mixed radiolucent and radiopaque lesions / oral surgery courses

Mixed Radiolucent- Radiopaque Lesions in
Jaws
By:
• INDIAN DENTALACADEMY
• Leader in continuing Dental Education
www.indiandentalacademy.com

Contents
• Definition
• Classification
• Clinical features
• Radiographic features
• Differential Diagnosis
• Treatment

• Radiolucent — refers that portion of a
processed radiograph which appears as dark /
black.
• Radiopaque — refers that portion of processed
radiograph which appears as light / white.
• Some normal anatomic structures and disease states
can produce mixed radiolucent-radiopaque images on
radiographs.

• Pathologic entity may commences as an osteolytic
lesion, which appears as radiolucency in radiograph.
• During its development, foci of calcified material may
form within the osteolytic area, when these foci
become large & sufficiently mineralized, they become
radiographically apparent.
• Thus mixed radiolucent-radiopaque condition
frequently represents an intermediate stage in
development of the lesion.

Mixed Radiolucent-Radiopaque
Lesions Associated With Teeth
1. Calcifying crown of developing tooth
2. Tooth root with rarefying osteitis
3. Rarefying & Condensing osteitis
4. Chronic Osteomyelitis
5. PCOD
6. Cementoossifying fibroma
7. Cementoblastoma
8. Odontoma
9. Adenomatoid Odontogenic Tumor
10. Calcifying Odontogenic Cyst
11. Ameloblastic fibroodontoma
12. Calcifying Epithelial Odontogenic Tumorwww.indiandentalacademy.com

MixedRadiolucent-Radiopaque
LesionsAssociatedWithTeeth

Calcifying crown of developing tooth
• Before calcification, permanent tooth buds may
appear in the periapical region of deciduous teeth.
• In early stages of development, tooth germs appear as
cyst like radiolucency.
• After few months undergo sufficient mineralization,
appear as periapical radiolucency with radiopaque
foci.

• The cusp tips are first part
to calcify in developing
tooth.
• As soon as sufficient mineral
deposited in matrix of cusp
tip, developing tooth can
recognized as a radiolucency
with radiopaque foci.

Tooth Root With Rarefying Osteitis
• Retained root & root tips are
abnormal radiopacities
commonly found in
edentulous region of the
jaws.
• Retained roots present in
jaws of every 1 of 4
edentulous persons.
• 80% of retained roots are in
posterior region of the jaws.
• 6% of all retained root
tips are associated with
radiolucent areas.
• Usually asymptomatic,
or c/o intermittent pain
or swelling.
• ill-defined radiolucency
with ragged margins.

• The root canal may
become channel for
infection with a resulting
rarefying osteitis in
periapex, and production
of radiolucent-
radiopaque jaw lesions.
• Usually identifiable by the
shape of root, shadow of
root canal, PDL space and
surrounding lamina dura.

Management
• Root tips should be removed.
• Surrounding soft tissue enucleate and bone
defect should curetted.

Rarefying and Condensing Osteitis
• Frequently occurs at apex of a nonvital tooth / retained
root.
• Chronic infection acts as irritating factor and as stimulating
factor.
• Bone resorption occurs at apex; on other hand bone
apposition occurs at periphery of rarefying lesion.
• When chronic infection is present well-defined
homogenous radiopacity is seen more / less circumscribing
radiolucency around root end.

Differential Diagnosis
• Chronic osteomyelitis
Treatment:
• Affected teeth should treat endodontically or
extraction

Periapical Cementoosseous Dysplasia
• It is a localized change in normal bone metabolism that
results in replacement of normal cancellous bone with
fibrous tissue & cementum-like material and abnormal
bone.
• It is a reactive fibroosseous lesion; it arises from
periodontal ligament, where mature osteoblasts,
cementoblasts & precursor cells reside.
• This lesion usually identified during routine dental
radiographic examination.

Clinical Features
• Typically it occurs in middle age mean age 39 years.
• Females > males (9:1)
• Involved teeth are vital; no H/O pain & swelling.
Radiographic features
• It usually lies at the apex of a tooth.
• Mainly in mandibular anteriors.

Internal structure
• In early stage normal bone is
resorbed and replaced with
fibrous tissue that continuous
with PDL ( causing loss of lamina
dura).
• Radiographically – radiolucency
at apex of tooth.
• In mixed stage radiopaque
tissue appears in the radiolucent
structure.
• This material is amorphous, has
a round, oval shape; composed
of cementum /abnormal bone.www.indiandentalacademy.com

• In mature stage internal
aspect may be totally
radiopaque without any
obvious pattern.
• Lamina dura of involved
teeth is lost making PDL
space less apparent / widen
appearance.
• Small lesions do not cause
jaw expansion but large
lesions may cause expansion,
always a thin intact outer
cortex.

