Radiopaque jaw lesions

Radiopaque lesions of the jaw

Radiopaque lesion or 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

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

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

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.

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.

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 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 from months 3-5. This is in their brochure.

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.

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.

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

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

More 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

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

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