Oral Hard Tissue Lesions: A Radiographic Diagnostic Decision Tree

BACKGROUND: Focusing on history taking and an analytical approach to patient’s radiographs, help to narrow the differential diagnoses. AIM: This narrative review article aimed to introduce an updated radiographical diagnostic decision tree for oral hard tissue lesions according to their radiographic features. METHODS: General search engines and specialized databases including PubMed, PubMed Central, Scopus, Embase, EBSCO, ScienceDirect, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “jaw diseases,” “maxilla,” “mandible,” “radiolucent,” “radiopaque,” “odontogenic,” “nonodontogenic,” “cysts,” and “tumors.” Related English-language articles published from 1973 to 2020, including reviews, meta-analyses, and original papers (randomized or non-randomized clinical trials; prospective; or retrospective cohort studies), case reports, and case series about oral hard tissue lesions were appraised. RESULTS: In this regard, bony lesions have been classified according to their radiographic pattern (radiolucent, mixed, radiopaque, and rarified), position (periapical, pericoronal and interradicular), margins (well and ill-defined), relation to dentition (with and without dental association), and number (solitary and multiple). In total, 50 entities were organized in the form of a decision tree. CONCLUSION: In this paper, an updated decision tree was proposed to help dental practitioners to make more accurate diagnoses and better treatment plans on the basis of radiographic characteristics.