Periapical Inflammatory Lesions Quiz
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Questions and Answers

What can be said about the margins of periapical inflammatory lesions?

  • They tend to be poorly defined in longstanding lesions.
  • Acute lesions always demonstrate well defined margins.
  • Many longstanding lesions typically have relatively well defined margins. (correct)
  • They are always well defined.

What is a common feature associated with chronic periapical inflammatory lesions?

  • Increased tooth vitality.
  • Rapid onset of symptoms.
  • Adjacent reactive sclerosis. (correct)
  • Immediate resorption of the tooth.

How does the degree of sclerosis in periapical lesions typically vary?

  • It can vary from mild to extensive and depends on chronicity. (correct)
  • It remains unchanged in acute lesions.
  • It is consistent across all lesions regardless of chronicity.
  • It is always dense and extensive.

What radiographic change might be observed in the pulp chamber of a tooth with chronic periapical inflammatory lesions?

<p>It may appear larger. (C)</p> Signup and view all the answers

What feature may indicate the presence of larger periapical lesions?

<p>Effacement of the jaw cortices. (D)</p> Signup and view all the answers

Which type of enamel caries is characterized by penetration at least halfway through the enamel?

<p>C-2 (C)</p> Signup and view all the answers

What is the typical clinical appearance of carious lesions compared to their radiographic appearance?

<p>They are usually larger clinically than radiographically. (B)</p> Signup and view all the answers

What can vary the appearance of a lesion confined to enamel during radiographic imaging?

<p>Angle of the tube head (C)</p> Signup and view all the answers

Which radiographic feature is characteristic of early periapical inflammatory lesions?

<p>Widened apical periodontal ligament space (B)</p> Signup and view all the answers

What is the radiographic presentation of advanced caries, particularly at the base of the enamel?

<p>Triangle at the dentin-enamel junction (A)</p> Signup and view all the answers

Which type of periapical inflammatory lesion is characterized by an asymptomatic chronic condition?

<p>Periapical granuloma (B)</p> Signup and view all the answers

Which radiographic method is mentioned as capable of detecting early periapical inflammatory changes that 2D radiography might miss?

<p>Cone Beam Computed Tomography (CBCT) (A)</p> Signup and view all the answers

What factor significantly affects the overall radiographic contrast and subsequently the appearance of carious lesions?

<p>Exposure factors (B)</p> Signup and view all the answers

Which of the following is TRUE regarding cervical burnout?

<p>Is often mistaken for a carious lesion. (D)</p> Signup and view all the answers

What can potentially obscure the bucco-lingual extent of a dental lesion on radiographs?

<p>Limitations of two-dimensional imaging (A)</p> Signup and view all the answers

What morphology is typically demonstrated by a radicular cyst?

<p>Spherical morphology (C)</p> Signup and view all the answers

What feature differentiates a lateral periodontal cyst from a radicular cyst?

<p>Location related to the lateral canal (D)</p> Signup and view all the answers

What is a radiological feature of a residual cyst?

<p>Corticated sclerotic borders (D)</p> Signup and view all the answers

What is a characteristic radiological feature of a dentigerous cyst?

<p>Well-defined corticated lucent lesion (B)</p> Signup and view all the answers

Which type of cyst is most commonly associated with the third molars?

<p>Dentigerous (Follicular) cyst (C)</p> Signup and view all the answers

What description best fits the borders of a periapical osseous dysplasia lesion?

<p>Sclerotic rather than corticated (C)</p> Signup and view all the answers

What is a common consequence when a dentigerous cyst becomes acutely secondarily infected?

<p>Focal regions of effacement of the corticated border (A)</p> Signup and view all the answers

What is typically absent in a residual cyst radiologically compared to a radicular cyst?

<p>Associated tooth (C)</p> Signup and view all the answers

Which statement regarding a KCOT (keratocystic odontogenic tumor) is true?

<p>It has a relative lack of expansion (B)</p> Signup and view all the answers

What feature is associated with the corticated pericoronal lucency of a dentigerous cyst?

<p>Extension to the cementoenamel junction (C)</p> Signup and view all the answers

Which is a typical feature of a buccal bifurcation cyst?

<p>The lesion tends to extend posteriorly from the bifurcation. (B)</p> Signup and view all the answers

What is a radiological characteristic of an odontogenic keratocyst (OKC)?

<p>It usually presents as unicystic and completely lucent internally. (B)</p> Signup and view all the answers

Which feature differentiates a dentigerous cyst from an odontogenic keratocyst?

<p>Dentigerous cysts are associated with impacted teeth. (C)</p> Signup and view all the answers

What might indicate secondary infection in a buccal bifurcation cyst?

<p>Periosteal new bone formation. (B)</p> Signup and view all the answers

How does an odontogenic keratocyst typically affect adjacent teeth?

