RADIOPAQUE LESIONS OF JAW

CONTENTS

 Introduction
 Classification
 Anatomic radiopacities of jaw
 Artefactual
 Pathological radiopacities of jaw
 References

INTRODUCTION

 Radiopaque refers to the portion of a processed radiograph that appears light or white.

 It appears dense & absorbs or resists the passage of the x-ray beam.
o Leaving silver halide crystals of film unexposed which are later dissolved &
washed away by fixer solution.
 “Radiographic appearances are governed by anatomic or physiologic changes in the
presence of the disease processes.
 Radiographic ‘diagnosis’ is founded on knowledge of these alterations, the
prerequisite being awareness of disease mechanisms.” (H.M. Worth)

These are usually described on the basis of:

 Site or anatomical position

 Size
 Shape
 Outline/edge or periphery
 Relative radiodensity and internal structure
 Effect on adjacent surrounding structures
 Time present, if known.

CLASSIFICATION
 
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 Bone –
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p ANATOMICAL RADIOPACITIES OF JAW

RADIOPACITIES COMMON TO BOTH JAWS -

Radiopacities produced by both the teeth and bones are common to both the jaws.
Tooth enamel is the densest tissue in the body and is also the most radiopaque
structure followed by dentin (less radiopaque).

 Cancellous bone appears as thin strands of trabeculae that cross each other in a
irregular fashion.
 Lamina dura – tooth sockets are normally lined with a thin layer of dense compact
bone.
 Alveolar process – The gingival margin of alveolar process is called the alveolar
crest which is a thin layer of dense cortical bone.
 Cortical plates appear as thin dense plates of compact bone seen on occlusal
radiographs.
RADIOPACITIES PECULIAR TO MAXILLA

 Nasal septum is seen as a wide vertical radiopaque shadow over the apices of the
central incisors.
 Anterior nasal spine – small white v-shaped opaque shadow below the nasal septum.
 Floor of nasal fossa – linear radiopacities seen extending bilaterally from the septum.
 On the periapical radiographs of canine, the floor of maxillary sinus and nasal cavity
are often superimposed forming inverted Y in that area.

 Wall and floor of maxillary sinus is formed by a thin layer of dense cortical bone.
 Zygomatic process – U-shaped radiopaque shadow above the roots of maxillary 1 st
molar.
 Coronoid process – cone shaped radiopaque shadow with its apex pointing upward
and forward.

 Pterygoid plates – lateral pterygoid plate is seen on maxillary 3rd molar region.
RADIOPACITIES PECULIAR TO THE MANDIBLE:

 External oblique ridge – prominent radiopaque line passing across the molar region,
forms continuation of anterior border of ramus.
 Mylohyoid ridge appears as a narrow radiopaque line passing over the lingual surface
of mandible.

 Genial tubercles – radiopacities seen on the internal surface of mandible at the

symphysis midway between superior and inferior borders.
 Mental ridge – two bilateral radiopaque lines run anteriorly and superiorly from
premolar area towards the midline, where they meet.

SUPERIMPOSED RADIOPACITIES:

 Soft tissue shadows:

a) Nasolabial fold superimposed over the maxillary premolar region.
 b) Outline of lip superimposed on maxillary and mandibular anteriors.

 Mineralized tissue shadows: Pathologic calcifications of normal structures such as

calcified arteries and lymph nodes.

ARTEFACTUAL:

Depend largely on the type of radiograph:

 Real or ghost earring shadows

 Fixer solution splashes

 Objects or scratches on intensifying screens

PATHOLOGICAL:

ABNORMALITIES OF THE TEETH -

 Unerupted and misplaced teeth including supernumeraries

 Odontomes — compound, complex
 Root remnants
 Hypercementosis

Conditions of variable radiopacity affecting the bone -

 Developmental - Exostoses including tori — mandibular or palatal

 Inflammatory - Low grade chronic infection — sclerosing osteitis, Osteomyelitis —
sequestra; Involucrum formation

 Tumours

 Odontogenic (late stages) –

 Calcifying epithelial odontogenic tumour (CEOT)

 Ameloblastic fibro-odontoma
 Adenomatoid odontogenic tumour
 Calcifying odontogenic cyst
 Odontomes — compound, complex

 Non-odontogenic –

 Benign — Osteoma; Chondroma

 Malignant — Osteosarcoma; Osteogenic secondary metastases

 Fibro-cementoosseous lesions (late stages)