• Periapical Abscess
• Periapical Granuloma
• Calcifying crown
• Rarefying and Condensing osteitis
• Odontoma

Cementoossifying fibroma
• It is uncommon neoplastic condition - originate from
elements of periodontal ligament.
• Usually occurs as periapical lesions – round and well
marginated.
• It can occur at any age; commonly found in adults
mainly 2nd to 3rd decades.
• Definite female predilection.

• Usually asymptomatic; displacement of teeth- early c/f
• 70-80% of lesions occur in mandible, primarily
premolar & molar region, superior to inferior alveolar
canal, in maxilla in canine fossa & zygomatic arch area.
• Juvenile ossifying fibroma is aggressive form; it occurs
in first 2 decades of life.
• Because of rapid growth in young patients deformity of
involved jaw may occur.

Radiographic Features
• Most of the lesions are discovered
during routine dental examination.
• The borders of the lesion is well
defined.
• A thin radiolucent line representing
a fibrous capsule, may separate it
from surrounding bone.
• The internal structure is mixed
radiolucent-radiopaque density.
• Lesions produce more cementum
like material may contain solid,
amorphous radiopacities.

Differential
Diagnosis
• Fibrous dysplasia
• P C O D
• C O C
• C E O T
• A O T
Management
• Surgical enucleation or
resection of the lesion
• Recurrence rate is 6%

Cementoblastoma
• It is a slow growing mesenchymal neoplasm principally
composed cementum
• It manifest as bulbous growth around & attached to the
apex of tooth root
• Tooth is vital and painful
• Males > females
• Relatively young adults
• Mandible > maxilla, premolar & 1st molarwww.indiandentalacademy.com

• These are mixed radiolucent-radiopaque lesions in
which majority of the internal structure is radiopaque.
• This central radiopaque mass is surrounded by a
radiolucent band; indicating tumor is maturing from
central aspect to periphery.
• In most of the cases external resorption seen.
• Large lesions can cause expansion of mandible with
intact outer cortex.

• Odontoma
• P C O D
• Hypercementosis
• Periapical sclerosing
osteitis
Treatment
• These are self-limiting
• Simple excision and
extraction of associated
tooth.
• Rarely recur after
enucleation.

Chronic Osteomyelitis
• Osteomyelitis is an inflammation of bone and bone
marrow.
1. Suppurative : a. Acute
b. Chronic
2. Sclerosing: a. focal
b. diffuse
3. Chronic nonsuppurative sclerosing osteitis

• It can occur at any age; common in first 3 decades of life.
• Proliferative periosteitis is common in children and
young adults.
• Mandible more frequently involved.
• Clinical examination shows signs of inflammation,
tenderness, pain, swelling, intraoral & extraoral draining
sinus tracts, fever and regional lymphadenopathy.

• Denuded bone may protrude from open mucosal or
cutaneous ulcers.
• The sequestra are surrounded by sclerotic bone which
is relatively avascular.
• Within the bone, the haversian canals become blocked
with scar tissue, and the bone becomes surrounded by
thickened periosteum
• Drainage in chronic disease is intermittent and modest
in volume.

• Acute osteomyelitis – No bony changes.
• Chronic osteomyelitis – radiographic images are
irregularly shaped radiolucency with ragged, poorly
defined borders.
• Sometimes lesions appear as mixed radiolucent-
radiopaque pattern.

• Radiolucent areas consists of infected granulation
tissue, fibrosis or both.
• Radiopaque areas represent sclerosed, often nonvital
bone sequestra or both.
• Proliferative periostitis may show an alternating
radiolucent-radiopaque laminated appearance at
surface of affected bone (onion-skin appearance)

Periapical changes
Sequestrum

Garre’s
Osteomyelitis
Unusual appearance of the
mandible produced by
osteomyelitis.

