Diese Präsentation wurde erfolgreich gemeldet.
Wir verwenden Ihre LinkedIn Profilangaben und Informationen zu Ihren Aktivitäten, um Anzeigen zu personalisieren und Ihnen relevantere Inhalte anzuzeigen. Sie können Ihre Anzeigeneinstellungen jederzeit ändern.

Inflammation

1.934 Aufrufe

Veröffentlicht am

x_ ray

Veröffentlicht in: Bildung
  • Als Erste(r) kommentieren

Inflammation

  1. 1. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 11 Dental RadiographicDental Radiographic Interpretation Inflammatory jaw lesions Dr. Ossama EL-Shall Chairman of Oral Medicine,Chairman of Oral Medicine, Periodontology, Diagnosis & RadiologyPeriodontology, Diagnosis & Radiology Department, Faculty of Dental MedicineDepartment, Faculty of Dental Medicine for girls, Al-Azhar University, Cairofor girls, Al-Azhar University, Cairo Egypt.Egypt. E.mail address: oelshall@hotmail.comE.mail address: oelshall@hotmail.com
  2. 2. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 22 Inflammatory jaw lesionsInflammatory jaw lesions - They are the most common- They are the most common pathologic conditions of thepathologic conditions of the jaws.jaws. - Usually due to infected pulp- Usually due to infected pulp or periodontal infectionor periodontal infection - Also it may occurs due to- Also it may occurs due to trauma or hematologicaltrauma or hematological diseasedisease
  3. 3. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 33 Inflammatory jaw lesionsInflammatory jaw lesions 1-1- Periapical Inflammatory lesions.Periapical Inflammatory lesions. Apical periodontitis, periapical abscess,Apical periodontitis, periapical abscess, granuloma, cystgranuloma, cyst 2-2- PericoronitisPericoronitis 3-3- Periodontal lesions.Periodontal lesions. 4-4- Osteomyelitis.Osteomyelitis. 5- Osteoradionecrosis5- Osteoradionecrosis
  4. 4. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 44
  5. 5. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 55 Diagnosis of inflammatory jaw lesionsDiagnosis of inflammatory jaw lesions AcuteAcute Rapid onset, Pain, Hotness, Redness, swellingRapid onset, Pain, Hotness, Redness, swelling FeverFever ChronicChronic Insidious onset, prolonged course, less pain,Insidious onset, prolonged course, less pain, low grade feverlow grade fever
  6. 6. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 66 General Radiographic featuresGeneral Radiographic features Location:Location: PeriapicallyPeriapically Alveolar crestAlveolar crest Mandibular areaMandibular area
  7. 7. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 77 Changes inside the lesion:Changes inside the lesion: RL in cases of abscess cyst granulomaRL in cases of abscess cyst granuloma RO condensing osteitisRO condensing osteitis RL + RORL + RO Effects on the surroundingEffects on the surrounding structures:structures: 1-May cause expansion, resorption, destruction or thinning of bone. 2-Compressed adjacent tissues as max. sinus or nasal cavity 3-Displacement of teeth, divergence or resorption. 4-Affection of lamina dura.
  8. 8. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 88 Periapical Inflamatory LesionsPeriapical Inflamatory Lesions Bone destruction around apexBone destruction around apex of tooth, mostly secondaryof tooth, mostly secondary to pulp exposure due toto pulp exposure due to caries or trauma.caries or trauma. Bacterial invasion of pulpBacterial invasion of pulp produces toxic metabolitesproduces toxic metabolites which escape to thewhich escape to the periapical bone throughperiapical bone through apical foramen and causeapical foramen and cause inflammation.inflammation.
  9. 9. Apical periodontitisApical periodontitis 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 99 It may be acute or chronic The acute form having no radiographic changes, only clinical manifestations as tender tooth to palpation and pain on biting
  10. 10. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1010 Apical periodontitis.Apical periodontitis.
  11. 11. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1111 Apical periodontitis Foreign body granuloma. AP
  12. 12. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1212 Periapical inflammatory lesions.Periapical inflammatory lesions. Periapical abscessPeriapical abscess Ill defined RL area, widening of PM space, loss of LD
  13. 13. Periapical abscessPeriapical abscess Acute: sever throbbingAcute: sever throbbing pain, tooth mobility,pain, tooth mobility, tenderness, swelling,tenderness, swelling, elevation of the toothelevation of the tooth Chronic: history ofChronic: history of acute case,acute case, asymptomatic, fistula,asymptomatic, fistula, dull paindull pain 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1313 It is a localizedIt is a localized collection of pus atcollection of pus at periapical areaperiapical area It may be acute orIt may be acute or chronicchronic
  14. 14. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1414
  15. 15. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1515 Periapical Inflamatory LesionsPeriapical Inflamatory Lesions Periapical granuloma:Periapical granuloma: Localized mass ofLocalized mass of chronic granulation tissuechronic granulation tissue containing PMN’s,containing PMN’s, lymphocytes, plasmalymphocytes, plasma cells.cells. Periapical Granuloma
  16. 16. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1616 Periapical GranulomaPeriapical Granuloma Radiographically,Radiographically, widening of PDL orwidening of PDL or variable size ofvariable size of periapical RL may beperiapical RL may be presentpresent Loss of lamina duraLoss of lamina dura AsymptomaticAsymptomatic Non vital toothNon vital tooth History of sensitivityHistory of sensitivity to hotto hot
  17. 17. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1717 Periapical GranulomaPeriapical Granuloma
  18. 18. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 1818 Periapical Granuloma??Periapical Granuloma??
  19. 19. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall
  20. 20. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2020
  21. 21. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2121
  22. 22. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2222
  23. 23. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2323 Radicular cystsRadicular cysts It developed around apexIt developed around apex of a diseases tooth orof a diseases tooth or around an accessoryaround an accessory canal from the pulpcanal from the pulp (lateral radicular cyst)(lateral radicular cyst) The radiographicThe radiographic appearance of aappearance of a clinically symptom-freeclinically symptom-free cyst reveals a clear, ROcyst reveals a clear, RO borders that surroundborders that surround the radiolucency.the radiolucency.
  24. 24. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2424 Radicular cystsRadicular cysts Rounded RL with RORounded RL with RO margin at periapicalmargin at periapical region.region. Apex of the tooth isApex of the tooth is within the cystic cavity.within the cystic cavity. Adjacent teeth andAdjacent teeth and structures are displaced.structures are displaced. Infected cysts exhibitsInfected cysts exhibits poorly demarcatedpoorly demarcated bordersborders Small, clinically symptom-Small, clinically symptom- free radicular cyst that isfree radicular cyst that is expanding towards the floorexpanding towards the floor of maxillary sinusof maxillary sinus
  25. 25. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2525 Small, symptomSmall, symptom free radicular cystfree radicular cyst with typical ROwith typical RO boundariesboundaries Infected radicular cyst, hasInfected radicular cyst, has lost its typical radiographiclost its typical radiographic signs as a result of seroussigns as a result of serous infiltration of theinfiltration of the surrounding tissue.surrounding tissue.
  26. 26. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2626 This infected radicular cystThis infected radicular cyst arising from second premolararising from second premolar and displaces the floor ofand displaces the floor of maxillary sinusmaxillary sinus
  27. 27. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2727 Typical manifestationTypical manifestation of radiclar cystof radiclar cyst Infected radiclar cystInfected radiclar cyst
  28. 28. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2828 Atypical manifestation of a radicular cyst -This cyst emanates from the remaining root of lower canine -The radiograph showing a multi-locular pattern -This picture may misdiagnosed as ameloblastoma or keratocyst
  29. 29. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 2929 Radicular maxillary cyst extending from central and lateral incisors. The cyst expanded in horizontal plane, which is clear in the occlusal view. From the panoramic view we can notice its relation to max.sinus.
