RADIOGRAPHIC APPEARANCES OF BENING

ODONTOGENIC TUMORS OF THE JAWS

Tumors derived from odontogenic tissues constitute an unusually
diverse group of lesions. These tumors are formed due to aberration from
normal pattern of complex process of development of dental structures
which is called as Odontogenesis.
Benign tumors are new growths that are resembling the tissue of its
origin. These tumors typically demonstrated an insidious onset, slow
growth, a frequently well defined mass of regular and smooth outline, a
fibrous capsule and displacement of adacent normal tissues. They are
usually painless and does not metastasis. !ost bening lesions do not
endanger life unless they develop in an area that interferes some vital
function of the organ.
" #ince painless, these tumors, many are discovered during routine
radiographic examinations.
" Or found an radiographs obtained no investigate swelling or mass
observed by patient, suggested by history and physical examination.
" $ny few benign tumors infiltrate or invade the adacent normal bone
beyond radiographic tumor margin. %xample, ameloblastoma &
which is a locally aggressive lesion, and tend to occur, because of
incomplete removal surgically.
Radiographic Appearance! Appearance o" #$%or on radiograph
gi&e!
" %vidence of type of tumor.
" #ometimes provide specific diagnosis.
" Benign either aggressive or non"aggressive.
'
$long with the radiographs, final diagnosis is mainly made by
correlating with other data from clinical, h(p and laboratory tests.
" )adiographs provide inflammation of tumor. !ainly location *+
anatomic relationships, radiodensity, si,e, shape, architecture of
tumor tissue, configurations of lesional borders, effect of lesion on
adacent structures.
" -esignation & benign ( aggressive benign ( malignant.
" #pecific anatomic prediliction & location, example, odontogenic
lesions occurs in the alveolar process where tooth formation ta.es
place.
" )adiolucency of benign tumors & lends evidence to behaviour of
tumor.
" Benign tumors may be / " )adiolucent
" !ixed radiolucent and radiopaque
" )adiopaque
" 0esions with internal calcification in terms of calcified flee.s, septa,
patterned compartments are usually benign lesions. 12sually due to
organi,ed biochemical process3.
" 4n radioluscent lesions & other tentors such as shape border
configuration.
" )egularity in shape & round or oval well defined borders and benign
lesions.
" Benign lesions / " Often encapsulate.
" 5radual enlargement.
6
" 7ence tumor border are smooth and
radiographically well defined.
" %ffect on adacent tissues & benign tumor excess pressure resulting
in displacement of teeth or bony cortices.
" )oot resorption & benign tumors & resorption of teeth in a smooth
fashion and any along the adacent edge of tumor.
" !alignant tumors & surround entire root if resorption occur &
specified appearance of roots some times no resorption.
WHO & 7istologically typing of odontogenic tumors. 8irst published in
'9:'. 4n which maor categories under which classified are/
'. ;eoplasms and other tumors related to odontogenic apparatus
" Benign
" !alignant
6. ;eoplasms and other tumors related to bone
" Osteogenic neoplasms.
" ;on"neoplastic bone lesions.
*. %pithelial cysts
" -evelopmental
" 4nflammatory
<. 2nclassified lesions.
Benign tumors related to odontogenic apparatus on/
'. $meloblastoma.
6. =%OT.
*. $meloblastic fibroma.
*
<. $OT.
>. =alcifying odontogenic cyst.
?. -entinoma.
:. $meloblastic fibro odontoma.
@. Odontoameloblastoma.
9. =omplex odontome.
'+. =ompound odontome.
''. 8ibroma 1Odontogenic fibroma3.
'6. !yroma 1!yofibroma3.
'*. =ementomas " Benign cementoblastoma 1true cementum3
" =ementifying fibroma.
" Aeriapical cemental dysplasia.
" 5igantiform cementoma.
'<. !elanotic neuro"ectodermal tumor of infancy.
WHO & 7istological typing of odontogenic tumors, 6
nd
edition '996
=lassified mainly as/
'. ;eoplasms and other tumors related to odontogenic apparatus
o Benign
o !alignant.
6. ;eoplasms and other lesions related to bone.
o Osteogenic neoplasms.
o ;on"neoplasmic bone lesions.
o Other tumors.
<
*. %pithelial cysts.
o -evelopmental.
o 4nflammatory.
C'ai"ica#ion!
;eoplasms and other tumors related to odontogenic apparatus/
() Benign
$3 Odontogenic epithelium without odontogenic
ectmesenchyme.
" $meloblastoma **@
" Odontogenic tumor 6:?
" =%OT *+@
" =lear cell odontogenic tumors <+* T
B3 Odontogenic epithelial without odontogenic
ectomesenchyme with or without dental hard tissue formation.
" $maloblastic fibroma 69@
" $melofibrodentinoma 1davinoma3 *6* and amelofibrio"
odotoma *'>
" Odontoameloblastoma *66
" $OT *'6
" =alcifying odontogenic cyst *+?
