkaline phosphatase
Classification:
- Monostotic (“craniofacial”): mandible or maxilla (not truly one bone); can cross sutures of maxilla, but cannot
cross periosteum; if reaches posterior maxilla, cannot cross to pterygoid plate, instead just forces mandible
forwards; usually diagnosed in 3rd decade; 85% of cases
- Polyostotic: systemic, involves multiple bones; usually diagnosed in childhood
- McCune - Albright syndrome: polyostotic FD + precocious puberty
- Jaffe syndrome
Radiographic
Features

Site Maxilla 2x more than mandible

Posterior Regions of the jaws
Monostotic: 1 Bone
Polyostotic: >1 Bone
Shape Poorly Defined
Fusiform expansion
Size
Shade Radiolucent with radiopaque features (granular ground glass, peau d’orange, fingerprint,
cotton wool)
- Early lesions are more RL
Surroundings - Bone expansion as lesion grows
- Thinning of the cortex (but not complete erosion)
- Displaces the borders of the sinus in the maxilla
- “Blurs” cortical boundaries of bone (Sinus floor, B/L plate, IAN walls) as the
cortical bone becomes affected
- Adjacent teeth may be displaced. Root resorption is rare
- Lamina Dura may disappear around affected bone
Density
Displacement Displaces Maxillary antrum floor, and may displace IAN canal superiorly if
underneath it
Diameter
Differential Dx Fibrous Dysplasia
Ossifying Fibroma
Tx • Surgery for cosmetic or functional problems, but may increase lesion activity
• Typically self-limiting and regress in early adulthood
• Do not irradiate: can induce sarcomatous changes
Ossifying Fibroma
A well-demarcated, encapsulated, expansile intraosseous lesion of the jaws composed of cellular fibrous tissue containing
spherical calcifications and irregular, randomly oriented bony structures.

Clinical Features

- Slow growing neoplastic lesion

- Asymptomatic
- Females more than Males

Juvenile Ossifying Fibroma

- <15 years old
- No Encapsulation
- Very aggressive form
Radiographic
Features

Site More often in the Mandible, apical to premolars and molars (superior to IAN
canal)
When in Maxilla -> Canine fossa area
Shape Well Defined, encapsulated with a thin RL line
- cortex may appear thickened and sclerotic
Size
Shade Mixed RL/RO -> Similar to Fibrous Dysplasia (ground glass, cotton-wool)
Surroundings Beach Ball expansion
Thinning (but still intact) of the cortical borders of the jaw
May resorb Teeth
- Lamina Dura is missing
Density
Displacement May displace IAN and expand cortical plates
Displacement of Maxillary sinus floor
Displaces adjacent teeth
Diameter
Differential Dx Fibrous Dysplasia
Osseous Dysplasia
Complex Odontoma
Tx Surgical Enucleation + Curettage
Local Excision + Block Resection

Osseous Dysplasia
- Diffuse asymptomatic radiopaque and radiolucent intraosseous areas of osseous tissue that involve one or both arches.
Focal variant: a single lesion, affecting only 1 sextant/tooth

- Young Females of European origin

Florid variant: affecting more than 1 sextant
- Middle-old age female of East Asia or Subsaharan African extraction
Periapical Variant: Associated with Apex of mandibular anterior teeth

Clinical Features - Most frequent in African American Women

- Usually painless with no external signs or symptoms

Radiographic
Features

Site Periapical: Centered around root apex, may be multiple lesions

- Teeth are vital
Focal: Usually a solitary lesion in 1 sextant
Florid: Multiple, bilateral lesions present in Max and Mand
Shape Well defined border, variable shape
Size
Shade RO center with variably wide RL rim. As lesions mature a band of thicker
sclerotic bone might appear around the perifery
Surroundings Large lesions can cause expansion of bone B-L
- Thin intact cortex is present
Adjacent teeth:
- Lost Lamina Dura (PDL space either looks VERY wide, or not present)
- No resorption though
Density
Displacement May displace antrum floor
May displace IAN canal
Diameter
Differential Dx Florid OD
Fibrous Dysplasia
Paget’s Disease
Ossifying Fibroma
Tx - Not treated unless a secondary infection produces osteomyelitis
Odontoma
An usually hamartomatous lesion commonly found over unerupted teeth, containing enamel, dentin, pulp, and cementum in either
recognizable tooth shapes (compound) or a solid gnarled mass (complex).

