Imaging of Inflammatory, Traumatic, and Metabolic Bone Disease
Inflammatory disease
Recognize periapical inflammatory lesions: widened periodontal ligament space, periapical radiolucency, and loss of lamina dura. Understand osteomyelitis: ill-defined radiolucency, sequestra, and periosteal reaction; chronic osteomyelitis may show sclerosis. Know that imaging findings lag behind clinical symptoms. Recognize maxillary sinusitis and its dental origin.
Trauma
Know fracture patterns: mandibular angle, body, condyle, and symphysis; maxillary Le Fort I–III; and dentoalveolar fractures. Look for step-offs, discontinuity of cortical outlines, and displacement. Understand that CBCT improves detection of fine fractures and root fractures compared with plain films. Recognize condylar fracture and its effect on occlusion.
Metabolic bone disease
Know hyperparathyroidism: subperiosteal resorption (classically radial aspect of middle phalanges), brown tumors, and loss of lamina dura. Recognize Paget disease (cotton-wool appearance, bone enlargement), osteomalacia/rickets, and renal osteodystrophy. Understand osteoporosis and its implications for implant planning.
Traps
Questions test whether imaging findings precede or follow clinical symptoms (they lag), and whether a lesion is inflammatory vs neoplastic. Watch for confusion between osteomyelitis and malignancy, and between brown tumors and true neoplasms.
Rule of thumb
Inflammatory lesions follow teeth and the periodontal ligament; traumatic lesions follow cortical outlines; metabolic lesions are often bilateral and systemic.