 Fibrous dysplasia
 Periapical cemento-osseous dysplasia
 Florid cemento-osseous dysplasia (gigantiform cementoma)
 Benign cementoblastoma (true cementoma)
 Cemento-ossifying fibroma

 Others -

 Paget's disease of bone

 Osteopetrosis

Superimposed soft tissue calcifications -

 Salivary calculi
 Calcified lymph nodes
 Calcified tonsils
 Phleboliths
 Calcified acne scars

Foreign bodies -
 Intra-bony
 Within the soft tissues
 On or overlying the skin

PERIAPICAL RADIOPACITIES

TRUE PERIAPICAL RADIOPACITIES-

  Condensing or sclerosing osteitis

 Periapical idiopathic osteosclerosis

 Periapical or focal cementoosseous dysplasia

 Unerupted succedaneous teeth

 Foreign bodies

 Hypercementosis

RARITIES

 Calcifying odontogenic cyst

 Cementoossifying fibroma

 Chondroma and chondrosarcoma

 Focal or diffuse sclerosing osteomyelitis

 Hamartoma

FALSE PERIAPICAL RADIOPACITIES-

 Anatomic structures
 Impacted teeth, supernumerary teeth, and compound odontomas
 Tori, exostoses, and peripheral Osteomas
 Retained root tips
 Foreign bodies
 Mucosal cyst of the maxillary sinus
 Ectopic calcifications

RARITIES

 Calcified acne lesions

 Calcified hematoma

 Calcifying odontogenic cyst

 Multiple Osteomas of the skin

 Myositis ossificans

SOLITARY RADIOPACITIES NOT NECESSARILY CONTACTING TEETH

TRUE INTRABONY RADIOPACITIES -

  Tori, exostoses, and peripheral osteomas

 Unerupted, impacted, and supernumerary teeth

 Retained roots

 Idiopathic osteosclerosis

 Condensing or sclerosing osteitis

 Mature focal cementoosseous dysplasia

 Fibrous dysplasia

 Focal sclerosing osteomyelitis

 Diffuse sclerosing osteomyelitis

 Proliferative periostitis (garre's osteomyelitis)

 Mature complex odontoma

RARITIES

 Cementifying and ossifying fibroma

 Chondromas and chondrosarcomas - radiopaque variety
 Mature osteobIastoma
 Metastatic osteoblastic carcinomas - radiopaque variety
 Osteoblastoma
 Osteochondroma
 Osteogenic sarcoma - radiopaque variety

PROJECTED RADIOPACITIES -

 Anatomic structures
 Foreign bodies
 Pathologic soft tissue masses
 Ectopic calcifications

RARITIES

 Calcified acne lesion

 Calcified hematoma (soft tissue)
 Hamartoma
 Myositis ossificans

MULTIPLE SEPARATE RADIOPACITIES:

 Tori and exostoses

  Multiple retained roots
 Multiple socket sclerosis
 Multiple periapical or focal cemento-osseous dysplasia
 Multiple periapical condensing osteitis
 Multiple embedded or impacted teeth
 Cleidocranial dysplasia
 Multiple Hypercementosis

RARITIES

 Multiple calcified nodes

 Multiple chondromas
 Multiple odontomas
 Multiple osteochondromas
 Multiple osteomas of skin
 Multiple phleboliths
 Multiple sialoliths
GENERALIZED RADIOPACITIES:

 Florid cementoosseous dysplasia

 Paget's disease-mature stage
 Osteopetrosis

RARITIES

 Albright's syndrome

 Caffey's disease

 Multiple large exostoses and tori

 Osteogenesis imperfecta

Unerupted or Misplaced Teeth Including Supernumeraries:

 Supernumerary teeth – develop in addition to normal complement.

 Supplemental teeth – when the extra teeth have normal morphology.
 Mesiodens – supernumerary teeth between maxillary central incisors.
  Parateeth are supernumerary teeth occurring in molar region
 Distomolars are parateeth that are usually presented distal to third molar.
 Peridens are supernumerary teeth that develop ectopically either buccally or lingually.

R/F:

 Most commonly in anterior maxilla and maxillary molar region.

 If multiple, usually seen in mandibular premolar region.
 Vary from normal appearing tooth structure to conical form and in extreme cases,
grossly deformed tooth structure.
 Tooth is usually small than normal dentition.
 It interferes with the normal eruption.
 In deciduous dentition it is seen after 3 or 4 yrs and > 9-12yrs in permanent dentition.
 Besides intraoral periapical radiographs, occlusal radiographs also help in determining
the location and number.

