theme 11 Flashcards
another name for odontomes
dental hamartoma
what is an odontome
benign tumour linked to tooth development
non-neoplastic
contain calcified dental tissue
limited growth potential
3 types of invaginated odontome
dens en dente
dens invaginatus
gestant odontome
which teeth usually affected by invaginated odontomes
mandibular premolars
where are dens en dente most common
lateral incisors
what is dens en dente
infolding of outer surface of tooth into interior
enamel organ invaginated into papilla
cingulum pits
complication of dens en dente
can lead to early pulp death
what is an enamel pearl
enamel on root
usually furcation of maxillary molar
growth disturbance of HERS
complication of enamel pearl
plaque retentive factor
2 types of odontomes
complex - not tooth like
compound - tooth like
tissue present in complex odontome
enamel, dentine, cementum, connective tissue
tissue present in compound odontome
enamel, dentine, cementum, pulp
radiological features of odontome
variable sixe
ovoid shape
well defined, radiolucent
radio-opaque as made of calcified tissue
effects of odontomes
impeded eruption of permanent dentition
displace teeth
cortical expansion
ages when odontomes common
complex - 10-30
compound - 10-20
where are complex odontomes most likely found
mandibular molar
where are compound odontomes most likely found
anterior maxialla, inter-canine area
3 classifications of benign odontogenic tumours
epithelial
epithelial + mesenchymal
mesenchymal
what must be present for odontogenic tumour to contain hard tissue
ep + mesenchymal cells
most common odontogenic tumour?
ameloblastoma
most common site to find ameloblastoma
80% mandbile - angle most common
presentations of ameloblastoma
asymptomatic early stage
facial deformity due to expansion of bone can cause loss of teeth
pain rarely
radiological features of ameloblastoma
variable size
multilocular
well defined, corticated
radiolucent
effects of ameloblastoma
cortical expansion
tooth displacement
knife edge root resorption
can get perforation of bone + extension in soft tissues
how big should margins be for resection of ameloblastoma
1cm
complication of ameloblastoma
undergo cystic change
features of unicystic ameloblastoma
young patients
mandibular third molar region, associated with unerupted tooth
simple uni-cystic cavity lined with ameloblastic ep - no solid tumour
doesn’t invade, low morbidity
4 types of odontogenic tumour - epithelial
ameloblastoma
squamous odontogenic tumour
adenomatoid odontogenic tumour
calcifying epithelial odontogenic tumour
features of squamous odontogenic tumour
lesion of PDL
maxilla>mandible
well circumscribed, triangular radiolucency with sclerotic border
effect of squamous odontogenic tumour
tooth displacement
features of adenomatoid odontogenic tumour
well defined, can get calcifications causing radio-opacities
anterior maxialla most common
small, unilocular
impedes eruption of teeth
features of calcifying epithelial odontogenic tumour
rare, benign, locally invasive mandibular molar region most common swelling variable size, multi or unilocular variable outline calcifies so radio-opaque/lucent mix
effects of calcifying epithelial tumour
cortical expansion
tooth displacement
root resorption
2 types of benign odontogenic tumour with ep + mesenchyme
ameloblastic fibroma
calcifying odontogenic cyst
where is ameloblastic fibroma most common
mandible (pre)molar - <20year old
presentation of ameloblastic fibroma
asymptomatic
slow growing
facial deformity
loose teeth
radiological presentation of ameloblastic fibroma
uni or multi locular
well defined, corticated
radiolucent
effects of ameloblastic fibroma
impeded eruption
tooth displacement
cortical expansion
how to differentiate ameloblastoma + ameloblastic fibroma
ameloblastic fibroma doesn’t extend beyond medullary spaces of bone
when is calcifying odontogeninc cyst most common
<40year old, maxilla = mandble
presentation of calcifying odontogenic cyst
asymptomatic
slow growing swelling
radiological features of calcifying odontogenic cyst
size variable
unilocular
well defined, corticated
radiolucent/mixed
effects of calcifying odontogenic cyst
impedes eruption, tooth displacement, root resorption
3 types of benign mesenchymal tumours
odontogenic fibroma
odontogenic myxoma
cementoblastoma
how to tell odontogenic fibroma + odontogeninc myxoma apart on radiograph
myxoma = multilocular (soap bubble appearance), difficult to remove
myxoma in younger people
where are odontogenic myxomas mostly found
posterior mandible - get cortical expansion
presentation of odontogenic fibromas + myxomas
slow growing
well defined
asymptomatic
what age presents with cementoblastoma
<25years
most common site for cementoblastoma
mandible (pre)molar - attached to root
features of cementoblastoma
variable size, round shape, well defined outline (radiolucent) - overall radio-opaque
effects of cementoblastoma
root resorption + cortical expansion
2 types of malignant odontogenic tumours
carcinomas
sarcomas
4 types of odontogeninc carcinomas
ameloblastic carcinoma
primary intraosseuous SCC
clear cell odontogenic carcinoma
malignant change in benign odontogenic cyst