  30. 30. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3030 Radicular residual cyst Notes the relation to max. sinus
  31. 31. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3131 Lateral Periodontal CystLateral Periodontal Cyst Arises directly fromArises directly from epithelial cells inepithelial cells in PDL on lateral aspectPDL on lateral aspect of tooth. Origin: cellof tooth. Origin: cell rests of Mallasez orrests of Mallasez or remnants of dentalremnants of dental lamina.lamina. Tooth is VITAL.Tooth is VITAL.
  32. 32. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3232 Lateral Periodontal CystLateral Periodontal Cyst How do youHow do you differentiate this cystdifferentiate this cyst from radicular cystfrom radicular cyst which may develop inwhich may develop in this location?this location? Seen as a unilocular,Seen as a unilocular, well-definedwell-defined radiolucency on lateralradiolucency on lateral aspect of a vitalaspect of a vital tooth.tooth.
  33. 33. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3333 Lateral Periodontal CystLateral Periodontal Cyst
  34. 34. Differential diagnosis of periapical inflammatoryDifferential diagnosis of periapical inflammatory lesionlesion 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3434 Periapical cemental dysplasiaPeriapical cemental dysplasia Periapical scarPeriapical scar Traumatic bone cystTraumatic bone cyst Central giant cell granulomaCentral giant cell granuloma
  35. 35. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3535 Failure apicectomy successful apicectomy
  36. 36. 2- Pericoronitis2- Pericoronitis Inflammation of theInflammation of the gingival tissues aroundgingival tissues around the crown of the tooththe crown of the tooth Associated with thirdAssociated with third molarmolar No radiographicNo radiographic changes, but may bechanges, but may be found in sever caseafound in sever casea 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3636
  37. 37. 3- Osteomyelitis3- Osteomyelitis The word “osteomyelitis” originates from the ancient GreekThe word “osteomyelitis” originates from the ancient Greek words osteon (bone) and muelinos (marrow) and means infectionwords osteon (bone) and muelinos (marrow) and means infection of medullary portion of the bone.of medullary portion of the bone. It is an acute & chronic inflammatory process in the medullaryIt is an acute & chronic inflammatory process in the medullary spaces or cortical surfaces of bone that extends away from thespaces or cortical surfaces of bone that extends away from the initial site of involvement.initial site of involvement. It is the inflammation of the bone as a result of spread ofIt is the inflammation of the bone as a result of spread of inflammatory process to involve bone marrow, cortex cancellousinflammatory process to involve bone marrow, cortex cancellous parts and periosteumparts and periosteum 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 3737
  38. 38. FactorsFactors predisposingpredisposing toto osteomyelitisosteomyelitis LOCAL FACTORS (decreased vascularity/vitality of bone) Trauma. Radiation injury. Paget’s disease. Osteoporosis. Major vessel disease. SYSTEMIC FACTORS (impaired host defense) Immunedeficie ncy states. Immunosuppr ession Diabetes mellitus. Malnutrition. Extremes of age.
  39. 39. types of osteomyelitistypes of osteomyelitis
  40. 40. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 4040 SUPPURATIVE OSTEOMYELITIS
  41. 41. ONSET OF DISEASE 4 WEEKS Acute suppurative osteomyelitis Chronic suppurative osteomyelitis Onset of disease: Deep bacterial invasion into medullary & cortical bone Suppurative osteomyelitisSuppurative osteomyelitis
  42. 42. Suppurative osteomyelitisSuppurative osteomyelitis Source of infection is usually an adjacent focus of infection associated with teeth or with local trauma. It is a polymicrobial infection, predominating anaerobes such as Bacteriods, Porphyromonas or Provetella. Staphylococci may be a cause when an open fracture is involved.  panoramic radiograph of suppurative osteomyelitis at the right side of mandible.
  43. 43. ACUTE SUPPURATIVE OSTEOMYELITIS Organisms entry into the jaw, mostly mandible, compromising the vascular supply Medullary infection spreads through marrow spaces Thrombosis in vessels leading to extensive necrosis of bone Lacunae empty of osteocytes but filled with pus , proliferate in the dead tissue Suppurative inflammation extend through the cortical bone to involve the periosteum Stripping of periosteum comprises blood supply to cortical plate, predispose to further bone necrosis Sequestrum is formed bathed in pus, separated from surrounding vital bone
  44. 44. Acute suppurative osteomyelitis CLINICAL FEATURES EARLY : Severe throbbing, deep- seated pain. Swelling due to inflammatory edema. Gingiva appears red, swollen & tender. LATE : Distension of periosteum with pus. FINAL: Subperiosteal bone formation cause swelling to become firm.
  45. 45. Acute suppurative osteomyelitisAcute suppurative osteomyelitis Radiographic featuers May be normal in early stages of disease . Do not appear until after at least 10 days. After sufficient bone resorption irregular, mot- eaten areas of radiolucency may appear. Radiograph may demonstrate ill-defined radiolucency.
  46. 46. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 4646 CHRONIC SUPPURATIVE OSTEOMYELITIS
  47. 47. CHRONIC SUPPURATIVE OSTEOMYELITIS Inadequate treatment of acute osteomyelitis Periodontal diseases, Pulpal infections, Extraction wounds Infected fractures Infection in the medulllary spaces spread and form granulation tissue Granulation tissue forms dense scar to wall off the infected area Encircled dead space acts as a reserviour for bacteria & antibiotics have great difficulty reaching the site
  48. 48. CHRONIC SUPPURATIVE OSTEOMYELITIS CAL FEATURES Swelling Intermittent Pain Sinus formation Purulent discharge Sequestrum formation Tooth loss Pathologic fracture
  49. 49. CHRONIC SUPPURATIVE OSTEOMYELITIS RADIOLOGY Patchy, ragged & ill defined radiolucency. Often contains radiopaque sequestra. • Sequestra lying close to the peripheral sclerosis & lower border. • New bone formation is evident below lower border.
  50. 50. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 5050 CHRONIC SUPPURATIVE OSTEOMYELITIS Sequestra
  51. 51. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 5151 FOCAL SCLEROSING OSTEOMYELITIS
  52. 52. FOCAL SCLEROSING OSTEOMYELITIS Also known as “Condensing osteitis”. Localized areas of bone sclerosis. Bony reaction to low-grade peri- apical infection or unusually strong host defensive response.
  53. 53. FOCAL SCLEROSING OSTEOMYELITISFOCAL SCLEROSING OSTEOMYELITIS CLINICAL FEATURES Children & young adults are affected.
  54. 54. RADIOLOGY Localized but uniform increased RO related to tooth. Widened periodontal ligament space or peri- apical area. Sometimes an adjacent radiolucent inflammatory lesion may be present. FOCAL SCLEROSING OSTEOMYELITISFOCAL SCLEROSING OSTEOMYELITIS Increased areas of radiodensity surrounding apices of nonvital mandibular first molar
  55. 55. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 5555 FOCAL SCLEROSING OSTEOMYELITISFOCAL SCLEROSING OSTEOMYELITIS
  56. 56. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 5656 FOCAL SCLEROSING OSTEOMYELITISFOCAL SCLEROSING OSTEOMYELITIS
  57. 57. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 5757 DIFFUSE SCLEROSING OSTEOMYELITIS
  58. 58. DIFFUSE SCLEROSING OSTEOMYELITIS It is an ill-defined, highly controversial type of osteomyelitis. Bone metabolism tipped toward increased bone formation.