Clinical Features = Most common non-cystic odontogenic lesion

- Asymptomatic swelling
- Most common in 1st and 2nd decade
- May interfere with eruption of permanent teeth
Compound:
- Bag of Teeth
- More common than complex
Complex:
- Strange tissue mass
Radiographic
Features

Site More common in Maxilla vs Mandible

- Compound -> Anterior Maxilla
- Complex -> Posterior Mandible
Shape Well Defined, smooth irregular periphery
- Corticated border
Size
Shade Heterogenously RO -> More RO than ossifying fibroma
- Compound -> Toothlike structures
- Complex -> irregular mass of calcified tissue
Surroundings Large lesions may expand bone -> Cortical boundary is maintained
Interferes with eruption of teeth
- Most associated with impacted or malposition tooth
Density
Displacement
Diameter
Differential Dx Dense Bony Island -> Doesn’t have the RL Rim
Ossifying Fibroma -> Less RO and not associated with unerupted teeth
Osseous Dysplasia -> These are more associated with multiple tooth apices and are less RO
Tx Simple Excision
 Other Radiopaque Lesions of the Jaws
(Antral Pseudocyst, Cementoblastoma, Dense Bone Island, Sclerosing Osteitis)

Antral Pseudocyst
- retention of fluid in the lining of the sinus

Clinical Features - More frequent in Caucasian

Radiographic
Features

Site Maxillary Antrum of course

Shape Well defined Dome Shape
- Non-corticated and smooth
If Multiple -> Think Polyps
- Polys have thick mucosal lining
Size
Shade Appears RO because it is projected over the airspace of the sinus, but it is still
fluid filled
Surroundings No affect on surroundings
Adjacent teeth
- PDL is intact and normal

Polys can cause bony destruction and displacement

Density
Displacement
Diameter
Differential Dx Antral Pseudocyst
Mucosal Polys
Tx Usually leave the Pseudocyst
Cementoblastoma
A benign, well-circumscribed neoplasm of cementum-like tissue growing in continuity with the apical cemental layer of a molar or
premolar that produce expansion of cortical plates and pain.

Clinical Features - Very rare

- Pain on biting, Swelling, Expansion of cortical places
- Continuous with the root
- Pulp vitality is unrelated
Age:
- 2-6rd decade (before 25 though)
Race:
- Commonly Caucasian males

Radiographic
Features

Site Mandible 1st premolar region primarily

Shape Well-Defined, round, surrounded by a RL rim
Size
Shade Mixed RO/RL (Mostly RO though) surrounded by RL band
- Center of RO mass obliterates the associated tooth root
Surroundings May cause expansion of bone and may perforate cortical plates
Adjacent teeth
- Varying abouts of external root resorption
- Lesion continuous with cementum of root
Density
Displacement
Diameter
Differential Dx Periapical OD -> Cementoblastoma has a better defined and uniform RL rim
Sclerosing Osteitis -> Doesn’t have a RL rim, and is associated with non-vital tooth
Dense Bone Island -> no RL rim and usually not associated with a tooth
Tx RCT + Root amputation

Sclerosing Osteitis/Condensing Osteitis

 Clinical Features - Pulpal necrosis of associated tooth
Radiographic
Features

Site Apex of carious/necrotic tooth

Shape
Size
Shade RO + possibly some periapical radiolucency as well
Surroundings May have root resorption and thickening of the Lamina Dura
Density
Displacement May displace adjacent teeth
Diameter
Differential Dx
Tx RCT of the affected tooth