D/D: Multiple supernumerary teeth are associated with cleidocranial dysplasia and gardener’s
syndrome.

EXOSTOSES

TORUS PALATINUS:

 Bony protuberance – middle third of midline of the palate.

 F>M
 Age: < 30 yrs
 It appears as flat, nodular, lobulated or mushroom-like.
R/F:

 Location – dense radiopaque shadow below and attached to hard palate. It may be
superimposed over the apical areas of maxillary teeth.
 Periphery and shape – well defined and may have convex or lobulated outline.
 Internal structure – homogenously radiopaque.

TORUS MANDIBULARIS:

 Hyperostosis – lingual aspect of mandibular alveolar process, premolar teeth.

 Occurs singly/multiply, unilaterally/bilaterally.
 Predominantly in women.
 Masticatory stress is an essential factor underlying its formation.

R/F:

 Location – radiopaque shadow usually superimposed on the roots of mandibular

premolars and molars and occasionally over canine or incisors.
 Periphery – sharply demarcated anteriorly. It is less dense and less well-defined as
they extend posteriorly.
 Internal structure – radiopaque and homogenous.

PERIAPICAL IDIOPATHIC OSTEOSCLEROSIS:

 Also known as dense bone island, enostosis.

 Localized growths of compact bone that extend from endosteal surface of cortical
bone into cancellous bone.
  Asymptomatic.

R/F:

 Location – mandible > maxilla, premolar – molar area.

 Periphery – well defined but occasionally blends with the trabeculae of surrounding
bone. No trace of radiolucent margin or capsule.
 Internal structure – uniformly radiopaque.
 Effect on surrounding structures – associated with external root resorption. In rare
cases, it inhibits the eruption of tooth.

D/D:

 Hypercemetosis
 Periapical cemental dysplasia
 Condensing osteitis

ODONTOMA:

 It refers to a tumor that is radiographically and histologically characterized by the

production of mature enamel, dentin, cementum and pulp tissue.
 It is a hamartoma.
 It usually interferes with eruption of permanent teeth.
 No gender predilection, 2nd decade.
 Compound > complex.

COMPOUND ODONTOMA:
COMPLEX ODONTOMA:

R/F:

 Location –
 Compound odontoma – anterior maxilla associated with crown of an unerupted
canine.
 Complex odontoma – mandibular 1st and 2nd molar area.
 Periphery – well defined borders and may be smooth or irregular. It is surrounded by
a cortical border and immediately inside and adjacent to cortical border is a soft tissue
capsule.
 Internal structure – radiopaque.
 Compound odontoma – number of tooth like structures or denticles that look like
deformed teeth.
 Complex odontoma – irregular mass of calcified tissue.
 Effect on surrounding structures – associated with impaction, malpositioning,
diastema and devitalization of adjacent teeth.

D/D:

 Cemento-ossifying fibroma
 Periapical cemental dysplasia

HYPERCEMENTOSIS:

 It refers to excessive deposition of cementum on the tooth roots.

 Occasionally appears on supra erupted tooth after loss of an opposing tooth or
periapical inflammatory lesions.
 No clinical signs or symptoms.
R/F:

 Occurs in the apical end of roots seen as irregular accumulation of cementum.

 The outline is usually smooth but occasionally seen as irregular enlargement of root.
 Cementum is more radiolucent than dentine.
 It is associated with widening of PDL space and lamina dura.

D/D:

 Mature cemental dysplasia

 Periapical idiopathic osteosclerosis
 Condensing osteitis
 Cementoblastoma
 Severely dilacerated root

CONDENSING OR SCLEROSING OSTEITIS:

It is a periapical inflammatory lesion.

R/F:

 Location – epicenter is found at the apex of involved tooth. The lesion usually starts
within the apical portion of PDL portion.
 Periphery – ill-defined showing gradual transition from surrounding normal
trabeculae into abnormal bone pattern.
 Internal structure – appears as radiolucent region at the apex surrounded by
radiopaque reaction of sclerotic dense bone.

D/D:

 Periapical idiopathic osteosclerosis

 Periapical cemental dysplasia
 Hypercementosis
 Unerupted tooth
 Foreign body introduced during root canal therapy

CALCIFYING EPITHELIAL ODONTOGENIC TUMOUR (CEOT) OR

PINDBORG TUMOUR:

 Located within bone and produce a mineralized substance within amyloid like
material.
 Predominantly in men, age of occurrence - 42yrs.
 Associated with jaw expansion.
 Palpation reveals a hard swelling.