" =omplex odontoma *'@
" =ompound odontoma *'@
>
=3 Odontogenic ectomesenchyme with or without
odontogenic epithelium
" Odontogenic fibroma *:'
" !ynoma 1odontogenic myofibroma3 myxaria *<:
" Benign cementoblastoma ><: 1=ementoblastoma true
cementures3.
*) Benign Odon#ogenic T$%or
$3 %ctodermal tumors
'. %nameloma.
6. $meloblastoma.
*. =%OT <6?
<. $OT 6@9
>. #quamous odontogenic tumor
B3 !esodermal tumors
'. Aeripheral odontogenic fibroma.
6. =entral odontogenic fibroma.
*. Odontogenic myxoma.
<. Aeriapical cemental dysplasia.
>. =entral cementifying fibroma.
?. Benign cementoblastoma.
:. 5iagantiform cementoma.
@. -entinoma 1$meloblastic fibro dentinoma3
=3 !ixed tumors
?
'. $meloblastic fibroma
6. $meloblastic fibrodentinoma.
*. Odontoma.
<. $meloblastic odontoma. *69. <<?.
-3 Terafoma
Radiographic Appearance
$meloblastoma & 1$damatinoma, $damontoblastoma. !ultiocular cyst3
8eatures / )ecogni,ed by '@6:
7istologically benign ameloblastoma * types.
o =lassic.
o !alignant.
o !ural
o !alignant ameloblastoma & ameloblastic =a
" 4t is a benign, locally aggressive infiltrative odontogenic lesions and
true neoplasm of enamel organ.
" -evelop in any age & average age *6"** years.
" #light perpendicular in men & '/' & ' ratio.
" #low growth.
" #ite post mandibular.
" #igns and symptoms " Aain and discomfort & 6?B.
" 2lceration or fistula & 69B
Others " Tooth mobility, paraesthesia
:
" Aurulent anchorage, trismus
" Treatment & surgical intervention.
@
Radio'ogica' appearance!
" =lassically describial multiocular, expansite radioluscevery.
" #ite & mandibular molar ( ramus area.
" $rchtypical multiocular lesion.
" 0ocation & mandibular @>B
!olar region & 9:B
%xtension into ramus & ?6B.
4ncluded symphyseal region & 69B.
Only one case & acute mandibular
" $meloblastoma begin as unilocular lesions and evolve into
multiocular lesions.
" !ean age for unilocular lesions 6? years.
" !ean age for unilocular lesions 6? years.
" !ean age for multilocular lesions & *@ years.
" :>B of ameloblastomas in younger people 1C than 6+ years3 are
unilocular.
" 0ocutes & less than 'cm, numerous resembling honey comb.
" 0arger locules & fewer, soap bubble.
" 2neo '9@? & 9: cases & <:B unilocular
*:B multilocular
'?B soap bubble.
" Buccal and lingual expansion of cortex invariably present
1distinguishes from dentigerous cyst & mainly buccal expansion3.
9
" Thinned out cortex & %gg shell li.e appearance or crac.ling on
palpation, and sometimes perforations seen.
" )elationship to teeth & 2neo '9@? & impacted tooth invariably *@B
of these @6B third molar.
" )oot resorption & *9B cases.
" )esorption .nife edge pattern because all adacent roots are cut off
along single linear plane corresponding to the margin of lesion.
" Dhen no resorption & they extend into lesion rather than straddle it.
C'aic decrip#ion o" a%e'o+'a#o%a ,(-./)
" $pplicable to mandibular lesions.
" -ivided into < possible radiologic manifestations.
" )adiographic appearances varies according to the stage of
development.
" %arly stage lesion well defined, indicative of slow growth,
frequently delineated by a hyperostatic border.
" 0arger stage =ompartments and septasis.
" Occassionally ameloblastoma forms from epithelial lining of
dentigerous cyst & !ural $meloblastoma.
" Occlusal radiograph & demonstrates expansion and thinning of
cortical plates.
" Aerforation of bone is a late features.
Radio'ogic "ea#$re o" %a0i''ar1 a%e'o+'a#o%a!
" !ainly *
rd
molar area, and premolar area & :>"9+B.
" 8ollowed by maxillary sinus and floor of nose & '6"6<B.
'+
" -angerous as they invade into facial structures.
" 4ncreased potential for recurrance.
" ?B are maxillary ameloblastoma.
" !/8 & '.>/'
" $verage age & <? years
" $ntral involvement & -estruction of antral wall. $ntral cleanliness.
Thic.ening and lining membrane.
" 2sually same features of mandibular lesions.
" 8ew unilocular lesions.
" Dorth 1'9?*3 & reported scalloped band of bone resorption could be
seen at margin in most cases in careful examination even though
lesion appeared unilocular.
" Enife edge resorption if maxillary teeth are resorbed.
