Comprehensive Examination: The OPG should be viewed as a comprehensive examination to identify abnormal lucencies and opacities.
Patient Positioning: Note that the patient in this case is tilted; the orbital floor and mandible are higher on the right side than the left.
Quadrant 3 (Left Mandible):
radiolucency in the 33 in the left side of the mandible
Location: Radiolucency at the periapical region of tooth 33, extending mesially to the apex of 32.
Well defined
some lucency at the distal aspect of the 33 root
but the lamina dura and pdl is preserved, thus it is only a loss of density
there is no apperent resorption. This indicates a lack of structural loss or frank resorption of the tooth.
Quadrant 4 (Right Mandible):
Third Molar (48): Partially erupted with adjacent sclerotic changes (increased bone density) near the residual follicular space.
Bone Density: The bone at the 48 site is more opaque compared to the normal trabecular density seen at the 38 site.
Visual Artifacts: A lucency appears below the opacity at 48, but this is often an optical illusion caused by the surrounding sclerotic bone; it is likely a large marrow space.
Differential Diagnosis
[!example] Differential Diagnosis for Mandibular Lesions
Inflammatory Lesions:
Periapical Lesion: Rule out by testing vitality. If the tooth is vital and the patient is not in pain, it is likely non-odontogenic.
Chronic Pericoronitis: Likely cause for the sclerotic changes seen around the partially erupted 48.
Cervical Burnout: Apparent lucency at the distal area of 33 and 45 is likely cervical burnout/overlapping rather than caries.
Cemental Osseous Dysplasia (COD):
A strong differential if there is “bone tightness” or internal opacities within the lesion.
More common in older female patients.
Can degenerate into simple bone cysts over time.
Simple Bone Cyst (Solitary/Traumatic Bone Cyst):
Common in the mandible of younger patients.
Appears as a solitary lucent lesion.
Tumors (e.g., Ameloblastoma):
Ruled out in this case because tumors typically cause root resorption, which is absent here.
Normal Anatomy:
Large Marrow Spaces: Commonly found in the posterior third molar regions; can look cystic but do not displace the mandibular canal.
Further Imaging
Clinical Correlation: Perform vitality testing on teeth associated with lucencies (e.g., 33).
Specialist Referral: Any bony lesions should be referred to an oral surgeon for management, as they can occasionally increase in size.
Radiological Consultation:
Second Opinions: Seek opinions from radiologists if unsure. This can be done via the reporting clinic or online Australian radiology services.
Professional Relationships: Establishing a relationship with a radiology clinic allows for informal consultations or formal reports on OPGs taken in-house.
