Pathology of Bone Tissue in the Clinical Practice of Dentists and Maxillofacial Surgeons

13 min read01 July 2026

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Original article is written in RU language (link to read it) .

The article presents the results of clinical observations of bone tissue pathology of the skull bones, which may be encountered in the practice of maxillofacial surgeons, dentists, and radiologists.

Introduction

The methodology for examining a patient in the clinic of dentistry and maxillofacial surgery (MFS) includes not only the collection of information regarding gender, age, complaints, and duration of the disease but also the assessment of the localization of the pathological process and the number of bones involved in the pathological process. In addition to a wide range of radiological studies, additional methods such as cone-beam computed tomography (CBCT), multi-slice computed tomography (MSCT), and/or magnetic resonance imaging (MRI) are used. If necessary, radionuclide technologies are employed, represented by positron emission computed tomography (PET-CT), single-photon emission computed tomography (SPECT-CT), and bone scintigraphy. Failure to adhere to the algorithm and thoroughness of the examination in some cases may lead to irreversible consequences.

Radiographic semiotics of bone and joint diseases includes changes in the position, shape, and size of bones, their contours and structure, as well as destructive and osteosclerotic processes.

Changes in the shape and size of bones may be characterized by volume disturbances (hyperostosis, "bulging", atrophy), pathological tissue growth (Fig. 1 a-g), curvature, elongation or shortening of bones, and changes in the articulating surfaces in the joint.

Fig. 1. Squamous cell keratinizing carcinoma (neoplastic process marked in the images with red arrows): a – appearance of altered soft tissues of the lower third of the face; b – MSCT angiography of the maxillofacial area, three-dimensional reconstruction

A pathological neoplasm may be a symptom of a primary or secondary bone tissue tumor (fig. 2; 3 a-b), fibrous dysplasia (fig. 4 a-b; 5), which may be hereditary, and the main radiological criterion for assessment is the preservation of the closure plate, indicating the benign nature of the pathological process.

Fig. 2. Osteoma of the skull (shown by the red arrow), three-dimensional reconstruction of MSCT

Fig. 3. Osteogenic sarcoma of the skull on CT of the skull (shown with red arrows): a – three-dimensional reconstruction; b – axial projection; c – planar reconstruction in the coronal plane

Fig. 4. Fibrous dysplasia of the mandible on the left (shown with red arrows) on CBCT: a – axial projection; b – atypical oblique projection

Fig. 5. Area of cemento-fibrous dysplasia in the region of the root of tooth 3.4 (shown with a red arrow) on CBCT: planar reconstruction in the sagittal plane

Using radiological diagnostic methods, pathological changes in the articulating surfaces of the temporomandibular joint (TMJ) can be identified. Examples of bone tissue pathology of the TMJ are shown in Fig. 6 a, b; 7 a, b; 8 a, b.

Fig. 6. Fibrous dysplasia of the left TMJ head (the area of pathological changes is marked with a red arrow in the images): a – axial projection of CT of the TMJ; b – coronal projection of MRI of the TMJ, T1 WI

Fig. 7. Osteoma of the condylar process of the mandible on the left: a – STL model of the skull (the pathological area is marked with a blue arrow in the image); b – histological preparation of the tumor stained with hematoxylin and eosin, magnification 200:1

Fig. 8. Incidental radiological findings in MRI diagnostics of TMJ dysfunction: a – intraosseous cyst of the left condylar head of the mandible, sagittal plane, T2*GRE pulse sequence in habitual occlusion; b – giant cell tumor of the right condylar head of the mandible, sagittal plane, PD pulse sequence with fat suppression in habitual occlusion (the area of pathological changes is marked with a red arrow in the images)

Bone tissue pathology can be characterized not only by changes in its structure but also by changes in the adjacent soft tissues (Fig. 9 a-c).