" 2se of =T & in maxillary cases & extension in infratemp, fossa soft
tissue extent of ameloblastoma.
-(-
Squamous Odontogenic Tumor : 1Benign epithelial odontogenic tumor3
" 8irst reported in '9:> by Aullon and associates.
" 0esions seem to arise within alveolar bone, between the roots of
teeth, may result from the proliferation of epithelial rests of
malasse,.
" $ge ?>B cases between '9"*' years.
" $verage age & 10ider3 & *? years.
" Arediliction for $frican $merican.
''
" !/8 & same.
" !ost common sign & tooth mobility & >+B.
" Tooth pain ( Tendomess & 6>B.
" Treatment & local excision, along with extraction of inv. -ucts.
" ;o recurrance.
" 7(A / 0esion characteri,ed by islands of structure squamous
epithelium in fibrous connective tissue trauma. $cute mista.en for
acanthamatous ameloblastoma or well differentiated epidermide
=a.
Radiographic "ea#$re!
?+B cases maxilla.
>+B cases mandibular pre"molar ( molar region.
6>"*+B cases multiple sites of involvement.
" ;o single feature in characteristic of reports.
" #tric.ingly constant features & triangular or semicircular
radiolucency within alveolar bone between roots of several teeth.
" 4n most reports in mandibular lesions & * additional features.
'3 One of both of adacent roots often displaced.
63 -estruction of crestal bone.
*3 !ost cases & scleronic rim may be this and biopsy out
more frequently & thic. and condensed ( more diffuse.
" )arely 'cm beyond apices and involved teeth.
'6
" 4n maxillary lesions & !ore destructive natureF tendency to perforate
through caries and extend to involve the palate, sinus 1maxillary3,
nasal flar and nasal spine.
" #ometimes multiple sites of involvement.
C2E2O2T2 ,Pind+org J$nor)
" 8irst discussed by pituitary & '9>> 'B of odontogenic tumors.
" Origin from odontogenic epithelium from stratum intermedium of
enamel organ or oral epithelium.
" 7istologically, sheets of poluhedral cells in which round or avoid
areas filled with homogenous esienophic substance believed to be
amyloid which becomes minerali,ed forming a pattern of concentric
rings of calcification described by pindborg as 0iesegangGs
concentrate banded rings.
Repor# lesions associated with =%OT are 1dangerous cyst H =%OT3,
1$OT H =%OT combined epithelial odontogenic tumor damn and
collapses '9@*3.
" !ean age <+ years, )ange 9"96 years.
" !/8 even
" :*B white patients.
" Aatients have a painless mass that increases slowly.
" 8ew cases & pain, rarely & nasal stuffiness, epistoxis, headache.
" 0ess aggressive hence marginal ( wide resection clinically behaves
li.e ameloblastoma, hence treated li.e one.
'*
Radiographically:
" !ost characteristic & radiolucency associated with an impacted or
unerupted mandibular '
st
or 6
nd
molar that may be displayed causing
bulge in infection cortex.
" Dithin radiolucency calcified material clustered at occlusal surface
of inverted tooth.
" 0ocation mandibular / maxillary & 6/'
Aremolar & molar area.
Am / ! & '/*
" =ommon radiographic presentation & that as dentigerous cyst.
" Dell or poorly defined.
" Thic. or thin sclerotic margin present along with expansion of
cortex.
" 7oneycomb pattern sometimes in part of the lesion.
" %xtension towards body rather than ramus.
" )adioopaque flee.s calcified material consists of tiny separate
pinpoints areas of calcification.
" )adiopaque material tend to collapse, with roughened or smooth
outlines and sometimes linear strea.s crisscross.
" These strea.s appear -riven #now appearances & suggestive of
=%OT.
" -riven snow appearance & indication of vector of growth of tumour
with progenitor end of strea. at occlusal surface of displaced tooth.
" Occlusal dustency & 5orlin cyst and =%OT.
'<
" #ometimes & minerali,ed material obscuring the impacted teeth.
" !inerali,ed material at margin of lesion.
" >6B cases associated undoubtedly with unerupted or embedded
tooth or teeth.
'+B cases & tooth once had been present at =%OT site.
*<B cases & no tooth associated.
" )esemblance with dentigerous cyst but different features
i3 #uspected when mandibular '
st
or 6
nd
molar is
impacted or embedded.
ii3 Arotruberence inferior cortex.
iii3 Occlusal clustering to obscure embedded
tooth.
" 5orlin cyst 1=O=3 similar to pindborg different features
o 5orlin cyst rarely associated with unerupted molar mostly
other teeth.
o 7ydraulic affect at expanded cortex in 5.T.
o 5= & rarely locules patient often shows loculation.
o 5= & calcification resembling odontoma in patient driven
snow.
" )ecurrence present & hence radiographic follow up for '+ years
-(-
Clear cell odontogenic tumor:
" This too is a locally invasive neoplasm, through very few exacytosis
have been reported.
