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Odontogenic Myxoma
Paul Concepcion
Odontogenic Myxoma
an uncommon benign odontogenic tumor arising from embryonic connective tissue associated with tooth formation This is a benign neoplasm that may be infiltrative and aggressive
Odontogenic Myxoma
Clinical Features
Mean age of occurrence is 30 years old With no gender predilection Lesions may be seen in either jaws
Mandible 63% Maxilla 37%
Odontogenic Myxoma
In the maxilla: it can be found anywhere in the maxilla and constantly involve the maxillary sinus
Odontogenic Myxoma
In the mandible: lesions are generally found in the molar and premolar region. Which may extend to the ascending ramus and the condylar region
Odontogenic Myxoma
Clinical Features
These are painless, slow growing which cause root dilaceration and in some cases root resorption Generally associated with retained or missing teeth Causes cortical expansion and eventual perforation, and results to tumefaction and facial deformity
Odontogenic Myxoma
Radiographic Features
It may appear as a well-circumscribed or a diffuse radiolucent lesion Often, it is multiloculated and has a honeycomb pattern
Odontogenic Myxoma
Odontogenic Myxoma
Odontogenic Myxoma
Histopathology
This tumor is composed of bland, relatively acellular myxomatous connective tissue Benign fibroblasts and myofibroblasts with variable amounts of collagen are found in a mucopolysaccharide matrix Odontogenic rests are absent
Odontogenic Myxoma
Odontogenic Myxoma
Odontogenic Myxoma
Differential Diagnosis
Ameloblastoma Central Hemangioma Giant Cell Granuloma
Odontogenic Myxoma
Treatment and Prognosis
Surgical excision For small unilocular lesions enucleation and curettage followed by chemical bone cautery can be done
Prognosis is very good.
Benign Cementoblastoma
Anne Celso
BENIGN CEMENTOBLASTOMA
CLINICAL FEATURES
-aka true cementoma -benign neoplasm and forms a mass of cementum-like tissue as an irregular or round mass attached to the roots of a tooth -often involving the mandibular molars or premolars -involved tooth usually has a vital pulp -usually occurs in people under the age of 25 -asymptomatic
BENIGN CEMENTOBLASTOMA
BENIGN CEMENTOBLASTOMA
CLINICAL FEATURES -have unlimited growth potential -behave in a locally aggressive manner resulting in bony expansion, root resorption, displacement of adjacent teeth, and jaw deformity -higher predilection for males
BENIGN CEMENTOBLASTOMA
BENIGN CEMENTOBLASTOMA
RADIOGRAPHIC APPEARANCE -appears as a well-defined, markedly radiopaque mass, with a radiolucent peripheral "line", which overlies and obliterates the tooth root -there is usually apparent external resorption of the root where the tumor and the root join.
BENIGN CEMENTOBLASTOMA
RADIOGRAPHIC APPEARANCE
BENIGN CEMENTOBLASTOMA
MICROSCOPIC APPEARANCE -presents cementum-like tissue with numerous reversal lines -prominent basophilic reversal lines may give a pagetoid appearance to the lesion
BENIGN CEMENTOBLASTOMA
BENIGN CEMENTOBLASTOMA
DIFFERENTIAL DIAGNOSIS - Severe hypercementosis -Chronic focal sclerosing osteomyelitis -Cementoblasts -Osteoblastoma
BENIGN CEMENTOBLASTOMA
TREATMENT -removal of the tumor, along with the affected tooth and curettage or peripheral ostectomy -enucleation of the tumor through apicoectomy following root canal treatment
BENIGN CEMENTOBLASTOMA
PROGNOSIS -an excellent prognosis is usually achieved after complete removal of the tumor. -recurrence and continued growth are possible if lesional tissues are left behind after initial surgery
Cementifying fibroma
Is a benign neoplasm of bone that has the potential for excessive growth, bone destruction, and recurrence.it is clinically and microscopically similar to ossifying fibroma. Composed of a fibrous connective tissue stroma in which new bone is formed, it is classified as one of the benign fibroosseous lesion of the jaws.
Clinical feature
Uncommon lesion that tends to occur during 3rd and 4th decades of life In women more than men Is a slow-growing, asymptomatic, and expansile lesion. Maybe seen in the jaws and craniofacial bones Lesion of the jaws characteristically arise in the tooth bearing regions
Clinical feature
Most often in the mandibular premolar ,molar area The slow but persistent growth of the tumor may ultimately produce expansion and thinning of the buccal and lingual cortical plates, although perforation and mucosal ulceration are rare. The most important radiographic feature of this lesion is the well_circumscribed, sharply defined border.
Clinical feature
Cementifying fibroma, cementoossifying fibroma, and psammomatoid ossifying fibroma are terms occasionally used when the bony islands in these lesions are round or spheroidal. These tumors occur in similar age groups and locations, exhibit comparable clinical characteristics, and have the same biologic behavior.