  59. 59. RADIOLOGY Increased radiodensity may be seen surrounding areas of lesion. DIFFUSE SCLEROSING OSTEOMYELITIS Diffuse area of increased radiodensity of Rt. Side of mandible
  60. 60. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 6060 DIFFUSE SCLEROSING OSTEOMYELITIS
  61. 61. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 6161 DIFFUSE SCLEROSING OSTEOMYELITIS
  62. 62. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 6262 Proliferative periosteitis “ Periostitis ossificans” “Garee’s osteomyelitis”.
  63. 63. Proliferative periosteitis Also known as “ Periostitis ossificans” & “Garee’s osteomyelitis”. It represents a periosteal reaction to the presence of inflammation.
  64. 64. ““Garee’s osteomyelitis”.Garee’s osteomyelitis”. CLINICAL FEATURES Affected patients are primarily children & young adults. Incidence is mean age of 13 years. No sex predominance is noted. Most cases arise in the premolar & molar area of mandible. Hyperplasia is located most commonly along lower border of mandible. Most cases are uni- focal, multiple quadrants may be
  65. 65. PROLIFERATIVEPROLIFERATIVE PERIOSTITIS RADIOLOGY Radiopaque laminations of bone roughly parallel each other & underlying cortical surface. Laminations may vary from 1-12 in
  66. 66. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 6666 PROLIFERATIVE PERIOSTITIS
  67. 67. OsteoradionecrosisOsteoradionecrosis 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 6767 -It is the inflammatory condition occurs in bone after the bone has been exposed to therapeutic dose of radiation - Infection or trauma are necessary - mandible more affected
  68. 68. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 6868 OsteoradionecrosisOsteoradionecrosis
  69. 69. Dental RadiographicDental Radiographic interpretationinterpretation 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 6969
  70. 70. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7070 Radiographically, Jaw lesions mayRadiographically, Jaw lesions may classified into:classified into: I-I- Radiolucent lesionsRadiolucent lesions II-II- Radiopaque lesionsRadiopaque lesions III-III- Combination of RL + RO. lesions.Combination of RL + RO. lesions.
  71. 71. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7171 Radiolucent lesionsRadiolucent lesions
  72. 72. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7272 Radiolucent lesionsRadiolucent lesions 1-1-Lesions related to tooth apexLesions related to tooth apex 2-2-Lesions related to side of rootsLesions related to side of roots 3-3-Lesions related to crown of unerupted orLesions related to crown of unerupted or impacted toothimpacted tooth 4-4-Unilocular lesions in midline of maxilla.Unilocular lesions in midline of maxilla. 5-5-Unilocular lesions lateral to midline of maxilla.Unilocular lesions lateral to midline of maxilla. 6-6-Solitary RL lesion with either well or ill- definedSolitary RL lesion with either well or ill- defined margins.margins. 7-7-Multilocular RL lesion with either well or ill-Multilocular RL lesion with either well or ill- defined margins.defined margins. 8-8-Multiple but separate RL with well-defined orMultiple but separate RL with well-defined or punched out marginspunched out margins
  73. 73. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7373 1-1- Radiolucent lesions related toRadiolucent lesions related to tooth apex:tooth apex: A- Periapical cystA- Periapical cyst B- Periapical granulomaB- Periapical granuloma C- Periapical abscessC- Periapical abscess D- Periapical periodontitisD- Periapical periodontitis E- Periapical cementoma. (early stage)E- Periapical cementoma. (early stage) F- Periapical scarF- Periapical scar
  74. 74. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7474 2-2-Radiolucent lesions related toRadiolucent lesions related to sides of roots:sides of roots: 1- Lateral periodontal cyst1- Lateral periodontal cyst 2- Periodontal abscess.2- Periodontal abscess.
  75. 75. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7575 3-3-Lesions related to crown ofLesions related to crown of unerupted or impacted toothunerupted or impacted tooth Pericoronal R.L, uni or multilocularPericoronal R.L, uni or multilocular A-Pericoronal or follicular space.A-Pericoronal or follicular space. B-Dentigerous cyst.B-Dentigerous cyst. C-AmeloblastomaC-Ameloblastoma D-Odontogenic keratocyst.D-Odontogenic keratocyst. E-Odontogenic fibroma.E-Odontogenic fibroma. F-Odontogenic myxoma.F-Odontogenic myxoma.
  76. 76. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7676 4-4-RL lesions in the midline of maxilla.RL lesions in the midline of maxilla. 1-Median palatine cyst.1-Median palatine cyst. 2-Incisive canal cyst.2-Incisive canal cyst.
  77. 77. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7777 5-5-RL lesions lateral to midline ofRL lesions lateral to midline of maxilla.maxilla. 1- Globulomaxillary cyst1- Globulomaxillary cyst 2- Residual cyst of any type2- Residual cyst of any type
  78. 78. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7878 6-6-Solitary R.L lesions with either wellSolitary R.L lesions with either well or ill-defined margins and notor ill-defined margins and not necessarily containing teeth.necessarily containing teeth. Well-defined marginWell-defined margin 1-Residual cyst1-Residual cyst 2-Traumatic bone cyst2-Traumatic bone cyst 3-Primordial cyst3-Primordial cyst 4-Odontogenic keratocyst4-Odontogenic keratocyst 5- Ameloblastoma5- Ameloblastoma 6-Central giant cell6-Central giant cell granulomagranuloma 7-Central odontogenic7-Central odontogenic fibromafibroma Ill-defined marginIll-defined margin 1-Residual infection1-Residual infection 2-bone loss due to PD2-bone loss due to PD 3-Myloma3-Myloma 4-carcinoma4-carcinoma 5-Ameloplastoma5-Ameloplastoma 6-metastasis6-metastasis 7-osteomylitis7-osteomylitis 8-odontoenic fibroma8-odontoenic fibroma
  79. 79. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 7979 77-Multilocular RL lesion with either well-Multilocular RL lesion with either well or ill-defined margins.or ill-defined margins. Well-definedWell-defined 1-Ameloblastoma1-Ameloblastoma 2-Odontogenic keratocyst2-Odontogenic keratocyst 3-Central g. cell granuloma3-Central g. cell granuloma 4-Odontogenic myxoma4-Odontogenic myxoma 5-Central hemangioma5-Central hemangioma 6-Fibrous dysplasia6-Fibrous dysplasia 7-Cherubism7-Cherubism 8-Anneyrsmal bone cyst8-Anneyrsmal bone cyst 9-Central fibroma9-Central fibroma 10-Traumatic bone cyst10-Traumatic bone cyst Ill-definedIll-defined 1-Ameloblastoma (late stage)1-Ameloblastoma (late stage) 2-Central myxoma (late stage)2-Central myxoma (late stage) 3-Fibrous dysplasia3-Fibrous dysplasia 4-Cherubism4-Cherubism
  80. 80. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8080 8-8- Multiple but separate RL with well-Multiple but separate RL with well- defined or punched out marginsdefined or punched out margins Well-defined marginWell-defined margin 1-Multible myloma.1-Multible myloma. 2-Metastatic carcinoma2-Metastatic carcinoma 3-Histocytosis-X3-Histocytosis-X 4-Cherubism4-Cherubism Punched out marginsPunched out margins 1-Multible myloma1-Multible myloma 2-Metastatic carcinoma2-Metastatic carcinoma 3-Histocytosis-X3-Histocytosis-X
  81. 81. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8181 Radio-opaque lesionsRadio-opaque lesions
  82. 82. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8282 Radio-opaque lesionsRadio-opaque lesions 1-1-Periapical solitary radio-opaque lesionsPeriapical solitary radio-opaque lesions 2-2-Solitary R.O lesions not contacting teethSolitary R.O lesions not contacting teeth 3-3-Multiple separate radio-opacities.Multiple separate radio-opacities. 4-4-Generalized radio-opacities.Generalized radio-opacities.
