Radiographic features of radiolucent odontogenic lesions associated with impacted teeth: a cross-sectional study of 454 cases.
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PURPOSE: To characterize and compare the radiographic and tomographic features of odontogenic lesions associated with impacted teeth in a Brazilian population. METHODS: This retrospective, cross-sectional study analyzed 31,378 cases diagnosed between 2001 and 2023 from the pathology database of a dental school. Of these, 454 cases of intraosseous odontogenic lesions associated with impacted teeth and with available plain radiographs or cone-beam computed tomography (CBCT) scans were included. Demographic, clinical, and imaging variables were recorded. Agreement between imaging modalities was assessed in cases where both images were available. RESULTS: The most frequent diagnoses/lesions were dentigerous cyst (57.5%), odontogenic keratocyst (25.1%) and ameloblastoma (10.8%). Lesion characteristics varied significantly by type, including internal structure, loculation, shape, and associated resorption or displacement. Comparative analysis between 2D radiographs and CBCT (n = 37) revealed high agreement (> 90%) for internal content, bone location, and resorption. However, cortical discontinuity (40.7%), cortical expansion (51.8%), and mandibular canal involvement (48.1%) showed low concordance. CBCT detected these features more reliably. CONCLUSIONS: CBCT provides superior diagnostic accuracy compared to 2D imaging, particularly for cortical and canal involvement, which may guide surgical planning and reduce the risk of complications. Its use is recommended for comprehensive evaluation of odontogenic lesions associated with impacted teeth.