R/F:

 Location – mandible, premolar – molar area.

 Periphery – well defined cyst like cortex. In some tumors it appears irregular and ill-
defined.
 Internal structure – unilocular or multilocular with numerous scattered radiopaque
foci of varying size and density.
Most characteristic – appearance of radiopacities close to crown of embedded tooth.
In addition, small thin opaque trabeculae may cross the radiolucency in many
directions.
 Effect on surrounding structures – it may displace a developing tooth or prevent its
eruption. It is also associated with expansion of jaw with maintenance of cortical
boundary.

D/D:

 Adenomatoid odontogenic tumor

 Ameloblastic fibro-odontoma
 Calcifying odontogenic cyst

AMELOBLASTIC FIBRO-ODONTOMA:

 Mixed tumor with all the elements of an ameloblastic fibroma but with scattered
collections of enamel and dentin.
 Associated with missing tooth or tooth that has failed to erupt.
 No gender predilection.

R/F:

 Location – posterior mandible. The epicenter of lesion is usually occlusal to a

developing tooth or towards the alveolar crest.
 Periphery – well defined and sometimes corticated.
 Internal structure – mixed with majority of lesion being radiolucent with small
discrete radiopacities.

D/D:

 Odontomas

ADENOMATOID ODONTOGENIC TUMOUR (AOT):

 Uncommon nonaggressive tumors of odontogenic epithelium.

 Second decade of life.
 Female predilection.
 Slow growing, painless swelling or asymmetry often associated with a missing tooth.

R/F:

 Location – maxilla, incisor- canine- premolar region especially canine.

 Periphery – well defined corticated or sclerotic border.
 Internal structure – it may be completely radiolucent or contain faint radiopaque foci
or dense clusters of ill-defined radiopacities.
 Effect on surrounding structures – as the tumor enlarges, adjacent teeth are displaced.
It inhibits eruption of involved teeth. Expansion of jaw may occur but outer cortex is
maintained.

D/D:

 Calcifying odontogenic cyst

 Ameloblastic fibro-odontoma
 Calcifying epithelial odontogenic tumor

CALCIFYING ODONTOGENIC CYST (GORLIN CYST):

 Uncommon, slow growing benign lesion.

 Age – 10 to 19 yrs
 Slow growing painless swelling of jaw.
 Discharge from advanced lesions.
 Aspiration yields viscous, granular, yellow fluid.
 Swelling is painless until it interferes with the function.

R/F:

 Location – equal distribution of jaws, anterior to 1 st molar esp. associated with cuspids
and incisors.
 Periphery – well defined and corticated.
 Internal structure – completely radiolucent, may show evidence of small foci of
calcified material or solid amorphous masses.
  Effect on surrounding structures – it interferes with eruption, displacement of teeth
and resorption of roots occurs. Perforation of cortical plates is seen with enlarging
lesions.

D/D:

 Adenomatoid odontogenic tumor

 Ameloblastic fibro-odontoma
 Calcifying epithelial odontogenic tumor

MUCOSAL CYST OF THE MAXILLARY SINUS:

 Occurs in approximately 2% of the population.

 Retention cyst in the lining mucosa of the maxillary sinus.

 Men = women.

 May be bilateral.

 Third decade of life.

 Asymptomatic, a significant number may produce accompanying symptoms of a

sinusitis.

R/F:

 It is a radiopaque lesion seen over the apices of maxillary molar roots.

 It appears as a dense dome-shaped mass with its base on the floor of maxillary sinus,
apices of maxillary 1st and 2nd molars.

D/D:

 Condensing or sclerosing osteitis

 Periapical idiopathic osteosclerosis

 Periapical cemental dysplasia

OSTEOMAS:

 Form from membranous bones of skull and face.

 Solitary or multiple.
 More common on frontal &ethmoidal sinuses.
 >40 yrs.
 Asymmetry, caused by bony hard swelling on the jaw.
 Swelling is painless until it interferes with the function.

R/F:

 Location - posterior mandible, lingual side of ramus or inferior mandible border,

condylar and coronoid regions, frontal sinus.

 Periphery – well defined.

