RADIOGRAPHIC INTERPRETATIONS

“Proficiency comes only with practice”

Steps to follow:
1. History and clinical exam info
2. Type of radiographs
3. Interpretation

*Class D – pulp exposure – needs radiograph

What are the things to consider in interpretation?

1. Quality of diagnostic image
- Any distortion in shape? Size?
- Appropriate density?
- Good contrast? (Low contrast – acceptable)
- No errors in technique and processing

2. Number and type of available images

- Don’t interpret based on only 1 radiograph.
- Localization techniques must be exhausted.
- Full-mouth series provide different views.
- Complete imaging prior to biopsy.

3. Viewing conditions
- Reduce ambient light
- Use a suitable film mount
- Use a recommended mounting – ADA mounting -> Labial mounting (Embossed dot faces the
reader)
- View box light should be uniform
- View box size GREATER than radiograph (View box aka NEGATOSCOPE)
- Use:
o Intense light to evaluate dark regions
o Magnifying glass to exam small regions

*All viewing conditions are eliminated in DIGITAL RADIOGRAPHY.

“Painting a picture with words”

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TERMINOLOGIES:
TISSUE DENSITY
- The capacity of a given tissue to absorb x-rays.

RADIOLUCENT
- Descriptive of BLACK areas on radiographs, represent areas where x-rays REACHED those
parts of the film because of LOW TISSUE DENSITY;
- Seen in inflammation, cyst, and central soft tissue.
- Ex: Periapical cyst
- CYST - pathologic cavity that has semisolid fluid content. It will appear radiolucent because
there is destruction of minerals of the bone. There is release of hydroxyapatite crystals
making it less dense.
-

- slow growing lesion

- well-bounded ; well-circumscribed

- SCLEROTIC LINING- represents area of reactive

bone

RADIOPAQUE
- Descriptive of WHITE areas on radiographs, represent areas where x-rays DID NOT REACH
those parts of the film because of HIGH TISSUE DENSITY; Seen in bone sclerosis and
calcified tumors.
- Ex: Cementoma

MIXED RADIOPACITY & RADIOLUCENCY

- Descriptive of white and black areas on radiographs;
- Represent areas where the lesion has elaborated calcific material intro lesion.
- Ex: Compound odontoma

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OSTEITIC MARGIN
- An indefinite, diffuse margin due to a gradual change froe diseased to normal bone. Seen in
inflammatory conditions and infiltrating tumors.
- Ex: Condensing osteitis

CLEAR-CUT MARGIN
- Sharply demarcated, punched-out, radiolucent area.
- Seen in perforation of cortex by periapical infections, central tumors, and rarely surface
erosions from periosteal tumors.
- (*Central tumor – lesion is within bone *Periapical tumor – beyond the surface of the bone
*Cortical plate is compact bone)
- Ex: Eosinophilic granuloma

CYSTIC MARGIN
- Formed by dense cortical bone surrounding the area.
- Seen in crypts around unerupted teeth, cysts, and benign central osteolytic tumors of the jaw.
- Like a cyst, but not definitely a cyst. Because it can be a tumor, lined with a cystic margin.
- Ex: Dentigerous cyst, Odontogenic keratocyst
- A cyst associated to an unerrupted tooth

EGG SHELL EFFECT *Attenuation of x-rays – x-rays are weakened

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BONE EXPANSION
- Caused by pressure of cystic content or encapsulated tumor tissue, cortex is reabsorbed
inside and added to outside by the periosteum.
- Seen in cysts, benign, giant cell lesions, Fibro-osteoma, ameloblastoma, and most central
tumors.
- Resorbs in the inside, deposition on the outside = expansion of the cortical plate of bone
- Ex: Ossifying fibroma

PERFORATION
- Infiltrating malignant central tumors may perforate the bone.
- A feature of fast growing lesions
- Ex: Renal tumor to jaw bone

TRABECULATED
- Radiolucent area is generally cystic. In character, often expands to bone, and is subdivided
by septae (Soap-bubble like).
- Seen in benign giant-cell lesions, central myxoma, central angioma, and central mixed
tumors.
- Ex: Ameloblastoma

LOCALIZED INVOLVEMENT
- The changes are confined to a definite area in the bone as in most conditions in osteitic,
clear-cut, and cystic margins.

DIFFUSED GENERALIZED INVOLVEMENT

- The entire bone or a large part of it is involved, without well-defined(?) osteomyelitis, benign
giant cell lesions, and locally malignant tumors.
- Di alam san yung end or start

UNICYSTIC LESION
- Involves one cystic lesion.

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POLYCYSTIC LESION
- A large part of the bone is involved by a tumor growing by extension through new cyst
forming at the periphery of the lesion.

NEW PERIOSTEAL FORMATION

- From the periosteum new bone is formed either parallel to the surface or vertical to the
periphery.
- The latter is found in syphilis and as the so-called “Sun-ray effect” in osteogenic sarcoma.
- SUN-RAY EFFECT - New periosteal formation
- Best manifested using occlusal technique

FILLING DEFECT
- If radiopaque substances are injected and part of a cavity or gland is not filled with it, we
speak of this as a filling defect.
- Filling defects are generally due to the presence of pathologic tissue such as tumors.
- Ex: To determine blockade in the SALIVARY DEFECT

“HAIR-ON-END” or “CREW CUT” EFFECT

- Skull with thickening of the diploe, poorly defined outer and inner plates, and elongated,
trabeculae, characteristics in THALASSEMIA/COOLEY’S ANEMIA.

“WISPY” INTERNAL SEPTA

- Internal septa that is faint/light.
- Ex: Central giant cell granuloma (CGCG)

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“ORANGE PEEL”
- Increased fibrous tissue in the marrow spaces.
- Ex: Fibrous dysplasia

*ALARA

Periodontal ligament (PDL) – Hour glass

Histologically ->

But in the radiograph, show uniformity, not like histologically.

For  Fr.  Lu