Authors: Bender IB, Seltzer S.
Title: Roentgenographic and direct observation of experimental lesions in bone: Part II.
Journal: J Am Dent Assoc
Date: Jun 1961
Citation: 62:708-716
Category: Radiology and Imaging
Evidence-based Ranking: 5
Purpose/Objectives: To study the radiographic appearance of experimentally placed periapical and periodontal bone lesions. To study the relation of root apexes to the cortex and cancellous bone.

Materials & Methods: Sections of human mandibles and maxillae were obtained, photographed and x-rayed. Artificial periodontic and periapical lesions of varying size and depth were made and then x-rayed for comparison to the original films. Dissections of the mandibles and maxillae were then preformed in order to study the relation of the apexes to the cortical plate.

Results: Periodontal Lesions – perforation of the interdental alveolar crest, regardless of depth, was only visible radiographically at the crestal region. Simulation of infrabony pocket revealed increasing radiolucency as the amount of bone destruction increased. Periapical Lesions – lesions made in the periapical region with file and reamers, up to no.4 (#30), and round burs up to no. 2 were undetectable. Lesions only became visible in the x-rays once the cortex/cacellous junction became affected. Apical relationships - most root apices of anterior and pre-molar teeth are near the buccal cortex. - mesial roots of bifurcated 1st molars are near the buccal cortex - most apices of upper molars, 2nd lower molars, and distal roots of lower 1st molars are suspended in cancellous bone - most lower 3rd molars are near or embedded in the lingual cortex.

Author’s Conclusion: Inflammatory and tumorous lesions that are confined within the medullary space are not detectable radiographically. In necrotic teeth, the radiographic lesion might first appear around the mesial root apex.

Validity of Conclusion: the radiographic conclusions are valid.