The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
4. Focal osteoporotic bone marrow
defects
May produce the radiographic image of a
cyst like rl
They are comon in mandible post region
Female
r/f varies from cyst like to multilocular to
irregular and borders are well defined
Rarely shows cortical expansion
They are seen at the apices of the teeth
www.indiandentalacademy.com
8. Marrow spaces
The trabecular pattern in the
posterior mandible is quite variable,
generally showing large marrow
spaces and sparse trabeculation,
www.indiandentalacademy.com
12. Basal cell nevus syndrome showing multiple
cysts in different parts of mandible
www.indiandentalacademy.com
13. Multiple myeloma
Synonym: Myeloma,Plasma cell myeloma, Plasmacytoma
It is defined as a chronic, progressive neoplastic
proliferation of the plasma cells which produces
immunoglobulins, occurring principally in the bone
marrow, but which may also appear in other organ
systems
Most common malignancy of bone in adults
Single lesions –Plasmacytoma
Multipe lesions-Multiple Myeloma
www.indiandentalacademy.com
14. Clinical features
4th to 7th
Male predileciton
Bone pain , Anemia, low back pain (typical
feature)
Secondary signs : Amyloidosis, Hypercalcemia
Bence jones proteins-50% patients
when clonal proliferation occurs it replaces
cancellous bone later cortical border replacing the
normal RO bone with areas of RL
www.indiandentalacademy.com
15. ORAL FINIDINGS
Pain, paresthesia;,mucosal ulcerations,swelling, soft
tissue mass, tooth mobility,tooth migration,
Amyloid deposition in the tongue and other oral
tissues, and pathological fracture.
www.indiandentalacademy.com
16. Radiographic findings
Type 1: Solitary type (similar to bone cyst)
Type 2: Multiple osteolytic lesions without
marginal sclerosis (a. central type, and b.
peripheral type)
Type 3: Diffuse osteoporosis with generalized
involvement
Type 4: Diffuse osteosclerosis.
www.indiandentalacademy.com
17. Diffuse Osteosclerosis
a) Diffuse
b) Focal osteocondensation
c) Bony speculation on the surface of the bone
d) Sclerotic reaction at the rim of lytic lesion.
www.indiandentalacademy.com
18. Radiographic Manifestations
The multiple lesions may be few or many
They are commonly rounded , with eighter well-
defined or fairly well-defined margins but lacks
cortication (punched out) ,some lesions may be
irregular (secondary cancer)
www.indiandentalacademy.com
19. Adjacent lesions often meet as they enlarge so that a
remnant of bone left between lesions-
The result of the formation of adjacent lesions is that
the surface of the bone is deformed –rippled
appereance
Separate areas of bone destruction varying in size
from few mm to many inches
In advanced cases there are thousands of such
rounded rl scattered - riddled appereance
Maxilla and mandible are rarely affected
Many very small lesions not over 3mm are seen but
seldom reaches 1cm
Margins are usually fairly sharp
www.indiandentalacademy.com
20. CRITERIA
Clonal plasma cells are present on biopsy of
bonemarrow or plasmacytoma
M-protein is present in serum or urine (either
intact immunoglobulin or free light chains)
Evidence of related organ or tissue impairment is
present (lytic bone lesions; renal insufficiency;
anemia; hypercalcemia; hyperviscosity;
amyloidosis; or recurrent infections).
