ODONTOGENIC CYSTS SUMMARY CHART

Lesion Radicular cyst (Periapical cyst) Description

Inflammatory cyst Originates from rests of Malassez

Clinical Features
Most common cyst Associated w/ non-vital teeth

Location
Apex of non-vital teeth Encircles tooth apex

Radiographic Appearance
RADIOLUCENT unilocular Loss lamina dura Root resorption is common

Residual cyst

Inflammatory cyst Originates from rests of malassez

Remains after extraction of non-vital tooth Secondary to periodontal disease or pulpal necrosis spread through lateral canal Age 10-30 yrs Male predilection More prevalent in caucasians Asymptomatic Age > 30yrs Male predilection uncommon (<2%) Asymptomatic Age 10-40 yrs Male predilection Associated with NBCC SYNDROME 30 % recurrence 75% OKC- usually multiple (OKC occurs at average age of 19) Multiple BCC of skin Bifid rib/ kyphoscoliosis Calcification of falx cerebri

Any tooth-bearing area Along lateral aspect of tooth Evaluate periodontal status and vitality Mandibular 3rd molar area Surrounds crown of IMPACTED tooth Mandibular canine/ premolar area lateral to root of VITAL tooth Mandiblemolar/ramus area 25-40% associated w/impacted teeth Multiple sites May be associated w/impacted teeth

RADIOLUCENT unilocular round to oval shaped RADIOLUCENT Unilocular

Lateral radicular cyst

Inflammatory cyst Originates from Rests of Malassez

Dentigerous cyst

Developmental cyst Originates from reduced enamel epithelium

RADIOLUCENT unilocular well defined sclerotic border root resorption is common RADIOLUCENT unilocular * Botryoid variant is Multilocular RADIOLUCENT Unilocular or multilocular

Lateral periodontal cyst

Developmental cyst Originates from remnants of dental lamina

Odontogenic Keratocyst (OKC)

Developmental cyst Originates from remnants of dental lamina

Nevoid Basal Cell Inherited AD Carcinoma Syndrome (NBCC) Gorlin Syndrome

RADIOLUCENT Unilocular or multilocular

Calcifying Odontogenic Cyst (COC)

Developmental cyst Originates from epithelial remnants

Age 10-30 yrs (x 33yrs) Uncommon

Incisor/canine area Mandible=maxilla 33% associated w/impacted teeth

MIXED LUCENT-OPAQUE unilocular radiolucency with radiopaque flecks

Christel Haberland DDS, MS

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ODONTOGENIC TUMORS SUMMARY CHART

Lesion Ameloblastoma Conventional Solid or Multicystic Description
Benign odontogenic tumor originates from odontogenic epithelium w/o ectomesenchyme

Clinical Features
20-60yrs (average 33 yrs) No sex predilection Painless swelling 55-90% recurrence Younger patients Average age 23 yrs Painless swelling

Location
mandible >maxilla Posterior regions Can be associated w/impacted teeth (Mand 3rd molar) mandible >maxilla Posterior regions *Associated with impacted teeth*

Radiographic Appearance
RADIOLUCENT Multilocular "soap bubble"

Ameloblastoma Unicystic

Benign odontogenic tumor Originates from odontogenic epithelium w/o ectomesenchyme

RADIOLUCENT Unilocular Well defined borders

Ameloblastic Fibroma

Benign odontogenic tumor Originates from odontogenic epithelium WITH ectomesenchyme

Age < 20yrs, Average 14 20% recurrence Slight male predilection Asymptomatic Average age 25-30yrs No sex predilection Asymptomatic Larger lesions = painless expansion

Mandible Posterior segments 50% Associated w/ impacted teeth mandible >maxilla

RADIOLUCENT Unilocular or multilocular

Myxoma

Benign odontogenic tumor Originates from ectomesenchyme

RADIOLUCENT Multilocular may have "soap bubble" appearance

Calcifying Epithelial Benign odontogenic Age 30-50yrs Odontogenic Tumor tumor No sex predilection (CEOT) Pinborg Tumor Originates from odontogenic epithelium w/o ectomesenchyme

mandible >maxilla Posterior regions Associated with impacted teeth (3rd molars)

MIXED LUCENT-OPAQUE Radiolucency- uni or multilocular Contains calcified structures, especially around crown of tooth MIXED LUCENT-OPAQUE Well defined unilocular radiolucency With radiopacities (snowflakes)

Adenomatoid Odontogenic tumor (AOT)

Benign odontogenic tumor Originates from odontogenic epithelium WITH ectomesenchyme

Young patients 10-19 yrs rare in adults Female predilection (2:1) Asymptomatic Children, average age 10 rare in adults No sex predilection Asymptomatic Age <20yrs, Average 14 Asymptomatic MOST COMMON ODONTOGENIC TUMOR

Maxilla > mandible Anterior maxilla Associated with impacted teeth Mandible=maxilla Associated with impacted teeth

Ameloblastic Fibro-Odontoma

Benign odontogenic tumor Originates from odontogenic epithelium WITH ectomesenchyme

MIXED LUCENT-OPAQUE Unilocular or multilocular radiolucency With radiopacities (flecks) similar to tooth structures

Odontoma Types: Compound Complex

Benign odontogenic tumor vs. hamartoma?

