Cysts and Odontogenic Tumors4

8/13/2019 Cysts and Odontogenic Tumors4

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Odontogenic ysts andTumorsPresented by:

Reema Al-Shawaf


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Introduction

There are variety of cysts and tumors that

affect the osseous marrow and cortex of

the jaw bones, which are uniquelyderived

from the tissues of developing teeth.


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Presentation Outline

Introduction

Odontogenic Cysts

Odontogenic tumors


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Odontogenic Cysts

A cyst is a pathologic cavity filled with

fluid, lined by epitheliumand surrounded

by a definite connective tissue wall.


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Odontogenic Jaw Cysts

Odontogenic cysts arise from tooth development

epithelium.

Odontogenic cysts are true cysts occurring in thejaws. They arisefrom stimulation ofepithelium

left over from tooth development.


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Odontogenic Jaw Cysts

Odontogenic cysts include:

Radicular (Apical) Cyst

Residual cysts

Dentigerous Cyst

Odontogenic Keratocyst

Lateral Periodontal cyst


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Apical Cyst (Radicular Cyst,

Periapical Cyst)

A radicular cystis a cyst

that most likely results

when rests of epthielial

cellsin the periodontal

ligament are stimulated

by inflammatory products

from a non vital tooth.


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Periapical Cyst) Features

It develops in apreexisting periapicalgranuloma.

It has similar radiographicappearance as theperiapical granuloma: round or oval radiolucency

well defined

well corticated iflongstanding

The adjacent teeth canbe displaced but rarelyresorbed.


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Periapical Cyst)


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Residual Cysts

A Residual cyst is a

cyst that develops

after incomplete

removalof the originalcyst.


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Residual Cysts

It is a radicular cyst remaining

after the tooth has been

extracted.

Usually asymptomatic. Usually

small size (less than 1 cm in

diameter).

Unilocular, round or oval, well-

defined, usually well-

corticated.

It can cause bone expansionand displacement of the

adjacent teeth.


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Dentigerous Cyst (Follicular

Cyst) A Dentigerous cyst is

a cyst that forms

around the crown of

an unerupted tooth.
http://www.usc.edu/hsc/dental/PTHL312abc/312b/10/IMGs/015big.html


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Dentigerous Cyst (Follicular Cyst)

It arises in the follicular region ofunerupted permanent tooth.

It develops after fluid accumulatesbetween the remnants of enamelorgan and the tooth crown.

Usually adolescents,20-40yearsold.

Most common sites:mandibularthird molar, maxillary canine,maxillary third molar.

Unilocular radiolucency, well-defined, often corticated,associated with the crown of anunerupted and displaced tooth.

Large cysts tend to expand the

outer plate (usually buccally)


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Dentigerous Cyst (Follicular Cyst)
http://www.usc.edu/hsc/dental/PTHL312abc/312b/10/IMGs/019big.htmlhttp://www.usc.edu/hsc/dental/PTHL312abc/312b/10/IMGs/017big.htmlhttp://www.usc.edu/hsc/dental/PTHL312abc/312b/10/IMGs/014big.htmlhttp://www.usc.edu/hsc/dental/PTHL312abc/312b/10/IMGs/013big.html


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Odontogenic Keratocyst(Keratocyst, Keratinizing Cyst)

This is a non-

inflammatory

odontogenic cyst that

arises from the dentallamina.


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Features

It is lined by keratinizing epithelium.

It is usually located in themandible(posterior body and ramus region).

most develop during the secondand third decade.

It can become very large. It extendsalong the body of the mandiblecausing minimal mediolateralexpansion.


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Features

Unilocular (often with scallopedmargins) or multilocular (more oftenin larger lesions)

Smooth margins, well-defined,

often well-corticated.

Tendency for recurrence afterinadequate surgery.

Adjacent teeth: vital, rarelyresorbed.


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Lateral Periodontal Cyst

Lateral Periodontal

Cystare thought to

arise from Epithelial

rests in periodontumlateralto the tooth

root.
http://www.usc.edu/hsc/dental/PTHL312abc/312b/10/IMGs/062big.htmlhttp://www.usc.edu/hsc/dental/PTHL312abc/312b/10/IMGs/061big.html


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Lateral Periodontal Cyst

It is a developmental odontogeniccyst. It arises from remnants of thedental lamina or from the reducedenamel epithelium.

Common site: Along the lateral

surface of the root of vital tooth.Usually in mandibularpremolar/canine region.

Usually asymptomatic.

Small size (less than 1 cm indiameter).

Unilocular, round or oval, well-defined, usually well corticatedradiolucency.


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II. Odontogenic Tumors


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OdontogenicTumors

Epithelial Mixed Mesodermal


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EpithelialOdontogenic

Tumors

AmeloblastomaAdenomatoidodontogenic

tumor

Calcifyingepithelial

odontogenictumor


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Ameloblastoma

This a true neoplasm of

odontogenic epithelium

It is an aggressive

neoplasm the arises from

the remnants of the

dental lamina and dental

organ( odontogenic

epithelium)


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Ameloblastoma Benign, locally aggressive

odontogenic tumor. Usually itslowly grows as painless swellingof the affected site.