  83. 83. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8383 1-1-Periapical solitary radio-opaquePeriapical solitary radio-opaque lesionslesions 1-Condesing osteitis1-Condesing osteitis 2-Sclerosing bone2-Sclerosing bone 3-Periapical cementoma (late stage)3-Periapical cementoma (late stage) 4-Odontoma4-Odontoma 5-supernumerary unerupted tooth5-supernumerary unerupted tooth 6-Hypercementosis6-Hypercementosis 7-forign body.7-forign body.
  84. 84. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8484 2-2-SolitarySolitary R.O lesions notR.O lesions not contacting teethcontacting teeth 1- All the above item (Periapical R.O)1- All the above item (Periapical R.O) 8-Osteoma8-Osteoma 9-Salivary gland stone9-Salivary gland stone 10-Osteomlitis10-Osteomlitis 11-Remeaning root11-Remeaning root 12-Unerupted tooth12-Unerupted tooth
  85. 85. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8585 3-3-MultipleMultiple separate radio-separate radio- opacities.opacities. 1-All the first item1-All the first item 8-Paget’s disease8-Paget’s disease 9-Osteogenic sarcoma9-Osteogenic sarcoma
  86. 86. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8686 4-4-Generalized radio-opacitiesGeneralized radio-opacities 1-Paget’s disease1-Paget’s disease 2-Osteopetrosis2-Osteopetrosis
  87. 87. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8787 Combined RL & RO lesionsCombined RL & RO lesions
  88. 88. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8888 Combined RL & RO lesionsCombined RL & RO lesions 1-1-Mixed Periapical lesionsMixed Periapical lesions 2-2-Mixed lesions not necessarily contactingMixed lesions not necessarily contacting a tooth.a tooth. 3-3-Pericoronal mixed lesions.Pericoronal mixed lesions.
  89. 89. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 8989 1-1-Mixed Periapical lesionsMixed Periapical lesions 1-Cementoma1-Cementoma 2-Sclerosing osteitis2-Sclerosing osteitis 3-Odontoma3-Odontoma 4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma
  90. 90. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9090 2-2-Mixed lesions not necessarilyMixed lesions not necessarily contacting a tooth.contacting a tooth. 1-Ostemylitis1-Ostemylitis 2-F.D2-F.D 3-Paget’s disease3-Paget’s disease 4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma 5-Sarcoma5-Sarcoma 6-calcifying cyst6-calcifying cyst 7-Odontoma7-Odontoma 8-Cementoma8-Cementoma
  91. 91. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9191 3-3-Pericoronal mixed lesions.Pericoronal mixed lesions. 1-Odontoma1-Odontoma 2-Calcifying Odontogenic tumor2-Calcifying Odontogenic tumor 3-Calcifying cyst3-Calcifying cyst 4-Odontogenic fibroma4-Odontogenic fibroma
  92. 92. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9292 Most common lesions as seen inMost common lesions as seen in dental radiographsdental radiographs 1-1- Inflammatory lesions.Inflammatory lesions. 2-2-Cysts and pseudocystsCysts and pseudocysts 3-3- Odontogenic tumors.Odontogenic tumors. 4-4- Non Odontogenic tumors.Non Odontogenic tumors. 5-5- Developmental anomalies of teeth.Developmental anomalies of teeth. 6-6- Foreign bodies.Foreign bodies.
  93. 93. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9393 Cysts affecting oral cavityCysts affecting oral cavity
  94. 94. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9494 Cysts affecting oral cavityCysts affecting oral cavity Cyst;Cyst; is a pathological cavity contains fluid oris a pathological cavity contains fluid or semi-solid materialssemi-solid materials Cysts can be true or pseudo according its lining tissues:Cysts can be true or pseudo according its lining tissues: True cysts:True cysts: cysts which lined with epitheliumcysts which lined with epithelium Pseudo-cysts:Pseudo-cysts: cysts whichcysts which notnot lined withlined with epithelium but lined with connective tissueepithelium but lined with connective tissue membranemembrane
  95. 95. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9595 Classification of true Cysts of interest toClassification of true Cysts of interest to the dentistthe dentist I- Odontogenic cystsI- Odontogenic cysts 1-1-Radicular cysts….Radicular cysts…. a-a- Apical…..Apical….. b-b- LateralLateral 2-2-Periodontal cystsPeriodontal cysts 3-3-Odontogenic Keratocysts.Odontogenic Keratocysts. 4-4-DentigerousDentigerous cystcyst 5-5-Residual cysts of all typesResidual cysts of all types..
  96. 96. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9696 II- Non-odontogenic cysts.II- Non-odontogenic cysts. 1- Nasopalatine cysts, Incisive canal cyst1- Nasopalatine cysts, Incisive canal cyst 2- Nasoalveolar cyst, (nasolabial cyst)2- Nasoalveolar cyst, (nasolabial cyst) 3- Median mandibular cyst.3- Median mandibular cyst.
  97. 97. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9797 III. PseudocystsIII. Pseudocysts (not lining with epithelial)(not lining with epithelial) Traumatic bone cyst.Traumatic bone cyst. Aneurysmal bone cyst.Aneurysmal bone cyst. Latent bone cyst.Latent bone cyst.
  98. 98. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9898 Radicular cystsRadicular cysts It developed around apexIt developed around apex of a diseases tooth orof a diseases tooth or around an accessory canalaround an accessory canal from the pulp (lateralfrom the pulp (lateral radicular cyst)radicular cyst) The radiographicThe radiographic appearance of a clinicallyappearance of a clinically symptom-free cyst revealssymptom-free cyst reveals a clear,a clear, RORO borders thatborders that surround the radiolucency.surround the radiolucency.
  99. 99. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 9999 Radicular cystsRadicular cysts
  100. 100. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 100100 Radicular cystsRadicular cysts RoundedRounded RLRL withwith RORO margin at periapicalmargin at periapical region.region. Apex of the toothApex of the tooth isis withinwithin the cystic cavity.the cystic cavity. Adjacent teeth andAdjacent teeth and structures are displaced.structures are displaced. Infected cysts exhibitsInfected cysts exhibits poorly demarcatedpoorly demarcated bordersborders Small, clinically symptom-Small, clinically symptom- free radicular cyst that isfree radicular cyst that is expanding towards the floorexpanding towards the floor of maxillary sinusof maxillary sinus
  101. 101. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 101101 Small, symptomSmall, symptom free radicular cystfree radicular cyst with typical ROwith typical RO boundariesboundaries Infected radicular cyst, hasInfected radicular cyst, has lost its typical radiographiclost its typical radiographic signs as a result of seroussigns as a result of serous infiltration of theinfiltration of the surrounding tissue.surrounding tissue.
  102. 102. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 102102 This infected radicular cystThis infected radicular cyst arising from second premolararising from second premolar and displaces the floor ofand displaces the floor of maxillary sinusmaxillary sinus
  103. 103. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 103103 Typical manifestationTypical manifestation of radiclar cystof radiclar cyst Infected radiclar cystInfected radiclar cyst
  104. 104. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 104104 Atypical manifestation of a radicular cyst -This cyst emanates from the remaining root of lower canine -The radiograph showing a multi-locular pattern -This picture may misdiagnosed as ameloblastoma or keratocyst
  105. 105. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 105105 Residual cyst Residual cyst, May developed following partial removal of any odontogenic cyst. It may be found after extraction of a tooth with radicular cyst
  106. 106. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 106106 Radicular residual cyst Notes the relation to max. sinus
  107. 107. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 107107 Residual cyst
  108. 108. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 108108 Dentigerous cystDentigerous cyst Most common site,Most common site, around the third molararound the third molar and the midline of theand the midline of the maxillamaxilla Radiographically itRadiographically it appears as wellappears as well demarcated unilocular,demarcated unilocular, radiolucent area,radiolucent area, surrounding a crown ofsurrounding a crown of unerupted tooth.unerupted tooth.
