midterm Flashcards
will get inflammatory exudate enter the PDL at root apex= widening of PDL space= first xr appearance
-discont. of lamina dura
acute periapical abscess
reversible and irreverisble pulpitis (acute= may not see anything or may see widening of PDL)
eventually get a PPA radiolucency = chronic
can be CPA, periapical granuloma, periapical cyst
these are all under the same term
abscess and granulomas go back and forth
periapical rarefying osteitis
normal to see small radiolucency with sclerotic bone around it
requires RCT
usually ill defined border
chronic periapical apical abscess
Inflammatory like granulation tissue
Develops from pre-existing abscess and then changed to granuloma
OR initial PA lesion from infection
Can have well or ill defined borders, may have a thin radiopaque border around it, may have external root resorption at apex
Requires RCT
periapical granuloma
most common cyst in jaw
-usually develops from granuloma, cystic degeneration of granuloma= fluid filled cavity
-may get larger and flatten out by other teeth
-usually well defined RADIOPAQUE BORDER
does not require RCT
periapical cyst
residual remnants of periapical cysts. they occur due to incomplete removal of periapical cysts during a previous tooth ext= more common
=cyst was nucleated during procedure but has returned is this:
recurrent/residual cyst
Aka parulis or gum boil or DST
Infection perforates through bone, drains, builds up, and drains again = feel good for a little bit
May or may not see the draining sinus tract in the radiograp
chronic apical abscess
Inflammatory fluid penetrating through sinus and elevates the periosteum = stimulates it to lay down a thin layer of bone, this process repeats itself multiple times
Aka periostitis
Essentially elevating the floor of sinus in that area
periapical halo formation
etiology unknown
mainly involves lower incisors (anterior mandible) → multiple lesions
Lamina dura is discontinuous, well-defined margins, BUT teeth are vital
radiolucent can easily be misdx as PA lesion
middle aged AA and asian females
3 stages of development:
radiolucent, fills in with small radiopacities, eventually mainly radiopaque with thin radiolucnet border
periapical cemento-osseous dysplasia
after tooth ext
If periosteum is destroyed, loses ability to produce bone = distinct radiolucent area with sharp border that is NOT corticated (not radiopaque)
should NOT change over time
also after surgery such as surgical apicoectomy
fibrous healing defect
variation of fibrous healing defect after doing endo on tooth
near apex, may reach a point where it stops filling in with bone
DOES NOT change over time and doesn’t mean RCT wasnt unsuccessful
apical scar
if cancer metastasizes from different other, it can affect teeth
PA radiolucent with strands of trabecular bone
if gets in PDL= irregular widening of PDL (not uniform)
metastatic carcinoma
remnant of dental follicle adjacent to a developed crown of an unerupted or impacted tooth should be no greater than
3 pano
2.5 PA
2 CBCT
follicular space
if dental follicle gets infected, the inflammation spreads along the deep fascial planes
redness, pain, fever
can cause cellulitis- facial swelling
abx and ext
pericoronitis
2nd most common cyst in jaw (20%)
-cystic lining arises from remnants of dental follicle
wider than 3mm
well defined radiolucency with corticated borders
ages 20-30
enucleate, surgery and remove tooth as well
older pts= dont need to remove impacted tooth bc hasn’t become cystic yet
-it can expand and displace nearby teeth, and eventually turn in to two things:
dentigerous cyst
ameloblastoma and squamous cell carcinoma
soft tissue fluid filled swelling of crestal mucosa in area of erupting tooth, usually blueish color due to trauma
lack of alveolar bone
younger than 10 and in mixed dent
usually mand molars
can rupture on own or may need simple excision
eruption cyst
mixed odontgenic tumor, filled with solid mass of cells
well defined pericoronal radiolucency assoc with developing tooth, usually corticated and can expand
exception: sometimes tissue can separate from developing tooth and be on its own
70 younger than 20yo!!!!!!!
sites: mand molar and PM area
enucleation and usually tooth with it
ameloblastic fibroma
where is it located again?
mixed odontogenic tumor, similar to ameloblastic fibroma but has mineralized stroma
radiopacity tooth like structures in the lumen, well corticated
younger than 15yo
site: posterior mandible
if it EXPANDs and displace tissues, really aggressive= odontoameloblastoma
ameloblastic fibro-odontoma
where is it located again?
