Exam 1 - Mixed Flashcards
What does a cementoblastoma arise from?
PDL of the tooth
Name that lesion: Opaque mass fused to roots, thin lucent rim around mass in mature lesions
Cementoblastoma
What it the tx of cementoblastoma?
It is a benign tumor so it needs to be removed. Conservation excision with either root amputation, endo, or ext.
What is the recurrence rate for a cementoblastoma after tx?
LOW
What would you see when looking at a cementoblastoma under a microscope?
Cellular cementum with plump cementoblast, often a periphery of radiating columns of calcified material
What may a cementoblastoma be mistaken for under a microscope?
Osteosarcoma
What is key in diagnosing a cementoblastoma?
Correletating history, radiograph, and histology
What is the most common odontogenic tumor?
Odontoma
Name the lesion:
Benign odontogenic tumor that contains odontogenic tissues but does not form small tooth appearing structures
Complex odontoma
What is the common location to find complex odontoma?
Complex- Posterior jaw; frequently pericoronal to an impacted tooth
Describe odontoma histology.
Show tooth like forming structures (dentin, enamel, pulp) but shows them in abnormal fashion
What is the common location to find compound odontoma?
Compound - Anterior jaws; may be associated with unerupted tooth
Resembles small teeth (toothlets/denticles)
T/F Tx of odontoma with enucleation you will likely see recurrence.
False NO recurrence
______ _______ __________(COC)/ Gorlin Cyst
is usually a unilocular RL, but up to ___ can have calcifications (mixed appearance).
May be associated with _______ tooth.
Calcifying odontogenic cyst (COC)/ Gorlin cyst is usually a unilocular RL, but up to 50% can have calcification (mixed appearance)
May be associated with unerupted tooth.
What region are you most likely to find a Gorlin cyst/ COC?
Anterior portion of the jaw 65%
What is the recurrence of gorlin cyst with enucleation?
unlikely recurrence
3 tumors that come from odontogenic epithelium
- Ameloblastoma
- Adenomatoid odontogenic tumor
- Cacifying, epithelial odontogenic tumor
3 tumors that come from odontogenic ectomesenchyme
- Odontogenic fibroma
- Odontogenic myxoma
- Cementoblastoma
3 tumors that come from odontogenic epithelium and ectomesenchyme (mixed)
- Ameloblastic fibroma
- Ameloblastic fibro odontoma
- Compound or complex odontoma
Name that lesion: Looks virtually identical to a complex odontoma
Ameloblastic fibro-odontoma
Where is Ameloblastic fibro-odontoma most commonly located?
posterior mandible
What age range is most common to find Ameloblastic fibro-odontoma?
average age 10 yrs old
Name that lesion:
Mixed lesion, <20 yrs, with 80% being in anterior jaw; unilocular RL which may develop snowflake/ fleck-like radiopacities
Adenomatoid odontogenic tumor (AOT)
Adenomatoid odontogenic tumor (AOT) ____ with unerupted teeth (most often canine) where RL extends beyond ___.
Adenomatoid odontogenic tumor (AOT) 75% with unerupted teeth (most often canine) where RL extends beyond CEJ.
Name that lesion: Has snowflake/fleck like RO, tx enucleation
Adenomatoid odontogenic tumor (AOT)
Calcifying epithelial odontogenic tumor (CEOT) is most likely to be found where and what age group?
In posterior jaw often with an impacted tooth and >30 yrs
Fall under category of benign odontogenic cyst/tumor with calcifications (4 things he talked about)
Calcifying Odontogenic Cyst (COC) - AKA Gorlin Cyst
Ameloblastic fibro-odontoma
Adenomatoid odontogenic tumor (AOT)
Calcifying epithelial odontogenic tumor (CEOT)
How do you treat a calcifying epithelial odontogenic tumor (CEOT)?
Conservative resection
T/F: All of the benign odontogenic cyst and tumors are asymptomatic or present with slow growing swelling/expansion.
True
What is another name for paget disease of bone?
