DIAGNOSTIC PROCESS

A systematic approach

CASE HISTORY

CLINICAL EXAMS

SUPPLEMENTAL EXAMS
[Lab exams, biopsies, radiographs (?)]

RADIOGRAPHIC EXAMS NONE

INTERPRETATION

Ø View per quadrant (I, II, III, IV)

Ø Examine the landmarks
A. Landmarks
Sinuses, canals, foramina, ridges…

B. Cortical bone and trabeculations

Determine whether they are normal, symmetrical (most important), sparse, dense, etc.

C. Interdental bone
Take note of the cortication, height/level of the crest, shape of the crest.

D. Lamina dura (For continuity)

E. Periodontal ligament space

Hour glass in shape

F. Teeth
Determine the:
Number
Density of enamel, dentin, pulp
Number of roots
General anatomy
Conditions of restorations

(*In radiographs, don’t look at the teeth right away)

NORMAL   ABNORMAL  
Acquired or developmental? (When abnormal, DESCRIBE)

CASTRO III, POMPEYO B. | DCC

 LESIONS

A guide to painting INTRAORAL “PICTURES”.

LESIONS

LOCATION
What is the lesion/s’:
*Position in the jaw
- Maxillary or mandibular?
- Anterior or posterior?
- Mesial or distal?
- Superior or inferior?

*Distribution in the jaw

- Generalized or localized?
- Unilateral or bilateral?
- Odontogenic or Non-odontogenic?

*Bilateral – usually when the epicenter of the lesion is below the mandibular
canal
*Odontogenic – lesion is in the maxillary sinus
*Non-odontogenic – lesion is away from the maxillary sinus

*Pathognomonic – points to a specific disease or defect

LESIONS

EDGE
What characterizes the lesion/s’:
*Border or edge?
- Well defined?
- ill-defined?
- Punched out?
- Corticated? (Thin opaque border)
- Sclerotic? (Wide, uneven border)
- Hyperostotic? (Increased density of trabeculation)

LESIONS

SHAPE
What is the lesion/s’:
*Form or shape?
- Regularly shaped
Ø Circular?
Ø Ovoid?
Ø Linear?
Ø Scalloped?

- Irregularly shaped
Ø Amorphous?

CASTRO III, POMPEYO B. | DCC

LESIONS

INTERNAL STRUCTURE
What is the lesion/s’:
*Radiographic density?
- Radiolucent?
- Radiopaque?
- Mixed?

*Internal architecture?
- Septae? (Bont walls)
- Lobulations? (Individual compartments)
- Tooth like?
- Radiolucent rim?
- Various specific terms (Cotton wool, soap-bubble like, honey comb, wispy, etc.)

LESIONS

OTHER STRUCTURES
What is the lesion/s’:
*Effects on adjacent (other) structures?
- Are TEETH: displaced or resorbed?
- Is the MANDIBULAR CANAL:
Ø Displaced or resorbed?
Ø Enlarged or smaller than normal?
- Is the CORTICAL PLATE:
Ø Expanded or perforated?
Ø Thinned or thickened?
Ø Displaced? (In what aspect)
- Is there any FILLING DEFECT?

LESIONS

NUMBER
How many are the lesions?
*Amount?
- Single or multiple?

LESIONS

SIZE
What is the lesion/s’:
*Magnitude or size?
- Give the ACTUAL MEASUREMENT from the radiograph (Use a ruler ; use mm
or cm)
- “If below 1cm, use mm”

CASTRO III, POMPEYO B. | DCC