• Rarefying and condensing osteitis
• Paget’s disease
• Malignant tumors

Management
Medical
• Systemic antibiotics
• Local antibiotics
- irrigation
- beads
Surgical
• Sequestrectomy
• Saucerization
• Decortication
• Resection

Odontoma
• It is benign odontogenic tumor representing 67% of all
odontogenic tumors.
• Odontomas result from budding of extra odontogenic
epithelial cells from dental lamina.
• 3 types of odontomas present;
1. Compound
2. Complex
3. Compound-Complex

• Compound odontoma –
comprises odontogenic tissues
laid down in a normal
relationship, resulting structures
will resemble to teeth.
• Complex odontoma – tooth
components are less well
organized; toothlike structures
are not formed.
• Compound-Complex – it contain
not only multiple tooth like
structures but also calcified
masses of dental tissue in
haphazard manner. www.indiandentalacademy.com

• 62% of compound variety occurs
in maxilla; predilection for incisor-
canine region, no gender bias.
• 70% of complex type occur in
mandible; located in 1st and 2nd
molar region, mostly in females.
• An odontoma frequently situated
between crown of an unerupted
tooth and crest of alveolar ridge,
blocks tooth eruption.

• Intermediate stage compound odontoma appears
as a well-defined radiolucent lesion containing
varying no. of radiopaque shadows of developing
tooth.
• Degree of calcification & opacity varies from stage
to stage and lesion to lesion.
• Complex type appears as a well-defined
radiolucency with many radiopaque foci vary
greatly in size, shape & prominence.

Differential
Diagnosis
• Cementoblastoma
• P C O D
• Cementoossifying
fibroma
Management
• Surgical enucleation
• Periodic
postoperative
examination

Adenomatoid Odontogenic Tumor
• It is a uncommon and nonaggressive tumor of
odontogenic epithelium.
• It is 2 types - central and peripheral.
• The central tumor divided into follicular type
(associated with embedded tooth) & extra-follicular
type( with no embedded tooth).
• 73% of central lesions are follicular type

• Age ranges from 5-50 years; 70% cases occur in 2nd
decade, average age is 16 years.
• It has female predilection (2:1)
• Commonly occur in maxilla; incisor-canine-premolar
• It is a slow growing & presents a gradually enlarging
painless swelling.
• Causes facial asymmetry, often associated with
missing tooth.
• It displace the teeth rather than root resorption.

• It is a pericoronal cyst-
like radiolucency.
• In maturing stages,
sharply defined
radiopaque foci are seen
within radiolucency.

• COC
• CEOT
• Odontoma
Management:
• Surgical enucleation.

Calcifying Odontogenic Cyst
• It is also called as Gorlin’s cyst.
• It is uncommon, benign slow growing lesion.
• WHO categories as benign tumor.
• It have a wide age distribution that peaks at 10-19
years and second peak age is during 7th decade;
• Mean age is 36yrs

• At least 75% occurs in bone
with equal distribution
between jaws.
• 75% lesions occur anterior to
the first molar, especially
incisor-canine region.
• Sometimes it manifests as a
pericoronal radiolucency.
• Periphery can vary from well
defined to irregular.

• The internal aspect can
vary in appearance.
• It is cyst like radiolucency
containing quite distinct
radiopaque foci
• It can be completely
radiolucent to mixed R/L-
R/O.

• AOT
• CEOT
• Odontoma
Treatment
• Surgical enucleation
• Recurrence is reported

Ameloblastic fibroodontoma
• It is benign mixed odontogenic tumor that contain
cords & nets of odontogenic epithelium & some
calcified odontogenic tissue.
• Clinical features are similar to odontoma, often
associated with missing tooth / tooth has failed to
erupt.
• Occasionally tumor takes in position of a missing
tooth.

Radiological features
• Most of the cases occur in
posterior aspect of mandible.
• The epicenter of lesion is
usually occlusal to a developing
tooth / towards the alveolar
crest.
• Lesion is well defined;
sometimes corticated.
• The internal structure is mixed
with the majority of the lesion
being radiolucent.

• Small lesions may appear as
enlarged follicles with one / two
small discrete radiopacities.
• Large lesions may have a more
extensive calcified internal
structure.
• In some cases small calcifications
have around shape with
radiopaque enamel like margin.