<p>It may displace teeth but to a lesser degree than dentigerous cysts. (C)</p> Signup and view all the answers

What is a common location for the odontogenic keratocyst?

<p>Posterior mandible. (B)</p> Signup and view all the answers

What is the typical appearance of an odontogenic keratocyst on a radiograph?

<p>Well-defined corticated border with possible scalloped appearance. (D)</p> Signup and view all the answers

How does the thickness of the corticated border in a simple bone cyst typically compare to that of a keratocystic odontogenic tumor?

<p>Thinner and less well-defined. (C)</p> Signup and view all the answers

What is the typical location for lateral periodontal cysts?

<p>On the lateral surface of a root (C)</p> Signup and view all the answers

What is a common effect of botryoid odontogenic cysts on teeth?

<p>Effacement of the lamina dura (A)</p> Signup and view all the answers

Which feature distinguishes radicular cysts from lateral periodontal cysts?

<p>Etiology related to lateral canals (C)</p> Signup and view all the answers

What is a key characteristic of keratocystic odontogenic tumors (KCOTs)?

<p>Relatively non-expansile growth (A)</p> Signup and view all the answers

Where are glandular odontogenic cysts most commonly located?

<p>In the anterior mandible (B)</p> Signup and view all the answers

What type of radiological features are associated with glandular odontogenic cysts?

<p>Multilocular lesions with corticated borders (D)</p> Signup and view all the answers

What is a common clinical presentation of glandular odontogenic cysts?

<p>Very slow progressive growth (D)</p> Signup and view all the answers

Which of the following conditions might be confused with a glandular odontogenic cyst?

<p>Keratocystic odontogenic tumor (A)</p> Signup and view all the answers

Which cyst is known for having less effacement of lamina dura and root resorption?

<p>Simple bone cyst (D)</p> Signup and view all the answers

What is a distinguishing feature of radicular cysts compared to odontogenic keratocysts?

<p>Radicular cysts typically exhibit tear-drop appearance (C)</p> Signup and view all the answers

Which feature is common to both odontogenic myxoma and odontogenic keratocyst?

<p>Internal septa (A)</p> Signup and view all the answers

Which syndrome is characterized by multiple KCOTs and other systemic abnormalities?

<p>Basal cell naevus syndrome (B)</p> Signup and view all the answers

Lateral periodontal cysts arise from which type of epithelium?

<p>Odontogenic epithelium (B)</p> Signup and view all the answers

How do the internal features of a KCOT compare to those of an ameloblastoma?

<p>Ameloblastomas have more scalloped margins (D)</p> Signup and view all the answers

What feature distinguishes the appearance of basal cell naevus syndrome lesions from similar cysts?

<p>Bilateral symmetry (C)</p> Signup and view all the answers

In the context of odontogenic keratocysts, what is true about their expansiveness?

<p>They are minimally expansile lesions (D)</p> Signup and view all the answers

Which feature is characteristic of a buccal bifurcation cyst as opposed to other cyst types?

<p>Present during post-eruptive dentition (B)</p> Signup and view all the answers

Flashcards

Cervical Burnout

A radiolucent area at the cervical region of a tooth, resembling a carious lesion, but caused by enamel loss due to abrasion, erosion, or attrition.

Radiolucent Restoration

A dental restoration that appears dark on a radiograph, indicating the presence of a material less dense than tooth structure.

C-1 Caries

Incipient caries - a small carious lesion that has not yet penetrated the enamel.

C-2 Caries

Enamel caries that has penetrated at least halfway through the enamel.

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C-3 Caries

Dental caries that has reached the D-E junction (dentin-enamel junction).

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C-4 Caries

Dentin caries that has progressed halfway to the pulp.

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Proximal Caries Progression

The progression of caries on the tooth surface closest to the adjacent tooth, starting from incipient to advanced stages.

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Occlusal Caries Progression

The progression of caries on the chewing surface of the tooth.

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Periapical Inflammatory Lesions

Inflammation and bone changes around the root tip of a tooth, usually caused by a bacterial infection of the pulp.

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Lamina Dura

A thin, radiopaque layer of bone surrounding the tooth root.

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Radiographic Visibility of Lateral Canals and Root Fractures

Lateral canals and root fractures may not be visible on radiographs.

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Periapical Lesion Margins

The margins of periapical inflammatory lesions can be ill-defined or relatively well-defined depending on the lesion's age. Chronic lesions often have well-defined margins, while acute lesions tend to have poorly defined margins.

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Sclerosis in Periapical Lesions

Adjacent reactive sclerosis is common in periapical lesions, especially chronic ones. This sclerosis can range from focal and mild to dense and extensive, reflecting the lesion's chronicity.