  109. 109. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 109109 It is usually attached to the crown at CEJIt is usually attached to the crown at CEJ It may appears lateral to the crown.It may appears lateral to the crown. It may displace the affected tooth from its locationIt may displace the affected tooth from its location
  110. 110. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 110110 Lateral Dentigerous cyst on lower third molar
  111. 111. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 111111 Dentigerous Cyst (Follicular Cyst)Dentigerous Cyst (Follicular Cyst) Always associatedAlways associated with crown of anwith crown of an impacted orimpacted or unerupted (normal orunerupted (normal or supernumerary) tooth.supernumerary) tooth. Due to accumulationDue to accumulation of fluid betweenof fluid between layers of reducedlayers of reduced enamel epithelium orenamel epithelium or between epitheliumbetween epithelium and crown.and crown.
  112. 112. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 112112 Coronal Dentigerous cyst surrounding lateralCoronal Dentigerous cyst surrounding lateral incisor with displaced of canine and retention ofincisor with displaced of canine and retention of deciduous canine.deciduous canine. Tooth 22 appears enlarged and overexposed.Tooth 22 appears enlarged and overexposed. Tooth 23 is displaced in the vistibular direction.Tooth 23 is displaced in the vistibular direction.
  113. 113. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 113113 Dentigerous Cyst (Follicular Cyst)Dentigerous Cyst (Follicular Cyst)
  114. 114. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 114114 Dentigerous Cyst (Follicular Cyst)Dentigerous Cyst (Follicular Cyst)
  115. 115. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 115115 Dentigerous Cyst (Follicular Cyst)Dentigerous Cyst (Follicular Cyst)
  116. 116. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 116116 Eruption cyst on upper 8 as seen in Periapical film It is a type of Dentigerous cysts developed after the formation of dental hard tissues from the enamel epithelium
  117. 117. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 117117 Odontogenic KeratocystOdontogenic Keratocyst Originate before tooth development from a remnantsOriginate before tooth development from a remnants of epithelium has the capacity to produce keratin.of epithelium has the capacity to produce keratin. it appears asit appears as unilocularunilocular oror multilocularmultilocular well-definedwell-defined RL lesion with an ability for root divergence andRL lesion with an ability for root divergence and cortical expansion both buccal & lingual.cortical expansion both buccal & lingual.
  118. 118. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 118118 Odontogenic Keratocyst (OKC)Odontogenic Keratocyst (OKC) Most common site is mandibleMost common site is mandible Can cause severe bone destruction.Can cause severe bone destruction. Can displace teeth and cause rootCan displace teeth and cause root resorption.resorption. Should be followed for recurrence for 5-10Should be followed for recurrence for 5-10 years.years.
  119. 119. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 119119 Odontogenic Keratocyst (OKC)Odontogenic Keratocyst (OKC)
  120. 120. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 120120 Lateral Periodontal CystLateral Periodontal Cyst Arises directly fromArises directly from epithelial cells in PDLepithelial cells in PDL on lateral aspect ofon lateral aspect of tooth.tooth. Origin: cell rests ofOrigin: cell rests of Mallasez or remnantsMallasez or remnants of dental lamina.of dental lamina. Tooth is VITAL.Tooth is VITAL.
  121. 121. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 121121 Lateral Periodontal CystLateral Periodontal Cyst How do youHow do you differentiate this cystdifferentiate this cyst from radicular cystfrom radicular cyst which may develop inwhich may develop in this location?this location? Seen as a unilocular,Seen as a unilocular, well-definedwell-defined radiolucency onradiolucency on lateral aspect of alateral aspect of a vital tooth.vital tooth.
  122. 122. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 122122 Lateral Periodontal CystLateral Periodontal Cyst
  123. 123. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 123123 Nonodontogenic cystsNonodontogenic cysts Nasopalatine cyst Nasoalveolar cystNasoalveolar cyst Soft ts cystSoft ts cyst Median mandibular cystMedian mandibular cyst
  124. 124. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 124124 Or incisive canal cyst, Or anterior maxillary cyst It forms in incisive canal, causing swelling of incisive papilla It may enlarge and extend posteriorly, where it called Median palatine cyst It may extend anteriorly, between central incisors, diverge them and destroy the labial cortical plate, (median alveolar cyst) Nasopalatine cyst
  125. 125. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 125125 Nasopalatine cystNasopalatine cyst Nasopalatine cyst in an earlyNasopalatine cyst in an early stagestage It developed between the rootsIt developed between the roots of two central incisors, forcingof two central incisors, forcing them apart.them apart.
  126. 126. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 126126 Typical nasopalatine cyst as seen in a panoramicTypical nasopalatine cyst as seen in a panoramic radiograph.radiograph. It appears as a typical heart-shape withoutIt appears as a typical heart-shape without displacement of roots of central incisorsdisplacement of roots of central incisors
  127. 127. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 127127 Nasopalatine cyst
  128. 128. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 128128 Nasopalatine cyst
  129. 129. Nasoalveolar cystNasoalveolar cyst Soft tissue cystSoft tissue cyst Swelling of nasolabial fold in the noseSwelling of nasolabial fold in the nose Flaring the ala of the noseFlaring the ala of the nose 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 129129
  130. 130. Symphyseal area of the mandibleSymphyseal area of the mandible Well defined RL area.Well defined RL area. Divergence of the rootsDivergence of the roots Vital teeth with intact LDVital teeth with intact LD 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 130130 Median mandibular cystMedian mandibular cyst
  131. 131. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 131131 Traumatic bone cystTraumatic bone cyst PseudocystsPseudocysts Usually affect mandibleUsually affect mandible Well or ill defined RLWell or ill defined RL areaarea Scalloped outlinesScalloped outlines Displaced of the rootsDisplaced of the roots
  132. 132. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 132132 Traumatic bone cystTraumatic bone cyst
  133. 133. Aneurysmal bone cystAneurysmal bone cyst Premolar molar areas of mandiblePremolar molar areas of mandible Well defined RL area, smooth outlinesWell defined RL area, smooth outlines Thining of inferior border of the mandibleThining of inferior border of the mandible Soab bubble appearanceSoab bubble appearance 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 133133
  134. 134. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 134134 Developmental Lingual Mandibular SalivaryDevelopmental Lingual Mandibular Salivary Gland Depression (Gland Depression (Latent bone cyst)Latent bone cyst) Other names: Stafne’s defect, Stafne’s cyst,Other names: Stafne’s defect, Stafne’s cyst, static bone cavity, latent bone cyst.static bone cavity, latent bone cyst. Part of submandibular salivary glandPart of submandibular salivary gland develops or lies in a deep, well-defineddevelops or lies in a deep, well-defined depression on lingual surface of mandible.depression on lingual surface of mandible. Occasionally, glandular tissue may beOccasionally, glandular tissue may be included centrally within the bone.included centrally within the bone.
  135. 135. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 135135 Developmental Lingual MandibularDevelopmental Lingual Mandibular Salivary Gland Depression (Cont.)Salivary Gland Depression (Cont.) Radiographically, seen asRadiographically, seen as a well-defineda well-defined radiolucency near lowerradiolucency near lower border and angle ofborder and angle of mandible, below themandible, below the inferior alveolar canal.inferior alveolar canal. Patients arePatients are asymptomatic; discoveredasymptomatic; discovered during routineduring routine radiographic exam.radiographic exam. May be unilateral orMay be unilateral or bilateral.bilateral.
