27: Differential diagnosis of lesions of variable radiopacity in the jaws

Differential diagnosis of lesions of variable radiopacity in the jaws

As explained in Chapter 25, a variety of conditions that can affect the jaws are radiopaque relative to the surrounding bone, although the degree of opacity can be very variable. A step-by-step guide, similar to that suggested for radiolucent lesions in Chapter 26, is outlined to emphasize the importance of a methodical approach when producing a differential diagnosis. The suggested approach is summarized in Fig. 27.1. Although most lesions are still detected using plain radiographs, this process can be greatly facilitated in many cases if advanced imaging modalities, described in Chapters 16 and 18, such as computed tomography (CT), cone beam CT or magnetic resonance (MR) are available.

Step IV

Consider the subdivisions of these pathological categories. A typical list is shown in Table 27.1.

Table 27.1

Classification of the more common lesions that can present as variable radiopacities in the jaws

Abnormalities of the teeth
Unerupted and misplaced teeth including supernumeraries
Odontomes — Compound
 — Complex (see odontogenic tumours)
Root remnants
Conditions of variable radiopacity affecting the bone
Developmental Exostoses including tori — mandibular or palatal
Inflammatory Low grade chronic infection — sclerosing osteitis
Osteomyelitis — sequestra; involucrum formation
(late stages)
Calcifying epithelial odontogenic tumour (CEOT)
Ameloblastic fibro-odontoma
Adenomatoid odontogenic tumour (AOT)
Calcifying cystic odontogenic tumour (calcifying odontogenic cyst)
Odontomes — Compound
 — Complex
Non-odontogenic Benign — Osteoma
 — Chondroma
Malignant — Osteosarcoma
 — Osteogenic secondary metastases
Bone-related lesions  
Osseous dysplasias
(Fibro-cemento-osseous lesions)
(late stages)
Periapical osseous dysplasia
Focal osseous dysplasia
Florid osseous dysplasia
Familial gigantiform cementoma
Other lesions Ossifying fibroma
Fibrous dysplasia
Bone diseases Paget’s disease of bone
Superimposed soft tissue calcifications
Salivary calculi  
Calcified lymph nodes  
Calcified tonsils  
Calcified acne scars  
Foreign bodies
Within the soft tissues  
On or overlying the skin  


Typical radiographic features of abnormalities of the teeth

Unerupted or misplaced teeth including supernumeraries (Fig. 27.2)

Radiopacities caused by unerupted or misplaced teeth and supernumeraries are readily identifiable as such radiographically, by their characteristic shape and radiodensity.


Although both compound and complex odontomes are more accurately classified as epithelial odontogenic tumours with odontogenic ectomesenchyme showing dental hard tissue formation (WHO Classification 2005), they are often also described as dental developmental anomalies (see Ch. 24).

Typical radiographic features of conditions of variable opacity affecting bone


Exostoses, including tori (mandibular or palatal)

Exostoses are small, irregular overgrowths of bone sometimes developing on the surface of the alveolar bone. They consist primarily of compact bone and produce an ill-defined radiopacity when superimposed over the bulk of the alveolar bone. Usually two views are required to establish the exact site (see Fig. 27.7).

Specific exostoses develop in particular sites and are often bilateral:


Calcifying epithelial odontogenic tumour (CEOT or Pindborg tumour) (Fig. 27.8)

Defined by the WHO as a locally invasive epithelial odontogenic neoplasm, characterized histologically by amyloid material that may become calcified.

Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 27: Differential diagnosis of lesions of variable radiopacity in the jaws
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