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www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
 Healing surgical site
 Chronic osteomyelitits
 Osteoradionecrosis
 Focal cementoosseous dysplasia
 Fibrous dysplasia...
 Adenomatoid odontogenic
tumor
 Ameloblatic fibrodentinoma
 Ameloblastic fibroodontoma
 Ameloblastoma (peripheral
scle...
 Central benign pathosis have been removed and
surgical wounds closed primary healing takes place
through ossification of...
Synonyms- fibrocystic diseae, osteitis fibrosa, focal
osteitis fibrosa, fibrosseous dystrophy
• Fibrous dysplasia is consi...
Types
Monostotic
Polyostotic
craniofacial
Jaffeys
Albright syndrome
Familial fibrous dysplasia
Malignant canges are rare
w...
 M=f
 Mandible-canine,premolar,molar areas; the ramus
and symphysis
 Maxilla – molar&premolar region n maxillary sinus
...
Divided into 3 groups
o Predominance of fibrous tissue-least common
Round or irregularly shaped radiolucency with no evide...
Equal mixture of fibrous tissue & bone-common
 upper molar n bicuspid regions are involved
frequently
 There may be comp...
Fibrous dysplasia
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
o Chronic osteomyelitis
o Cementossifying fibroma-shape,jaw
expansion,margins,age
o pagets disease-complete bone, age
o Os...
Synonym - osteitis deformans
Paget’s is a skeletal disorder ,essentially a disease involving
osteoclasts, resultig in abno...
Initial stage- osteolytic and fibrolytic
Intermediate stage-osteolytic & osteoblastic
Mature stage-predominantly osteoblas...
Pagets disease occur most often in the pelvis,femur,skull
and vertebrae
Maxilla
Bilaterally
It has 3 radiographic appearan...
1. Trebeculae are reduced in number , but these
remaining are coarse and tend to run in the
direction of bone with minimum...
 A common radiographic manifestation is structure of
the bone is altered in such a way that trebaculae are
replaced by de...
Pagets disease
www.indiandentalacademy.com
Pagets disease-
cottonwool
appereance
www.indiandentalacademy.com
www.indiandentalacademy.com
Periapical radiograph showing
hypercementosis in pagets disease
www.indiandentalacademy.com
 Outer cortex may be thinned out but remains intact
 The lamina dura may become less evident.
 Hypercementosis .
 The ...
o Fibrous dysplasia
o Metabolic bone disease
o Florid osseous dysplasia-other bones are unaffected
www.indiandentalacademy...
 Osteomyelitis is an inflamation of the bone n its
marrow spaces caused by pathogenic microraganisms
 Types
Acute osteom...
Predisposing factors
Hypoxic conditons
Immunodefficiency
Low defence response disease
c/f:
Mandible
Male patients
Inflamat...
Chronic osteomyelitis may produce 5 different
radiographc patterns
1. A radiolucency with ragged border
2. A radiolucency ...
The earliest radiographic change - trebacular pattern
Frankbone destruction
One or several such areas present seperated by...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
 Fibrous dysplasia
 Pagets disease
 osteogenic sarcoma
 Chondrosarcoma
 Metastatic carcinoma
 Rarefying and condensi...
 Establishment of new foci of malignant disease from
distinct malignant tumour usually by the way of
blood vessels
 Meta...
• Metastatic prostatic tumors to bone may develop as
entirely radiolucent ,entirely radiopaque or mixed RL
& RO
• METASTAT...
www.indiandentalacademy.com
Originates in cartilage and are uncommon tumors of
jaw bone
Both chodroma and chondrosarcoma may cause root
resorption and...
Chondrosarcoma is an uncommon ,slow enlarging
malignant neoplasm that originates from primitive
cartilage forming mesenchy...
Conventional radiograpic findings are not pathognomic
1. Single/multiple RL with poorly defined borders
2. Bone destructio...
www.indiandentalacademy.com
the presence of a large osteolytic lesion involving the
right body of mandible showing sun-ray appearance
and expansion of...
 According to W.H.O the term Osteosarcoma refers to a
Heterogeneous group of Primary Malignant
Neoplasms affecting Bone f...
Painless or Painful Swelling to Trismus, Non healing of
Extraction Socket ,Paraesthesia over the affected region
Radiograp...