Dense Bone Island (DBI)

Clinical Features - Asymptomatic

- Not directly associated with pulpally involved teeth

Radiographic
Features

Site More common in Mandible -> Posterior sextant

Shape Well defined periphery that blends with trabeculae of surrounding bone
Size
Shade Variable from ground glass to uniformly RO
Surroundings No expansion of bone

Adjacent teeth
- Rare to see root resorption
- Very rare to see displacement
- PDL space is visible and separates the root from the lesion
Density
Displacement Displacement is very rare
Diameter
Differential Dx Sclerosing Osteitis -> SO has an associated widened PDL and is centered around the root apex
Osseous Dysplacia, Cementoblastoma -> Both of these have RL rim
Tx No Tx
 Radiolucent Lesions of the Jaws
(Lateral Periodontal Cyst, Lateral Radicular Cyst, Dentigerous Cyst, Nasopalatine Duct Cyst, Simple Bone Cyst) (Ameloblastoma,
Keratocystic Odontogenic Tumor, Odontogenic Myxoma)
- Well defined radiolucencies: consider cysts
o cysts rarely cause root resorption compared to neoplasms and inflammation
- Poorly defined radiolucencies: consider inflammation and malignancy

Lateral Periodontal Cyst

A slow-growing, non-expansile developmental odontogenic cyst derived from one or more cell rests of
Malassez, containing an embryonic lining of 1 to 3 cuboidal cells and distinctive focal thickenings (plaques).

Clinical Features

- Often Asymptomatic
- Tooth is vital
Radiographic
Features

Site Mandible -> Incisor Premolar area

Maxilla -> Lateral incisor and canine area

*Along lateral root surface

Shape Well Defined, with corticated border
- Round or tear-dropped(large ones can be very irregular)
Size
Shade RL
Surroundings Minimal Expansion of bone, grows mostly M-D
Adjacent teeth
- Large cysts may displace roots or obliterate the Lamina dura
Density
Displacement
Diameter
Differential Dx Very similar to many other solitary cysts:
- KCOT
- Ameloblastoma
Lateral radicular cyst -> This would be a non-vital tooth
Glandular Odontogenic Cyst
Tx Simple enucleation
Dentigerous Cyst
An odontogenic cyst that surrounds the crown of an impacted tooth; caused by fluid accumulation between the reduced enamel
epithelium and the enamel surface, resulting in a cyst in which the crown is located within the lumen and root(s) outside.

Clinical Features

- Asymptomatic usually. Possible firm mass

- Associated with unerupted 3rd mandibular molars or Maxillary canines
nd
- 2 most common cyst in the jaws
Radiographic
Features

**Associated with the CEJ of the affected tooth**

Central: Attached to CEJ on both sides with the entire body of the cyst above the CEJ
Lateral: Only attached to 1 side of the CEJ, cyst is coronal to the CEJ on the other side
Circumferential: Similar to central, but portions of the cyst are apical to the CEJ

Site Most frequent in Mandibular 3rd molars or Maxillary canines

Shape Well Defined corticated border, Unilocular
Size
Shade Completely RL except for the Crown of the associated tooth
Surroundings May displace adjacent bone borders (interior border of mandible, maxillary
sinus
Adjacent teeth:
- Displaces adjacent teeth
- Previously thought to resorb roots..but it doesn’t. if you see this
think neoplasm
Density
Displacement May displace sinus floor, IAN canal, and other bony borders
Diameter
Differential Dx CEJ association is pretty pathognomic
Tx Surgical Removal
Keratocystic Odontogenic Tumor (KCOT)
Previously known as Odontogenic Keratocyst, now divided into two diagnoses:
- Keratocystic Odontogenic Tumor: a neoplasm, which is primarily parakeratinized
- Orthokeratinized Odontogenic Cyst: a true cyst, which is primarily orthokeratinized,

