Radiolucency with indistinct margins and radiopacity

OBJECTIVES The aim of this Module is to provide the clinician with an in-depth knowledge of the aspects, primarily radiographic, of radiolucent lesions with indistinct margins and radiopaque lesions. It will also compare the similarities between lesions, which allow to exclude certain diagnostic hypotheses in the first instance, and the elements of radiographic-clinical diversity, in order to make a correct differential diagnosis. MATERIALS AND METHODS The most recent international literature available on osteomyelitis, osteoradionecrosis, bisphosphonate osteonecrosis, metastatic and primary intra-alveolar epidermoid carcinoma, Langerhans cell histiocytosis group, plasmacytic myeloma, idiopathic osteosclerosis, condensing osteitis, hypercementosis, bone-cement dysplasia, cementoblastoma, osteoblastoma, central cement-ossifying fibroma, exostosis, enostosis, osteosclerosis, osteoma, chondrosarcoma, osteosarcoma, odontoma, ameloblastic odontoma, and foreign bodies was taken into consideration. This literature was found through the main databases (PubMed, Medline, Scopus, Google Scholar and Cochrane Library), which was combined with the experience derived from several years of clinical activity of the authors. RESULTS The data reported in the literature show that it is possible to identify peculiar identifying features for each type of lesion such that diagnostic suspicion can be ascribed to a few lesion types. The location, radiographic appearance, distribution in the population divided by age, and features related to the elements involved in radiolucency/radiation can guide the clinician in a correct diagnosis. DISCUSSION The lesions examined can be distinguished into pathological radiolucencies with indistinct margins and radiopacity, based on radiographic presentation. Radiographic pictures are indeed fundamental for a correct diagnosis, but often alone they are not diriment if not correlated with an accurate history and knowledge of topography and demographic distribution. Diagnostic framing is ultimately aimed at treatment and the correct follow-up programme, as well as identifying potentially more aggressive lesions and distinguishing them from paraphysiological conditions. CONCLUSIONS The dentist must be able to discriminate, through in-depth anamnestic knowledge and a careful clinical and radiographic investigation, the more or less aggressive forms of osteolytic lesions in order to be able to distinguish cases that require an observational approach and patient maintenance under follow-up from cases that require conservative and more aggressive treatment, preceded by a bioptic evaluation when indicated. Finally, it is important to be able to identify and distinguish oral manifestations of systemic pathologies, sometimes the first manifestations.