pericoronal radiolucencies Flashcards
Pericoronal Radiolucencies
typically with non-erupted teeth
* Do not contain radiopaque flecks within the lumen
* May or may not contain radiopaque flecks within the lumen
Pericoronal RadiolucenciesThat do not Contain Radiographic Flecks
- Normal Follicular Space
- Pericoronitis
- Dentigerous Cyst
– Ameloblastoma
– Squamous cell carcinoma - Eruption Cyst
- Ameloblastic Fibroma
dentigerous cysts may become:
ameolblastoma or SCCa
Pericoronal Radiolucencies
That May Contain Radiopaque Flecks
- Ameloblastic Fibro-odontoma
- Odontoameloblastoma
- Adenomatoid Odontogenic Tumor
- Calcifying Epithelial Odontogenic Tumor
- Calcifying Odontogenic Cyst
Follicular Space
normal sizes?
- 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
is this pathological?
no, WNL follicle size
Pericoronitis
- If dental follicle gets infected, the inflammation often
spreads along the deep fascial planes
Pericoronitis diagnosis
The diagnosis must be based on evidence of pericoronal tissues, and the clinical signs and symptoms of disease
signs and symptoms of pericoronitis
Edematous, erythematous mucosa;
pain; fever; malaise, etc…
cellulitis to deep fasical planes in pericoronitis
Cellulitis to fascial plane deep spaces causing dramatic facial swelling
dentigerous cyst
% jaw cysts
Cystic lining arises from remnants of dental follicle
Accounts for 20% of jaw cysts
Dentigerous Cyst
Radiographic
- Consistently widened follicular space of >3.0mm
- Well-delineated radiolucency with corticated borders
potential expansion of dentigerous cysts
can occur and make surgical managment much more complicated
how can dentigerous cysts affect other teeth
potential for displacement of other teeth
dentigerous cyst age group
Highest incidence in 20’s and 30’s
most common site of dentigerous cysts
Most common in mandibular third molars and maxillary canines; can affect any impacted tooth
management dentigerous cysts
*Enucleate
*Degree of surgery dependent on size of
tumor
potential future complications of dentigerous cysts
Potential for degeneration of the cyst lining to an ameloblastoma or a squamous cell carcinoma.
Eruption Cyst Clinical app
- Presents as a soft fluid-filled swelling of crestal mucosa in area of an erupting tooth
- Often has bluish coloration due to trauma creating blood in cystic fluid
Eruption Cyst Radiographic app
May see lack of crestal alveolar bone because of position
of erupting crown and cyst near crest
likely eruption cyst
Eruption Cyst
Age
< 10 years
mixed dentition stage
Eruption Cyst most common site
Most common in mandibular molar region
Eruption Cyst Management
- Often rupture spontaneously
- Some may require simple excision
Ameloblastic Fibroma
Clinical
A mixed odontogenic tumor
Ameloblastic Fibroma
Radiographic app
A pericoronal radio-lucency associated with a developing tooth
Ameloblastic Fibroma
Age
70% of cases are < 20 years
Mean age 14-15.5 years
ameloblastic fibroma site
Highest incidence in mandibular molar-
premolar region
Ameloblastic Fibroma
Management
Enucleation
Ameloblastic Fibroma recurrence %
20% recurrence
Ameloblastic Fibro-Odontoma
Clinical
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 app
Pericoronal radio-lucency associated with a developing
tooth
Radiopaque flecks noted in the lumen
Ameloblastic Fibro-Odontoma
Age
Age – mean age ~15 years
Ameloblastic Fibro-Odontoma
Site
Site – posterior mandible
Ameloblastic Fibro-Odontoma
Must be differentiated from? why?
Must be differentiated from the odontoameloblastoma as the latter is more aggressive.
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) location
mandible
Odontoameloblastoma
(a.k.a. ameloblastic odontoma) age
children and teens
Odontoameloblastoma
(a.k.a. ameloblastic odontoma)
Radiographic app
Expansive with destruction of adjacent bone
Rudimentary tooth-like structures similar to complex odontoma
Adenomatoid Odontogenic Tumor
% of odontogenic tumors?
3-7% of odontogenic tumors
Adenomatoid Odontogenic
Tumor
Histological
Histologically a cross between a dentigerous cyst and ameloblastoma
Odontogenic epithelium is arranged in duct-like glandular array (pseudoducts)
Adenomatoid Odontogenic
Tumor
Radiographic app
- 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.
AOT lucency always pericoronal?
may not app as pericoronal as other lesions discussed, may also be non-attatched to a tooth
AOT age
Occur at any age but majority occur in teens (10- 19 years) and young adults (~20 -35 years)
AOT site
65% occur in anterior jaws
Maxilla:Mandible is 2:1
AOt gender?
no gender predilection
previously reported as female:male is 2:1
AOT management
Enucleation with rare recurrence
Calcifying Epithelial Odontogenic Tumor
Clinical
Approximately % occur in association with
impacted teeth?
Approximately 50% occur in association with
impacted teeth.
another name for CEOT
pindborg tumor
Calcifying Epithelial Odontogenic Tumor
Management
Larger lesions require en bloc resections to go beyond margins, due to aggressive nature of tumor
Calcifying Epithelial Odontogenic Tumor
Radiographic app
felcks? result of?
- Radiopaque flecks are due to calcified amyloid
- A breakdown product of the neoplastic epithelial cells; these mineralizations are called Leisegang’s rings
multilocular common
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 facts
* a.k.a.
* variabilty?
* neoplastic behavior?
* sizes?
- a.k.a. Gorlin cyst
- Extremely variable presentation
- Approximately 2-16% behave as neoplasms
- Present from 2.0-4.0cm diameter; as large as 12cm
Calcifying Odontogenic Cyst
Radiographic app
- Vary from uni to multilocular
- 50% have radiopacities in the lumen
- 33% present as pericoronal radiolucencies
COC age
Occur at any age but majority diagnosed in
teens and young adults
COC site
65% ant maxilla
COC gender?
no preference
COC management/ recurrence
Simple enucleation with minimal
recurrence
