Bone lecture 1 Flashcards
basic bne anatomy
Focal Osteoporotic Defect
Area of hematopoietic marrow which produces a defect
Focal Osteoporotic Defect potential pathogenesis
Aberrant bone regeneration after tooth extraction
Persistence of fetal marrow
Marrow hyperplasia in response to increased demand for erythrocytes
Focal Osteoporotic Defect common demo
75% adult females
Focal Osteoporotic Defect
Clinical and Radiographic features:
location?
symptoms/expansion?
radio app?
70% posterior mandible, MC in edentulous areas
Asymptomatic, nonexpansile
Well-defined or ill-defined radiolucency
Focal Osteoporotic Defect
Histopathologic features:
Cellular hematopoietic/fatty marrow
what bony lesion could this be? cystic lesion?
focal osteoporotic defect
borytiod cyst
OKC
odontogenic fibroma
focal osteoporotic defect
normal marrow with increased fat
dif dx (2)
focal osteo defect
traumatic bone cyst
Focal Osteoporotic Defect
Treatment:
Incisional biopsy indicated to establish diagnosis
No further treatment needed after diagnosis established
focal osteo defect
Traumatic bone cyst
Bone cavity that is empty or fluid-filled
NOT a true cyst – no epithelial lining (pseudocyst)
traumatic bone cyst etilogy
Trauma-hemorrhage theory
where can simple bone cysts occur
Reported in most bones of the body
Traumatic bone cyst
location?
age?
Pain and paresthesia?
May exhibit?
MC in mandible
MC in young patients, peak in the second decade
Pain and paresthesia infrequent
May exhibit painless jaw swelling
Traumatic bone cyst
Radiographic features:
Well-defined, unilocular RL
Occasionally ill-defined, multi-locular
Range from 1-10 cm
RL defect often scallops upward between roots of teeth
Root resorption, cortical expansion infrequent
does root resorb occur with traumatic bone cysts
usually not
Traumatic bone cyst
Treatment:
Cavity contents
resolution
recurrence
Surgical exploration and biopsy
Cavity often empty, may contain serosanguinous fluid
New bone formation, resolve after 1-2 years
Low recurrence
Idiopathic osteosclerosis
(Dense bone island, Bone scar)
Most arise when?
Focally increased bone density of unknown cause
Most arise in late 1st decade or early 2nd decade
Idiopathic osteosclerosis
Clinical features:
growth?
symptoms/expansion?
% location? fav tooth?
May remain static or slowly increase in size
Asymptomatic and nonexpansile
90% occur in mandible, 1st molar MC
Idiopathic osteosclerosis
Radiographic features:
Well-defined radiopacity, 0.2 cm to 2.0 cm
Nonexpansile
Idiopathic osteosclerosis
Diagnosis:
how can we rule against a neoplastic process?
History, clinical features and radiographic findings
Lack of cortical expansion and continued growth rule against a neoplastic process
Idiopathic osteosclerosis tx
Periodic radiographs during adolescence
idiopathic osteosclerosis
dif app of dif opacities associated with apices:
COD
condensing osteitis
idiopathic osteosclerosis
cementoblastoma
hypercementosis
unlabled one: idio osteoscler
Osteogenesis imperfecta
Group of? characterized by?
Worldwide prevalence?
“Brittle bone disease”
Group of heritable disorders characterized by osteopenia and bone fragility
Worldwide prevalence of 6-7 per 100,000 population
Osteogenesis Imperfecta
inheritence?
mutation to?
results?
categories?
90% AD inheritance pattern
Type I collagen gene mutations: COL1A1 and COL1A2
Type I collagen: bone, dentin, sclerae, ligaments, skin
Mutations result in abnormal type I collagen, low tensile strength
Disease characterized as mild, moderate, severe
OI clinical findings
Bone injury?
deformity in which bones commonly?
Growth?
sclerae?
Hearing?
Joints?
Bone fractures
Long bone, spine deformity
Growth impairment
Blue sclerae
Hearing loss
Joint hyperextensibility or contractures
OI radiograph findings (systemic)
Osteopenia
Bowing deformity of long bones
Multiple fractures
Wormian bones (skull)
Small sutural bones arranged in a mosaic pattern
OI dental alterations
Clinically and radiographically identical to?
tooth color?
wear on teeth?
Tooth roots?
malocclusions?
Clinically and radiographically identical to dentinogenesis imperfecta
Blue, yellow, brown translucence (primary and permanent)
Severe attrition, loss of VDO
Tooth roots narrow
Class III malocclusion due to maxillary hypoplasia, crossbite, open bite
Osteogenesis Imperfecta
Diagnosis requires?
Treatment
Diagnosis requires correlation of the clinical features, radiographic and/or prenatal ultrasound findings, family hx
Treatment: physiotherapy, rehabilitation, orthopedic surgery, IV bisphosphonates
Osteopetrosis
bone density?
