Well-defined (pt. II) and multilocular radiolucencies

OBJECTIVES The aim of this Module is to provide the clinician with an in-depth knowledge of the features, primarily radiographic, of the pathological well-defined radiolucency and multilocular radiolucency. The second group includes keratocysts and ameloblastomas that will be treated in the next Module. 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 most recent international literature available on the collateral cyst, naso- palatine cyst, naso-labial cyst, surgical ciliated cyst, radicular cyst, residual cyst, odontogenic glandular cyst, odontogenic myxoma, aneurysmal bone cyst, central bone hemangioma, and kerubismus has been reviewed. This literature was found through the major databases (PubMed, Medline, Scopus, and Cochrane Library), in addition to decades of academic clinical practice of the authors. RESULTS The datas show that it is possible to identify specific features for each type of lesion. This allows to ascribed a diagnostic hypothesis to a few lesions. The clinician must consider the location, the radiographic appearance, the distribution in the population divided by age and the elements involved in radiolucency. These features can guide the clinician trough a correct diagnosis, distinguishing lesions proper from clinical conditions not requiring any treatment. DISCUSSION The radiolucent lesions examined can be distinguished into pathologic well-defined and multilocular radiolucent lesions based on the radiographic presentation. Radiographics are essential for a correct diagnosis, but often alone are not diriment if not correlated with an accurate anamnesis and knowledge of topography and demographic 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 paraphysiological conditions. CONCLUSIONS The dental surgeon must be able to discriminate by a thorough anamnestic knowledge and an accurate clinical and radiographic investigation 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 bioptic evaluation when indicated. CLINICAL SIGNIFICANCE This Module provides the clinician with radiographic information useful in formulating a correct diagnostic hypothesis regarding the macrocategories of pathological well-defined lesions and multilocular ones.