Radiology · patient case question
A second panoramic film shows a sharply outlined, uniformly dense radiopacity in the posterior mandible that does not conform to any anatomic structure and has a geometric border. What is it?
Patient case: Routine radiographic survey
Patient: Male, 34 years old
Chief complaint: “I'm just here for my check-up.”
History: No significant medical history. No medications. Last radiographs five years ago.
Findings: A panoramic radiograph and a full-mouth periapical series are taken today. Several incidental findings are noted for discussion.
Show answer and explanation
Correct answer: A. A foreign body
- A. CORRECT. Metallic foreign bodies are recognised by density and by SHAPE: they are more radiopaque than any bone or tooth structure, have sharply defined geometric or manufactured outlines, and ignore anatomic boundaries. Broken instrument fragments, retained root-canal materials, bullet or shrapnel fragments, and surgical wire all present this way.
- B. Condensing osteitis is a diffuse sclerotic bone response to chronic low-grade pulpal inflammation, always centred on the apex of a tooth with a carious or restored crown, and it blends into the surrounding trabeculae.
- C. Idiopathic osteosclerosis (dense bone island) is a well-defined but bone-density opacity with no inflammatory source and no capsule, usually in the premolar-molar mandible.
- D. A complex odontoma is a disorganised mass of enamel, dentine and cementum. It has a soft-tissue capsule and a thin radiolucent rim, and its density matches tooth structure rather than metal.