ACJ Quiz – Pathological Lesions

This X ray is typical lateral periodontal cyst considering the location and vital teeth

Not a common condition to see on X ray, No treatment is necessary

Because the lesion shows a diffuse “ground-glass” radiopacity with poorly defined borders that blend into the surrounding bone and cause smooth bony expansion, which is characteristic of fibrous dysplasia

This is a well-defined, corticated, unilocular radiolucency located in an edentulous area where a tooth has been extracted, which is characteristic of a residual cyst (a radicular cyst that remains after removal of the offending tooth).

This image shows a well-defined, dense radiopacity superimposed over the mandibular premolar roots in the typical lingual location, unrelated to the periodontal ligament space or periapical pathology, consistent with a bony exostosis (mandibular tori).

The image shows a well-defined, expansile radiolucency in the mandible that appears multilocular and locally destructive, a classic appearance for central giant cell granuloma, especially in a younger patient and in the tooth-bearing area of the jaws.

The right mandibular body shows rarefied bone with several crisscrossing radiolucent tracts extending to the inferior cortex, small bony sequestra near the 2nd and 3rd molars, and an irregular V-shaped cortical notch with adjacent sclerotic, likely infarcted bone—findings characteristic of chronic rarefying osteomyelitis.

A mandibular 1st molar with deep caries and apical abscess is associated with a bony hard swelling and characteristic “onion-skin” periosteal reaction—multiple alternating radiolucent and radiopaque bands of new bone along the thinned cortex—typical of osteomyelitis with proliferative periostitis (Garrè’s osteomyelitis).

There is a well-defined, corticated, ovoid radiolucency located below the mandibular canal in the posterior mandible, separate from tooth roots and asymptomatic—classic for a Stafne bone cyst, a static lingual mandibular salivary gland depression rather than a true cyst.

A large, well-defined but expansile unilocular radiolucency in the posterior mandible causes marked displacement of the 2nd and 3rd molars, knife-edge root resorption of the 1st molar, cortical expansion, and inferior displacement of the mandibular canal, all features that strongly favor an odontogenic tumor—most consistent with unicystic ameloblastoma rather than a simple cyst.

An enlarged segment of mandibular bone is replaced by a ground-glass opacity showing a characteristic “fingerprint pattern” of swirling trabeculae, a pathognomonic appearance that strongly points to fibrous dysplasia rather than a discrete, well-circumscribed fibro-osseous lesion.

This is a large multilocular radiolucency from the left premolar region into the ramus showing angular, “geometric” loculi and a fish-skeleton pattern of thin septa breaking through the cortex with expansion and perforation—features that are classic for a locally aggressive benign odontogenic tumor, odontogenic myxoma.

A well-defined, noncorticated radiolucency extends from the canine to the 3rd molar, scalloping between the roots of vital teeth with minimal root change and endosteal cortical resorption—an interradicular, scalloped pattern that is classic for a simple bone cyst.

A well-defined lesion around anterior teeth shows a mixed radiolucent–radiopaque appearance with a central calcified mass and associated root resorption, a classic pattern for a calcifying odontogenic cyst rather than a solid odontogenic tumor.

A well-defined radiolucency is centered in the maxillary midline between the vital central incisors of a 37-year-old woman, with slight discomfort and a salty taste from possible drainage—classic for a nasopalatine duct cyst rather than a periapical lesion.

A deep restoration in the mandibular right 2nd molar is associated with a localized, irregular radiopaque area at the root apex without a radiolucent rim, adjacent to a likely nonvital tooth—classic for condensing osteitis, a reactive bone sclerosis secondary to chronic pulpal inflammation.

A painful, rapidly progressive swelling with paresthesia, loosening of teeth, widened periodontal ligament space, pathologic fracture, increased bone density, and a classic “sunburst” periosteal reactionon oosteosarcoma of the jaws.

Although it appears as a multilocular radiolucency like the other options, cross-sectional imaging shows minimal buccolingual expansion with an anteroposterior “tunneling” growth pattern, which is characteristic of an odontogenic keratocyst and less typical of the more

There is a round, predominantly radiopaque mass fused to the roots of the mandibular 1st molar, partly obscuring root outlines, with small internal radiolucent foci and a surrounding radiolucent halo and displacement of adjacent roots—features that are characteristic of a cementoblastoma rather than reactive sclerosis or dysplasia.

There are bilateral, multifocal mixed radiolucent–radiopaque masses confined to the tooth-bearing areas of the jaws, with dense lobular “cotton-wool” opacities and areas of sequestration—classic for florid cemento-osseous dysplasia, which can be complicated by secondary infection and sequestration of a cemento-osseous mass.

There are bilateral periapical mixed radiolucent–radiopaque lesions around intact anterior teeth with loss of normal lamina dura but no obvious caries or large restorations, a pattern typical of PCOD rather than inflammatory periapical disease (A/B/C) or a solitary mass fused to the root as in cementoblastoma.