CDA Essentials 2019 • Volume 6 • Issue 4

39 Issue 4 | 2019 | S upporting Y our P ractice RadiologyObservationChecklist What do you see, and what do you not see that you should? 1. Overall degree of radiopacity/ radiolucency a. Radiolucent? b. Radiopaque? c. Mixture of lucent/opaque? 2. Anatomical position of area of interest a. Mandible? b. Maxilla? c. Both jaws? d. In dental tissue? e. In osseous tissue (cortical or cancellous or both)? f. In soft tissue? 3. Estimated site of origin of the area of interest a. Where is its centre? b. Is it from outside going into bone or inside bone growing out? c. Any associated soft tissue mass? 4. Border/Margin/Periphery of area of interest a. Demarcation i. Well demarcated? ii. Moderately well demarcated? iii. Poorly demarcated? iv. Not demarcated? b. Cortication i. Well-corticated (thick or thin peripheral cortex)? ii. Moderately well corticated? iii. Poorly corticated? iv. Not corticated? c. Encapsulation i. Encapsulated? ii. Not-encapsulated? d. Border sub-types i. Infiltrative? ii. Smooth edged? iii. Etched smooth hydraulic border? iv. Crenulated undulating intact border? v. Ragged, moth-eaten border? vi. Diffuse border that melds with normal bone? vii. Displaced border that maintains its dimensional stability? viii.Punched-out border? ix. Sharp sclerotic border? 5. Nature of the internal structure. What’s inside the area of interest? a. Single piece of internal structure? b. Multiple separate internal structures? c. Rarefying osteitis? d. Blurring of trabeculae inside the area of interest? e. Diminished density of trabeculae? f. Diminished number of trabeculae? If something is radiopaque, is it: i. Tooth? ii. Bone? iii. Something else (calcifications or foreign body)? If it is tooth: - Is enamel present? - Is dentin present? - Are dental soft tissues present mixed with either of the above? - Masses or globules the density of cementum? - A combination of the above? If it is bone, is there evidence of: - Sequestrum? - Sclerosing osteitis? - Granular bone? - Increased size of individual trabeculae? - Long spindly trabeculae? - Septations? - Normal residual/leftover bone? - Appearance of “tubular bone?” - Linear striations of bone? If it is something else, and is likely calcification, is there evidence of: - Metastatic calcification? - Dystrophic calcification? - Calcification of a lymph node? - Tonsillar calcifications? - Salivary gland or duct calcifications? - Calcifications in muscle planes? If it is something else, and is likely a foreign body, is it: - Metallic? - Non-metallic? 6. Effects on adjacent structures a. Bone i. Alterations in cortical definition or density? ii. Alterations in trabecular bone? iii. Changes in bone density? iv. Changes in bone architecture? v. Thinning of normal anatomic boundaries? vi. True “hair-on-end” trabecular bone pattern? vii. False hair-on-end trabecular bone pattern? viii.Codman’s triangle? ix. Expansion of bone with cortical breaching? x. Laminar periosteal new bone? xi. Displaced and destroyed periosteal new bone? b. Teeth i. Hypercementosis? ii. Root resorption? • Internal • External • With inostoses iii. Bodily movement of teeth? iv. Alterations or prevention of eruption? v. Alterations in tooth formation (hypoplasia/aplasia/dilacerations) c. Effects on specific anatomical structures i. Mandibular canal? ii. Mental foramen? iii. Inferior/posterior/superior border of mandibular cortex? iv. Mandibular angle? v. Condylar head shape, orientation, location? vi. Maxillary sinus walls, floor? vii. Pterygomaxillary fissure? viii.Orbital cortices? - Dr. Bob Wood