  136. 136. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 136136 Latent bone cystLatent bone cyst closedclosed openopen openopen
  137. 137. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 137137
  138. 138. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 138138
  139. 139. Dental RadiographicDental Radiographic interpretationinterpretation 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 139139 15 March 2016
  140. 140. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 140140 Radiographically, Jaw lesions may classified into:Radiographically, Jaw lesions may classified into: I-I- Radiolucent lesionsRadiolucent lesions II-II- Radiopaque lesionsRadiopaque lesions III-III- Combination of RL + RO. lesions.Combination of RL + RO. lesions.
  141. 141. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 141141 Radiolucent lesionsRadiolucent lesions
  142. 142. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 142142 Radiolucent lesionsRadiolucent lesions 1-1-Lesions related to tooth apexLesions related to tooth apex 2-2-Lesions related to side of rootsLesions related to side of roots 3-3-Lesions related to crown of unerupted orLesions related to crown of unerupted or impacted toothimpacted tooth 4-4-Unilocular lesions in midline of maxilla.Unilocular lesions in midline of maxilla. 5-5-Unilocular lesions lateral to midline of maxilla.Unilocular lesions lateral to midline of maxilla. 6-6-Solitary RL lesion with either well or ill- definedSolitary RL lesion with either well or ill- defined margins.margins. 7-7-Multilocular RL lesion with either well or ill-Multilocular RL lesion with either well or ill- defined margins.defined margins. 8-8-Multiple but separate RL with well-defined orMultiple but separate RL with well-defined or punched out marginspunched out margins
  143. 143. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 143143 1-1- Radiolucent lesions related toRadiolucent lesions related to tooth apex:tooth apex: A- Periapical cystA- Periapical cyst B- Periapical granulomaB- Periapical granuloma C- Periapical abscessC- Periapical abscess D- Periapical periodontitisD- Periapical periodontitis E- Periapical cementoma. (early stage)E- Periapical cementoma. (early stage) F- Periapical scarF- Periapical scar
  144. 144. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 144144 2-2-Radiolucent lesions related toRadiolucent lesions related to sides of roots:sides of roots: 1- Lateral periodontal cyst1- Lateral periodontal cyst 2- Periodontal abscess.2- Periodontal abscess.
  145. 145. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 145145 3-3-Lesions related to crown ofLesions related to crown of unerupted or impacted toothunerupted or impacted tooth Pericoronal R.L, uni or multilocularPericoronal R.L, uni or multilocular A-Pericoronal or follicular space.A-Pericoronal or follicular space. B-Dentigerous cyst.B-Dentigerous cyst. C-AmeloblastomaC-Ameloblastoma D-Odontogenic keratocyst.D-Odontogenic keratocyst. E-Odontogenic fibroma.E-Odontogenic fibroma. F-Odontogenic myxoma.F-Odontogenic myxoma.
  146. 146. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 146146 4-4-RL lesions in the midline of maxilla.RL lesions in the midline of maxilla. 1-Median palatine cyst.1-Median palatine cyst. 2-Incisive canal cyst.2-Incisive canal cyst.
  147. 147. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 147147 5-5-RL lesions lateral to midline ofRL lesions lateral to midline of maxilla.maxilla. 1- Globulomaxillary cyst1- Globulomaxillary cyst 2- Residual cyst of any type2- Residual cyst of any type
  148. 148. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 148148 6-6-Solitary R.L lesions with either wellSolitary R.L lesions with either well or ill-defined margins and notor ill-defined margins and not necessarily containing teeth.necessarily containing teeth. Well-defined marginWell-defined margin 1-Residual cyst1-Residual cyst 2-Traumatic bone cyst2-Traumatic bone cyst 3-Primordial cyst3-Primordial cyst 4-Odontogenic keratocyst4-Odontogenic keratocyst 5- Ameloblastoma5- Ameloblastoma 6-Central giant cell6-Central giant cell granulomagranuloma 7-Central odontogenic7-Central odontogenic fibromafibroma Ill-defined marginIll-defined margin 1-Residual infection1-Residual infection 2-bone loss due to PD2-bone loss due to PD 3-Myloma3-Myloma 4-carcinoma4-carcinoma 5-Ameloplastoma5-Ameloplastoma 6-metastasis6-metastasis 7-osteomylitis7-osteomylitis 8-odontoenic fibroma8-odontoenic fibroma
  149. 149. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 149149 77-Multilocular RL lesion with either well-Multilocular RL lesion with either well or ill-defined margins.or ill-defined margins. Well-definedWell-defined 1-Ameloblastoma1-Ameloblastoma 2-Odontogenic keratocyst2-Odontogenic keratocyst 3-Central g. cell granuloma3-Central g. cell granuloma 4-Odontogenic myxoma4-Odontogenic myxoma 5-Central hemangioma5-Central hemangioma 6-Fibrous dysplasia6-Fibrous dysplasia 7-Cherubism7-Cherubism 8-Anneyrsmal bone cyst8-Anneyrsmal bone cyst 9-Central fibroma9-Central fibroma 10-Traumatic bone cyst10-Traumatic bone cyst Ill-definedIll-defined 1-Ameloblastoma (late stage)1-Ameloblastoma (late stage) 2-Central myxoma (late stage)2-Central myxoma (late stage) 3-Fibrous dysplasia3-Fibrous dysplasia 4-Cherubism4-Cherubism
  150. 150. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 150150 8-8- Multiple but separate RL with well-Multiple but separate RL with well- defined or punched out marginsdefined or punched out margins Well-defined marginWell-defined margin 1-Multible myloma.1-Multible myloma. 2-Metastatic carcinoma2-Metastatic carcinoma 3-Histocytosis-X3-Histocytosis-X 4-Cherubism4-Cherubism Punched out marginsPunched out margins 1-Multible myloma1-Multible myloma 2-Metastatic carcinoma2-Metastatic carcinoma 3-Histocytosis-X3-Histocytosis-X
  151. 151. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 151151 Radio-opaque lesionsRadio-opaque lesions
  152. 152. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 152152 Radio-opaque lesionsRadio-opaque lesions 1-1-Periapical solitary radio-opaque lesionsPeriapical solitary radio-opaque lesions 2-2-Solitary R.O lesions not contacting teethSolitary R.O lesions not contacting teeth 3-3-Multiple separate radio-opacities.Multiple separate radio-opacities. 4-4-Generalized radio-opacities.Generalized radio-opacities.
  153. 153. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 153153 1-1-Periapical solitary radio-opaquePeriapical solitary radio-opaque lesionslesions 1-Condesing osteitis1-Condesing osteitis 2-Sclerosing bone2-Sclerosing bone 3-Periapical cementoma (late stage)3-Periapical cementoma (late stage) 4-Odontoma4-Odontoma 5-supernumerary unerupted tooth5-supernumerary unerupted tooth 6-Hypercementosis6-Hypercementosis 7-forign body.7-forign body.