 Internal structure – uniformly radiopaque composed of compact bone. Internal
trabecular structure is composed of cancellous bone.
 Effect on surrounding structures – it displaces adjacent soft tisues such as muscles and
cause dysfunction.

D/D:

 Osteochondroma
 Condylar hyperplasia
 Torus

OSTEOSARCOMA:

 Malignant neoplasm of bone.

 4th decade, males.
 Swelling – rapid.
 Pain, erythema of overlying mucosa, ulceration, loose teeth, haemorrhage, trismus &
nasal obstruction.

R/F:

 Location – Mandible – posterior including tooth bearing region, angle and vertical
ramus.
Maxilla – alveolar ridge, antrum and palate.
 Periphery – ill defined border. When the lesion involves the periosteum directly, it
shows typical sunray spicules or “hair on end” trabeculae.
 Internal structure – it may be entirely radiolucent or mixed radiolucent-radiopaque or
completely radiopaque. It has granular or sclerotic appearing bone, cotton balls, wisps
or honey combed internal structure with adjacent destruction of pre-existing osseous
architecture.
 Effect on surrounding structures – it is associated with widening of PDL. Antral or
nasal cortices may be lost. Mandibular lesions may destroy the cortex of
neurovascular canal.

D/D:

 Fibrosarcoma
 Metastatic carcinoma
 Chondrosarcoma
 Fibrous dysplasia

FIBROUS DYSPLASIA (MONOSTOTIC):

 Localized change in normal bone metabolism that leads to replacement of all

components of cancellous bone by fibrous tissue containing varying amounts of
abnormal appearing bone.
 Most often involves jaws.
 Unilateral facial swelling or an enlarging deformity of the alveolar process.

R/F:
  Location – maxilla > mandible, posterior aspect.

 Periphery – ill-defined with gradual blending of normal trabecular bone into abnormal
pattern.
 Internal structure – the density of trabecular pattern varies. It is more pronounced in
the mandible and more homogenous in the maxilla. It may be more radiolucent or
radiopaque or mixture. Abnormal trabeculae usually are shorter, thinner, irregularly
shaped and more numerous than normal. This creates a radiopaque pattern that can
vary
 Granular appearance – ground glass appearance.
 Orange peel appearance.
 Cotton wool arrangement.
 Amorphous dense pattern.
A distinct characteristic is organization of abnormal trabeculae into swirling pattern
similar to finger print.
 Effect on surrounding structures – it may cause expansion with maintenance of
thinned cortex. It may also displace teeth or interfere with normal eruption
complicating orthodontic treatment. It displaces inferior alveolar canal in a superior
direction.

D/D:

 Paget’s disease
 Osteomyelitis
 Osteosarcoma

PERIAPICAL CEMENTO-OSSEOUS DYSPLASIA – MATURE STAGE:

 Localized change in normal bone metabolism that results in replacement of the

components of normal cancellous bone with fibrous tissue and cementum like
material.
 Middle age, females.
 Vital tooth.
 Incidental finding in the radiographs.
 R/F:

 Location – the epicenter usually lies at the apex of tooth, mandibular anteriors. It may
be multiple and bilateral. If involved teeth have been extracted, the lesion can still
develop but periapical location is less evident and known as cemental dysplasia.
 Periphery – well defined.
 Internal structure – it has 3 stages – early radiolucent stage, mixed radiolucent-
radiopaque stage and mature radiopaque stage. A thin radiolucent margin can be seen
at the periphery because the lesion matures from the center outward.
 Effect on surrounding structures – lamina dura is lost and periodontal ligament
appears widened.

D/D:

 Cemento-ossifying fibroma
 Peripheral idiopathic osteosclerosis

FLORID CEMENTO-OSSEOUS DYSPLASIA (GIGANTIFORM CEMENTOMA):

 Widespread form of PCD.

 Normal cancellous bone is replaced with dense, acellular cemento-osseous tissue in a
background of fibrous connective tissue.
 Middle aged, females.
 Asymptomatic.

R/F:
  Location – usually bilateral, mandible > maxilla. The epicenter is usually apical to the
teeth.
 Periphery – well defined with a sclerotic border.
 Internal structure – varies from the mixture of radiopaque-radiolucent to complete
radiopaque. Radiopaque regions can vary from small oval and circular regions to
large, irregular and amorphous areas of calcifications.
 Effect on surrounding structures – it displaces inferior alveolar canal in an inferior
border and floor of antrum in superior direction. There may be enlargement of
alveolar process by displacement of buccal and lingual cortical plates.