Clinical Features - One of the 3 most common Benign odontogenic Neoplasms

- More common in males
- Typically asymptomatic

Radiographic
Features

Site Mostly Posterior sextant of Mandible

Shape Well defined, corticated and scalloped border
- May be multilocular
Size
Shade RL, might have internal Septa
Surroundings Grows M-D with minimal B-L expansion
Adjacent teeth
- May displace and resorb roots, but to a much lesser extent vs
ameloblastoma
Density
Displacement
Diameter
Differential Dx KCOT
Ameloblastoma -> Differentiate based on resorption and expansion
Odontogenic Myxoma
Simple Bone Cyst
Dentigerous Cyst
Tx Enucleation with Carnoy’s solution

Ameloblastoma
- A benign and locally aggressive neoplasm of odontogenic epithelium that has a wide spectrum of histologic patterns resembling early
odontogenesis (enamel organ)

Clinical Features - #1 most common odontogenic neoplasm

3 Subtypes:
- Solid
- Unicystic
- Desmoplastic
Radiographic
Features

Site Mostly Posterior of the Mandible

Shape Well defined borders
Size
Shade Solid (Multilocular): May have multilocular septa ->Soap Bubble or Honeycomb
structure

Unicystic: Unilocular well defined RL

Desmoplastic -> Irregular sclerotic bone

Surroundings Beach-Ball Expansion (B-L)
- Perforation of the cortical plates with erosion
Adjacent teeth
- Aggressive root resorption
- Displacement possible
Density
Displacement
Diameter
Differential Dx Residual Cyst
Cemento-osseous Dysplasia (Early lesion)
KCOT
Odontogenic Myxoma
Tx En bloc resection

Odontogenic Myxoma
- An aggressive intraosseous lesion derived from embryonic connective tissue associated with odontogenesis and primarily consisting of a
mucoid ground substance with widely scattered undifferentiated spindled mesenchymal cells, similar to embryonic dental papilla
Clinical Features - Rare
- Painless, slowly growing swelling of the jaw
Radiographic
Features

Site More common in the mandible (premolar, molar area)

Shape Poorly defined margins with adjacent sclerosed bone
Multilocular with straight septa
Scallops between roots (like a simple bone cyst)
Size
Shade Residual bone trapped in the tumor gives it straight septa and “Tennis Racket”
appearance
- (This is a rarely seen appearance though… but if you see it its pathognomic)
Surroundings Grows M-D with little B-L expansion

Adjacent teeth:
- Causes tooth displacement (less than ameloblastoma)
- Rarely causes resorption
Density
Displacement
Diameter
Differential Dx Ameloblastoma
KCOT
Central Giant Cell Granuloma
Tx Resection
Nasopalatine Duct Cyst
- An intraosseous developmental cyst of the midline of the anterior palate, derived from the islands of epithelium remaining
after closure of the embryonic nasopalatine duct.
Clinical Features

- Arises from embryologic remnants of the nasopalatine duct

- Presents in the midline of the maxilla
- Fluctuant, painless swelling

Radiographic
Features

Site Centered in the maxillary midline within the nasopalatine foramen or canal
Shape Well defined corticated border, round or ovoid in shape
- Anterior nasal spine may be superimposed giving it a heart shape
Size
Shade RL
Surroundings May expand the labial or palatal cortices of the maxilla
Adjacent teeth
- May displace roots so they diverge
- Root resorption is possible
Density
Displacement May displace the floor of the nasal fossa superiorly
Diameter
Differential Dx PRIO -> Check to ensure the PDL is intact and separate from this lesion
Tx Enucleate
 Pseudocysts
Simple Bone Cyst (Traumatic Bone Cyst)
- Asymptomatic intraosseous empty cavity of young patients located primarily within the mandible, lined by a thin loose
connective tissue membrane and is adequately treated when blood enters the space during an intraosseous biopsy.
Clinical Features
- Commonly in children and teeths
- Usually asymptomatic
- Primarily in the Mandible
- Associated teeth are vital