It can occur at any age.

Localized invasion into thesurrounding bone.

80-95% in the mandible (posteriorbody, ramus region). In the maxilla

mostly in the premolar-molarregion.


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Ameloblastoma Unilocular (small lesions).

Multilocular (large discrete areas orhoneycomb appearance)

Smooth, well-defined, well-corticated margins

Adjacent teeth are often displacedand resorbed.

It causes extensive boneexpansion.

Incomplete removal can result inrecurrence.


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Ameloblastoma


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Ameloblastoma


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Adenomatoid Odontogenic Tumor

("Adenoameloblastoma")

These are uncommon ,

nonaggressive tumors of

odontoginc epthilum.


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Adenomatoid odontogenic tumor

Features

Benign. Relatively rare.

It occurs in young patients (70% of

cases in patients younger than 20years).

Most common site: anterior maxilla.

Often surrounds an entire unerupted

tooth (most commonly the canine).

Usually well defined, well corticated.Some tumors are totally radiolucent;others show evidence of internalclassification.


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Calcifying epithelial odontogenic

tumor (Pindborg tumor

These are rare

neoplasms of the

toothproducingapparuts.


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Calcifying epithelial odontogenic

tumor (Pindborg tumor Rare benign neoplasm.

It occurs more often in middle-

aged patients.

Usually in mandible.

Small lesions may be

radiolucent. In advanced

stages irregularly sizedcalcifications may be scattered

in the radiolucency.

It can cause displacement and

impaction of teeth.


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MixedOdontogenic

Tumors

OdontomasAmeloblastic

fibro-odontomaAmeloblastic

fibromaAmeloblastic

odontomaOdontomas


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Odontomas

It is a tumor that is

radiogrphically and

histologically

characterized by theproduction of mature

enamel , dentin ,

cementum and pulp

tissue . Compound # complex


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Odontoma

Features

Relatively common lesion.

It usually occurs in young patients.

Usually asymptomatic.

Failure of eruption of a permanent toothmay be the first presenting symptom.It iscommonly found occlusal to the involved

tooth.


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Odontoma

Features

Two types: complex and compoundodontoma.

Complex odontoma is composed ofhaphazardly arranged dental hard andsoft tissues.

Compound odontoma is composed of

many small "denticles" .

Well defined. The internal aspect isvery radiopaque in comparison tobone.


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Odontoma


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Ameloblastic fibroma

These are benign mixed

odontogenic tumors .

They are characterized

by neoplastic proliferationof maturing and early

functional ameloblasts as

well as the primitive

mesnchymel componentsof the dental papilla


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Benign Rare. Occurs in children and

adolescents.

Most common site: mandible posterior

region.

Often associated with an unerupted

tooth.

Well defined, well corticated. Small

lesions are monolocular. Large lesionsare multilocular.

It may cause displacement of adjacent

teeth. Large lesions cause

buccal/lingual expansion.


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A l bl ti


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Ameloblastic

fibro-odontoma

This is an extremely rare lesion. It consists

of elements of ameloblastic fibroma with

small segments of enamel and dentin.


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MesodermalOdontogenic

Tumors

Odontogenicmyxoma

(myxofibroma)

Cemento-blastoma

Odontogenicfibroma


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Odontogenic myxoma (myxofibroma)

They are benign,

intraosseous

neoplasms that arise

from the

mesenchymal portion

of the dental papilla.


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Features

It represents approximately 3 - 6%of all odontogenic tumors. It ispainless and grows slowly.

It can occur at any age but mostcommonly in the second and thirddecades of life.

More often affect the mandible(molar/premolar region).


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Features

Typically multilocular (internalsepta- strings of a tennis racket orhoneycomb appearance). Largelesions can have the sun ray

appearance of an osteosarcoma.

Often well-defined.

Adjacent teeth can be displacedbut rarely resorbed. It causes less

bone expansion than in otherbenign tumors.


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Cementoblastoma

This is a slow growing

mesenchymal

neoplasms composed

principally ofcementum.


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Cementoblastoma

Features

Benign neoplasm. Most commonlyin the second and third decade.

Site: usually mandibular premolar

and molar regions.

Attached to the root of the affectedtooth. Tooth displacement,resorption are common.

Pain in 50% of the cases,swelling.

When radiopaque is usuallysurrounded by a thin radiolucenthalo.


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Radiographic Features

Location:

Periphery:well defined RO

with RL hallo surrounding the

calcified mass.

Internal structure:mixed RL-

RO leseions may be

amorphous

Effect on surrounding tissues:

expansion, external root

resorption

Cementoblastoma


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Cementoblastoma

Odontogenic


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Odontogenic

fibroma

Features Rare neoplasm. More often

between the ages 10 and 40 years.

Asymptomatic or swelling and tooth

mobility

More common sites: mandible(premolar-molar region), maxilla(anterior region)

Small lesions are usually unilocular,and larger lesions multilocular.

Well-defined margins.

Adjacent teeth: often displaced,impaction, root resorption.


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Thank you

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Cysts and Odontogenic Tumors4