D/D:

 Paget’s disease
 Chronic sclerosing osteomyelitis

BENIGN CEMENTOBLASTOMA (TRUE CEMENTOMA):

 Slow growing, mesenchyme neoplasms composed principally of cementum.

 Bulbous growth around & attached to apex of tooth root.
 12-65 yrs, males.
 Slow growing solitary lesion.
 Involved tooth vital & painful.

R/F:

 Location – mandible, premolar or 1st molar.

 Periphery – well defined radiopacity with cortical border and a well-defined
radiolucent band inside the cortical border.
 Internal structure – mixed radiopaque – radiolucent lesion in which a majority is
radiopaque. It may have an amorphous or wheel spoke pattern.
 Effect on surrounding structures – it is associated with external root resorption. If
large enough, there may be expansion of mandible but with intact cortex.

D/D:

 Periapical cemental dysplasia

 Enostosis
 Hypercementosis

CEMENTO-OSSIFYING FIBROMA:

 Ossifying fibroma, cementifying fibroma.

 Highly cellular, fibrous tissue that contains varying amounts of abnormal bone or
cementum – like tissue.
 Young adults, females.
 Asymptomatic.
 Occasionally associated with facial asymmetry, displacement of teeth.

R/F:

 Location –Mandible-inferior to premolars and molars, superior to inferior alveolar

canal.
Maxilla – canine fossa and zygomatic arch area.
 Periphery – well defined surrounded by a thin radiolucent capsule.
 Internal structure – varies from mixed radiolucent-radiopaque to complete radiopaque
lesion.
 Effect on surrounding structures – displacement of teeth or inferior alveolar canal and
expansion of outer cortical plates of bone but remains intact.

D/D:

 Periapical cemental dysplasia

 Fibrous dysplasia
 Calcifying odontogenic tumor
 Calcifying odontogenic cyst
 Adenomatoid odontogenic tumor

PAGET'S DISEASE – MATURE STAGE:

 Condition of abnormal resorption & apposition of osseous tissue in one or more

bones.
  >40 yrs, male.
 Separation & movement of teeth occurs causing malocclusion.
 Dentures may fit tight or poorly.
 Bone pain, elevated alkaline phosphatase.

R/F:

 Location – occurs often in pelvis, skull and vertebrae and infrequently in jaw.
maxillary predominanceusually occurs bilateral.
 Internal structure – there are 3 stages – early, mixed and mature stage. The mature
stage is completely radiopaque. It is seen when the trabeculae may be organized into
rounded, radiopaque patches of abnormal bone creating cotton wool appearance.
 Effect on surrounding structures – It causes enlargement of bone. Hypercementosis of
teeth occurs which is exuberant and irregular. If it occurs in maxilla, it may involve
maxillary sinus.

D/D:

 Fibrous dysplasia
 Florid osseous dysplasia

PULP STONES:

 These are foci of calcification seen in the dental pulp.

 Seen as round or oval radiopaque structure within pulp chambers or root canals.
D/D:

 Pulpal sclerosis.

RADIOPAQUE SALIVARY CALCULI:

 Submandibular gland calculi are often radiopaque and develop within the main duct
or gland.
 If it is present in the duct, it may be superimposed on alveolar bone producing opacity
within the bone.
 If it is present in gland, it is seen below the lower border of mandible.

CALCIFIED LYMPH NODES:

 Involves submandibular or cervical chain, single or multiple.

 Occurs as behind or below the angle of mandible.
 Appear as heterogenous radiopaque mass.
CALCIFIED TONSILS:

 Incidental finding on panoramic tomographs in elderly patients.

 Appear as small radiopaque masses overlying the superior aspect of ramus of
mandible, often bilateral.

PHLEBOLITHS:

 These are calcifications of thrombi within the veins and occasionally seen in
hemangiomas.
 They have characteristic target appearance – radiopaque around the periphery and
radiolucent in the center.

FOREIGN BODIES:

These may be

 Amalgam remnants.
 Radiopaque foreign body in the lower lip.
 Radiopaque root canal sealer in inferior alveolar canal.
REFERENCES:

 Essentials of dental radiography and radiology. Eric Whaites 3rd edition.

 Oral radiology. White, Pharaoh 5th edition.
 Differential diagnosis of oral and maxillofacial lesions. Wood, Goaz. 5th edition.
 Radiographic findings of diseases involving the maxilla and mandible. AJR I59; 345-
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