 Chondrosarcoma-older age group & maxilla
 Osteoblastic metastatic carcinoma
 Ossifying subperiosteal hematoma
 Periph...
www.indiandentalacademy.com
www.indiandentalacademy.com
 Disease condition of hard n soft tissue after
irradiation leads to hypovascularity, hypocellular and
hypoxic tissue with...
 Radiograph shows mixed radiolucent and RO lesion in
advanced cases
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
 The term FCOD is recently given to PCOD like lesions
that occur in the premolar – molar region of the jaws
 These are r...
 Asymptamatic
 Edentulous premolar – molar area
 Female predilection
r/g:
3 types
1. Radilucent
2. Mixed radiolucent an...
www.indiandentalacademy.com
www.indiandentalacademy.com
 The ossifying subperiosteal hematoma sometimes
occurs when a subperiosteal hematoma of the jaw
bones is induced by traum...
 Osteogenic sarcoma
 Ewings sarcoma
 Chondrosarcoma
 Proliferative periostitits
www.indiandentalacademy.com
 It is a clinical variant of ameloblastoma
 Maxillary anterior region
 M=F
 4TH AND 5TH decade
 It appears as mixed r...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
 cemento-ossifying fibromas are rare benign, non-
odontogenic tumors of the jaw, a subdivision of
fibro-osseous lesions.
...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
Pagets disease-the late age onset, generalized enlargment of
involved bone and extreme elevation of alkaline phoshatase
an...
 Desmoplastic-mixed ro % rl lesionseen(honeycomb )
in maxillary anterior region
 Ossifying subperiosteal hematoma-h/o tr...
 Principles practice oral radiologic interpretation H.m
worth
 Oral radiology principles and interpretation 5th
edition ...
www.indiandentalacademy.com
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Mixed rl adnd ro lesions / dental courses

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
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Mixed rl adnd ro lesions / dental courses

  1. 1. www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing Dental Education
  2. 2.  Healing surgical site  Chronic osteomyelitits  Osteoradionecrosis  Focal cementoosseous dysplasia  Fibrous dysplasia  Pagets disease- intermediate stage  Cemento ossifying fibroma  Osteogenic sarcoma  Osteoblastic metastatic carcinoma  Chondroma and chondrosarcoma  Ossifying sub periotsteal hematoma  Desmplastic ameloblastoma www.indiandentalacademy.com
  3. 3.  Adenomatoid odontogenic tumor  Ameloblatic fibrodentinoma  Ameloblastic fibroodontoma  Ameloblastoma (peripheral sclerosis)  Calcifying epithelial odontogenic tumor  Calcifying odontogenic cyst  Central hemangioma  Diffuse sclerosing osteomyelitis  Ewing’s sarcoma  Florid osseous dysplasia  Intrabony hamatoma  Juvenile ossifying fibroma  Langerhans cell disease  Lymphoma of bone  Malignant tumors with superimposed osteomyelitis  Odontogenic myxoma  Odontoma  Osteoblastoma  Osteoid osteoma www.indiandentalacademy.com
  4. 4.  Central benign pathosis have been removed and surgical wounds closed primary healing takes place through ossification of the surgically produced hematoma  A radiograph taken shortly after the surgery shows a well defined homogeneous radiolucency if the radiograph is made after some calcification of the hemartoma the radioluceny contains foci of pattern that progress from ground glass to speculed to trebecular www.indiandentalacademy.com
  5. 5. Synonyms- fibrocystic diseae, osteitis fibrosa, focal osteitis fibrosa, fibrosseous dystrophy • Fibrous dysplasia is considered a hamartomatous fibrosseous lesion which is not of periodontal origin • It is a lesion of bone that produces lysis of bone in its early stage • As it ages immature bone is laid down in chinese- character spicules • Later becomes larger & larger (complete R0) • It generally remodels into regular bone www.indiandentalacademy.com
  6. 6. Types Monostotic Polyostotic craniofacial Jaffeys Albright syndrome Familial fibrous dysplasia Malignant canges are rare www.indiandentalacademy.com
  7. 7.  M=f  Mandible-canine,premolar,molar areas; the ramus and symphysis  Maxilla – molar&premolar region n maxillary sinus  Painless expansion of jaw bone  Expansion is usually fusiforn ,firm, smoothly contoured and covered by normal mucosa  Teeth in the region remain firm www.indiandentalacademy.com
