Pericoronal and well-defined radiolucencies (pt. I)

OBJECTIVES The aim of this Module is to provide the clinician with an in-depth knowledge of the aspects, primarily radio graphic, of the radiolucent lesions that surround the crown of dental elements as well as non-pathological well-de fined radiolucent entities. Similarities and differences among the lesions have been highlighted and the elements of radiographic as well as clinical diversity analyzed, allowing proper differential diagnosis. MATERIALS AND METHODS The authors have included the most recent international literature available on: normal follicular space; den tigerous cysts (also know as follicular cyst); botryoid cyst; eruptive cyst (also know as gengival cyst); osteolysis-related pericoronitis; ameloblastic fibro ma; ameloblastic fibro-odontoma; odontogenic adenomatoid tumor; Pindborg’s tumor; early dental crypts; variants of trabecular medullary structure; Stafne’s lacuna; post-ex traction alveolar socket; focal osteoporotic medullary defect and fibrous healing defect. This literature have been found through the major databases (PubMed, Medline, Scopus, Google Scholar, and Cochrane Library), in addition to decades of aca demic clinical practice of the authors. RESULTS Many lesions have specific features that allow to reduce the diagnostic hypothesis to a smaller pool of cases. The clinician must consider the location, the radiographic appearance, the prevalence among the population divided by age and the elements involved with the radiolucency. These features can guide the clinician trough a correct diagnosis, distinguishing proper lesions from clinical conditions not requiring any treatment. DISCUSSION Based on the involvement or non-involvement of dental elements, the radiolucent lesions examined can be distinguished into peri-coronal and well-defined radiolucency. Radiographies are necessary for a correct diagnosis, but often are not di agnostic alone. They need in fact to be correlated with an accurate anamnesis and knowledge of topography as well as age-distribution. Diagnostic hypothesis guides the treatment approach and the correct follow-up programs, as well as identifying potentially more aggressive lesions and distinguishing them from physiological conditions. CONCLUSIONS Through anamnestic knowledge and an accurate clinical and radiographic investigation, the dental surgeon must be able to discriminate the nature of osteolytic lesions. This diagnostic hypotesis allows to distinguish the cases that require a wait-and-see approach from the cases that require a conservative or aggressive treatment, preceded by a biopsy evaluation when indicated. CLINICAL SIGNIFICANCE This Module provides the clinician with radiographic information useful in formulating a correct diagnostic hypothesis regarding the macro-categories of peri coronal radiolucency lesions and non-pathological well-de fined lesions.