'>
" #ome evidence that they may be more aggressive than
ameloblastoma.
" #ame may be fran.ly malignant & clear cell odontogenic carcinoma.
" #een more frequently in elderly women.
" #ome say that it is low grade malignant neoplasm.
" )adiopgraphically & features similar to benign locally aggressive
lesion as it is low grade neoplasms, very little is .nown about these
lesions.
AME3OB3ASTIC FIBROMA & 18ibrous $danantinoma, soft mixed
odontogenic tumor, soft mixed odontoma, fibro odomatoblastoma3.
" 8irst described by Erause '@9'.
" !ixed odontogenic tumor arising from both epithelial and
mesenchymal elements of tooth germ.
" 0ess common than ameloblastoma, but not rare.
" !/8 & '.' / '
" $ge & >"6+ years, mean & '> years.
<+B cases children C '+ years
" Aresentation & >+B cases swelling in initial sign.
Other findings & -ischarge, pain, tenderness, failure of teeth to erupt.
" Treatment & #imple enucleation produced excellent results.
Radiographically:
" ':B cases incidental radiologic findings.
" :*B cases post mandible.
" '>B cases post maxilla.
" ?*B in molar region.
'?
Features:
" $lthough small lesion & often causes expansion of cortex.
" 2sually distinct and well corticated 1plain radiographs3.
" =T & bone window & thin layer of subperiosteal new bone often
found in burnout areas on pain radiographs characteristic features on
=T, may explain low recurrece rate of tumor.
" ?>B cases & multilocular lesion resembles ameloblastoma not much
destruction of expanded cortex.
" 0esion may also resemble lateral periodontal cyst.
" $8 & $ssociated with impacted or unerupted teeths.
" Teeth usually displaced.
" Teeth usually within lesion or at the edge of lesion.
" ;o evidence of lesion attached to tooth, as in dentigerous cyst.
" ;o root resorbtion.
Summary of radiologic features:
" 4n patients with younger than 6+ years, cases found in post
mandibular impacted tooth usually present, but not always.
" Tumor large and expansite, resembling dentigerous cyst because an
unerupted tooth is involved.
" )elationship of lesion to tooth not cystic radiologically.
AME3OB3ASTIC FIBRODENTINOMA & 1immature dentinoma,
fibroameloblastic dentinoma, calcifying fibroodontomablastoma3.
" %xtremely rare tumor.
" )eported first by field and $llerman & '9<6.
':
" #hafer & epithelial component proliferates in a neoplastic fashion
along with connective tissue portion of the lesion with dysplastic
dentin being formed.
" =(8 $verage age '? years 1<>"?* years3
" !ale / female & >/*
" Iounger age group.
" $ssociated with unerupted primary incisor or permanent molar.
" 0esions are painless though facial swelling present.
" Treatment & %nucleation recurrence not expected.
" )(8 & '
st
decade &location maxillary and mandibular anterior region.
" 6
nd
decade & mandibular molar most common.
" !any cases associated with unerupted tooth.
" 0esion predominantly radioluscent however radioopaque flec.s
consisting of calcified dentinoid may be seen within the lesion.
" 0esion demarcated by thin rim of sclerotic lops.
" !ultilocular lesion possible.
" 8ollicular sac of unerupted tooth may be enlarged.
DENTINOMA
" %xtremely rare tumor of odontogenic mesenchymal origin.
" )eported initially by #traith in '9*<.
" 6 variants & dentinoma and ameloblastic fibrodentinoma
" dentinoma composed of odontogenic epithelial, irregular or
dysplastic dentinoma and immature =T resembling dental papillae.
4n addition fibrous =T capsule present.
'@
" !/8 & >/*.
" !ean age 6+ years
" 4ntraoral swelling of alveolar ridge observed invariably along with
non"eruption of corresponding tooth.
" Treatment by enucleation along with curettage capsule.
" )(8 & features similar to odontome.
" -entinomas follow pattern increasing 1of age with posterior
location3.
" $ homogenous or mottled radioopaque mass with density similar to
dentin.
" !ass & circular, or ovoid and rarely several masses grouped
together.
" !argins of mass & smooth, lobulated, spi.ed or combination of
these.
" 0esion surrounded by a thin radioluscent line corresponding capsule
and beyond thin in a thin rim of condensed bone. 4f inferior present
& no thin rim.
" #trong tendency for dentinoma to occur directly over coronal
portion of impacted tooth, usually mandibular molar.
" -entinoma points same way as impacted tooth, 1#trangeJJ3
AME3OB3ASTIC FIBROODONTOMA 1Odontoameloblastic fibroma3
" 7oo.er '9?:, identified and coined the name for the entity.
" =ontroversy regarding its being a true neoplasm and some
recommended it to be as hamartoma.
'9
" $ge & younger age group C 6+ years.
:*B " '> years age
" !/8 & '.6/' favoring males.
" 0esion expands slowly without any symptoms.