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Apical Root Resorption in Periapical Lesions

Apical root resorption can occur in chronic periapical lesions.

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Pulp Chamber and Root Canal Changes in Periapical Lesions

The pulp chamber and root canals of a tooth affected by a periapical lesion may appear larger due to inflammation and tissue breakdown.

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Lateral Periodontal Cyst

A benign cyst that develops between the root of a tooth and the surrounding bone, often in the lateral canal.

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Radicular Cyst

A common type of cyst that forms at the root of a tooth, usually due to a dead pulp.

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Periapical Osseous Dysplasia

A benign bone condition that affects the jaw bone, often near the tooth root.

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Residual Cyst

A cyst that remains in the bone after a tooth has been extracted.

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Well-Defined Corticated Lucent Lesion

A visible area of bone loss on a radiograph, with a clear, defined border.

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Unilocular Radiolucency

A single, well-defined area of bone loss on a radiograph.

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Dentigerous Cyst

A cyst that forms around the crown of an unerupted tooth.

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Dentigerous Cyst - Radiological Features

Appears as a well-defined, radiolucent area surrounding the crown of an unerupted tooth.

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CEJ

The junction between the enamel and cementum, the two hard tissues covering a tooth.

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Sclerotic Border

A dense or thickened border of a radiolucent lesion on a radiograph.

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Buccal Bifurcation Cyst

A cyst that forms at the buccal furcation of a tooth, usually a molar.

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Odontogenic Keratocyst (OKC)

A developmental cyst with a high recurrence rate, often found in the posterior mandible.

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OKC - Radiographic Features

The OKC appears as a well-defined radiolucency with a scalloped border, often with minimal expansion.

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OKC - Tooth Displacement and Resorption

The OKC can displace teeth and cause root resorption, but less dramatically than a dentigerous cyst.

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OKC - Location Importance

When the OKC affects the posterior maxilla, the integrity of the sinus wall and possible extension into the pterygopalatine fossa must be assessed.

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OKC vs. Dentigerous Cyst - Radiographic Features

KCOTs have scalloped borders, while dentigerous cysts are usually more expansile.

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OKC vs. Simple Bone Cyst (SBC) - Radiographic Features

SBCs have a thinner and more delicate corticated border compared to OKCs.

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OKC Differential Diagnosis: Odontogenic Myxoma

Both OKCs and Odontogenic Myxomas can appear similar in the posterior mandible. While OKCs can demonstrate internal septa, Myxomas are often expansile.

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OKC Differential Diagnosis: Radicular Cyst

Radicular cysts have a 'tear-drop' appearance with acute angles to the offending tooth, while OKCs often demonstrate a right angle or obtuse angle.

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OKC Differential Diagnosis: Ameloblastoma

Ameloblastomas are expansile lesions, while OKCs are less expansile. The scalloped margins of OKCs can be mistaken for a multilocular ameloblastoma.

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Basal Cell Naevus Syndrome (Gorlin-Goltz Syndrome)

A genetic disorder characterized by multiple occurrences of OKCs in the jaws, along with other abnormalities including skin tumors and bone malformations.

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Basal Cell Naevus Syndrome (Gorlin-Goltz Syndrome) Radiological Features

Radiological features of Gorlin-Goltz Syndrome include multiple OKCs, early calcification of the falx cerebri, and often presents bilaterally.

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Basal Cell Naevus Syndrome (Gorlin-Goltz Syndrome) Differential Diagnosis: Buccal Bifurcation Cysts

Buccal bifurcation cysts can be found bilaterally, but are often symmetrical in appearance, unlike the multiple OKCs in Gorlin-Goltz syndrome.

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Basal Cell Naevus Syndrome (Gorlin-Goltz Syndrome) Differential Diagnosis: Radicular, Residual, and Dentigerous Cysts

These cysts are considered in the differential diagnosis, but the presence of multiple OKCs and specific radiological features help differentiate Gorlin-Goltz Syndrome.

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Lateral Periodontal Cyst Location

Lateral periodontal cysts are commonly found in the mandible, mostly affecting premolars, canines, and lateral incisors.

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Lateral Periodontal Cyst - Appearance

A radiolucent, well-defined, round or oval lesion with a distinct border.

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Lateral Periodontal Cyst - Differential Diagnosis

Distinguish it from a radicular cyst (at the root tip) by looking for signs of a healthy pulp and no periapical inflammation.

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Glandular Odontogenic Cyst - Location

Most commonly found in the lower jaw (mandible), usually in the front.

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Glandular Odontogenic Cyst - Appearance

A slow-growing cyst that can be single or have multiple compartments and pushes on the bone.

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Glandular Odontogenic Cyst - Radiographic Features

A well-defined, round or oval radiolucent area that can encompass a large area and displace teeth.