Radiographic
Features

Site Almost all are in the mandible -> most common in the posterior
Shape Well defined, delicately (sometimes not visible) corticated border
- Scallops between roots and teeth
Size
Shade RL
Surroundings May expand the bone if large, otherwise they prefer to scallop along the inside
of the bone

Adjacent teeth
- Usually no effect, Lamina dura is usually intact
Density
Displacement
Diameter
Differential Dx Aneurysmal Bone Cyst
Lateral Periodontal Cyst
Odontogenic Myxoma
Unicystic Ameloblastoma
Radicular Cyst
KCOT
Central Giant Cell Granuloma
Tx Monitor
Lingual Bone Defect (Stafne Defect)
A developmental concavity of the lingual cortex of the mandible, usually in the third molar area, caused by overextension of an accessory
lateral lobe of the submandibular gland, and has the radiographic appearance of a well-circumscribed cystic lesion within the bone, usually
below the inferior alveolar canal.
Clinical Features - Anatomic indentation of the posterior lingual mandible
- Always under the IAN Canal
- Asymptomatic
- Found later in life (5th decade) -> So not associated with mandibular fracture really

Radiographic
Features

Site All in the mandible, inferior to the IAN canal

Shape Well defined with a corticated margin
- Margin might be continuous with lingual cortical plate
Size
Shade Completely RL
Surroundings Thinning of the lingual cortex, or complete erosion of the lingual cortex
Adjacent teeth
- No issues
Differential Dx
Tx No Tx

Periapical Radiolucency of Inflammatory Origin (PRIO)

A progression of an acute pulpitis in which exudate extends into the adjacent soft and hard tissues.
Radiographic term that includes 3 Dx:
- Periapical granuloma
- Cyst
- Abscess

Radiographic
Features

Site Centered on carious/necrotic tooth

Shape Unilocular with a poorly defined border
Size
Shade RL
Surroundings Significant widening of the PDL
Density
Displacement
Diameter
Differential Dx
Tx
 Various Radiographs

Cherubism

Radicular Cyst (A and B)

NPDC (C)

Dentigerous Cyst
 A: Unicystic Ameloblastoma

B: Solid Ameloblastoma

C: Desmoplastic Ameloblastoma

A-D: Solid Ameloblastoma

E: Unicystic Ameloblastoma

KCOT
 KCOT

Odontogenic Myxoma

Lingual Bone Defect

Simple Bone Cyst

 Fibrous Dysplasia (Polyostotic)

Fibrous Dysplasia (Monostotic)

 MRONJ

Florid Osseous Dysplasia

Periapical Osseous Dysplasia

Ossifying Fibroma
Differential Diagnosis Flowcharts
44 | P a g e
 A Very Large Table
Lesion Shade Shape Site size surroundings Diameter density displacement DDX
Fibrous displasia Variable – Mostly Fusiform Mx>Md Variable, Poorly defined Decrease Lamina dura lost – Mx antrum: a. Paget’s disease (b/c
(McCune - Albright Radiopaque (more (spindle Polystotic / Define margins Mx (PDL space keeps shape* similar bone pattern and
syndrome/) trabeculae) shaped), ground monostotic boundari antrum, wider), expansion),
- IAN canal
glass, peau es, lower Occasional
superiorly b. Osteomylitis (b/c jaw
d’orange, finger border of hypercementosis
and in enlargement and new bone)
print* (swirling mandible of root
mm
pattern), cotton
wool
Ossifying Fibroma, mixed Ball-like B-L Md – Well defined, Resorption of Teeth, Mx a. Fibrous dysplasia (similar
COF expansion premolar/molar sup encapsulated, teeth and lamina antrum, IAN, irregular trabelulae, cotton or
to IAN Rlucent line dura, Mx antrum cortical plate flocculent)
separates it (grow into and (remains intact)
b. juvenile ossifying fibroma
from replace)
surrounding c. Periapical Cementodysplasia?
d. Giant Cell Granuloma (internal
calcifications similar)

