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In the name of god

This guide provides important guidelines for ordering dental radiographs, emphasizing the importance of clinical examination and only ordering radiographs that directly benefit patients in diagnosis and treatment. It also includes instructions for specific types of radiographic examinations and identifies normal anatomical landmarks and common pathologies.

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In the name of god

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  1. In the name of god Your Subtitle Here

  2. Dr.Raha Heirat DDS,MS Oral & maxillofacial radiologist

  3. GUIDELINES FOR ORDERING DENTAL RADIOGRAPHS • Make radiography only after Clinical examination. • Order only radiographs that directly benefit the patients in diagnosis &treatment. • Use the Least amount of exposure

  4. Inraoral images>>>examine the periapical films before the bitewing films • For panoramic images starting in the RT maxilla to its LT then drop down in the LT mandible to its RT • Systematic radiographic examination>>>identify normal anatomy & examinte the entire film

  5. Normal anatomic landmarks

  6. enlargement of the foramen & canal > 1cm Incisive foramen Incisive canal cyst

  7. The red arrow identifies the lateral foss • The pink arrow identifies chronic periapicalperiodontitis

  8. Pneumatization. Expansion of sinus wall into surrounding bone, usually in areas where teeth have been lost prematurely. Increases with age and may be accelerated as a result of chronic sinus infections. most commonly seen when the first molar is extracted prematurly.

  9. Nutrient canals appear as uniform thin radiolucent lines . most often seen in older persons with thin bone, and in those with high blood pressure or advanced periodontitis

  10. chronic periapical periodontitis; these teeth are non-vital Mental fossa

  11. Mental foramen • usually located midway between the upper and lower borders of the body of the mandible, in the area of the premolars. • May mimic pathology if superimposed over the apex of one of the premolars

  12. Submandibular gland fossa depression on the lingual side of the mandible below the mylohyoid ridge. Thininig of the bone, and sparse trabecular pattern results in the area being very radiolucent. bilaterally helps to differentiate from pathology

  13. submandibular salivary gland defect ( staphne defect) is a developmental abnormality • appears as a radiolucent area in the mandible. It may be mistakenly diagnosed as a cyst or a tumor. There are no clinical signs nor symptoms.

  14. s Staphne defect

  15. Pulp pathosis lesions • Acute apical periodontitis • Chronic apical periodontitis rarefying osteitis condensing osteitis Thickening PDL space

  16. Apical periodontitis is an inflammatory disorder of the periradicular tissue caused by a persistent microbial infection of the root canal system of the affected tooth

  17. Condensing osteitisor chronic focal sclerosing osteomyelitis usually observed around the apices of mandibular posterior teeth with pulp necrosis or chronic pulpitis

  18. Dens bone island( enostosis) • an area of dense bone without apparent cause • There are no signs or symptoms

  19. Presentation Outline • Introduction • Odontogenic Cysts • Odontogenic tumors

  20. Odontogenic cysts

  21. Introduction • There are variety of cysts and tumors that affect the osseous marrow and cortex of the jaw bones, which are uniquelyderived from the tissues of developing teeth.

  22. Odontogenic Cysts • A cyst is a pathologic cavity filled with fluid, lined by epithelium and surrounded by a definite connective tissue wall.

  23. Odontogenic Jaw Cysts • Odontogenic cysts arise from tooth development epithelium. • Odontogenic cysts are true cysts occurring in the jaws. They arisefrom stimulation ofepithelium left over from tooth development.

  24. Odontogenic Jaw Cysts Odontogenic cysts include: • Radicular (Apical) Cyst • Dentigerous Cyst • Odontogenic Keratocyst • Lateral Periodontal cyst

  25. Apical Cyst (Radicular Cyst, Periapical Cyst) • A radicular cyst is a cyst that most likely results when rests of epthielial cells in the periodontal ligament are stimulated by inflammatory products from a non vital tooth.

