Oral medicine: 14. radiolucencies and radio-opacities. a. bone diseases

Specialist referral may be indicated if the Practitioner feels:

Radiographic features to be assessed include the lesional size, site, shape, margins, radio-density and effects on adjacent structures (displacement of the inferior alveolar nerve or tooth displacement or resorption).

Well-defined corticated radiolucencies are often odontogenic cysts and benign tumours as they are generally slow growing and allow the bone surrounding them to remodel. If they become infected cortication may be lost and they may appear to be less well defined.

Well-defined non-corticated lesions (punched out lesions) may be odontogenic cysts, granulomas that have become infected, or more sinister rapidly-growing lesions such as multiple myeloma, malignancy or histiocytosis.

Poorly defined radiolucencies are often infections or malignant tumours.

Jaw radiolucencies may include:

Giant cell lesions such as the Central Giant Cell granuloma – initially a small, unilocular radiolucency – eventually become multilocular, and may then mimic brown tumours of hyperparathyroidism (histologically similar). Biochemistry distinguishes these entities. Other giant cell lesions include brown tumour of hyperparathyroidism, cherubism and aneurysmal bone cysts.