  8. 8. Divided into 3 groups o Predominance of fibrous tissue-least common Round or irregularly shaped radiolucency with no evidence bone formation n thin cortex o Predominance of bone Stippled(orange peel appeareance) groundglass appereance-adults Dense structureless homogeneous density-maxilla The margins of the abnormal bone blends with normal bone Inferior cortical margin is maintained but when lost gives an impression of thumb print www.indiandentalacademy.com
  9. 9. Equal mixture of fibrous tissue & bone-common  upper molar n bicuspid regions are involved frequently  There may be complete effacement of some portion of the lower margin while in other regions the cortical band may persist and displaced downwards  The margins of Rl area varies from very sharp and clearly defined but not corticated to indistinct and illdefined www.indiandentalacademy.com
  10. 10. Fibrous dysplasia www.indiandentalacademy.com
  11. 11. www.indiandentalacademy.com
  12. 12. www.indiandentalacademy.com
  13. 13. www.indiandentalacademy.com
  14. 14. o Chronic osteomyelitis o Cementossifying fibroma-shape,jaw expansion,margins,age o pagets disease-complete bone, age o Osteogenic sarcoma o Osteoblastic metastatic carcinoma o Chondrosarcoma 30 to 60 o lymphomas www.indiandentalacademy.com
  15. 15. Synonym - osteitis deformans Paget’s is a skeletal disorder ,essentially a disease involving osteoclasts, resultig in abnormal resoption and apposition of osseous tissue in one or more bones c/f: o Older than 40 yrs o Males o Affected bone is enlarged o Bone pain ,Neurologic pain o Serum alkaline phosphatase levels are greatly increased o Hydroxyproline in urine o Jaw involvement in 17% of cases www.indiandentalacademy.com
  16. 16. Initial stage- osteolytic and fibrolytic Intermediate stage-osteolytic & osteoblastic Mature stage-predominantly osteoblastic www.indiandentalacademy.com
  17. 17. Pagets disease occur most often in the pelvis,femur,skull and vertebrae Maxilla Bilaterally It has 3 radiographic appearances 1. An early radiolucent resorptive stage 2. Granular ground glass appearing second stage 3. A denser and more radiopaque appositional late stage –cotton wool appearance www.indiandentalacademy.com
  18. 18. 1. Trebeculae are reduced in number , but these remaining are coarse and tend to run in the direction of bone with minimum intersection –post to bicuspids 2. Increase In the number of trebecula which are finer in texture-greater density of bone 3. Coarse and sparse trebecula some times tend to converge towords the midline of the mandible – highly suggestive of pagets disease 4. Cortex at the inferior border of the mandible to loose density and reveals laminated structures www.indiandentalacademy.com
  19. 19.  A common radiographic manifestation is structure of the bone is altered in such a way that trebaculae are replaced by dense bone which is granular in nature  Jaw is enlarged which is usually uniform  With in the radiolucent bone areas of greatly increased density -Cotton wool apperance www.indiandentalacademy.com
  20. 20. Pagets disease www.indiandentalacademy.com
  21. 21. Pagets disease- cottonwool appereance www.indiandentalacademy.com
  22. 22. www.indiandentalacademy.com
  23. 23. Periapical radiograph showing hypercementosis in pagets disease www.indiandentalacademy.com
  24. 24.  Outer cortex may be thinned out but remains intact  The lamina dura may become less evident.  Hypercementosis .  The teeth in that region may become spread or displaced  Foramina in the skull gets constricted www.indiandentalacademy.com
  25. 25. o Fibrous dysplasia o Metabolic bone disease o Florid osseous dysplasia-other bones are unaffected www.indiandentalacademy.com
  26. 26.  Osteomyelitis is an inflamation of the bone n its marrow spaces caused by pathogenic microraganisms  Types Acute osteomyelitis Chronic steomyelitis Proliferative periosteitis Sclerosing osteomyelitis Local Diffuse www.indiandentalacademy.com