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Glandular Odontogenic Cyst - Differential Diagnosis

Distinguish from Ameloblastoma and KCOT (Keratocystic Odontogenic Tumour) based on its specific features and growth rate.

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Glandular Odontogenic Cyst - Symptoms

Often causes swelling, but can also be painless and slow-growing.

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Study Notes

Dental Caries

  • Early enamel lesions appear as well-defined triangular radiolucencies, with the base at the enamel surface.
  • As the lesion grows, it loses its triangular shape and becomes more rounded.
  • When the lesion reaches the dentinoenamel junction (DEJ), it spreads out, forming a less well-defined triangular lucency in the dentin.
  • The dentin lesion progresses faster than the enamel lesion.
  • Large lesions cause significant dentin involvement, potentially undermining the overlying enamel, leading to fractures.
  • Very large lesions can result in the complete or near-complete loss of the tooth crown.

Cervical Burnout

  • Radiographic lucencies can appear in the interproximal regions, extending from the cementoenamel junction to the interdental alveolar crest.
  • These lucencies are often artefactual, appearing on intraoral and panoramic radiographs.
  • Lucent or absent restorations are typically more clearly defined and exhibit sharp surgically-prepared angles.

Interproximal Caries

  • These lesions originate at the mesial and distal surfaces of the crowns, usually between the contact point and the gingival margin.
  • Initial stages display a well-defined triangular lucency within the enamel.

Pit and Fissure Caries

  • Dentin lucency is often seen first in 2D radiographs, appearing under the enamel.
  • Enamel lesions are usually not visible unless they are large.
  • Identifying buccal or lingual location of these lesions can be challenging.

Root Caries

  • These lesions appear as lucent regions at the cementoenamel junction.
  • They typically appear coronal to the alveolar crest, and sometimes extend beyond it.

Active vs Inactive Lesions

  • Active lesions are characterized by radiographic features that suggest ongoing damage.
  • Inactive lesions indicate that the decay process has likely slowed or stopped.

Radiolucent Restorations

  • Incipient caries are less than halfway through the enamel.
  • Enamel caries that extend halfway through the enamel.
  • Caries at the DEJ (moderate).
  • Dentin caries extending to the pulp (severe).

Periapical Inflammatory Lesions

  • These conditions include apical periodontitis, periapical rarefying osteitis, periapical condensing/sclerosing osteitis, and periapical granuloma.

  • They're most commonly at the apical aspects of tooth roots.

  • Clinical presentations range from asymptomatic to severe infections.

  • Early or lower-grade lesions show widened periodontal ligament spaces, while more advanced lesions demonstrate a lucency centered at the root apex, with effacement of the lamina dura.

  • Extensive or chronic lesions may reveal periapical sclerotic areas.

  • Lesions can resemble those seen in acute inflammatory reactions.

Periapical Osseous Dysplasia

  • Radiographic characteristic of these conditions is the appearance of radiolucent areas in the jaw/maxillary.

Radicular Cyst

  • These lesions appear as round or ovoid radiolucencies; they are typically greater than 1.5 cm and involve non-vital teeth..

Dentigerous Cyst (Follicular Cyst)

  • A common jaw cyst, often associated with impacted or unerupted teeth, primarily third molars.
  • Lesions are typically corticated (well-defined edges).
  • They present as a pericoronal radiolucency or the appearance of an enlarged follicular space of a tooth crown, most often centered at one region or limited to one side of a tooth crown.

Buccal Bifurcation Cyst

  • It's a cyst centered at the buccal furcation of a mandibular molar.
  • A well-defined, expansile, corticated lucent lesion.
  • The affected tooth root is typically displaced lingually.
  • Root resorption isn't usually associated with this condition.

Keratocystic Odontogenic Tumor (KCOT)

  • Usually located in the posterior mandible.
  • Mostly asymptomatic unless large or infected.
  • Appear as well-defined, corticated, lucent or slightly radiopaque lesions within the mandible.

Basal Cell Nevus Syndrome

  • An inherited syndrome featuring significant oral manifestations, including multiple KCOTs.
  • Radiologically, the syndrome is characterized by multiple, well-defined KCOTs, often bilateral in the jaws.

Lateral Periodontal Cyst

  • They arise from odontogenic epithelium on the lateral surface of a tooth root, unrelated to the root's pulp status.
  • Typically appear as well-defined lucent lesions centered on the lateral surface of the tooth roots.

Glandular Odontogenic Cyst

  • Appear as unilocular or multilocular, well-defined radiolucencies, often with corticated borders.
  • Frequently associated with the mandible.

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Description

Test your knowledge on the characteristics and radiographic features of periapical inflammatory lesions. This quiz covers various aspects such as margins, sclerosis, and clinical appearances of carious lesions. Understand the differences between acute and chronic periapical conditions through focused questions.

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