Histopathology
Is composed of fibrous connective tissue with well differentiated spindled fibroblast. Cellularity is uniform but may vary from one lesion to the next. Collagen fibers are arranged haphazardly , although a whorled, storiform pattern may be evident.
Histo pathology
Bony spheroids , trabeculae, or islands are evenly distributed throughout the fibrous stroma. Bone is immature and often surrounded by osteoblasts; osteoclasts are infrequently seen.
Cemento-Osseous Dysplasias
Mohsen Derakshanfard
Cemento-Osseous Dysplasias
Includes Periapical Cemental Dysplasia (PCD) Florid cemento-osseous dysplasia (aka Florid Osseous Dysplasia, FCOD, FOD) Focal Cemento-osseous dysplasia (aka Focal osseous dysplasia, FCOD, FOD) This lesion appears to arise from the periodontal ligament and contains various amounts of fibrous tissue, cementum, and bone. All of these lesions represent the same histopathological process, but are distinguished by the location and extent of lesions in the jaws.
Radiographic features
PCD is a localized change in bone metabolism. It occurs at the apices of lower anterior teeth This lesion passes through three stages in its maturation. The osteolytic stage occurs first and is characterized by localized dental periapical radiolucencies similar in appearance to those that occur with a dental abscess. The next period is termed the cementoblastic stage. During this time cementoblasts become more active and produce spicules of cementum, which produce a mixed radiolucent/radiopaque appearance. The final or mature stage consists of an abnormally large amount of calcification that appears as a dense periapical radiopacity surrounded by a thin radiolucent border.
Radiographic Features
Location Apices of mandibular anterior teeth Multiple or solitary Shape and Borders Well defined Round, oval or irregular shape May have a sclerotic border
Effects on adjacent structures May efface the lamina dura of adjacent teeth Root resorption is rare Surrounding bone may become sclerotic Occasionally, large lesions may cause expansion of the jaws
Dentinoma
Mohsen Derakshanfard
Histologic description This lesion contains varying amounts of fibrous connective tissue, cementoblasts, and cemental tissue depending on the stage of the lesion. Treatment Periodic radiographic observation is appropriate. The teeth are vital and should not be treated by extraction or endodontic therapy. Electrical, thermal, and mechanical stimulation of the teeth can aid the clinician who is attempting to rule out dental infection during the osteolytic or cementoblastic stages.
dentinoma
This type is quite rare, is composed of connective tissue, odontogenic epithelium, and abnormal dentin associated with coronary portions of unerupted permanent teeth. Its radiographic appearance is radiopaque mass in close proximity to the crown of an unerupted tooth.
Age and sex it seen in px younger than 36 years with an average of age 26 years with no sex predilection for occurrence It is often associated with an impacted tooth; however, extraosseous cases can occur. Pain, swelling, and mucosal perforation have been reported. Site it is predominately seen in mandible. especially in molar area and frequently is associated with an impacted tooth. The tumor is located, usually in intraosseous structures, although there are reports that say they have found in the soft tissues. Causes increased bone volume expansion. May or may not be pain. Symptomes patient notices a swelling over a variable period of time with pain. Sign perforation of mucosa and subsequent infection may be present. There may be redness of overlying mucosa with discharge.
Clinical feature
Radiographic features
The radiographic picture may be extremely variable. It may appear as a radiolucency, a radiolucency with small radiopaque flecks, or a solitary radiopaque mass. Internal structure the lesion offers a radiolucency, specific limits,within which are irregular radiopaque mass that may vary in size and extension. it contain either a large, solitary, opaque mass or numerous smaller irregular radiopaque masses of calcified material which may vary considerably in size Bone It may cause local destruction of bone.
Histopathological features
The connective tissue stroma resembles dental papilla. Masses of irregular Dentin(which has been termed as dentinoid or osteodentine) with demonstrable dentinal tubules are present. Undifferentiated odontogenic epitheliumis present and enamel is absent. If enamel were present the lesion would be called a complex composite odontoma.
Dentinoma. Histological section showing a tumor composed mostlyof dentin dysplasia ,poorly calcified.
Microscopically, the dentinoma may resemble ameloblastic fibroma.Epithelial tissue that composes Pathology it often takes the form of fine strands, consisting of round or cuboidal cells are arranged in one or two layers. The connective tissue resembles that of the dental papilla by the type and degree of cellularity.
Among the connective tissue and odontogenic epithelium shows a poorly organized dentin deposition which gives sometimes an aspect of osteodentin or interglobular dentin. Some cells, like odontoblasts-often present around the islets of dentine. In the dentin frequently poorly mineralized mesenchymal cells can be seen inside.
management
Surgical incision with through curettage of area and enucleation . A careful excision with removal of all tumor formation, is sufficient for control. It should be detailed in the eventual removal of fibrous capsule, since at the expense of it, when left remains, recurrence occurs, although this is unusual.