  27. 27. Predisposing factors Hypoxic conditons Immunodefficiency Low defence response disease c/f: Mandible Male patients Inflamation.tenderness,pain,swelling,extraoral draining sinusregional lymphedenopathy Denuded bone may produce mucosal or cutaneous ulcers www.indiandentalacademy.com
  28. 28. Chronic osteomyelitis may produce 5 different radiographc patterns 1. A radiolucency with ragged border 2. A radiolucency containing one or more radiopaque foci 3. Salt and pepper appereance 4. Dense radiopacity 5. Cortical redundacy www.indiandentalacademy.com
  29. 29. The earliest radiographic change - trebacular pattern Frankbone destruction One or several such areas present seperated by normal bone – moth eaten apperance The extent of bone involvement greatly varies Localized –saucer shaped defect Widespread case –uniform pattern ,dark line appears at the sites of seperation Localized apperance with acute infection dark line appears sepearting dead bone with living bone  Loss of lamina dura  Subperiosteal new bone is formed  Periosteal new bone-gray shadow parallel to inferior border  Cloacae are seen  Involvement of tmj is rare www.indiandentalacademy.com
  30. 30. www.indiandentalacademy.com
  31. 31. www.indiandentalacademy.com
  32. 32. www.indiandentalacademy.com
  33. 33. www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. www.indiandentalacademy.com
  36. 36.  Fibrous dysplasia  Pagets disease  osteogenic sarcoma  Chondrosarcoma  Metastatic carcinoma  Rarefying and condensing osteitis www.indiandentalacademy.com
  37. 37.  Establishment of new foci of malignant disease from distinct malignant tumour usually by the way of blood vessels  Metatsatic tumors of jaws usually produces poor ad ragged radiolucencies  Osteoblastic metastasis is unsual  Some scondary tumors from primary lesions in the prostate may be osteoblastic type www.indiandentalacademy.com
  38. 38. • Metastatic prostatic tumors to bone may develop as entirely radiolucent ,entirely radiopaque or mixed RL & RO • METASTATIC TUMORS THAT ARE USUALLY OSTEOLYTIC May induce osteoblastic ativity within the tumor or neigbouring bone produces mixed RO & rl lesion with vague irregular borders • When multiple small nests of sclerosing or osteoblastic tumor have become dissiminated through out the jaw bone-salt & pepper appereance www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com
  40. 40. Originates in cartilage and are uncommon tumors of jaw bone Both chodroma and chondrosarcoma may cause root resorption and both may show well defined or ill defined railucencies The opacities in the chondroma usualy appear more orderly than in osteosarcoma Both tumors may also develop radiopaque patter www.indiandentalacademy.com
  41. 41. Chondrosarcoma is an uncommon ,slow enlarging malignant neoplasm that originates from primitive cartilage forming mesenchyme and produces a pure hyaline cartilage that results in abnormal bone or cartilage growth The invovlvement of cranifacial region is rare and accounts for less than 10% of all  3rd n 6th decade  M>F  Painless swelling leadint to expansion of the buccal and lingual with occasional premature exfoliation of teeth www.indiandentalacademy.com
  42. 42. Conventional radiograpic findings are not pathognomic 1. Single/multiple RL with poorly defined borders 2. Bone destruction associated with calcificatios or ground-glass appereance 3. Sunburst appereance and uniform widening of PDL space www.indiandentalacademy.com
  43. 43. www.indiandentalacademy.com
  44. 44. the presence of a large osteolytic lesion involving the right body of mandible showing sun-ray appearance and expansion of the cortical plates www.indiandentalacademy.com
  45. 45.  According to W.H.O the term Osteosarcoma refers to a Heterogeneous group of Primary Malignant Neoplasms affecting Bone forming or Mesenchymal tissue that have Histopathologic evidence of Osteogenic Differentiation.  Osteosarcoma of the jaws (JOS) is a rare, aggressive, malignant mesenchymal tumour which is characterized by the formation of osteoid tissue, www.indiandentalacademy.com