• Odontoma
• COC
• AOT
Management
 Surgical enucleation.
 No tendency to recur.
 Follow up is necessary

Calcifying Epithelial Odontogenic
Tumor
• It is also called Pindborg tumor.
• It is less aggressive lesion; rarely may have an
extraosseous location.
• Males > females.
• Mean age is 42 years
• 68% tumors occur in mandible; especially molar regionwww.indiandentalacademy.com

Radiological Features
• It may have several radiographic appearance.
1. Pericoronal radiolucency,
2. Pericoronal radiolucency with radiopaque foci,
3. Mixed radiolucent-radiopaque lesion not associated with
an unerupted tooth,
4. A “driven snow” appearance,
5. Dense radiopacity (occasionally).www.indiandentalacademy.com

• More common in
mandible (2:1)
• 52% associated with
unerupted / impacted
tooth.
• Borders are well defined,
cyst like cortex, sometimes
irregular & ill defined

• The internal aspect may
appear unilocular /
multilocular with numerous
scattered radiopaque foci.
• Characteristic & diagnostic
finding is radiopacities close
to crown of embedded
tooth.
• In addition small, thin
opaque trabeculae may cross
the radiolucency in many
directions

• A O T
• C O C
Management
• Surgical resection is
recommended.
• Low recurrence rate.
• Follow up is mandatory

MixedRadiolucent-RadiopaqueLesionsNot
NecessarilyContactingTeeth

Osteoradionecrosis
• A disease condition of hard and soft tissue after
irradiation of the region.
• Usually develops after 12 months radiotherapy
completion.
• Asymptomatic in early stages.
• When ulceration occurs, tenderness and pain are
common complaint.
• Mixed radiolucent-radiopaque lesion in a full-blown
case.

Irradiation
Narrowing of lumina ( principally of small arterioles)
Hypovascular, hypocellular, hypoxic tissue
Diminished capacity for normal repair
Breakdown of tissue and its overlying mucosa
Superficial infection of the denuded bone
Osteoradionecrosis

• Mandible is more commonly affected than maxilla.
• This due to microanatomy & reduced vascularity of bone.
• Posterior mandible is more affected than anterior portion.
• Loss of mucosal covering & exposure of bone is hall mark of
ORN.
• Exposed bone becomes necrotic as a result of loss of
vascularity from periosteum.
• Intense pain may occur, with intermittent swelling & extra-
oral drainage.

Radiological features
• The periphery is ill defined similar to osteomyelitis.
• If the lesion reaches the inferior border, irregular
resorption of bony cortex occurs.
• Internal structure appearance will be depends on range
of bone destruction and bone formation.
• It will be overall sclerotic to radiopaque appearance.

Prevention
• Pt should undergo
thorough dental checkup
• Patient oral hygiene should
be assessed & motivate the
pt for good oral hygiene
after radiotherapy.
• Pt should undergo
extraction of grossly
carious teeth, periodontally
involved teeth at least 10-
14 days before
commencement of
radiotherapy.
• Restore if any decayed
tooth present & patient
must undergo thorough
oral prophylaxis.
• Teeth sockets should heal
completely prior to
radiation exposure.
• After radiation exposure, all
extractions, and invasive
procedures should be
avoided for a period of 3
months

Management
• Both surgical and nonsurgical treatments have been
done.
• Hyperbaric oxygen therapy is effective treatment.
• Treatment is done in 3 stages;
• Stage I: 30 dives
• Stage II: sequestrectomy+ primary closure+ 60 dives
• Stage III: 30 dives, resection and remaining 30 dives

Focal Cementoosseous Dysplasia
• It is a reactive lesion of
PDLO.
• It is PCOD like lesions occur
in the premolar-molar
region.
• These are asymptomatic
lesions occur in edentulous
areas.
• Females are commonly
affected.
• Average age is 37 yrs.
The lesion matures through 3
stages:
1. Early radiolucent
2. Middle mixed stage
3. Late radiopaque

Radiological Features
• The distinctness of
margin varies;
radiopaque pattern
scattered throughout the
lesion.
• Radiolucent area is
surrounded by thin
radiopaque border.
• Often it appears as
ground glass appearance

Management
• Periodic follow up is recommended.
• If lesion shows signs of serious enlargement
surgical intervention is indicated.

Sailolith
• Sailoliths are stones found
within ducts of salivary
glands.
• Most common in
submandibular glands.
• Men > women
• Age ranges 3rd to 4th
decade.
• Usually occur single (70-
80%) but may occur
multiple
• Patients usually
asymptomatic but H/O
pain swelling in floor of
the mouth.
• This discomfort may
intensify at meal time.

• Sailoliths usually
cylindrical
• Some stones are
homogenously
radiopaque and some
show multiple layers of
calcification.
Management
• Small stones may be
“milked out” through
duct orifice using
bimanual palpation.
• Large stones can remove
by lithotripsy or surgical
intervention.

Phlebolith
• These are calcified thrombi found in veins, venulae or
sinusoidal vessels of hemangiomas.
• In head & neck phleboliths indicates presence of
hemangioma.
• Involved soft tissue swollen, throbbing or discolored by
presence of veins or soft tissue hemangioma

• In cross section round or
oval in shape with smooth
periphery.
• Internal aspect maybe
homogenously radiopaque.
• It gives “bulls eye” or
target appearance.