" 0esion associated with impacted or unerupted teeth.
" )esembling complaints non eruption of one or more permanent
teeth, facial swelling and facial asymmetry.
" Treatment & simple enucleation or curettage.
" )(8 & few special features/
'. Occurs in posterior aws.
6. Odontoma in observed but has more radioluscent component
than odontoma.
*. $ssociated with impacted tooth.
" !ost cases posterior awsF equal in both aws.
" :6B of posterior region.
" Aericoronal radiolucency & small to large, expanding into ramus
maintains smooth, well defined cortical outline.
" =entral radioopaque area may resemble composite or complex
odontome.
" =onsists of non"specific radioopaque flec.s distributed throughout
the lesion.
" #ometimes & individual radioopaque structures, very distinct and
non"coalescent with round outlines '"6mm to 'cm in diameter.
6+
" Dasher li.e appearance" when odontoma component is recogni,ed
easily, cross section appearance consisting of thic. radioopaque rim
1enamel, dentin3, with radioluscent center 1pulp3.
" $ssociated with impacted or unerupted tooth,
" 4ncreased tooth displacement 1even of small si,e3 important
diagnostic features.
ODONTOAME3OB3ASTOMA 1$meloblastoma odontoma, odontome
odontoma, soft and calcified odontome, adamontite epithelioma3.
" 4t is clinically aggressive, rare benign odontogenic neoplasm.
" 8irst definitive reports & Eemper and )oof '9<<.
" 4t is of mixed tissue origin, composed of tissues of ameloblastoma
odontoma 1compound or complex3.
" $ge & >"*> years, Aatients C 6+ years.
<*B first decade.
>:B 6
nd
decade.
" !/8 K equal.
" Aresentation & painless swelling for several months.
" #welling usually buccal cortex.
" On palpation & no pain, curettage or enucleation.
Radiographically & challenging aspect of radiologic interpretation
identification of ameloblastoma component.
Location & preferentially according to odontoma component
=ompound type & anterior lesions
=omplex type & posterior lesion
6'
" 0esions either small or large.
#mall lesions Between teeth, confined to alveolar bone.
Between crest of ridge and apices of teeth
#clerotic margin usually absent.
%xpansion towards buccal aspect.
Odontoma component
=an be in various stages of development
%arly lesion & predominantly radioluscent with few )O
flec.s.
!ature lesions more radioopaque odontome component
resembling teeth or non sp. !ass complex typed.
0arge lesions & %xtend beyond apical region
%nlarge more $A direction.
)arely inv. Of inf. =ortex of mandibular.
!ay occupy entire quadrant or extend into
ramus.
4n maxilla & 4n maxilla, encroachment s.in.
%xpansion of cortex present, tends to be in
buccolingual direction.
%xpansion of infection cortex rare.
0arge lesion & 2sually well defined and sometimes may be sclerotic,
although focal areas of perforation present.
" )elation to teeth " $ppear associated to one or more impacted or
unerupted teeth when is severely displaced.
66
" $dacent teeths may be displaced
" ;o resorption of roots.
AOT/ 1$denoameloblastoma, $meloblastic adenomatoid tumor
odontogenic adenomatoid tumor, pseudoadenoma adamantinum3.
" #tafne credited for recogni,ing $OT in '9<@.
" -reibaldt '9+: first described this entity.
" *B of odontogenic tumors 1)ege,i3.
" Believed to be from primitive enamel epithelial.
" 7istologically & tumor surrounded by thic. capsule and duct li.e
structures often containing ameloid in a =T stroma.
" $OT may be seen in one of 6 stages of development/
i3 %arly radioluscent stage with histologic evidence
of calcification.
ii3 !ature stage & characteri,ed by calcification
within the lesion.
" Lery typical in presentation.
" !ost common in 6
nd
decade.
" !ean age '@ years.
" !/8 & '/ 6
" 5rowth is slow and progressive.
" 0esion often asymptomatic and discovered only on radiographic
examination.
" 8requent complaint & swelling, very rarely pain.
" !ay be associated with unerupted tooth 1usually canine3.
6*
" On palpation & spongy, cyst li.e & few thin or hard
" Treatment & simple enucleation & no recurrence.
" )(8 & typically seen as pericoronal radiolucency in maxillary canine
region.
" !andibular canine and premolars also involved.
" Often radioopaque flec.s within the lesion.
" ?>B of cases maxilla.
" *>B mandibular.
" >+B in maxillary are anterior region.
" '<B in premolar.
" 4n mandibular ?9B anterior region.
6:B premolar region.
" #i,e & '.>"*cms 1large lesion more than tens3.
" Dell corticated, non scalloped outer margin and sometimes may be
thic..
" This feature may be absent in pass of the lesion.
" 4n maxilla #light buccal expansion of cortex
#ignificant expansion in maidbular.
" 4n maxilla " 0esions grow preferentially medially towards antrum
and nasal fossa.