signs of malignant tumours
pain + swelling ulceration of mucoas mobility of teeth parasthesia/anaesthesia extensive bone destruction regional lymph node metastasis distant metastasis
definition of a cyst
pathological cavity with fluid/semi fluid contents, not created by accumulation of pus
+/- ep lined
types of epithelial cysts
odontogenic - radicular, paradental, dentigerous, keratocyst, lateral periodontal, gingival
non-odontogenic - nasopalatine, nasolabial
3 types of non-epithelial cysts
solitary bone
aneurysmal
stafne bone cavity
3 types of radicular cyst
periapical
lateral
residual
features of radicular cyst
apex of non-vital tooth
asymptomatic, swelling, tooth mobility/displacement
radiologically - round, unilocular, well defined/corticated
effects of radicular cyst
buccal expansion
root resorption
antral-halo
tooth displacement
what should be suspected if heavy root resorption
malignancy
histopathology of radicular/residual cyst
non-keratinised SSE
rusthon bodies, squamous metaplasia
cyst wall - fibrous, inflammatory cells, cholesterol clefts, haemosiderin
how can you tell no invasion into deeper layers
healthy basement membrane layer
pathogenesis of radicular cyst
ep cells of malassez stimulated by inflammatory mediators degeneration of central ep ep cuts from blood supply cells die off + degrade + form cavity cavity expands due to osmosis
features of paradental cyst
side of tooth - usually lower 8s
same features as radicular
features of dentigerous cyst
same as radicular - around unerupted tooth
histopathology of dentigerous cyst
thin flattened non-keratinised SEE
cyst wall fibrous +/- inflammation
pathogenesis of dentigerous cyst
pressure of impacted tooth on follicle obstruction of venous drainage serum transudation fluid accumulated between REE + enamel pressure causes expansion
eruption cyst presentation in mouth
fluctuant bluish swelling
presentation of keratocyst
asymptomatic swelling +/- pain tooth mobility patholigical fracture adjacent teeth vital
pathogenesis of keratocyst
derived from dental lamina or remnants (cell rests of serves)
radiological presentation of keratocyst
body/angle of mandible variable size oval unilocular/multilocular well defined, corticated, scalloped uniformly radiolucent
effects of keratocyst
minimal affect of adjacent structures
expands through cancellous bone
may cause fracture
histopathology of karatocyst
keratinised SEE
cyst wall - fibrous +/- inflammation
satellite cysts
what would be in keratocyst aspirate
low level of total protein + albumin
clinical presentation of keratocyst
through cancellus bone, little/no buck/lingual expansion
intrinsic growth potential
what syndrome present as multiple BCC and keratocysts
golin-goltz syndrome
also have cleft lip/palate
mutation of PTCH1
features of lateral periodontal cyst
same as radicular but PDL side of tooth, <1cm, teeth vital
histopathology of lateral periodontal cyst
non-keratinised SSE
pathogenesis of lateral periodontal cyst
REE
serres rests
cell rests of a malassez
gingival cysts are common in what age of person
infants
possible presentation of nasopalatine duct cyst
asymptomatic swelling of midline palate pain + salty discharge tooth mobility/displacement anterior teeth vital
epithelium lining nasopalatine + nasolabial cyst
respiratory ep
pathogenesis of nasopalatine cyst
remnants of nasopalatine duct
presentation of nasolabial cyst
swelling in nasolabial fold
pain
nasal obstruction
pathogenesis of nasolabial cyst
remnants of embryonic nasolacrimal rod or duct
3 types of non-epithelial cysts
solitary bone cyst
aneurysmal cyst
stafne bone cavity
radiological presentation of solitary bone cyst
well defined, corticated
unilocular radiolucency
undulating
radiological presentation of aneurysmal cyst
multilocular radiolucency at angle of mandible
4 reasons to treat cysts
stop further growth
avoid infection
avoid pathological fracture
stop displacement/resorption of teeth
methods to treat cysts
enuceation +/- extra measure
marsupialistion
decompression
resection
what is marsupialisation
open cyst + leave open
bone healing from base upwards
lining will undergo metaplasia + becomes normal ep
may need to pack ope - BIPP/gauze
what is decompression
same as marsupialisation but instead of pack, use drink with tube to keep open
when might marsupialsiation/decompression be used
larger cysts - reduces threat to vital structures
Dentigerous cyst - vitality preserved
what is enucleation
remove all cyst lining, close flap over, pack if necessary
disadvantages of enucleation
leaves dead space - infection risk
damage to adjacent structures - loss of vitality, IAN
jaw fracture
antra/nasal involvement
what is carnoys solution
adjunct to enucleation
aims to remove any remaining viable lining in thin friable lines cyst
modified carnoys - removed chloroform due to carcinogenic potential
what is cryotherapy
adjunct to enucleation
freezes everything, cell death by intra/extra cellular ice formation
what is a peripheral osteotomy
adjunct to enucleation
margin around cyst removed using bur
3 types of adjunct treatment to enucleation
carnoys
cryotherapy
peripheral osteotomy
