Authors: Bender IB, Seltzer S.
Title: Roentgenographic and direct observation of experimental lesions in bone: Part I.
Journal: J Am Dent Assoc
Date: Feb 1961
Citation: 62:152-160
Category: Radiology and Imaging
Evidence-based Ranking: 5
Purpose/Objectives: To determine (in vitro) what conditions of bone destruction are not visible radiographically and to also correlate the location and extent of experimentally placed bone lesions with their radiographic appearance.

Materials & Methods: Both wet and dry samples of human mandibles were obtained. The samples were photographed and x-rayed prior to any manipulation. Simulated bone lesion were then made in the samples with different instruments (diamond stones, reamers, files and round burrs). The lesions varied in location, size and depth. X-rays were then taken and evaluated to determine the correlation between lesion and radiographic appearance.

Results: Depth - lesions of 1mm in cortical bone did not appear on the x-ray - as depth of lesion increased radiolucency increased Angulation – as angulation increased the radiographic shadows elongated and became less dense Cancellous Bone – lesions which remained entirely in cancellous bone were undetectable Cortical/Cancellous Junction – lesions at the junction of the cortex and cancellous bone were radiographically detectable - as the junction of cortex and cancellous bone is removed a loss of the trabecular pattern is discernable

Author’s Conclusion: Lesions are only radiographically detectable if there is perforation of the cortex, destruction of the cortical/cancellous junction, or extensive destruction of the outer surface of the bone. The loss of trabeculation is actually a destruction of the cortical/cancellous junction. Lesion that are contained entirely within the medullary space are not radiographically detectable.

Validity of Conclusion: the conclusions are valid

Reviewer’s Comments: How does this relate to digital x-ray?