" #ome times & encroach on antrum, obliteration of antrum, if large
expand orbital floor.
" )adioopaque flec.s & evidence of calcification within the lesion
suggests diagnosis
6<
>6B cases & preserve and calcification.
?>B cases & detatable radioopaque foci which are faint to
quite dense and radioopaque.
" )O foci may be observed in one area or calcific material may
predominate.
" =alcification arranged in tiny patients, resembling snow & fla.es
animal pints, hand or foot print, dough shape, semicircle, group of
dogs.
" $lthough clumping present & predominant arrangement even
distribution flec.s without much variation of si,e, shape or distance
from each other.
" 2nique feature & well defined radioluscent band, free )O flec.s
that partly or completely surrounds the periphery of lesion.
" Band refer to capsular space" approx +.*"+.@cms wide.
" )O flec.s & presence may signal lesions maturity and significantly
reduced potentral to grow.
" )elation of teeth & associated with unerupted permanent teeth &
:<B.
" !ost common & canine 1?@B3.
" ;ot involving with deciduous unerupted tooth.
" ;o root resorption.
" -(- & dentigerous cyst & usually does not extend apically beyond
=%M.
CA3CIF4ING ODONTOGENIC C4ST 1Eeratini,ing ( or calcifying
epithelial odontogenic cyst, 5orlin cyst3.
6>
" 8or discussion & prefer term calcifying odontogenic lesion because
some cases are cysts some are tumors, others contain elements both.
" =yst accounted 6B most are tumors or mixed type.
" -ivided this lesion into < subtypes histologically.
Type 4$ & simple unicystic type & typical 5orlin cyst with or
without dentinoid.
Type 4B & odontoma producing type &features of 4$ but
dental hard tissue consist of compound or complex odontoma
producing type.
Type 4= & ameloblastomatoma proliferating type and dental
tissue of dentinoid.
Type 44 & termed dentinogeric 5host cell tumor.
=(8 & $ny age group 1often 6
nd
decade3.
" %qual sex distribution.
" Aainless, slow growing swelling.
" %nucleation & no recurrence.
)(8 & !ultiple views preferred
" 0ocation & any where in aws, equally in maxillary and mandibular.
" =O= & developed on right side.
" !ost common appearance & cystic radiolucency.
" $ll lesions showed radioluscency in some aspect of lesion.
" @:B cases & 2nilocular
8ew cases multilocular
" %xpansion of perforation observed in @*B of cases.
6?
" #hear mentioned lesion may have regular outline with well
demarcated margins or the outline may be irregular with poorly
defined margins.
" There may be admixtures, foodedly thic.ened, tainned and absent
sclerotic margins.
" )O flec.s & calcification in characteric.
" Aercentage of calcification & 6'B to *9B in various strea.s.
" =alcification & resembled tooth li.e structure in other cases )O foci,
faint, dispersed or rather unidentifiable.
" $dditional features which may aid diagnosis.
" )O foci around occlusal or in oral surface of impacted teeth.
" )O material clustered at edge of lesion.
" )O foci resemble complex or compound odontome.
" 4mpacted is not permanent molar.
" %xpanded bone appears perforated.
" )elation to tooth ;o instance of =O= with unerupted molars.
;o resorption of root.
-isplacement of erupted and unerupted tooth
present.
ODONTOMA / 1Odomtome, compound composite odontome, complex
composite odontome, compound odontome, complex odontome3.
" Term first coined by Broca '@??.
" Aindborg '9:' & 6 types of odontome/
6:
i3 =ompound & malformation in which all dental tissues
are represented and arranged in orderly pattern such
that lesion resembles several or many tooth li.e
structures.
ii3 =omplex & malformation in which all dental tissues
are well formed but arranged in disorderly pattern
such that lesion does not resemble tooth structure.
)ege,i & *:B compound odontomes.
*+B complex odontomes
" Odontomas most common abnormalities of aws.
" Benign tumor of mixed origin, but now believed to be hamanoma.
=(8 / $ge '? years.
><B " 6
nd
decade.
'>B " older than *+ years
" $verage age for =ompound odontome & ': years.
=omplex odontome & 66 years
" ?@B " white patients.
" *'B Blac.s.
" 6B other races.
" !ale preponderover
" -entists diagnose mainly by non"exception of permanent tooth or
persistence of primary tooth.
" Other finding mild swelling, displacement of erupted teeth, pain or
pressure.
6@
" Treatment " #urgical excision.
;o recurrence
4mpacted tooth may not erupt.
)(8 & ;ot difficult to diagnose
Occur any where in aw
=ommon location anterior maxilla.
6(*
rd
occur in anterior aws.
?+":+B compound anteriority.
!axillary / mandibular 6/'
?+B complex odontome posterior region more in mandibular
)ight side prediction in aws.
%arly stages & Odontoma radioluscent radioopaque flec.s develop as the
teeth begin to calcify.