Failure of?
result?
Markedly increased bone density
Failure of osteoclast function or differentiation
Decreased bone resorption →sclerotic bone
AD Adult Osteopetrosis
commonality? severity?
what part of skeleton affected?
Bone pain?
dental implications?
Most Common type, less severe manifestations
Sclerosis affects axial skeleton, minimal involvement in long bones
Bone pain frequent
Increased risk of fracture and osteomyelitis following tooth extraction
AD adult osteopetrosis radiogrpahs
Diffuse radiopacity of medullary bone
osteopetrosis, no clear cortex and medulla for mandible
Osteopetrosis
Treatment:
Adult osteopetrosis:s
Infantile osteopetrosis:
Adult osteopetrosis: management of disease complications
Infantile osteopetrosis: Poor prognosis, Most patients die during 1st decade
Cleidocranial Dysplasia
disorder of? abnormalities where?
Mutation?
May also have role in?
Worldwide prevalence?
Bone disorder, dental and clavicular abnormalities
Mutations in RUNX2 gene: Osteoblastic differentiation, chondrocyte maturation
May also have role in odontogenesis
Worldwide prevalence: 1:1,000,000
Cleidocranial Dysplasia
Clinical Features:
Clavicles?
stature?
skull?
Ocular?
nose?
Clavicles: hypoplastic, 10% cases absent
Approximate shoulders anteriorly
Short stature
Enlarged skull
Ocular hypertelorism
Broad-based nose
Cleidocranial Dysplasia
Radiographic features (skull)
Skull radiographs: sutures and fontanels show delayed closure
Wormian bones
Cleidocranial Dysplasia dental findings
Over-retained deciduous teeth
Numerous unerupted permanent and supernumerary teeth
Cleidocranial Dysplasia tx
Removal of primary and supernumerary teeth
Orthognathic surgery
likely diagnosis?
clediocran dys
Paget disease of bone
mechanism
result?
demo?
factors involved in pathgenesis
Abnormal, anarchic resorption and deposition of bone
Skeletal weakening
Anglo-Saxon ancestry, highest rates in UK
Genetic and environmental factors involved
Paget disease of bone
Clinical features:
demo
% present with bone pain
Arises where?
common locations?
Older patients, rare in patients <40 years
Male predilection
40% present with bone pain
Arises in one or more bones simultaneously
Pelvis, femur, lumbar vertebrae, skull and tibia
Paget disease of bone
Clinical features:
Affected bones app?
Bowing?
Skull involvement?
Affected bones: thickened, enlarged, weakened →increased risk of fracture
Bowing deformity
Skull involvement: progressive increase in head circumference
Paget disease of bone
DENTAL Clinical features:
Jaw involvement %
Maxilla: mandible ratio
Enlargement of?
what vital structures can be obstructed/obliterated
Severe cases?
Alveolar ridges ca become?
Dentures?
Jaw involvement (17% patients)
Maxilla: mandible (2:1):
Enlargement of middle third of face
Nasal obstruction, obliterated sinuses
Severe cases: leontiasis ossea
Alveolar ridges grossly enlarged: spacing between teeth
Denture too small!
Paget disease of bone
Radiographic findings: early and late stages
Generalized what can be observed at the teeth?
Early stages: decreased radiodensity, course trabecular pattern
Later stages: patchy areas of bone sclerosis: “cotton wool” appearance
Generalized hypercementosis may be observed
paget dx of bone, cotton wool pattern= late stage
Paget disease of bone
Diagnosis:
lab values?
Correlation of clinical and radiographic findings
Lab testing: elevated serum alkaline phosphatase levels
Paget disease of bone
Dental complications:
extractions?
hemorrhage?
wound healing?
Edentulous patients?
Difficult extractions (hypercementosis/ankylosis)
Extensive hemorrhage –vascular lytic phase
Poor wound healing, osteomyelitis – avascular sclerotic phase
Edentulous patients- provide new dentures periodically
Paget disease of bone
Disease progression?
Malignant transformation?
Disease is chronic and slowly progressive
Malignant transformation: osteosarcoma <1%
Paget disease of bone tx
Bisphosphonate therapy – reduce bone turnover, decrease bone pain
Orthotics, canes, orthopedic surgery
Antral Pseudocyst
Common finding on?
Develops due to?
Results in?
Common finding on panoramic
Develops due to an accumulation of inflammatory exudate
Results in a sessile elevation
Antral Pseudocyst
Radiographic findings:
Uniform, dome shaped faintly opaque lesion
Antral Pseudocyst
Treatment:
No treatment if asymptomatic
Symptomatic cases – endoscopic surgery
antral pseudocyst
antral pseudocyst