Osteitis deformans
Name the lesion: Pathogenesis is Increased uncontrolled bone remodeling resulting in thickened but distorted and weakened bones
Paget disease
Paget Disease:
Unknown etiology
> ____ yrs
_______ _______ ancestry
May have bone pain and possible _______
Paget Disease:
Unknown etiology
> 40 yrs
Anglo-saxon ancestry
May have bone pain and possible fractures
Paget Disease:
Most cases are ________ (85%) affecting pelvis, femur, ______ vertebrae, _____ (hat doesnt fit) and _______ most common
Most cases are polyostotic (85%) affecting pelvis, femur, lumbar vertebrae, skull (hat doesn’t fit) and tibia most common
Paget disease is more likely to affect the mandible or maxilla?
Maxilla causes symmetric enlargement (denture doesn’t fit) space develops between teeth
T/F Enlargement of bones in paget disease has the potential to pinch nerves leaving pt deaf and blind. (Narrowing ostea)
True
What is the marker of osteoblastic activity in paget disease?
Elevated total serum alkaline phosphatase
Paget Disease: Chronic progression from _________ (lytic) phase to late lesions that show patchy ______ (“cotton-wool”) appearance with thickened ______. This is the classic cotton-wool appearance!
Chronic progression from vascular (lytic) phase to late lesions that show patchy sclerosis (“cotton-wool”) appearance with thickened cortices. This is the classic cotton-wool appearance!
What may you see in teeth of pt with paget disease?
Extensive hypercementosis of teeth
How do you tx paget’s disease?
NSAIDS for mild pain
Bisphosphanates - help slow bone turnover
What do you need to monitor pt for with pagets disease?
They can develop bone tumors (ex. osteosarcoma)
What are dental considerations with paget disease?
Difficult ext due to hypercementosis and ankylosis
Place implants with caution
Surgical Bleeding risk during vascular lytic phase
Poor wound healing with risk for osteomyelitis during sclerotic phase
Fibro-osseous lesion:
Non specific term that describes a group of process with different pathogenesis, where normal bone is replaced by ______ tissue with a newly formed ___________ product.
Non specific term that describes a group of process with different pathogenesis, where normal bone is replaced by fibrous tissue with a newly formed mineralized product.
What does an accurate diagnosis of fibro-osseous lesions require?
Accurate diagnosis requires correlation of the clinical and radiographic features with the microscopic features because they look very similar microscopically ***
What are the three fibro-osseous lesions?
- Fibrous Dysplasia
- Ossifying fibroma (central) (COF)
- Cemento-osseous dysplasia (Focal, PA, and Florida variants)
When do you often discover fibrous dysplasia?
Early 20s, 2nd to 3rd decade
Fibrous dysplasia is a developmental, tumor like lesion due to a mutation in the _________ ___ protein gene (ie. GNAS)
Fibrous dysplasia is a developmental, tumor like lesion due to a mutation in the stimulatory G protein gene (ie. GNAS)
Fibrous dysplasia is usually monostotic (one bone only); in which ______ are commonly affected.
When _________ (more than one bone) you may see see ______ ___ _____ pigmentation and _______ problems.
Fibrous dysplasia is usually monostotic (one bone only); in which jaws are commonly affected.
When polyostotic (more than one bone) you may see see cafe au lait pigmentation and endocrine problems.
Fibrous dysplasia in the maxilla may involve adjacent facial bone causing facial deformity calle ______ _______ ________.
Craniofacial fibrous dysplasia
What is the appearance usually if you catch fibrous dysplasia early?
RL or mottled followed by classic “ground glass” (really close trabeculae with fibrous stuff loose in between) pattern with blending margins so no RL rim or capsule
(why? Abnormal bone fuses to adjacent normal bone - no capsule)
How do you treat fibrous dysplasia?
Wait till the person is done growing. At that point you decide definitive tx that should be done for it.
Conservative management advised
Surgical reduction on if significant cosmetic or functional deformity (up to 50% can show regrowth)
What percent can show regrowth in fibrous dysplasia?
50%
T/F Fibrous dysplasia is not a true neoplasm it or a tumor so you better not do a resection on the pt.
TRUE
What type of border will you see in fibrous dysplasia?
Blending border
Name that lesion: Benign neoplasm considered by most to be derived from bone, though often also has cementum like material in it. Asymptomatic when small, and painless swelling when large.