" $ll odontome surrounded by thin radioluscent ,one consisting =T
capsule corresponding in all respects to follicle of normal tooth.
" Beyond this area" lesion is surrounded by thin sclerotic line &
corresponding normal tooth crypt.
" 4mportant feature & tendency to cause only mild expansion to
accommodate in bone.
" Only @B cases & swelling present.
=ompound odontome & several tooth li.e structure.
" -oes not exceed diameter of tooth. Occasionally may enlarge.
69
" Teeth structures resemble rudimentary teeth, their morpholic
characteristics varying with location in aws. %xample, anterior area
& may resemble tiny incisors.
" On cross section washer li.e approaches.
" )udimentary teeth same radiologic density.
=omplex odontome & single )O mass with density somewhat more than
bone.
" 2sually not exceed diameter of teeth longest complex odontome &
museum at 5uyGs hospital in 0ondon & '' """"""
" !ass round or ovoid with smooth margins.
" !argins sometimes lobulated or spi.e li.e.
" 4nternal elements & may show mottled appearance & varying
densities.
" #ynburst appearance & oderly arrangements.
" #ometimes & odontomes symmetrically bilateral.
)elationship to teeth
" <@B cases associated with unerupted teeth.
" 4n maxilla seen equally in anterior and posterior impacted teeth less
in premolar.
" 4n mandibular seen in molar area, followed by anterior region.
" 8ound between roots of erupted teeth or may cause impaction of
normal teeth.
" )elationship of odontomas to impacted teeth. =omplex odontomes/
=omplex odontomes & >+B cases above
*+
*'B next to impacted teeth.
'9B around the tooth of impacted tooth
=ompound odontomes & ?+B next to tooth
*+B above
'+B around
" #ometimes complex odontomes completely surround the associated
unerupted tooth, obliterately it entirely 1bright light can be used to
assess3.
=ystic odontoma/
" Odontomes may be associated with develop of dentigerous cyst.
" 6@B incidence of cystic odontomas & Eangars series.
" Dorth & '9?* states & radioluscent area surrounding the mass is
increased when cystic transformation has occurred.
" =yst may be slightly or much larger than odontome.
" =omplex odontome may be in center of cystic cavity or to one side,
sometimes vise versa.
" Odontoma may lie freely in cystic cavity.
" =ompound odontomes may also become cystic separation of tooth
li.e structures suggestive of cystic degeneration.
" #ometimes & infection cystic odontome can cause loss of sclerotic
bone surrounding cystic wall.
" =(8, pain, swelling, suppuration.
ODONTOGENIC FIBROMA
" 0esion has poorly defined parameters.
*'
" * histologically distinct variants.
'. #imple type & resembles dental follicle and has few islands
odontogenic epithelium.
6. D7O type & contains minerali,ed material 1osteoid, cementum
li.e or dysplastic durm3.
*. 5ranular cell variants of O8 also .nown as granular cell
ameloblastic fibroma.
" $ge & mean *< years, range ''"@+ years, average age & *' years.
" ;o sex predilection.
" Treatment & =urettages no recurrences.
)(8 & 8eatures not described, because lesion is rare.
" Only feature is its propensity to occur in mandibular.
" !olar region more common.
" 0esions extend into ramus 1usually posterior extension3.
" !oderately destructive lesion.
" 7alf of cases & multilocular.
" Others & unilocular, irregularity osteolytic or radioluscent.
" 0arge lesion &expansion of convex no perforation.
" !argins well defined.
" ;o sclerotic margin.
" #epta no as radioopaque as ameloblastoma.
" Teeth may be displaced.
*6
5ranular cell & all lesions radioluscent, well denervated, circumscribed,
well defined, mostly unilocular.
" #light displacement of mandibular canal. They do not grow no large
si,e.
ODONTOGENIC M45OMA / 1Odontogenic fibro myxomia,
odontogenic myxoma fibroma3.
Lirchow '@?* & first described histologic features.
" 8irst reported & '9<: & Thoma and 5oldman
" *"?B of all odontogenic levers.
" 6"< times less frequent than ameloblastoma.
" 0ocally aggressive benign neoplasm.
" $rise from odontogenic mesenchymal elements of dental papilla.
=(8 & )are in young children, less than '+ years and old more than >+
years.
" !ean age & 6>"*> years.
" !andibular lesions > years earlier than maxillary lesions.
" > years early in male compared to female.
" !/8 & */6.
" !ost lesions grow slowly, without pain. Teeth usually not affected
clinically.
" 4n mandibular buccal and lingual swelling.
" !axillary & swelling if sinus not involved. 4t inv. 0ess swelling,
exopthalmus, nasal obstruction.
Treatment & #mall lesions & curettage.
**
0arge lesion & resection.
)ecurrence 6?"*6B
)(8 / %mphasis on OA5
" !andibular favoured over maxilla.
" -evelops in tooth bearing areas.
" !olars followed by premolar area.
" !andibular lesions cross midline.
