WIDENED PDL SPACE: MALIGNANCY OR FRACTURED TOOTH? SHAHBAZI

Publication date: January 2019

Source: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 127, Issue 1

Author(s): J.C. KATS, L. AL MATNY, M. NOUJEIM

Background

Despite the development of several modern imaging modalities, radiography remains the first and the most important mode of investigation for evaluating jaw lesions. Osteosarcoma is the most common primary malignant bone tumor, accounting for approximately 20% of the sarcomas, but only 5% of the osteosarcomas occur in the jaws. Malignant lesions are known to quickly grow downward into the periodontal ligament (PDL) space, resulting in an irregular widening and destruction of the lamina dura. Often, root fractures can result in a similar radiographic appearance of the surrounding periodontium. We present a case series of 2 patients with vertical root fractures and 1 case of osteosarcoma of the jaw.

Clinical and Radiographic Findings

The 3 patients portrayed similar radiographic findings. Cone beam computed tomography (CBCT) images and panoramic radiography images revealed osseous defects resembling periodontal destruction, periradicular radiolucency, and irregular widening of the surrounding PDL space. Clinically, the 3 patients did not suffer from pain. However, the last of the three patients presented with tooth mobility.

Differential or Definitive Interpretation

Biopsy and histologic analysis revealed case #1 to have osteosarcoma and cases #2 and #3 to have a periodontal defect resulting from a root fracture.

Discussion/Conclusions

Localized swelling, with or without pain, is the characteristic feature of osteosarcoma. A purely osteolytic lesion demonstrates a radiolucency with "moth-eaten" or irregular borders that seem to infiltrate into the surrounding bone. Early-stage osteosarcoma of the jaw can also appear as symmetric widening of the PDL space. Therefore, when there is suspicion, biopsy should be performed to rule out malignancy.

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