3-7% of odontogenic tumors, can cause asymptomatic swelling in jaw, will get larger and displaced more tissue
histo: arranged into duct like glandular array
widened follicular space, well demarcated radiolucency with corticated border, may or may not see flecks on xr
mostly in anterior jaw of maxilla
remove tumor and usually doesnt reoccur
adenomatoid odontogenic tumor
where is it located again?
aka pindborg tumor
50% assoc with impacted teeth
VERY aggressive, rare
radiopaque flecks due to calcifed amyloid, breakdown product of neoplastic epithelial cells that calcify called Leisegang rings
tx resection (tumor and more tissue)
age 40 yo
most in mandible posterior
calcifying epithelial odontogenic tumor
where is it located?
age?
gorlin cyst
variable, can behave as neoplasm but is true cyst
varies from uni-multi and have some radiopacities in lumen
not age/gender specific
enucleation, minimal recurrence
calcifying odontogenic cyst
described as heart shaped radiolucency when superimposed with anterior nasal spine, but its actually shaped ovoid
incisive canal (nasopalatine) cyst
developmental cyst that occurs along line of embryonic fusion
when primary and secondary palate fuse
between CI where incise foramen is
may have DST, very slow growing
unilocular radiolucency in max midline, alters incisive canals, can cause root divergence, usually corticated
older age
incisive canal (nasopalatine) cyst
development cyst from fusion of mand halves, VERY rare
in middle of mandible (symphysis)
unilocular radiolucency in the symphyseal region
median mandibular cyst
development cyst from fusion of palatal shelves, more posterior to nasopalatine
mid palatine posterior to papilla
simple enucleation
mid-palatine cyst
occurs between roots, pathognomonic
canine/PM region in mandible
well defined, radiolucency, round, corticated
MIDDLE AGE MORE IN MALES
not recurrent, surgical enculeation, diff from OKC and ameloblastoma
lateral periodontal cyst
area where there is NOT trabecular pattern due to uncoordinated bone growth and turnover, not actually a cyst at all
> 1 root apex in body and ramus of mandible
no solid tumor, no cystic lining, just empty bone pattern, unilocular radiolucency with interradicular scalloped superior margins
<25yo because activity growing
**INITIATE BLEEDING by scraping the bone= bone healing, rare recurrent
simple (solitary, Traumatic bone) cyst
other names for simple bone cyst
USHITE
unicameral bone cyst
solitary bone cyst
hemorrhagic bone cyst
itravastional bone cyst
traumatic bone cystic
extravasational bone cyst
pathognomonic, WILL see and need to know, occurs in BASAL bone, not alveolar bone
depresion in posterior mandible, M3 area anterior to mandibular canal
between mandibular canal and inferior border
over 50 yo VERY specific to men
monitor over time!!!! do NOT biopsy
PLMSG
posterior lingual mandibular salivary gland depression
stafne cyst
PLMSG bone defect
lack of trabeculation (bone is less dense),
mandible
not expansive
unilocular FAINT radiolucency, difficult to discern as separate entity, not clearly defined lack of trabeculation
females since slower bone turnover
no tx
focal osteoporotic bone marrow defect
went away and came back:
never was removed completely (usually this):
recurrent went away and came back
residual never was removed completel
more common in max
-found on xr of edentulous areas
tooth or root may be present, hx of PA disease
well defined radiolucency with smooth round corticated borders
middle age or older males
recurrent/residual cyst
develops after trauma that affects the integrity of periosteum and only fibrous CT fills the site–> seen in fractures
location is where there has been previous disease or trauma
well circumscribed radiolucent lesion at site of previous surgery
“punched out or see through”
fibrous healing defect
IN MANDIBULAR CANAL
expanison, pain, paraesthesia, burning, tingling, aching sensations