  154. 154. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 154154 2-2-SolitarySolitary R.O lesions notR.O lesions not contacting teethcontacting teeth 1- All the above item (Periapical R.O)1- All the above item (Periapical R.O) 8-Osteoma8-Osteoma 9-Salivary gland stone9-Salivary gland stone 10-Osteomlitis10-Osteomlitis 11-Remeaning root11-Remeaning root 12-Unerupted tooth12-Unerupted tooth
  155. 155. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 155155 3-3-MultipleMultiple separate radio-separate radio- opacities.opacities. 1-All the first item1-All the first item 8-Paget’s disease8-Paget’s disease 9-Osteogenic sarcoma9-Osteogenic sarcoma
  156. 156. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 156156 4-4-Generalized radio-opacitiesGeneralized radio-opacities 1-Paget’s disease1-Paget’s disease 2-Osteopetrosis2-Osteopetrosis
  157. 157. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 157157 Combined RL & RO lesionsCombined RL & RO lesions
  158. 158. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 158158 Combined RL & RO lesionsCombined RL & RO lesions 1-1-Mixed Periapical lesionsMixed Periapical lesions 2-2-Mixed lesions not necessarily contactingMixed lesions not necessarily contacting a tooth.a tooth. 3-3-Pericoronal mixed lesions.Pericoronal mixed lesions.
  159. 159. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 159159 1-1-Mixed Periapical lesionsMixed Periapical lesions 1-Cementoma1-Cementoma 2-Sclerosing osteitis2-Sclerosing osteitis 3-Odontoma3-Odontoma 4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma
  160. 160. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 160160 2-2-Mixed lesions not necessarilyMixed lesions not necessarily contacting a tooth.contacting a tooth. 1-Ostemylitis1-Ostemylitis 2-F.D2-F.D 3-Paget’s disease3-Paget’s disease 4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma 5-Sarcoma5-Sarcoma 6-calcifying cyst6-calcifying cyst 7-Odontoma7-Odontoma 8-Cementoma8-Cementoma
  161. 161. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 161161 3-3-Pericoronal mixed lesions.Pericoronal mixed lesions. 1-Odontoma1-Odontoma 2-Calcifying Odontogenic tumor2-Calcifying Odontogenic tumor 3-Calcifying cyst3-Calcifying cyst 4-Odontogenic fibroma4-Odontogenic fibroma
  162. 162. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 162162 Odontogenic TumorsOdontogenic Tumors
  163. 163. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 163163 Odontogenic TumorsOdontogenic Tumors They develops as neoplasias from the dental lamina. They are usually benign but several of them have the tendency towards malignant transformation. Because growth occurs only slowly, asymptomatically and without any changes in mucosal appearance, The existence of such lesions in their early stages is usually detected only by chance, or after the development of some structural deformation.
  164. 164. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 164164 AmeloblastomaAmeloblastoma Benign but locally invasive neoplasm.Benign but locally invasive neoplasm. Arises from epithelial remnants of dentalArises from epithelial remnants of dental lamina or dental organ.lamina or dental organ. Cells do not differentiate enough to formCells do not differentiate enough to form enamel.enamel. Extreme expansion of bone,Extreme expansion of bone, Resorption of adjoining roots.Resorption of adjoining roots. May cause perforation of cortical bone.May cause perforation of cortical bone. Average age at discovery: 35-40 years.Average age at discovery: 35-40 years.
  165. 165. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 165165 Most common sites of ameloblastoma 80% 20%
  166. 166. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 166166 Ameloblastoma (Cont.)Ameloblastoma (Cont.) Occasionally develops in the wall ofOccasionally develops in the wall of dentigerous cyst (mural Ameloblatoma).dentigerous cyst (mural Ameloblatoma). 80% in mandible. ¾ of these in molar-80% in mandible. ¾ of these in molar- ramus area.ramus area. Pain and paresthesia not common.Pain and paresthesia not common. Extremely high recurrence rate.Extremely high recurrence rate.
  167. 167. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 167167 Ameloblastoma (Cont.)Ameloblastoma (Cont.) Most often a well-corticated multilocularMost often a well-corticated multilocular radiolucency.radiolucency. ““Honey-comb”, “soap-bubble” or “tennis-racket”Honey-comb”, “soap-bubble” or “tennis-racket” appearance.appearance. May be a well-corticated unilocular lesionMay be a well-corticated unilocular lesion resembling a cyst.resembling a cyst. HoneyHoney comb-like smallcomb-like small ameloblastoma atameloblastoma at early stage withearly stage with evidence of rootevidence of root resorption.resorption.
  168. 168. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 168168 Ameloblastoma Ameloblastoma at the angle of the mandible. Expansive form with oval RL traversed by few very thin septa
  169. 169. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 169169 Ameloblastoma Soap-like form of ameloblastoma of the molar region.
  170. 170. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 170170 Ameloblastoma Large multilocular soap bubble appearance. Typically located in the molar region, angle of the mandible and ascending ramus Thin not penetrated cortical plate. Impacted or neighboring teeth are displaced with roots often resorped.
  171. 171. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 171171 Ameloblastoma in early stages with lobularAmeloblastoma in early stages with lobular patternpattern
  172. 172. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 172172 AmeloblastomaAmeloblastoma
  173. 173. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 173173 Large ameloblastoma in the right ascending ramus of the mandible
  174. 174. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 174174 AmeloblastomaAmeloblastoma
  175. 175. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 175175 AmeloblastomaAmeloblastoma
  176. 176. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 176176 Ameloblastic fibromaAmeloblastic fibroma
  177. 177. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 177177 Ameloblastic fibromaAmeloblastic fibroma Appears as a follecularAppears as a follecular cystic cavitycystic cavity surrounding a crown ofsurrounding a crown of a tooth.a tooth. In early stages appearsIn early stages appears as a hat upon theas a hat upon the occlusal surface ofocclusal surface of affected toothaffected tooth
  178. 178. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 178178 Most common site, lower premolar molar region Well defined RL, may be corticated, unilocular or sometimes multilocular Inhibition of eruption of involved tooth or displaced apically
  179. 179. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 179179 More advanced case of ameloblastic fibroma demonstrates how the follicular sac is opened. Note also the displacement of the tooth bud of lower 8 in the ascending ramus.
  180. 180. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 180180 Odontogenic myxomaOdontogenic myxoma It is a benign, mucous-It is a benign, mucous- containing tumor thatcontaining tumor that originates from the toothoriginates from the tooth bud.bud. It appears as a soapIt appears as a soap bubble-like appearance.bubble-like appearance. Cyst like unilocular orCyst like unilocular or multilocular with mantmultilocular with mant septa giving tennis racketsepta giving tennis racket apperancapperanc It cause toothIt cause tooth displacementdisplacement
  181. 181. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 181181
  182. 182. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 182182 CementomaCementoma
  183. 183. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 183183 CementomaCementoma Usually appears at lowerUsually appears at lower anterior area.anterior area. First appears as fibrousFirst appears as fibrous tissue stage, which maytissue stage, which may confused with aconfused with a granuloma (vitality test).granuloma (vitality test). The second stage isThe second stage is characterized withcharacterized with accumulation of calcifiedaccumulation of calcified materials.materials. The third stage consists ofThe third stage consists of radio-opaque materials.radio-opaque materials. Early stageEarly stage
  184. 184. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 184184 R.LR.L R.L+R.OR.L+R.O
  185. 185. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 185185 Periapical cemental dysplasia
  186. 186. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 186186 Periapical Cemental DysplasiaPeriapical Cemental Dysplasia
  187. 187. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 187187 CementoblastomaCementoblastoma ( True Cementoma )( True Cementoma ) Slow growing neoplasmSlow growing neoplasm composed of cementum.composed of cementum. Usually solitary lesionUsually solitary lesion seen as a growth onseen as a growth on root of tooth.root of tooth. Most common inMost common in mandible, premolar ormandible, premolar or 11stst molar (80%).molar (80%).
  188. 188. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 188188 Cementoblastoma Appears as a wellAppears as a well defined RO areadefined RO area with a thin RL bandwith a thin RL band around itaround it May cause externalMay cause external root resorptionroot resorption
  189. 189. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 189189 Cementoblastoma It not removed after tooth extraction Remarks the RL related to canine and second premolar, it is another cementoblastoma in the fibrous stage.
