Radiopaque jaw lesions

idiopathic osteosclerosis

Radiopaque lesions of the jaw

Radiopaque jaw lesions or radiopaque area found on an x-ray? What is it? I’m going to slowly update with more interesting finds. Be aware most of these are bet guesses and not biopsy confirmed, as most do not warrant that. We have a post for radiolucent lesions on panos as well with much of the same information.

An unknown radiopaque area or lesion is a regular find in dentistry.

So what is the calcification that you found on the pano? Typically you can decide by location what the calcification is, but this is not always the case. I have found the following diagram very helpful.

Is there a calcification found on pano?

Phleboliths

 

Image of idopathic osteosclerosis
Clinically and radiographically consistent with idiopathic osteosclerosis

Calcified lymph nodes

Calcified lymph nodes on a pano.Calcified lymph node found on dental panoLymph node calcifications on a pano

Tonsilloliths

A radioopaque pano showing tonsils with tonsilloliths.

Pano of many tonsilloliths
Appears to be a lot of diffuse tonsilloliths

Radiopacity on a pano that shows tonsiliths

Giant tonsillolith with a ghost image seen on the opposite side.
Giant tonsillolith with a ghost image seen on the opposite side.

Tonsilloliths

Antrolith

An antrolith is a calcified mass in the maxillary sinus.

Maxillary antrolith is a calcified mass within the sinus

Reactional osteogenesis of the maxillary sinus

Very similar to antrolith. Asymmetrical bone growth in response to inflammatory process resulting from an odontogenic issue. Silva Gen Dent 2022

Condylar osteophyte

Condylar osteophyte is a form of osteoarthritis.

Osteochondroma (OC) of temporo mandibular joint

This is a slow growing tumor that causes a progressive enlargement of the condyle.

Osteochondroma of the mandibular condyle unofficial diagnosis.

Synovial osteochondromatosis of the temporomandibular joint

This would look very similar to the above.

Ossification or calcification of stylohyoid ligament

This can cause Eagle syndrome WHEN their is pain.

Calcification of stylohyoid ligament seen on pano x-ray

Sialolith

Sialoliths are present in .1-1% of the population although I think that is a very high number. 94% are in the submandibular gland, 5% in parotid and rest in sublingual and minor glands. Pinheiro 2021 Gen Dent. Removal is not necessary unless symptomatic. Deeper stone requires removal of submandibular gland and ligation of duct.

A very large submanidbular sialolith was removed.

Huge sialolith with ghost image on opposite side.
Huge sialolith with ghost image on opposite side. Brooks AGD Nov 2020
Salivary stone in submandibular gland
Stone in the hilum of the submandibular gland.
 

Radiopacity on panoMucous Retention pseudocyst

Pano showing a mucous retention cyst
If this one appears funny to you, then good eye. We thought it was strange looking so took a CT to confirm and there is nothing there. This is some sort of artifact.

Idiopathic osteosclerosis or dense bone island DBI

The cause and classification of these is controversial. Biopsy is not necessary unless large changes occur; 25% growth in 6 months or 50% in one year according to Mariani 2009 Oral Implant. Here is a short video of a dense bone island with the PA and CT. Here is another better quality video from a patient we saw.

This guy has an amazing website with tons of information on all sorts of pathology.

 

Idiopathic osteosclerosis defintion table

Idiopathic osteosclerosis around teeth numbers 29 and 30.
Idiopathic osteosclerosis is the working diagnosis of this radiopaque jaw lesion.
Dense bone island DBI CBCT showing the outlines of the bone.
CT of a dense bone island.
Idiopathic osteosclerosis can cause root resorption.
Although rare idiopathic osteosclerosis can cause root resorption over time. Sisman 2010 Eur J Dent

Condensing osteitis

Condensing osteitis from a necrotic tooth.
Condensing osteitis from a tooth that is necrotic.

Hypercementosis vs Cementoblastoma

These two can be difficult to differentiate between. Is is an early cementoblastoma or hypercementosis? This case shows hypercementosis but even with the CT this could be an early cementoblastoma and a follow up x-ray would verify. Pinto JOMR 2017

Hypercementosis of lower first molars.

Osteoma cutis

This is simply bone formation in the skin and usually the patient has acne in the area. Presents as doughnut shaped with smooth borders.