  46. 46. Painless or Painful Swelling to Trismus, Non healing of Extraction Socket ,Paraesthesia over the affected region Radiographically osteosarcoma has variable presentations ranging from osteolytic, mixed osteolytic- osteogenic to predominantly Osteogenic 1. Sun ray appereance 2. Codman’s traingle 3. Motheaten ,cumulous cloud apppereance 4. Garringtons’sign www.indiandentalacademy.com
  47. 47.  Chondrosarcoma-older age group & maxilla  Osteoblastic metastatic carcinoma  Ossifying subperiosteal hematoma  Peripheral fibroma with calcification  Fibrous dysplasia  Chronic osteomyelitis www.indiandentalacademy.com
  48. 48. www.indiandentalacademy.com
  49. 49. www.indiandentalacademy.com
  50. 50.  Disease condition of hard n soft tissue after irradiation leads to hypovascularity, hypocellular and hypoxic tissue with diminished capacity to repair  Overlying mucosa may breakdown leading to superficial infection of the denuded bone  Incidence is 4-22% www.indiandentalacademy.com
  51. 51.  Radiograph shows mixed radiolucent and RO lesion in advanced cases www.indiandentalacademy.com
  52. 52. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54.  The term FCOD is recently given to PCOD like lesions that occur in the premolar – molar region of the jaws  These are reactive lesions of the PDLO that are solitary  Fit into the spectrum of fibrocementosseous lesions range from local PCOD to Florid cementoosseous dysplasia www.indiandentalacademy.com
  55. 55.  Asymptamatic  Edentulous premolar – molar area  Female predilection r/g: 3 types 1. Radilucent 2. Mixed radiolucent and radiopaque 3. Predominatly radiopaque Margins of the lesion vary and radiopaque pattterns scattered through out the lesion Usually there is a radiolucent periphery but bone periphery may show thin radiopaque border or smudged or groundglass or thick radiopaque pattern www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. www.indiandentalacademy.com
  58. 58.  The ossifying subperiosteal hematoma sometimes occurs when a subperiosteal hematoma of the jaw bones is induced by trauma  Under 15 yrs of age  The hematoma ossifies rapidly  The new bone is often formed in perpendicular coloumn from the cotical plate outwards  Such an osseous gives a sunburst pattern or irregular thickened cortex www.indiandentalacademy.com
  59. 59.  Osteogenic sarcoma  Ewings sarcoma  Chondrosarcoma  Proliferative periostitits www.indiandentalacademy.com
  60. 60.  It is a clinical variant of ameloblastoma  Maxillary anterior region  M=F  4TH AND 5TH decade  It appears as mixed radiopaque and radiolucent lesion with ill defined borders www.indiandentalacademy.com
  61. 61. www.indiandentalacademy.com
  62. 62. www.indiandentalacademy.com
  63. 63. www.indiandentalacademy.com
  64. 64.  cemento-ossifying fibromas are rare benign, non- odontogenic tumors of the jaw, a subdivision of fibro-osseous lesions.  massive formation of cementum, cementoid substance or calcified material in the interior of a predominantly fibrous tissue.  3rd & 4th  F>M  Post region of mandible-premolar n molar region  They lesions may also occur seperately from teeth www.indiandentalacademy.com
  65. 65. www.indiandentalacademy.com
  66. 66. www.indiandentalacademy.com
  67. 67. www.indiandentalacademy.com
  68. 68. Pagets disease-the late age onset, generalized enlargment of involved bone and extreme elevation of alkaline phoshatase and hydroxyproline Fibrous dysplasia-young adults, fusiform expansion ,orangepeel and groundglass apperance Osteogenic sarcoma-garringtons’sign,codmans traingle,early age onset ,sunburst appereance,motheaten &cumulous cloud Chronic osteomyelits-predisposing factors n periosteal n subperiostel new bone formation Osteoblastic metastaic carcinoma- h/o primary tumor,chest xray ,acid phosphatase and pet ct www.indiandentalacademy.com
  69. 69.  Desmoplastic-mixed ro % rl lesionseen(honeycomb ) in maxillary anterior region  Ossifying subperiosteal hematoma-h/o trauma www.indiandentalacademy.com
  70. 70.  Principles practice oral radiologic interpretation H.m worth  Oral radiology principles and interpretation 5th edition white & pharaoh  Differential diagnosis of orol and maxillofacial lesions 5th edition norman.k and wood,paul w.goaz www.indiandentalacademy.com
  71. 71. www.indiandentalacademy.com

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