  26. FeaturesIt develops in a preexisting periapical granuloma. It has similar radiographic appearance as the periapical granuloma: round or oval radiolucency well defined well corticated if longstanding The adjacent teeth can be displaced but rarely resorbed. Apical Cyst (Radicular Cyst, Periapical Cyst)

  27. Apical Cyst (Radicular Cyst, Periapical Cyst)

  28. Dentigerous Cyst (Follicular Cyst) • A Dentigerous cyst is a cyst that forms around the crown of an unerupted tooth.

  29. It arises in the follicular region of unerupted permanent tooth. It develops after fluid accumulates between the remnants of enamel organ and the tooth crown. Usually adolescents, 20-40 years old. Most common sites: mandibular third molar, maxillary canine, maxillary third molar. Unilocular radiolucency, well-defined, often corticated, associated with the crown of an unerupted and displaced tooth. Large cysts tend to expand the outer plate (usually buccally) Dentigerous Cyst (Follicular Cyst)

  30. Dentigerous Cyst (Follicular Cyst)

  31. Odontogenic Keratocyst (Keratocyst, Keratinizing Cyst) • This is a non-inflammatory odontogenic cyst that arises from the dental lamina.

  32. Features It is lined by keratinizing epithelium. It is usually located in the mandible (posterior body and ramus region). most develop during the second and third decade. It can become very large. It extends along the body of the mandible causing minimal mediolateral expansion. OdontogenicKeratocyst(Keratocyst, Keratinizing Cyst)

  33. Features Unilocular (often with scalloped margins) or multilocular (more often in larger lesions) Smooth margins, well-defined, often well-corticated. Tendency for recurrence after inadequate surgery. Adjacent teeth: vital, rarely resorbed. OdontogenicKeratocyst(Keratocyst, Keratinizing Cyst)

  34. OdontogenicKeratocyst

  35. Lateral Periodontal Cyst • Lateral Periodontal Cystare thought to arise from Epithelial rests in periodontum lateral to the tooth root.

  36. It is a developmental odontogenic cyst. It arises from remnants of the dental lamina or from the reduced enamel epithelium. Common site: Along the lateral surface of the root of vital tooth. Usually in mandibular premolar/canine region. Usually asymptomatic. Small size (less than 1 cm in diameter). Unilocular, round or oval, well-defined, usually well corticated radiolucency. Lateral Periodontal Cyst

  37. II. Odontogenic Tumors

  38. This a true neoplasm of odontogenic epithelium It is an aggressive neoplasm the arises from the remnants of the dental lamina and dental organ( odontogenic epithelium) Ameloblastoma

  39. Benign, locally aggressive odontogenic tumor. Usually it slowly grows as painless swelling of the affected site. It can occur at any age. Localized invasion into the surrounding bone. 80-95% in the mandible (posterior body, ramus region). In the maxilla mostly in the premolar-molar region. Ameloblastoma

  40. Unilocular (small lesions). Multilocular (large discrete areas or honeycomb appearance) Smooth, well-defined, well-corticated margins Adjacent teeth are often displaced and resorbed. It causes extensive bone expansion. Incomplete removal can result in recurrence. Ameloblastoma

  41. It is a tumor that is radiogrphically and histologically characterized by the production of mature enamel , dentin , cementum and pulp tissue . Relatively Common lesion Odontomas

  42. It usually occurs in young patients. Usually asymptomatic. Failure of eruption of a permanent tooth may be the first presenting symptom.It is commonly found occlusal to the involved tooth. Odontoma

  43. Well defined Two types: complex and compoundodontoma Complexodontoma is composed of haphazardly arranged dental hard and soft tissues. Compound odontoma is composed of many small "denticles" . internal aspect is very radiopaque in comparison to bone. Odontoma

  44. Odontoma

  45. Ameloblasticfibroma

  46. These are benign mixed odontogenic tumors . They are characterized by neoplastic proliferation of maturing and early functional ameloblasts as well as the primitive mesnchymel components of the dental papilla Ameloblasticfibroma

  47. Benign Rare. Occurs in children and adolescents. Most common site: mandible posterior region. Often associated with an unerupted tooth. Well defined, well corticated. Small lesions are monolocular. Large lesions are multilocular. It may cause displacement of adjacent teeth. Large lesions cause buccal/lingual expansion. Ameloblasticfibroma

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