Fig. 9. Central giant cell reparative granuloma of the mandible on the left (the area of pathological changes is marked with a red arrow in the images): a – axial projection of MSCT; b – axial projection of MRI, T2 WI; c – histological preparation of the tumor, stained with hematoxylin and eosin, magnification 200:1

In the practice of a radiologist, a condition such as eosinophilic granuloma (Taratynov's disease) is regularly encountered. Its radiological signs include areas of bone tissue rarefaction with indistinct "fringed" contours without a sclerotic rim, possible destruction of the outer and inner cortical plates of bone tissue, and invasion into soft tissues, with the formation of sequestra (the "button" sign on the X-ray, Fig. 10). It is worth noting that these changes can be detected on X-ray images used for cephalometric analysis in the practice of an orthodontist and maxillofacial surgeon. This refers to lateral and frontal cephalometric radiographs (CR) of the skull and 3D cephalometry. Myeloma (multiple myeloma, generalized plasmacytoma, Rustitsky-Kalera disease) is a malignant tumor of plasma cells (differentiated B-lymphocytes that produce antibodies). This blood system disease, classified as paraproteinemic leukemias, is radiologically characterized by well-defined "stamped" foci of destruction of varying sizes in the bones of the skull vault, clavicles, ribs, and pelvic bones (Fig. 11).

Fig. 10. Eosinophilic granuloma on CT and MRI (the area of pathological changes is marked with a red arrow in the images): a – CT, axial plane; b – MRI, T2 WI, axial plane

Fig. 11. Areas of destruction in the bones of the skull cap on the X-ray of the cranial bones in lateral projection (indicated by red arrows) in myeloma disease

A sad finding in the practice of a dentist and maxillofacial surgeon can be osteolytic metastases in the skeleton's bones, including the vertebrae (Fig. 12).

Fig. 12. Area of destruction of the bone tissue of the vertebral body with uneven, unclear contours and minimal sclerosis rim (indicated by the red arrow)

Iatrogenesis occupies a special place in the practice of a dentist, maxillofacial surgeon, and radiologist (Fig. 13 a-c; 14 a, b; 15 a-c; 16; 17).

Fig. 13. Ameloblastoma of the mandible on the left: a – frontal slice of the CT scan of the jaws (the pathological area is indicated by a red arrow); b – axial slice of the CT scan of the mandible (“Codman’s triangle”, a radiological sign of the tumor, indicated by a blue arrow); c – histological preparation of the tumor, stained with hematoxylin and eosin, magnification 200:1

Fig. 14. Dental implant (indicated by the red arrow) installed in the area of the odontoma of the mandible (indicated by the blue arrow): a – oblique projection of CT; b – axial projection of the skull CT

Fig. 15. Installation of a dental implant (indicated by the red arrow) in the carcinoma of the maxilla on the right (indicated by the blue arrow) – frontal projection of the skull CT

Fig. 16. Tooth 2.7, serving as a support for the bridge prosthesis, is located in the carcinoma of the upper jaw on the left (the area of interest is indicated in the images with red arrows): a – CT scan of the skull, planar reconstruction in the coronal plane; b – CT scan of the skull, planar reconstruction in an atypical sagittal plane

Fig. 17. Orthopantomogram (tooth 4.8 was removed on an outpatient basis by a dental surgeon, adjacent to the intraosseous hemangioma indicated by the red arrow in the figure)

Thus, based on a number of clinical examples provided by us, the diversity of pathological changes in the bone tissue of the jaws and other bones of the skull encountered in the routine practice of a dentist and maxillofacial surgeon is clearly illustrated. The interaction of the clinician with the radiologist and pathologist plays a crucial role in the timely detection and correct interpretation of these changes.

In order to prevent iatrogenesis, the authors' collective considers it possible to propose the following practical recommendations:

Compliance with the Order of the Ministry of Health of the Russian Federation dated 09.06.2020 No. 560n regarding the description of the X-ray image of the jaws (skull bones) by the radiologist.
Radiological control at all stages of dental treatment.
Use of additional examination methods (MSCT and MRI, PET-CT, SPECT-CT, osteoscintigraphy, densitometry, laboratory re-examination, etc.).
Performing tissue biopsy (if indicated).
Exclusion of teeth located near the pathological area from the action zone of orthodontic appliances.
Control of the presence in the outpatient card (medical history) of informed voluntary consent for examination and treatment.
Assessment of the psycho-sensory and anatomical-functional disadaptation of the patient at the stages of treatment and involving (if necessary) a clinical psychologist in the work.

N.V. Vishneva, A.N. Lanina, O.V. Lukina, E.V. Bubnova, A.G. Tyurin, R.A. Fadeev, A.I. Yaremenko

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