RADIOGRAPHIC INTERPRETATION OF

DISEASE OF BONE MANIFESTED IN

THE JAWS
DRG. SHANTY CHAIRANI

FIBRO-OSSEUS LESION
In fibro-osseus lesion, normal bone has
been replaced by benign fibrous tissue
containing variable amounts of
mineralization.
There are 2 catagories of these lesion :
those are not of periodontal ligament
origin (fibrous dysplasia) and those
that may be of periodontal ligament
origin (periapical cemental dysplasia,
ossifying or cementifying fibroma).

FIBROUS DYSPLASIA
An idiopathic regional alteration of bone in
which the normal architecture is replaced by
fibrous tissue and nonfunctional trabeculae-like
osseous structures; with or without associated
endocrine disturbances.
Clinical Features:
Most often juveniles and young adults
It can affect just one bone (monostotic) or
multiple bones (polyostotic). Jaw involvement is
common (especially the maxilla).
Singular, slow-growing, painless swelling of the
affected bone.
Overgrowth of tissue that occurs centrally in the
jaws
May involve impacted or unerupted teeth
Increased level of serum alkaline phosphatase

 Radiographic Features:
Multilocular radiolucency or mixed
radiolucent and radiopaque appearance
Initially ill-defined radiolucency, gradually
fine trabeculae become evident to produce
the typical ground glass or orange
peel appearance.
Lamina dura is usually obscured and the
cortical plates thinned.
May displaced the adjacent teeth, resorbed
roots and destructed the developing teeth.

CEMENTO-OSSEUS DYSPLASIA
A disease process of the jaw which is
classified as fibrosous lesions
Includes periapical cementoosseous
dysplasia, focal cementoosseous
dysplasia, and florid
cementoosseous dysplasia

PERIAPICAL CEMENTAL DYSPLASIA

Also known as Cementoma, Periapical CementoOsseous Dysplasia, Periapical Fibrous
Dysplasia and Periapical Osteofibrosis
Asymptomatic diffuse periapical radiolucent and
radiopaque areas, primarily of the anterior
mandible, in which cemento-osseous tissue
replaces the normal architecture of bone.
Clinical Features:

Predilection for black women

Middle aged adults, 4th to 6th decade of life
Asymptomatic
Usually occur in apices of mandibular anterior
region
The involved teeth are vital

 Radiographic features :
Round, monolocular, often multiple.
Adjacent teeth: typically vital, not displaced, not
resorbed.
The periapical ligament space is intact. Lamina
dura may lost or intact
Small, up to 1 cm in diameter.

Radiodensity
Stage 1 (osteolytic stage) : Radiolucent, not
corticated
Stage 2 (cementoblastic stage) : Radiopacity
within the apical radiolucencies
Stage 3 (mature stage) : Densely radiopaque but
surrounded by a thin radiolucent line.

Cementoma 1st stage

Cementoma 2nd stage

Cementoma 3rd stage

CEMENTO-OSSIFYING FIBROMA
Also known as Ossifying Fibroma
Benign fibro-osseous neoplasm. It is difficult
to differentiate the calcified tissue within the
lesion between bone and cementum.
Clinical Features:
Slow growing neoplastic lesion
Any age but more common in children and young
adults
More often in the premolar/molar area in the
mandible.
Generally asymptomatic, unless they become
large enough.

 Radiographic Features:
Well defined radiolucency, mixed radiolucentradiopaque, and radiopaque.
Cortical expansion without perforation
Three stages of development : radiolucent
mixed radiopaque.
In early stage it appears as unilocular, welldefined radiolucency.
With time radiopaque foci develop within the
lesion.
When radiopaque is usually surrounded by a
thin radiolucent halo.

It can cause displacement of the adjacent

teeth. Root resorption may range from mild to
severe.

FLORID OSSEOUS DYSPLASIA

Also known as Florid Cemento-Osseous Dysplasia
(FCOD)
Diffuse asymptomatic radiopaque and radiolucent
intraosseous areas of cemento-osseous tissue that
involve one or both arches.
It is a benign condition that usually involves multiple
quadrants of the jaws.
Clinical Features:
Uncommon in males, most often in African American
women
Most patients are middle aged.
Located in the mandible or maxilla
No external signs or symptoms
Usually painless
The lesions are often bilaterally and symmetrically
positioned in edentulous areas.

 Radiographic Features:
Multiple radiolucent cavity partially filled with one or more
dense, radiopaque masses
Early stage completely radiolucent
Resembles cloud like masses which vary in size and shape
Cotton wool appearance

CHERUBISM
Autosomal dominant fibro-osseous lesion of the
jaws involving more than one quadrant that
stabilizes after the growth period, usually leaving
some facial deformity and malocclusion.
Clinical Features:
Normal appearance at birth
Starts in early childhood, progress rapidly in the 7th
& 8th year of life, slows during puberty and stabilizes
after puberty
Chubby cheek appearance
More common in mandible than maxilla
Bilateral, symmetrical enlargement of alveolar ridge
Painless
Premature exfoliation of primary teeth and failure of
permanent teeth to erupt

 Radiographic Features:
Unilocular or more commonly multilocular
symmetrical bilateral expansile radiolucencies in
mandible. Occasionally posterior maxilla.
Typically the initation of bone destruction is near
the angles of mandible, with later expansion of
the lesions posteriorly into the rami and anteriorly
into the mandibular body.
Well-defined, well-corticated border.
Expansion of the buccal and lingual cortical
plates.
Adjacent teeth: marked displacement, impaction,
root resorption.