Osteoma cutis in dental x-ray

Osteoma cutis on bitewing x-raysOsteoma cutis on several dental PA and bitewing x-ray films.

Grafting materials

There are so many different types of grafting material out there than could possibly show up as radiopaque. The minerlaized collagen ones can show up radiopaque. Most dentists do not know that, as evidenced from this facebook thread of a collagen plug. The OsteoGen Plug will be radiopaque for months 3-5. This is in their brochure. PreservaRidge Plug is another possibility and there are certainly others.

Radiopaque osteogen collagen plug
You can see all molars sites have a graft material which is one of the big clues this is a collagen plug that shows up radiopaque.

Radiopaque foreign body in pano

This one is a gun shot wound patient (GSW). It’s actually just a pellet from a college incident of boys screwing around.

Gun show wound pano
Pellet is still in sinus

This one is the back to an ear ring. She is 12 and there is no memory of doing this. It was not visible in pano so never found until and orthodontic scan was done.

BB on a peri-apical x-ray.
BB on a peri-apical x-ray.

 

Dental product foreign bodies

You name it and you can find it. Below is PVS that got into the sinus and ENT recommends to leave.

PVS material in sinus

 

This is from a patient that was inserting temp cement over and over into the sinus cavity after an extraction.

Temp cement foreign body in sinus

Unknown objects

This radiopaque object appears to be resting on the condylar process or head.

Our opinion is this is some type of silver nanoparticle. Perhaps a silver nanoparticle medicament that was pushed out the apex or injected into a fistula.

Radiopaque globules in failing root canal lesion

 

Brachytherapy

Ligature clips or staples can be seen in the neck region of panos

These pop up on panos. Usually will see a lot of them and they are on only one side in comparison to the next category which is on both sides.

Ligature clips from patient with cancer history
Ligature clips from surgery

Surgical ligature clips show in a dental pano. Ligature clips in cbct

 

Sleep apnea anchors

These implant anchors are part of a sleep apnea treatment. They can anchor the tongue or the hyoid bone up to the inferior border of the mandible.

Sleep apnea anchors that look like implants on the inferior border of the mandible.
Sleep apnea anchors are implants in the inferior border of the mandible to lift the hyoid or tongue to help alleviate sleep apnea.

Nano hair extensions

These use metal that shows up on the radiographs and could get in the way of seeing what you need to see.

Nano hair extensions on a radiograph

Susuk charm needles

Will be in south east Asian women most likely. Put in place for health or beauty beliefs. Will likely be symmetrical to some degree, unlike surgical ligation clips.

 

Hundreds of metallic linear susuk charm needles in a south east Asian women's pano. Susuk charm needles in a FMX

Landmarks on a pano.

Unknown findings radiopaque

Barnacle tartar

Have come across this one several times online. Often will form in rings around the tooth and appears like black barnacles growing off the roots.

Molar tooth with barnacle tartarPhoto of barnicle tartar

Unusual tartar

This tartar looks like a fracture in the tooth. Upon extraction we saw it was tartar.

Unusual tartar on PA x-ray

 

Radiopaque jaw lesions that also have a radiolucent component. These are mixed lesions.

There are several lesions that are both radiopaque and radiolucent in the jaw bone. Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion that affects young patients associated with an impacted tooth, usually canine. Floridcemento-osseous dysplasia (FCOD) is a“fibro-osseouslesion” that characteristically affects the jaw bones of the middle-aged with multi-quadrant radiopaque cementum-like masses. An ossifying fibroma is a rare noncancerous (benign) tumor made of bone tissue that forms within connective tissue.

Mixed density jaw lesions containing both radiopaque and radiolucent areas.

Ossifying fibroma

Ossifying fibroma is a rare benign tumor of connective tissue. A really large one is seen on Fayette Williams Instagram account.

Osteomyelitis

This one is a mixture of radiopaque and radiolucent. In the areas that are struggling to stay alive the bone will be very radiopaque, as the bone is undergoing reactive sclerosis. As it dies, the area obviously becomes radiolucent. Treatment is aggressive removal of necrotic bone and 6-8 weeks of IV antibiotics.

Osteomyelitis of the jaw showing both radiopaque areas and radiolucent areas.

 

If you are looking for radiolucent lesions check out that blog.