Rhinolith / Antrolith
• Hard calcified bodies or stones occur in the nose or
maxillary sinus.
• Pt is asymptomatic for long time but expanding mass
may impinge on mucosa which cause pain, congestion
and ulceration.
• Pt may develop a unilateral purulent rhinorrhea,
sinusitis, headache, fetor and fever

• These stones have variety of
shapes & sizes
• Stones present as
homogenous or
heterogeneous radiopacities.
• Occasionally density will
exceed the surrounding
bone.

Traumatic Myositis Ossificans
• It is characterised by ossification of muscle by single
acute traumatic episode or multiple minor traumatic
episodes.
• Exact mechanism for ossification is not clear.
• It usually manifests as firm painful mass in the injured
muscle within 1-4 weeks.
• In facial muscles masseter and temporalis muscle
frequently involved.

• It may appear as a feather type of calcification in
muscle following ossification of hematoma along
dissected muscle bundle.
• Calcification may be seen within 2-3 weeks after
trauma.
Treatment:
• Surgical excision

Fibrous dysplasia
• It is a hamartomatous fibroosseous lesion.
• Etiology- Unknown
• It is a bone lesion that produces lysis of bone with
fibrous proliferation as a replacement (radiolucent) in its
early stage.

• Monostotic type most common & frequently involves
the jaws and skull ( older adults).
• Mandibular lesions are usually solitary.
• Maxillary lesions may involve neighboring bones
(Craniofacial FD).
• Polyostotic form usually seen in children and young
adults ( < 6 years).
• Polyostotic form is static when skeletal growth stops,
but proliferation may continue.

• Early lesions are spherical radiolucency
• Margins are ragged and poorly defined, merging into
normal bone.
• Lesions are usually situated deep within jaw bone.
• Maturing changes produce ground glass appearance
may commence at periphery of the lesion.
• Gross displacement of mandibular canal is seen.

(intermediate stage)
A) Smoky or mottled
appearance(also seen in
B).
• B)Radiograph showing
one lesion in maxilla &
one in mandible.

• Chronic osteomyelitis
• Paget’s disease
• Osteogenic sarcoma

Paget’s Disease (Osteitis Deformins)
• First described in England by Sir James Paget in 1876.
• Etiology: Unclear; genetics and undetected slow-acting
virus may play roles.
• Usually old age people are affected.
• It is disorder of bone metabolism.

• Osteoclastic resorptive process is overactive, with a
compensatory increase in osteoblastic action
attempting to maintain strong bones.
• Progresses so slowly that annual radiographs show little
change.
• The vertebrae, pelvis, skull, tibia, femur and humerus
are most likely to be involved
• Patient may develop arthritis like symptoms & bowed
legs with a waddling gait and may complain of an
increasing hat size, which is due to skull expansion.

• Maxilla>Mandible
• Involved bones are thickened, and the foramina are often
constricted.
• Consequently pressure is induced on the structures that pass
through the foramina, causing neurologic signs such as
deafness and diminishing vision.
• Calcified areas interspersed with radiolucent areas producing
the cotton-wool appearance.
• Teeth in the involved jaw may demonstrate spreading,
migration, diminution of the laminadura, and
(characteristically) hypercementosis.

• Florid Cementoosseous
dysplasia
Management
• In early stages, drug
therapy with
diphosphonates or
calcitonin arrests
osteoclastic activity.
• Anti-inflammatory agents
for pain relief.
• Edentulous pts may
require frequent
adjustment or continued
fabrication of new
dentures.

Osteogenic Sarcoma
• Arises from primitive
undifferentiated cells and
from malignant
transformation of osteoblasts.
• Etiology – unknown.
• Irradiated bone is more
prone to become osteogenic
sarcoma.
• Age: 3rd - 4th decade.
• Jaw lesions have less
tendency to metastasize.
• Prognosis is better for jaw
lesions.
• Metastasizes almost
exclusively through
hematogenous spread.
• Intermittent local pain,
swelling.