www.indiandentalacademy.com
26. Multiple Myeloma With Osteoporosis
It is a very rare entity which involves the
greater part of skeleton and jaws
Whole of the bone appears unusually dark
and the trabeculae may be diffcicult to
identify –except for the persistacne of cortical
margins
d/d:
Hyperparathyroidism
www.indiandentalacademy.com
27. Solitary myeloma
Jaws are uncommon sites to occur
2 main types:
1st type-An area of bone destruction is well demarcated
from surrounding bone ,some times may be corticated
Sub periosteal new bone may form
Trabeculae –thin or coarse
2nd type-purely destructive with no new bone at the
margins surrounding the tumor ,
The margins shows infilteration
Flat bones- sausage shaped lesions with undulating
margins
www.indiandentalacademy.com
29. Effects on surrounding structure
Teeth may appear as too RO
Lamina dura and follicles of impacted tooth
may lose their typical corticated surrounding
bone
Thinning of lower border of mandible ,or
endosteal scalloping
Periosteal reaction is rare but if present takes
the form of single RO line or more rarely
sunray appereance
www.indiandentalacademy.com
30. Langerhan Cell Histocytosis
Synonym: Idiopathic histiocytosis,histiocytosis X
Acute disseminated form –letterer-siwe
disease
Chronic disseminated form-hand-schuller-
christian
Chronic localized form-eosinophilic
granuloma
www.indiandentalacademy.com
31. Acute disseminated Chronic disseminated Chronic localized
disseminated
Age Infants under 1yr of age Children & young
adults
Adults & juvenile
Clinical
manifestati
ons
Enlargement of organs
and other swellings
Cachectic,petechiae &
necrotic ulcer ,severe
pancytopenia
3- bony lesions,
exophthalamus & DI
Male predominance
Oral
manifestati
ons
Necrotic ulcers
Petechiae
Mobility of teeth &
gingival bleeding
Ulcerations
Edematous gingiva
Loosened teeth
Destruction of dental follicle
Missing teeth
R/F Multiple small rounded
RL with well defined
borders
BL appear ragged n
may coalasce –
geographi c
appeareance
Proliferative periostitis,with
radiolucet ragged borders-
juvenile
Sclerosig borders in adults
www.indiandentalacademy.com
32. Alveolar process Intraosseous
Multiple
Mandibular posterior
region
Well defined without
cotiction
Lesion starts from mid root
region of tooth
Scooped out shape
Solitary
Mandibular ramus
Well defined
Shape is irregular or oval
www.indiandentalacademy.com
33. Surrounding Structure
Teeth appear to be standing in space
The lesion does not displace teeth
Periosteal new bone formation
Can destroy outer ortical plate
www.indiandentalacademy.com
37. A panoramic film of multiple lesions of
Langerhans' cell histiocytosis. Note the scooped-out shape
of the bone destruction in the mandible. The floor of the
right maxillary antrum has been destroyed.
www.indiandentalacademy.com
40. Metastatic Carcinoma
Establishment of new foci of malignant disease
from distinct malignant tumour usually by the
way of blood vessels.
1-3%of all metastasis.
Women-from breast, adrenal gland, genital
organ, thyroid gland.
Man-lung, prostate, kidney, adrenal gland
www.indiandentalacademy.com
41. Mand post region
50-70 yrs of life
Female predilection
Oral neoplasm may be 1st sign of
malignancy-30%of cases.
Enlarging tumours erode rapidly through
cortical plates.
www.indiandentalacademy.com
42. Radiographic Features
1.A solitary well defined cyst like r/l
2.A solitary poorly defined r/l-localized,
3.multiple, separate, poorly defined r/l-
4.multiple,punched out r/l
5.r/o patterns with any of foregoing r/l
6.Irregular salt and pepper appearance-
7.A relatively dense, solitary, r/o area
www.indiandentalacademy.com
43. Secondary deposits from carcinoma may be
purely destructive(osteolytic) or they may be
bone forming (osteoblastic)
Osteolytic -2 types
Frank destruction
Infilteration
Combination of area having bone destruction
and islands of bone
Abnormality is centrally located
www.indiandentalacademy.com
44. 2nd lytic type
Resemblance with osteomyeltis
Infilterated margins of areas of bone
destruction
Normal bone representng islands of various
sizes seperates the areas of bone destruciton
which is in continuity with the remaning
bone
www.indiandentalacademy.com
45. AFFECT Of SURROUNDING STRUCTURES
Periosteal reaction –speculated pattern
Floating of teeth in air
Extraction sockets fail to heal
Resorption of teeth is rare
Occasionally the tumor breaches into
surrounding soft tissue and present as an
intraoral mass
Cortical borders of normal anatomical
structures are destroyed
www.indiandentalacademy.com
49. references
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
Editor's Notes
b) axial CT scan, bone window; at the level of mandibular alveolar crest, exhibiting erosion of buccal
and lingual cortical plates bilaterally in both the body and the lower portion of the ascending ramus, with soft tissue swelling buccally on the left side
Skull view showing the ‘‘hair on end’’ appearance at the
vault and the sunburst pattern
Most common similar to that of the benign ginat cell tumor of bone