CENTRAL GIANT CELL GRANULOMA

An intraosseous destructive lesion of the
anterior mandible and maxilla, probably
reactive to some unknown stimulus;
composed of multinucleated giant cells in a
background of mononuclear fibro-histiocytic
cells and red blood cells.
Clinical Features:
Common in children and young adults
More often in females than males
Mandible more often than maxilla, usually occur
in anterior to the first molar.
Slow growing will be asymptomatic swelling,
producing an asymmetry of facial.
Rapid growing will be painful and dentition will be
loose

 Radiographic Features:
Unilocular (early stages), multilocular
(internal septa, honeycomb appearance)
radiolucencies
Well defined or irregular borders
It can cause considerable expansion
Possible effects on adjacent teeth:
displacement, resorption, destruction of
lamina dura.

PAGETS DISEASE
Also known as Osteitis Deformans
Idiopathic, chronic, slowly progressive
disease of bone in the elderly.
Abnormal resorption and deposition of bone,
leading eventually to sclerosis and expansion
of the effected bone.
It is produces larger but weaker bones,
extensive pain, high levels of serum alkaline
phosphatase and urinary hydroxyproline, and
an increased tendency to develop malignant
bone neoplasms.
The jaws are involved in approximately 20%
of the cases.

 Clinical Features:
More common in males
Rarely occurs before the age of 40
Increased serum alkaline phosphatase, normal
calcium and phosphorus
Neurologic complaints include headache, auditory
or visual disturbances, facial paralysis, vertigo,
and weakness
Bone pain and enlargement, deformity and
increased risk of bone fracture and osteosarcoma
Maxilla is more often involved than mandible.
Teeth: increased spacing as well as loosening is
noted

 Radiographic Features:
It can be divided into three stages:
1st stage - Bone resorption: Generally
radiolucency/ osteoporosis)
2nd stage Ostoblastic repair (mixed
radiolucency/ radiopacity) : granular or ground
glass appearance
3rd stage Sclerosing phase (haphazard
deposition of sclerotic bone) : cotton wool
appearance.

Hypercementosis of roots
Other radiographic features: loss of lamina
dura and obliteration of the periapical ligament
spacesresulting in ankylosis of teeth, external
root resorption.

OSTEOPETROSIS
Also known as Marble Bone Disease
Generalized hereditary condition consisting of
excessive bone mineralization, resulting in
altered stature, frequent fractures, lack of bone
marrow hematopoietic function, and a
tendency for severe osteomyelitis of the jaws.
It is generally subdivided in two main types,
the clinically benign and the clinically
malignant forms.
It is characterized by overgrowth and sclerosis
of bone with resultant thickening of the bony
cortices and narrowing of the marrow cavities.

 Clinical Features:
Begins in infancy with breathing and hearing
difficulties
Very dense bone, fragile bone.
Stunted growth, no proper medullary space, and
bone marrow. Short life span.
Hydrocephalus, abnormal dental development
(oligodontia)
Anemia, neutropenia, increased rate of infection,
increased rate of bleeding, hepatosplenomegaly.
Pain, deafness, blindness, stroke, cardiac disease.

Radiographic Features:

Generalized increase in bone density

Cranial plates are thickened
Sinus cavities are reduced in size
Embedded or unerupted teeth are common

INFANTILE CORTICAL
HYPEROSTOSIS
Also known as Caffeys disease.
Abnormality of bone without a known cause
or a definite pathogenesis.
The feature of this disease is unusual
cortical thickening in certain bones, such as
the mandible (more frequent), the clavicle
and the ulna
Clinical features :
Occurs in first year of life, usually under 6 months
of age
Soft tissue swellings in the areas where bones
will later be thickened.
Infant have fever and are irritable

 Radiographic features :
Symmetrical, bilateral involvement of the
mandible.
Enlargement or thickening of the lower border of
the mandible and thickening of the cortex of the
other affected bones.

OSTEOGENESIS IMPERFECTA
A spectrum of diseases of bone due to a
basic alteration in the formation of bone
connective tissue matrix, resulting in an
inability of the matrix to fully mineralize,
a tendency for multiple broken bones,
blue sclera of the eyes, and associated
dentinogenesis imperfecta.
Osteogenesis imperfecta is a serious
disease of unknown etiology.

 Clinical Features:
It is usually present at birth, although some cases
are not recognized until later in childhood.
Fragile bones resulting in multiple fracture and
defomity of long bones
May be born with multiple fractures just from birth
process
Blue sclera, hearing loss, hyperthermia
Opalescent dentin

Radiographic Features:
Multiple fractures and healed fractures
Bulbous crowns of teeth, obliteration of pulpal
chambers and shortened roots
Unilocular radiolucencies on both sides of the
mandible
Wormian bones in the skull