Giant Cell Radiopaque Ground glass, Md:Mx = 2:1 66% Poorly Resorption teeth, Displace teeth, a. FOL/COF (ground glass)
Granuloma/Tumor multilocular, if defined lamina dura IAN inferiorly,
1st 2 Decades ant to b. Ameloblastoma/odontogenic
(or Central Giant granular wispy malignancy missing Expands cortical
1st molar Md or myxoma (b/c multilocular)
Cell Lesion septa* often Mx, plate Mx & Md
cuspid in Mx,
Md well (undulating),can
Older more
defined destroy Mx plate
posterior
= malignant
appearance
COD – Focal 3 phases; Round, oval Ant. Md apex tooth; Well defined No resorption No a. (mature) benign
PCD Young solitary, Lamina Dura lost cementoblastoma
Early – Rlucent, Seldom >1cm,
Midle age
Mixed – mixed, Can displace jaw b. periapical abscess/cyst
unilateral,
Mature – Rpaque and antrum
c. periapical granuloma
center & Rlucent Old bilateral
boarder often
continuous with
PDL*
COD - Florid PCD in 3-4 quads or a. Paget’s (cotton wool,
extensive in one jaw hypercementosis)
b. chronic diffuse sclerosing
osteomyelitis (cementum like
masses)
d. fibrous dysplasia
e. cementifying/ossifying fibroma
Odontoma Radiopaque = or > Compound (bag Complex – Md 1st & Complex Well defined, Prevent eruption a. COF (odontoma more
adjacent tooth of teeth)* 2nd molar area, smooth or of teeth, Lg radiopaque)
– large
Compund – ant Mx irregular, Complex expand
Compou b. PCD (pcd more centered)
cortical jaw
– crown of nd – size
boarder c. cementoblastoma
unerupted canine of tooth

Cementoblastoma Radiopaque Wheel spoke Md 1st Premolar – Well defined, External root Expansion of a. Solitary PCD
pattern*, Molar, Rlucent Halo resorption, cortical plates,
b. COD (Rlucent band)
Round, B-L just inside Obscures PDL Displace teeth
Fused w/ roots, c. DBI
expansion cortical
boarded
 Lesion Shade Shape Site size surroundings Diameter density displacement DDX
Garnder’s Uniformly Rpaque bony trabeculae Angle of Md (look well-defined
Syndrome (multiple for multiple
osteomas) impacted
supernumerary
teeth)

Periapical RadioLucent Unilocular, Tooth apex (assoc. Abcess = Ill Widening of Abcess: Often > a. PCD (early)
Inflamatory Lesion spherical, w/ carious/resto’d defined PDL, can have 1.5cm expansive
b. DBI (for sclerosing ostitis)
PA Abcess (acute) teeth) Granuloma/Cy more bone and displacing*,
Granuloma st have capsul formation = PA Granuloma:
(chronic) sclerosing ostitis, Often < 1.5cm
Cyst(after bone resorption = non-displacing,
granuloma) PA rarefying in chronic -
ostitis external root
resorption, may
destroy cortical
boundaries
Residual Cyst PA Cyst minus the
tooth

Lateral Periodontal RLucent Round/oval Md 2nd premolar – < 1cm Well defined, Resorbs Lamina a. Small KOT (b/c location & x-
Cyst lateral incisor, prominent dura, Lg cysts ray appearance)
Later root surface cortical can cause b. Mental foramen (location)
boundary expansion
c. Radicular Cyst

Dentigerous Cyst RLucent unilocular 3rm molars and Mx Well No root Displaces a. hyperplastic follicle
Canines, w/n 1mm Circumscribed, resorption but can affected tooth
b. OKC ( not at CEJ, doesn’t
of CEJ* & around resorb adjacent apically,
resorb/expand as much)
crown of unerupted teeth expands corical
or supernumery bone, displaces c. ameloblastoma – unicystic
teeth (mesiodens teeth & IAN, (early stage)
Mx) grows into
d. Radicular cyst at apex of
antrum,
primary tooth (looks like DC of
crown of 2ndary)

