Pericoronal Radiolucencies Flashcards
Pericoronal Radiolucencies
* Do not contain
* May or may not contain
radiopaque flecks within the lumen
radiopaque flecks within the lumen
skipped
Pericoronal RadiolucenciesThat do not Contain Radiographic Flecks
(5)
- Normal Follicular Space
- Pericoronitis
- Dentigerous Cyst
– Ameloblastoma
– Squamous cell carcinoma - Eruption Cyst
- Ameloblastic Fibroma
skipped
Pericoronal Radiolucencies
That May Contain Radiopaque Flecks
(5)
- Ameloblastic Fibro-odontoma
- Odontoameloblastoma
- Adenomatoid Odontogenic
Tumor - Calcifying Epithelial
Odontogenic Tumor - Calcifying Odontogenic Cyst
Follicular Space*
Remnant of dental follicle adjacent a
developed crown of an unerupted or
impacted tooth should be no greater
than;
– 3.0mm wide on panoramic image
– 2.5mm wide on intraoral film image
– 2.0mm on CBCT
Pericoronitis
- If dental follicle gets
infected, the
inflammation often
spreads along the
deep fascial planes
Pericoronitis
* The diagnosis must be based on
evidence of
pericoronal tissues,
and the clinical signs and
symptoms of disease
Pericoronitis
Edematous, erythematous mucosa;
pain; fever; malaise, etc…
* Cellulitis to fascial plane deep
spaces causing
dramatic facial
swelling
Dentigerous Cyst
Clinical
Cystic lining arises from
remnants of
Accounts for –% of jaw
cysts
dental
follicle
20
Dentigerous Cyst
Clinical
Cystic lining arises from
remnants of dental
follicle
Accounts for
–% of jaw
cysts!
20
Dentigerous Cyst
Radiographic
(2)
- Consistently
widened follicular
space of >3.0mm - Well-delineated
radiolucency with
corticated borders
Dentigerous Cyst
Age
Highest incidence in
20’s and 30’s
Dentigerous Cyst
Site
Most common in
mandibular third molars
and maxillary canines;
can affect any impacted
tooth
Dentigerous Cyst
Management
(2)
Other
*Enucleate
*Degree of surgery dependent on size of
tumor
Potential for degeneration of the cyst
lining to an ameloblastoma or a
squamous cell carcinoma.
Eruption Cyst
Clinical
* Presents as a
* Often has bluish coloration due to
soft fluid-filled swelling of
crestal mucosa in area of an erupting
tooth
trauma
creating blood in cystic fluid
Eruption Cyst
Radiographic
May see lack of
crestal alveolar bone
because of position
of erupting crown
and cyst near crest
Eruption Cyst
Age
< 10 years
mixed dentition stage
Eruption Cyst
Site
Most common in mandibular molar region
Eruption Cyst
Management
(2)
- Often rupture spontaneously
- Some may require simple excision
Ameloblastic Fibroma
Clinical
A — odontogenic tumor
mixed
Ameloblastic Fibroma
Radiographic
A pericoronal radio-
lucency associated
with a developing
tooth
Ameloblastic Fibroma
Age
70% of cases are — years
Mean age — years
< 20
14-15.5
Ameloblastic Fibroma
Site
Highest incidence in
mandibular molar-
premolar region
Ameloblastic Fibroma
Management
Other
–% recurrence
Enucleation
20
Ameloblastic Fibro-Odontoma
Clinical
(2)
A mixed odontogenic tumor, similar to
ameloblastic fibroma but has a mineralized
stroma
If mineralization is high, then radiopaque
flecks may be evident radiographically
Ameloblastic Fibro-Odontoma
Radiographic
Pericoronal radio-
lucency associated
with a developing
tooth
Radiopaque flecks
noted in the lumen
Ameloblastic Fibro-Odontoma
Age – mean age ~– years
Site –
15
posterior mandible
Ameloblastic Fibro-Odontoma
Other
Must be differentiated from the
— as the latter is more
aggressive.
odontoameloblastoma
Odontoameloblastoma
(a.k.a. ameloblastic odontoma)
Clinical
Rare
Must be differentiated from the
ameloblastic
fibro-odontoma, as it is more aggressive
and requires surgical resection
Odontoameloblastoma
(a.k.a. ameloblastic odontoma)
Clinical
- Seen mainly in –
- Affects
mandible
teens and children
Odontoameloblastoma
(a.k.a. ameloblastic odontoma)
Radiographic
(2)
Expansive with destruction of adjacent bone
Rudimentary tooth-like structures similar to
complex odontoma
Adenomatoid Odontogenic
Tumor
Clinical
–% of odontogenic tumors
3-7
Adenomatoid Odontogenic
Tumor
Histological
(2)
Histologically a cross between a
dentigerous cyst and ameloblastoma
Odontogenic epithelium is arranged in duct-
like glandular array
Adenomatoid Odontogenic
Tumor
Radiographic
- Consistently widened
follicular space of
>3.0mm if associated
with crown of
impacted tooth (75%
of cases are
pericoronal). - Well-delineated
radioluceny with
corticated border,
usually >3.0cm.
Adenomatoid Odontogenic Tumormore recent systematic reviews report
Age
Occur at any age but majority occur in
teens (10- 19 years) and
young adults (~20 -35 years)
Adenomatoid Odontogenic
Tumor
Site
65% occur in anterior jaws
Maxilla:Mandible is 2:1
Adenomatoid Odontogenic
Tumor
Gender
no gender predilection
previously reported as female:male is 2:1
Adenomatoid Odontogenic
Tumor
Management
Enucleation with rare recurrence
Calcifying Epithelial
Odontogenic Tumor
Clinical
Approximately 50% occur in association with
impacted teeth.
Calcifying Epithelial
Odontogenic Tumor
Another name for the tumor is…..
Pindborg tumor
Calcifying Epithelial
Odontogenic Tumor
Management
Larger lesions
require en bloc
resections
Calcifying Epithelial
Odontogenic Tumor
Radiographic
(2)
- Radiopaque flecks are
due to calcified
amyloid - A breakdown product
of the neoplastic
epithelial cells; these
mineralizations are
called Leisegang’s
rings
Calcifying Epithelial
Odontogenic Tumor
Age
Mean age of 40 years
Calcifying Epithelial
Odontogenic Tumor
Site
Mandible:Maxilla is 2:1
More likely in posterior mandible
Calcifying Odontogenic Cyst
Clinical
* a.k.a.
* Extremely variable presentation
* Approximately —% behave as
neoplasms
* Present from — diameter; as large
as —
Gorlin cyst
2-16
2.0-4.0cm, 12cm
Calcifying Odontogenic Cyst
Radiographic
(3)
- Vary from uni to
multilocular - 50% have
radiopacities in the
lumen - 33% present as
pericoronal
radiolucencies
Calcifying Odontogenic Cyst
Age
Occur at any age but majority diagnosed in
teens and young adults
Calcifying Odontogenic Cyst
Site
65% in anterior maxilla
Calcifying Odontogenic Cyst
Sex
No predilection
Calcifying Odontogenic Cyst
Management
Simple enucleation with minimal
recurrence