" !axilla usually inv sinus & <<B.
)adiographic appearance consist of one of the 6 patterns depending
on evolution of tumor.
'
st
stage & begins with osteoporotic appearance with more prominent
medullary spaces, separated by thin septa of bone.
" #epta thinner and more elongated as tumor infiltrates locally,
forming larger osteolytic areas.
" -uring this stage & classic appearance.
" !ultilocular radiolucency with well developed locules.
" 0obeculae interest at right angles to each other.
" Bony septa forming locules are usually straight, thin, elongated,
lacy.
" %versole '9@+ & said N0ichenplanus of aw.
" !any authors suggested soap bone bubble or honey comb
appearances, but lesions tend to form angular locules resembling
T%;;4# )$=O2%#T.
*<
" Other shapes & small or large diagnosis, diamonds squares
rectangles, P, I and L figures.
" !argin poorly defined even in first stage.
6
nd
stage & Brea.out or destructive phase.
" =haracteri,ed by loss of internal locules, significant expansion,
perforation of cortex.
" 4nvasion into surrounding soft tissues.
" 4n maxillary extension into antrum.
" %arly feature in this stage & appearance of septa beyond peripheral
margin of lesion.
" %xtending right angles to the margin, thus importing a NhairG brush
or sun burst appearance.
" Odontogenic myxoma may destroy the angle of mandibular but
ameloblastoma almost never does this.
" )elation to teeth brea.out phase.
o )oot resorption
o Tooth displacement.
o 4nv of adacent teeth rare.
o Enife edge cut of resorption of roots high up with '(* of root
remaining.
%xtragnathic odontogenic myxoma & very rare, involves somatic tissues.
4solated cases in parotid, lower lip, chee. and soft palate.
BENIGN CEMENTOB3ASTOMA/ 1True cementoma, cemento"
blastoma3.
*>
" 8irst reported by ;orber, in '9*+.
" -efinite clinical and histologic criteria of lesion.
i3 Bulbous growth of cementum on root of tooth.
ii3 Tendency to expand bony plates of aws.
iii3 $ctive histologic appearance.
" This is one of < cemental lesions categori,ed by D7O the other *
placed under non"neoplastic bone lesions.
" This lesion unique in 6 ways.
i3 True neoplasm of cementum and the only
cemental lesion, excluding hypercementosis.
ii3 0ess uncommon.
" Arobably derived from root cementum or =T of A-0.
" -iscussion cementum( cementum li.e ( osseous but believe that
since affected to roots the lesion were benign cementoblastoma.
" !ale predilection.
" $ge '+":6 years.
" $verage age 6? years.
" Q of tumour & younger than 6+ years.
" =ommon sign swelling :*B, pain >*B, usually low grade and
intermittent.
" =linically affected teeth are vital.
Treatment " #urgical extraction
)(8 & 8eatures of benign cementoblastoma
*?
i3 4ntimate involvement with whole tooth root, usually '
st
molar.
ii3 %arly, contentious, radioluscent stage followed by )O stage with
an obscured root outline within the lesion.
" 0ocation & @>B mandibular, ?+B mandibular '
st
molar.
* radiologically distinct stages/
'. 2ncalcified matrix stage
" =ircular radioluscent area at apex of vital tooth.
" $pical *
rd
of root seen within the area.
" 7alf of root length may be resorbed by )0 mass.
" )0 area surrounded by thic. band and reactive sclerotic bone may
be '"* mm thic.ness and rather diffuse.
" '.>cm diameter during this stage.
" 0asts for several wee.s.
6. =ementoblastic stage
" $ppearance of radioluscent material in center of lesion.
" 0esion minerali,es and cementum li.e material may coalase with
central mass with more minerali,ation at periphery.
" 4ncreased to *cms, becomes more avoid, with egg li.e appearance.
" 0esion surrounded by distinct and prominent )0 band of
approximately 6mm wide.
" $n outer rim of sclerotic bone is a variable finding.
*. !ature stage
" 2nlimited growth protection
*:
" 0esion approaches the inf cortex of mandibular and becomes ovoid
and enlarges along length of the body with minimal expansion of inf
cortex.
" 4n large lesion outer )0 rim and sclerotic margin are variable
features.
" )eported si,es & +.> & @cms.
" %xpansion +.> cm(yr.
" !ass has mottled appearance with multiple radioluscent areas
within radioluscent mass.
" )oots of inv teeth parnally observed towards apex.
" -isplacement of adacent tooth roots without resorption.
" Buccal and lingual expansion of cortex.
" =haracteristic finding & sometimes observed in occlusal view &
N)adiating spicules of cementoid material emanating from central
area and radiating to periphery giving sunray appearance.
" ;o inv of lesion of crestal portion of alveolar bone.
" ;o expansion of inf cortex mandibular.
" #light bowing late denture in huge lexus.
" -ownward displacement of inf alveolar canal may be seen.
*@