Simple Bone Cyst Rlucent Unilocular Post. Md Variable Lost lamina dura, Generally no a. KOT (b/c longitudinal growth
(traumatic BC) (scalloped), can boarder no tooth expansion of w/ little expansion & scalloped
have septae resorption cortex boarder)
(longitudinal
b. Dentigerous cyst (if
growth)
associated with impacted tooth)

Odontogenic Round/oval or 80% Md, 60% 3rd Well Defined Can resorb roots Little B/L a. Dentigerous cyst (b/c
Keratocyst (OKC) scalloped, expansion, pericoronal center)
molar, Epicenter
(KOT) uni/multilocular Displace IAN
sup. To IAN b. Ameloblastoma (b/c
inf., grow into
multilocular and scalloped)
antrum
c. Odontogenic myxoma (b/c
multilocular & mild expansion)
d. Simple bone cyst (b/c scalloped
& minimal expansion)
 Lesion Shade Shape Site size surroundings Diameter density displacement DDX
Gorlin-Goltz multiple a. Cherubism
Syndrome (multiple odontogenetic
b. Multiple dentigous cysts
KOT) keratocysts in Md
molar/premolar &
Mx 3rd molar

Ameloblastoma RLucent unilocular Post Md, can be Larger Well defined, Extensive Root tooth a. Dentigerous cyst – (b/c small
(Unicystic) (early) or occlusal to tooth posterior corticated and Resorption** displacement, unilocular if surround crown of
(also mentioned are multilocular bud , smaller sclerotic thinning of unerupted)
polycystic & (advanced): anterior margins cortical plate &
b. OKT (b/c internal boney septae
peripheral) Soapbubble or B/L expansion
honeycomb – multilocular)
c. odontogenic myxomas (b/c of
septa)
d. Giant Cell Granuloma (b/c
Septae)
e. Ossifying Fibroma (b/c septae)

Odontogenic RLucent 50% mutilocular Md premolar/molar Poorer defined Rare root Tendency for a. Simple bone cyst (b/c scallops
Myxoma resorption longitudinal b/w roots of teeth)
– Tennis
growth (may get
Racquet**, b. Septae list
B/L exp with Lg
fusiform
lesion),
expansion
Displaces teeth
Dense Bone Island RPaque Md premolar/molar, Well defined, May cause root a. Periapical Cemento Dysplasia
(5 or more think DBI vs SO: no capsule or resorption (on (Rpaque)
Gardner’s margin vital tooth & self-
DBI if not assoc. w/ b. Periapical sclerosing osteitis (if
syndrome) limiting) if
tooth, at apex)
involving tooth
Or a non-carious,
unrestored tooth;
SO if carious,
heavily resto’d tooth
Sclerosing Osteitis RPaque Premolar/molar, No bone a. DBI
(response to PA around tooth apex expansion
b. Cementoblastoma (b/c Rpacity
inflammation)
near root)
Stafne bone defect RLucency Round, ovoid, Submandibular Well Defined, Readily Differentiated
lobulated gland fossa, close to dense sclerotic
a. If rare and above IAN – other
inf boarder of Md, boarder,
odontogenic lesion
below IAN* Thicker on
superior
aspect*
Nasopalatine duct RLucent Round or oval, Nasopalatine Well defined, Occasional root Expand bone, a. Lg incisive foramen
cyst may be heart foramen or canal corticated resorption displace teeth
 shaped b/c of (b/w apex of 11- (centrals roots b. Radicular cyst (only if cyst
superimposition 21)* diverge), can associated with central incisor
of anterior nasal displace floor of apex b/c it’s asymmetric)
spine nasal fossa
Stylohyoid complex RPaque (seen on Long tapering Mastoid process
PAN) thin process toward hyoid bone,
(thicker at base)