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W4.1 Oral Radiography Workshop

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Radiology Workshop Part 1: Lucencies and Opacities

Workshop Overview1

This session focuses on the identification and analysis of radiographic findings in dental imaging, specifically categorizing them into two primary classifications:

  • Lucencies: Areas of decreased density that appear dark on a radiograph.
  • Opacities: Areas of increased density that appear light or white on a radiograph.

Presented by Dr. Dayea Oh for the DMD3 curriculum.

Orthopantomogram Interpretation Fundamentals

To ensure accurate interpretation of an Orthopantomogram (OPG), the following core principles should be applied:

Key Points of Orthopantomogram Interpretation2

  • Review the initial clinical indication for the OPG.
  • Identify any present OPG artefacts.
  • Maintain a comprehensive knowledge of the normal radiographic anatomy of the maxillofacial region.
  • Study the radiographic features of various jaw pathologies, specifically determining if they are lucent or opaque.
  • Utilize a systematic approach by establishing a consistent routine for review.

Initial Clinical Indication and screening

Medico-legally this counts more as a comprehensive exam with no previous opgs instead

Orthopantomogram Artefacts Revision

Common Radiographic Artefacts3

  • Foreign materials: Examples include earrings, necklaces, or dentures left in situ.
  • Ghost images
  • Incorrect patient positioning:
    • Chin down
    • Chin up
    • Head tilting
    • Head rotation
  • Movement:
    • Horizontal (following the beam or opposite to the beam direction)
    • Vertical
    • Swallowing
  • Soft tissue position:
    • Tongue not pressed to the palate
    • Lips not closed
  • Focal trough position:
    • Head in front of the focal trough
    • Head behind the focal trough
  • Neck extension
  • Collision with shoulder

Instructional Methodology

A structured review of the radiograph should follow these steps:

Systematic Approach to Radiographic Analysis4

  1. Address Clinical Concerns
  2. Dentoalveolar Analysis
    • Count teeth and identify ectopic and/or impacted teeth.
    • Identify dental anomalies (position, shape, etc.).
    • Assess periodontal bone loss.
    • Identify dental pathology (non-carious tooth loss, caries, fractures, periapical pathologies, etc.).
  3. Maxilla and Mandible
    • Identify abnormal (radio)lucencies.
    • Identify abnormal (radio)opacities.
    • Note altered trabecular patterns.
    • Identify fractures.
    • Assess jaw asymmetry.
  4. Maxillary Sinuses: Evaluate for mucosal changes.
  5. TM Joints: Evaluate for morphological changes of the condyles.
  6. Soft Tissues: Identify swelling or soft tissue calcifications (e.g., tonsilloliths, salivary gland stones, etc.).
  7. Other Sites: Evaluate the spine, orbits, and other visible structures for structural changes.

Descriptive Features of Lucencies and Opacities5

When analyzing lucencies and opacities, consider the following descriptive features:

  • Location: Where is the lesion located in relation to anatomical or dental structures?
  • Number: How many lesions are present?
  • Symmetry: Are they unilateral or bilateral?
  • Definition: Are the margins well-defined?
  • Shape: For example, round, ovoid, teardrop, lobulated, or irregular.
  • Size: Use anatomical or dental landmarks for measurement (e.g., the 38-34 region).
  • Homogeneity: Is the lesion uniform in density?
  • Internal Architecture: Does the lesion have internal structures or patterns?
  • Effects on Adjacent Structures: What is the impact on surrounding anatomy? Examples include:
    • Displacement of teeth, the sinus floor, or mandibular canals.
    • Resorption of teeth.
    • Scalloping around adjacent teeth.
    • Sclerosis of the surrounding bone.

Surgical Sieve for Lesion Identification6

The surgical sieve is used to identify the nature of a lesion by categorizing it into one of the following groups:

  • Artefactual
  • Anatomical
  • Anomaly
  • Inflammatory / Infection
  • Cysts / Cyst-like Lesions
  • Hamartoma
  • Benign Tumour
    • Odontogenic
    • Non-odontogenic
  • Idiopathic
  • Fibro-osseous Lesions
  • Malignancy
  • Trauma
  • Vascular Anomalies
  • Metabolic / Systemic Disease
  • Other: Including giant cell lesions, syndromes, etc.

Indications for Further Imaging7

If the initial OPG is insufficient for a definitive diagnosis, consider the following advanced imaging modalities:

  • CBCT (Cone Beam Computed Tomography)
  • MSCT (Multi-Slice Computed Tomography)
  • MRI (Magnetic Resonance Imaging)

If you are unsure of the appropriate next step, contact a radiologist for consultation.

Footnotes

  1. Original PDF page 1: W4.1 Radiology Workshop, p.1 ↩

  2. Original PDF page 2: W4.1 Radiology Workshop, p.2 ↩

  3. Original PDF page 3: W4.1 Radiology Workshop, p.3 ↩

  4. Original PDF page 4: W4.1 Radiology Workshop, p.4 ↩

  5. Original PDF page 5: W4.1 Radiology Workshop, p.5 ↩

  6. Original PDF page 6: W4.1 Radiology Workshop, p.6 ↩

  7. Original PDF page 7: W4.1 Radiology Workshop, p.7 ↩

Graph View

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