Central Ossifying Fibroma (COF)
Name that lesion:
Starts off RL then develops some calcifications. Keeps RL periphery. Histology usually shows smooth surgical margin, with fibrous and osseous tissue and cementum sphericules
Central Ossifying Fibroma (COF)
Central Ossifying Fibroma (COF) location
mandible far more than maxilla especially posterior region
Demographic and age for a pt with Cemento-osseous dysplasia (COD)
Middle age >30 yrs females, mostly in african americans
What fibro-osseous lesion does this match Central ossifying Fibroma or Cemento-osseous dysplasia: Painless, typically NO expansion, around tooth roots/apices and teeth are vital. Well defined but irregular borders. RL at first and will slowly develop central RO.
Cemento-osseous dysplasia (COD)
COF is well defined, unilocular, expansile.
Describe cemento-osseous dysplasia lesion tissue appearance.
Lesional tissue appears as really fragmented, gritty (like little coffee grounds), red/brown tissue (different than COF or FD) early on and denser as it matures
What is important when diagnosing early cemento-osseous dysplasia lesions.
Doing a tooth vitality test so you don’t do RCT thinking its a PA cyst/granuloma.
T/F: Cemento-osseous dysplasia is not a tumor and will not continue to grow the way fibrous dysplasia grows.
True
How do you treat Cemento-osseous dysplasia?
None just radiographic follow up
T/F Cemento-osseous dysplasia can appear in multiple different lesions in the jaw.
True
Name the variant of Cemento-osseous dysplasia: posterior mandible, solitary lesions, may mimic COF requiring biopsy
Focal
Name the variant of Cemento-osseous dysplasia: anterior mandible predominantly, often with multiple lesions
Periapical
Name the variant of Cemento-osseous dysplasia: bilateral mandible (ant & post); can affect all 4 quadrants (Mx & Md); dense RO that can fuse to roots, possible expansion
Florid
T/F Florid Cemento-osseous dysplasia dense RO that can fuse to roots.
True
With _______ Cemento-osseous dysplasia if there is dense bone exposure it can cause 2ndary infection and sequestration. So be sure to avoid EXT and losing bone b/c don’t want it to be exposed and become infected (osteomyelitis)
Florid
T/F Florid Cemento-osseous dysplasia can expand the bone while the other ones don’t.
False florid does but also central ossifying fibroma does
What is the age that cementoblastoma often occurs?
Young adults
Osteoblastoma:
2-4 cm up to 10 cm
Dull Pain and expansion are common
Well/ill-defined RL with patchy to diffuse mineralization
What is histologically identical to a cementoblastoma but NOT fused to a tooth root?
Osteoblastoma
Age you are most likely to find Cementoblastoma
Young Adults
Age you are most likely to find Odontoma
Detected before 20 usually
Age you are most likely to find Calcifying odontogenic cyst (COC) / Gorlin Cyst
Wide age range
Age you are most likely to find Ameloblastic fibro-odontoma
average age is 10 yrs old
Age and demographic you are most likely to find Paget disease
> 40 yrs anglo saxon ancestry
Age you are most likely to find Fibrous dysplasia
2nd to 3rd decade usually adolescent early 20
Age and demographic you are most likely to find Cemento-osseous dysplasia (COD)?
Middle age >30 yrs females, mostly in african americans
Region most likely to find cementoblastoma
posterior mandible, especially 1st permanent molar
Region most likely to find Odontoma (compound and complex)
associated with unerupted tooth and prevent closing gaps
Compound - anterior jaws maybe with unerupted teeth (toothlets)
Complex- posterior jaw pericoronal to an impacted teeth (does not form small tooth appearing structures.
Region most likely to find Calcifying Odontogenic Cyst (COC) - AKA Gorlin Cyst
Anterior jaw 65% of the time
Region most likely to find Ameloblastic fibro-odontoma
posterior mandible
Region most likely to find Paget disease
Maxilla > mandible
Region most likely to find Fibrous dysplasia
Usually monostotic (one bone only); jaws are commonly affected
Region most likely to find Central Ossifying Fibroma (COF)
mandible > maxilla, posterior region most common
Age most likely to find Osteoblastoma
Most pt are <30 yrs
What three mixed lesions did we talk about that are associated with pain?
Cementoblastoma
Paget Disease
Osteoblastoma (dull pain)
________ __________ is a developmental, tumor like lesion due to a mutation in the stimulatory G protein gene (ie. GNAS)
Fibrous dysplasia