  190. 190. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 190190 Cementoblastoma Another case remaining after tooth extraction. It surrounded by the radiographic signs of chronic inflammation. Periapical cemental dysplasia related to 4 tooth
  191. 191. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 191191 Odontoma Most common sites Tumor characterized by production of enamel, dentin, cementum and pulp tissue
  192. 192. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 192192 OdontomaOdontoma Complex typeComplex type
  193. 193. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 193193 OdontomaOdontoma Intermediate typeIntermediate type
  194. 194. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 194194 OdontomaOdontoma Intermediate typeIntermediate type
  195. 195. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 195195 OdontomaOdontoma Compound typeCompound type
  196. 196. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 196196 Compound odontoma in maxillary tubrosity
  197. 197. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 197197 Complex odontoma in maxillary tubrosity
  198. 198. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 198198 Compound Composite OdontomaCompound Composite Odontoma Composed of enamelComposed of enamel and dentin.and dentin. Enamel and dentinEnamel and dentin are laid down in anare laid down in an orderly fashion soorderly fashion so that the mass hasthat the mass has some similarity tosome similarity to normal teeth.normal teeth. Appears like a bunchAppears like a bunch of small teeth.of small teeth.
  199. 199. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 199199 Compound Composite OdontomaCompound Composite Odontoma
  200. 200. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 200200 Osteoma Central Osteoma at the mental area Symptomless lesion Mandible is more affected post area Compact bone
  201. 201. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 201201 Central Osteoma anterior to remaining roots of lower 7
  202. 202. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 202202 Peripheral osteoma located in maxillary sinus
  203. 203. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 203203 Peripheral osteoma in right angle of the mandible It may confused with calcified lymph noads
  204. 204. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 204204 OsteomaOsteoma
  205. 205. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 205205 Central HemangiomaCentral Hemangioma Tumor characterized byTumor characterized by proliferation of bloodproliferation of blood vessels.vessels. Central hemangiomas ofCentral hemangiomas of jaws uncommon.jaws uncommon. 50% occur in children50% occur in children and teens.and teens. More common in femalesMore common in females and mandible.and mandible. Well-defined or ill-Well-defined or ill- defined, unilocular ordefined, unilocular or multilocular radiolucency.multilocular radiolucency.
  206. 206. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 206206 Central Hemangioma (Cont.)Central Hemangioma (Cont.) May cause expansion of bone andMay cause expansion of bone and resorption of teeth.resorption of teeth. Early treatment is desirable in orderEarly treatment is desirable in order to avoid profuse bleeding due toto avoid profuse bleeding due to accidental trauma. Aspiration prior toaccidental trauma. Aspiration prior to surgical procedure is advised.surgical procedure is advised.
  207. 207. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 207207 Central Hemangioma (Cont.)Central Hemangioma (Cont.)
  208. 208. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 208208 Central Hemangioma (Cont.)Central Hemangioma (Cont.)
  209. 209. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 209209 Malignant tumors Sarcoma Carcinoma. Metastasis.
  210. 210. Benign tumorsBenign tumors Growth of new tissues resemble tGrowth of new tissues resemble t the originthe origin Growth by direct extensionGrowth by direct extension Insidious onsetInsidious onset Rl + RO, Well defined bordersRl + RO, Well defined borders Tooth displacement, or rootTooth displacement, or root resorptionresorption Expansion or thinning of corticalExpansion or thinning of cortical bonebone No metastasisNo metastasis Not life thearatingNot life thearating 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 210210 Malignant tumorsMalignant tumors Growth a newGrowth a new tissue with anaplasiatissue with anaplasia Growth byGrowth by infiltration and destructioninfiltration and destruction Sudden onsetSudden onset Totally RL, IllTotally RL, Ill defined bordersdefined borders Punched outPunched out bordersborders Destruction ofDestruction of alveolar bone, teeth floating oralveolar bone, teeth floating or displaced occlusallydisplaced occlusally Erosion andErosion and destruction of cortical bonedestruction of cortical bone
  211. 211. Radiographic features of malignantRadiographic features of malignant tumorstumors Ill defined, invasive borders.Ill defined, invasive borders. Bone destructionBone destruction Destruction of cortical boundary like floor of Max.sinusDestruction of cortical boundary like floor of Max.sinus Irregular thickening of periodontal membrane spaceIrregular thickening of periodontal membrane space due to invasion of bonedue to invasion of bone Displacing the developing teeth in occlusal direction.Displacing the developing teeth in occlusal direction. Bone destruction around teeth make teeth like floatingBone destruction around teeth make teeth like floating in spacein space 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 211211
  212. 212. Radiographic features of malignant tumorsRadiographic features of malignant tumors 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 212212
  213. 213. Clinical features of malignant tumorsClinical features of malignant tumors Displaced teeth,Displaced teeth, Looseness of teeth in short timeLooseness of teeth in short time Ulcers unhealed for more than 3 monthsUlcers unhealed for more than 3 months Foul odorFoul odor Fixed lymphadenopathyFixed lymphadenopathy Exposure of boneExposure of bone Sever painSever pain SwellingSwelling 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 213213
  214. 214. Classification of malignant tumorsClassification of malignant tumors CarcinomaCarcinoma, Lateral border of tongue, lip floor of mouth, soft palate, Lateral border of tongue, lip floor of mouth, soft palate SarcomaSarcoma OsteosarcomaOsteosarcoma Hematopoietic systemHematopoietic system Multiple myelomaMultiple myeloma 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 214214
  215. 215. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 215215 Osteosarcoma This tumor, which affects males twice as females, exhibit a predilection for the mandible. Radiographically, bone destruction as well as new bone formation (Osteoblastic) and osteolysis can be observed, along with perforation of the compact bone with spicules (sunrays effect), where the lesion borders on the soft tissues
  216. 216. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 216216 Osteosarcoma Ill defined border, RL Appears as irregular areas of osteolysis and new osteoblastic bone formation at the extraction site of lower 6.
  217. 217. Radiographic appearanceRadiographic appearance Appears ill defined RL Or combined Rl +Appears ill defined RL Or combined Rl + RO, area with no peripheral sclerosisRO, area with no peripheral sclerosis If it involve periosteum, it give Sunray orIf it involve periosteum, it give Sunray or Hair-on-end speculate appearance, due toHair-on-end speculate appearance, due to radiating mineralized speculateradiating mineralized speculate Widening of periodontal membrane spaceWidening of periodontal membrane space Loss of lamina duraLoss of lamina dura Floating teethFloating teeth 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 217217
  218. 218. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 218218 Mixed form of ostiosarcoma: In addition to areas of new bone formation, osteolysis and destruction of the compact bone can be observed. Note the areas of spicules (arrows) and spontaneous fracture (arrow)
  219. 219. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 219219 Osteosarcoma
  220. 220. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 220220 Osteosarcoma
  221. 221. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 221221
  222. 222. Multiple mylomaMultiple myloma 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 222222 Malignant fatal neoplasm of plasma cells Long bone more then jaws (2%) Mandible more than maxilla Well defined RL area not corticated, appears punched out Teeth may appears floating
  223. 223. Multiple mylomaMultiple myloma 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 223223
  224. 224. 03/15/1603/15/16 Ossama El-ShallOssama El-Shall 224224 Thank you all for listening Dr. Ossama El-Shall Chairman of Oral Medicine & Periodontology department, Faculty of Dental Medicine for girls, Al-Azhar University, Cairo, Egypt. E-mail address: oelshall@hotmail.com

×