Compound: Anterior maxilla Complex: Posterior segments Mandible=maxilla

RADIOPAQUE toothlets with radiolucent rim RADIOPAQUE mass surrounded by radiolucent rim

Christel Haberland DDS, MS

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BONE PATHOLOGY SUMMARY CHART

Lesion Osteoma Description
Benign bone tumor

Clinical Features
Young adults < 20yrs Asymptomatic Solitary lesions Associated w/ GARDNER'S SYNDROME

Location
Maxilla = mandible

Radiographic Appearance
RADIOPAQUE well defined

Cementoblastoma

Benign bone tumor

Adults 20-30 yrs

Mandibular 1st molar

RADIOPAQUE mass- well defined attached to root with a radiolucent border ** diagnostic appearance

Idiopathic Osteosclerosis Paget's Disease

Areas of dense bone Unknown cause Chronic bone disease Unknown etiology

Age 20-40yrs Female predilection Asymptomatic Adults > 40yrs, Male predilection (2:1) Bony enlargement w/pain "hat/dentures don't fit" 1% Osteosarcoma

Mandible > maxilla First molar area Pelvis, femur, skull Maxilla > mandible

RADIOPAQUE well defined RADIOPAQUE- multifocal MIXED LUCENT-OPAQUE- Multifocal "cotton wool" appearance HYPERCEMENTOSIS of teeth

Fibrous Dysplasia

Chronic bone disease Developmental

Young adults <20yrs Unilateral enlargement Painless Recurrence 25-50% NO RADIATION

Skull Maxilla > mandible

RADIOPAQUE poorly defined "Ground glass" appearance Multifocal in- Craniofacial Fibrous Dysplasia

Langerhan's Cell Disease

Bone disease Neoplasm? Proliferation of Langerhan's cells

Age- teens and older Loose teeth Pain Average age 70yrs Male predilection Blacks > whites Bone pain

Mandible > maxilla Posterior mandible Skull, ribs, vertebra 30% affects jaws Multiple sites

RADIOLUCENT Multifocal Floating teeth- alveolar bone loss Punched-out radiolucency-skull film RADIOLUCENT Poorly defined Multifocal "Punched-out" appearance

Multiple Myeloma

Malignant tumor of plasma cells

Hemangioma of Bone (Central Hemangioma) Central Giant Cell Granuloma Cherubism

Benign tumor vs. hamartoma

Age 10-20 yrs Female predilection May have pain/swelling Bruit/pulsations

Mandible > maxilla

RADIOLUCENT Mulitlocular "honeycomb" or "soap bubble"

Benign bone lesion

Most < 30yrs Recurrence 16%

Mandible > maxilla Mandibular anterior Posterior mandible

RADIOLUCENT Multilocular RADIOLUCENT Multilocular Bilateral- multifocal Expansile

area-crosses midline Expansile Developmental disease Inherited AD Age 7yrs average Painless BILATERAL expansion

Hyperparathyroidism (BROWN TUMORS)

Endocrine disorder Elevated PTH levels Primary or Secondary

Primary- >60yrs, females Stones, bones and groans

Mandible > maxilla

RADIOLUCENT Multifocal Unilocular or multilocular Other bony abnormalities: "Ground glass" appearance Loss of lamina dura

Christel Haberland DDS, MS

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BONE PATHOLOGY SUMMARY CHART cont.

Lesion Traumatic Bone Cyst Description
Benign bone lesion Not a true cystno epithelium

Clinical Features
Age 10-20 yrs Adjacent teeth vital Painless expansion Children + adolescents Whites > blacks or asians Male predilection Pain and swelling Paresthesia, loose teeth

Location
Mandible only

Radiographic Appearance
RADIOLUCENT poorly defined Scalloping around teeth

Ewing's Sarcoma

Malignant tumor of bone

Mandible > maxilla

RADIOLUCENT Ill-defined "onion skin" sometimes seen

Metastatic Tumors to Jaws

Metastatic carcinoma to jaws (breast, prostate, lung, kidney)

Older patients Pain, swelling, loose teeth, paresthesia, clinically a mass may be seen Age 20-30yrs Female predilection Larger lesions may cause painless expansion

Mandible>maxilla

RADIOLUCENT- ill defined MIXED LUCENT-OPAQUE (breast or prostate ca)

Cemento-Ossifying Fibroma (Ossyfing Fibroma)

Benign bone tumor

Mandible > maxilla Premolar area

MIXED LUCENT-OPAQUE well defined unilocular radiolucency radiopaque flecks Never seen with impacted teeth

Periapical CementoOsseous Dysplasia

Benign bone lesion

Age 30-50yrs Female predilection Blacks > whites Asymptomatic No expansion Vital teeth

Mandible > maxilla Periapical area of mandibular anteriors

RADIOLUCENT- early MIXED LUCENT-OPAQUE (late)

Focal CementoOsseous Dysplasia

Benign bone lesion

Age 30-50yrs Female predilection Blacks < whites Asymptomatic No expansion

Mandible > maxilla Posterior segments

RADIOLUCENT- early MIXED LUCENT-OPAQUE (late)

Florid CementoOsseous Dysplasia

Benign bone lesion

Female predilection Blacks > whites Asymptomatic May have fistulas

Bilateral-symmetrical MIXED LUCENT-OPAQUE 4 quadrants may be involved Mandible = maxilla MIXED LUCENT-OPAQUE Ill-defined root resorption "sun-burst" pattern on occlusal Multifocal

Osteosarcoma

Malignant tumor of bone

Average age 33yrs Male predilection Swelling, pain, loose teeth paresthesia

Christel Haberland DDS, MS

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