Radiographic features
• Three different
radiographic images:
1. Totally radiolucent
2. Mixed radiolucent-
radiopaque
3. Completely radiopaque
• The classic sun-burst
appearance may be seen in
the latter two types.
• The lesion may have
ragged, ill-defined borders.
• In some lesions sequestra
are formed.
• If the tumor invades the
periosteum, many thin,
irregular spicules of new
bone may develop
outward and perpendicular
to the surface of the
lesion. This produces the
sun-burst effect.www.indiandentalacademy.com

• Sometimes, two triangular radiopacities project from
the cortex and mark the lateral extremities of the
lesion. These are referred to as Codman’s triangles.
• Rarely, it causes periosteal deposition of bone in an
“onion-skin” pattern.
• In some cases a bandlike widening involving complete
length of PDL space on one or both sides of the root &
involvement of the mandibular canal with widening of
the canal can be seen.
• Cemental resorption may be seen.

• Chondrosarcoma
• Fibrosarcoma
• Osteoblastic metastatic
carcinoma
Management
• Resection with large
border of normal bone
• Radiation &
chemotherapy used for
control metastatic
spread.

Osteoblastic metastatic carcinoma
• Occasionally metastatic
tumors to the jawbone
from primary lesions in
the prostate or breast
may be seen.
• It may appear as entirely
radiolucent, mixed
radiolucent-radiopaque,
or entirely radiopaque.
• Less aggressive– more
circumscribed.
• When small nests of
sclerotic foci are
disseminated throughout
the jawbone, salt & pepper
pattern may be seen.
• H/o surgery or symptoms of
a primary tumor indicate
metastatic disease.

PA view cotton-wool
appearance in skull & large
bilateral radiolucent lesions
seen in mandible
Lateral view showing
radiolucent & radiopaque
areas

• Chondrosarcoma
• Ossifying subperiosteal hematoma

Chondrosarcoma
• It is malignant tumor of cartilaginous origin.
• It can occur at any age; common in adults.
• Male and females are equally affected.
• Maxilla more frequently involved than mandible
• Pt may have firm to hard swelling with long duration.
• Enlargement cause pain headache and deformity

• Maxillary lesions occur in anterior maxilla
• Mandibular lesions occur In coronoid process, condylar
head and neck; occasionally symphysis region.
• Lesions are round, ovoid, or lobulated
• Borders are well defined and corticated some times meld
with adjacent normal bone.
• Aggressive lesions have infiltrative, ill-defined, and
nonocorticated borders.

• Internal structure usually exhibit some form of
calcification within center of the lesion which gives
mixed radiolucent-radiopaque appearance.
• This diffuse calcification may be superimposed on a
bony background that resembles granular / ground-
glass appearance.
• Lesions are rarely completely radiolucent.
• In mandibular cases the inferior border / alveolar
process grossly expanded with intact cortical covering.

• Radiograph of a surgical specimen.
• Radiopaque foci can be seen in the exophytic mass

• Osteogenic sarcoma
Management
• Surgical resection is
mandatory
• It is quite radioresistent;
radiation therapy can used
as palliative procedure
with large inoperable
tumors.
• At least 60% of cases have
recurrences within 5 years.

Desmoblastic Ameloblastoma
• It is histologic variant of ameloblastoma.
• Distinctive with a moderately cellular fibrous connective
tissue with an abundance of collagen.
• The tumor epithelium consists of small, ovoid, or follicle
shaped islands & narrow cords.
• Maxilla>Mandible.
• Anterior region is commonly affected.

Edentulous premolar
region of maxilla
Canine and premolar
region of mandible

Rarities

• Eruption sequestrum
• Ameloblastic fibrodentinoma
• Calcifying hyperplastic dental
follicle
• Central odontogenic fibroma
• Ameloblastoma
• Cystic odontoma
• Lymphoma of bone
• Juvenile ossifying fibroma
• Odontodysplasia
• Odontogenic myxoma
• Central hemangioma
• Ewing’s sarcoma
• Osteoblastoma
• Osteiod osteoma
RARITIES

Foreign Bodies
• Usually root canal filling
materials.
• Extruded gutta percha,
silver points, sealers or
retrograde amalgam
and filled root canal

Florid Cementoosseous Dysplasia
• It appears as widespread form of
periapical cemental dysplasia.
• It has poor vascular supply, more
susceptible for infections.
• Females > Males
• Mean age 42 years
• Mandible > Maxilla
• Mostly posterior to cuspids

Lymphoma of Bone

Cystic odontoma

References
• Differential Diagnosis Wood & Goaz 5th Edition
• Dental Radiology White & Pharow 5th Edition
• Oral Pathology Shafer 5th Edition
• Oral pathology Neville & Dam 2nd Edition
• Oral Radiographic Diagnosis Stafne’s 5th Edition

THANK YOU

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