well circumscribed radiolucency of various shapes in the mand and it usually forms in the mand canal
excision, rare recurrence
neuroma, neurofibroma
**benign odontogenic neoplasm (solid tumor of odontogenic origin)
capable of uncontrolled, unlimited growth if leave alone
- most common type
- five subtypes: follicular is most common
- painless, small lesions detected by xr, large by clinically
-unilocular, corticated small lesions or large aggressive lesions
(finger like extensions, can displace teeth, soap bubbles)
adults more
85% in mand
BONE RESECTION
50-90% RECURRENT if not resected (v high due to finger like projections)
conventional (multicystic) ameloblastoma
amelobastoma arising within a lining of a cyst (dentigerous or PA) still within wall of cyst and is contained
- less aggressive form bc contained
- no finger like projections
lower recurrence rates and no need for resection
looks like dentigerous cyst but attachment is at root and like CEJ (looks like periapical cyst)
age: 23
90% mand
unilocular ameloblastoma
3rd most common cyst in jaw 10-12%
- arises from cell rests of dental lamina, very aggressive and behaves like benign neoplasm
-increasing size and produces keraitn
-multilocular
-MILD B-L expansion, most AP
males
60-80% posterior mand to canines
do NOT resection because well contained
*multiple (bilateral) found in jaw in nevoid basal cell carcinoma syndrome **
OKC
odontogenic keratocyst
benign, intraosseous lesion of jaw, multinnucleated giant cells
well-defined borders, displacement of teeth, MULTILOCULAR, MIXED
<30 yo females
70% mand between molars
(looks like browns tumor of hyperparathy, so need to rule out)
central giant cell granuloma
CGCG
CT/pulpal tissue growing out of control, lesion of alveolar bone
consider ameloblastoma, CGCG, need, biopsy
scalloped and multiolocular
25-30
mandible
not resect
odontogenic myxoma
autosomal dominant inherited = 50% offspring
cosmetic osseous contouring at age 12+, can leave because is self-limiting
bilateral multilocular
Familial Fibrous Dysplasia
Aka Cherubism
most serious because arterial proliferation in jaw bone
vascular lesion
more blood= more red, firm, gingival bleeding
variable soap buubbles
teens and young adults, females
posterior mand
sclerosing agents, radiation, ebolization of major artieries prior to surgery
Central Hemangioma
island of dead bones because pockets of bone break off
sequestration
Localized inflammation and infection of alveolar bone, consequently it will be; around teeth and generally milder than acute osteomyelitis
*Predisposing Factors: immunodeficient states (leukemia)
*Sequestration
> 30 days!!
(osteomyelitis: inflamm of alveolar bone AND basal bone)
(oesteitis is ONLY alveolar bone)
40-80 yo males
body of mand
(doe this affect trabecular, cortical and periosteal bone?)
chronic osteomyelitis
classic TRIAD: radiation therapy, ,trauma, infection
when patient has radiaiton for malign
40-80yo male
hyperbaric oxygen tanks
osteoradionecrosis (ORN)
joint and muscle pain??
-take medication that prevent angiogenesis to bone which makes them compromised to fight off infection
sequestration
MRONJ (BRONJ)
medication related osteonecrosis of the jaws
bisphosphonate related oestonecrosis of the jaws
malignancies that START in the jaw
CSCC, this
poorly ragged borders, rapid growth, follow path of least resistance, push thru bone
Primary Epidermoid Carcinoma
Malignancies that have metastasized to the jaw, <1%
Can be local invasion, lymphatic spread (usually this), vascular spread, or transcoelomic spread
****mandible:maxilla is 7:1
metastatic disease
Well-contained
May push teeth apart
Expands bone to create onion skin layers of reactive bone
Smooth outline
benign
Not well contained because rapidly grow
Do not push teeth
Does not expand bone, pushes through it instead by following path of least resistance
Poorly defined borders, ragged irregular borders
malignant
