This document discusses different types of osteomyelitis, including suppurative and nonsuppurative forms. Suppurative osteomyelitis can be acute or chronic and most commonly involves the mandible. Symptoms include fever, pain, and bone destruction visible on radiographs. Treatment involves antibiotics, surgery to remove infected bone (sequestrectomy), and cleaning of the bone cavity. Nonsuppurative forms include chronic focal sclerosing osteomyelitis and Garre's osteomyelitis, characterized by bone proliferation. Osteomyelitis can also accompany systemic diseases like tuberculosis.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
A absolutely minimalist way to describe each and every diagnostic aid in the beautiful stream of endodontics.
one has to understand the topic by going through the bible, "Grossman 13th Edition" along with the slides I've created.
Hope this helps.
by Dr. Ishaan Adhaulia
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
Odontogenic keratocyst (OKC) is the cyst arising from the cell rests of dental lamina. It can occur anywhere in the jaw, but commonly seen in the posterior part of the mandible. Radiographically, most OKCs are unilocular when presented at the periapex and can be mistaken for radicular or lateral periodontal cyst.
A absolutely minimalist way to describe each and every diagnostic aid in the beautiful stream of endodontics.
one has to understand the topic by going through the bible, "Grossman 13th Edition" along with the slides I've created.
Hope this helps.
by Dr. Ishaan Adhaulia
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostoticii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformansc. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitisb. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibromab. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular typeii. Psammomatoid type
d. Gigantiform cementomas
osteomyelitis of jaw bones / dental implant courses by Indian dental academy Indian dental academy
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2. INTRODUCTION
Osteomyelitis is an extensive inflammation of
a bone.
Involves the cancellous portion, bone marrow,
cortex, and periosteum.
Because of the benefit of antibiotic Therapy
osteomyelitis is -no longer a common, severe
infection producing serious systemic involvement.
4. SUPPURATIVE OSTEOMYELITIS
Osteomyelitis In Infants (osteomyelltis neonaterum)
The microorganisms are believed to enter
wounds made during delivery when the finger is
inserted into the child's mouth and the mucosa
scratched or later through injuries of the mucosa
made by sucking an object.
5. Four- year – old child with acute osteomyelitis of the
mandible
6. Clinical Findings
Ostemyelitis in infants may have a sudden
onset and run an acute course.
Such cases are associated with a severe
constitutional reaction
High fever
Rapid pulse,
Vomiting, delirium, and prostration.
7. In chronic course - slow onset, with slight
fever, and moderate pain.
The local signs are swelling of the face,
Edema of the eyelids,
Subperiosteal abscesses that develop on
the alveolar mucosa and palate,
Sinustracts draining pus.
Treatment
Antibiotics should be given intravenously
8. Acute suppurative Ostsomyelitls
Acute, osteomyelitis in adults Involves the
mandible more often than the maxilla.
the various vulnerable parts of the jaw may
succumb, especially the alveolar process, the
angle of the jaw, the posterior part of the
ramus and the coronoid process.
10. The onset of acute osteomyelitis is
accompanied by fever and chills, rapid
pulse and respiration, and sometimes
nausea and vomiting. Dehydration and
acidosis may accompany the toxemia, and
albuminuria is a frequent finding.
11. The white cell count may show an
appreciable leukocytosis.
In addition, there is a decided "shift to left.
Toxemia is indicated by the presence of
immature cells.
12. Acute osteomyelitis causing considerable bone
destruction and resulting in a radiolucent appearance
of the ramus
13. RADIOGRAPHIC FINDINGS
Enlargement of the marrow spaces.
Later the cortex becomes involved,
Forms osteolytic channels
Surround dead pieces of bone, or sequestrum.
Larger radiolucent areas denote active destruction of
bone.
14. Treatment
Complete bed rest,
a high-protein and high caloric diet,
Adequate multivitamins.
Dehydration - administration of intravenous
solutions.
15. Blood transfusions when RBC count is low.
Analgesics for pain.
Antibiotic therapy.
Penicillin - immediate drug of choice.
16. Chronic Suppurative Osteomyelitis
Chronic osteomyelitis, results from infection
by subvirulent organisms.
The failure to drain the pus results in
accumulation of pus and
consequent elevation of
periosteum from the bone.
The subperiosteal blood vessels are
stretched, breaks resulting in ischemia.
17. Due to ischemia, cortical bone becomes
devitalized
Such a devitalized piece of bone appears
sclerosed and becomes a foreign body known
as sequestrum.
The mandibular premolar regions are
mostly involved.
This is due to the thrombosis of the inferior
dental vessels exerting its pressure on the
inferior dental canal.
19. Clinical Features
Similar to those of acute osteomyelitis.
The pain is less severe
The temperature is still elevated
Leukocytosis is only slightly greater
than normal.
20. Teeth may not be loose or sore, so that
mastication is at least possible.
Acute exacerbations of the chronic stage
may occur periodically.
The suppuration may perforate the bone
to form a fistulous tract
This form should be treated on the same
principles as its acute counterpart.
21. Radiographic findings
The sequestrum often appears
radiopaque,
separated by a zone of radiolucency, -
“moth eaten appearance”
A layer of subperiosteal new bone
formation – “involucrum”
Appears as a linear laminated opacity,
parallel to the cortical surface.
25. TREATMENT
Emperical antibiotic therapy
Sequestrectomy and curettage
Saucerization – cleaning up the bone cavity
rendering the cavity broad.
26. Partial or total removal of cortex – known as
decortiication
Cavity is packed with iodoform or whitehead’s
varnish
27. NON SUPPURATIVE OSTEOMYELITIS
CHRONIC FOCAL SCLEROSING OSTEOMYELITIS
(Condensing Osteitis)
Chronic focal scelrosing osteomyelitis is an unusual
reaction of bone to infection,
Occurrs in instances of extremely high tissue
resistance
In cases of a low – grade infection.
28. Clinical Features
Exclusively in young persons
before the age of 20 years.
Tooth most commonly is the mandibular
first molar.
Mild pain associated with an infected
pulp.
29. RADIOGRAPHIC FINDINGS
Well – circumscribed radiopaque mass of
sclerotic bone
surrounds and extends below the apex of
one or both roots
The entire root outline is nearly always visible
31. An important feature in distinguishing it from
the benign cementoblastoma
Radiopacity stands out in distinct contrast to
the trabeculation of the normal bone.
This is basically a reaction of bone to a mild
bacterial infection.
32. TREATMENT
The tooth is treated endodontically or extracted.
The sclerotic bone constituting the osteomyelitis
is not attached to the tooth.
Remains after the tooth is removed.
33. Chronic Diffuse sclerosing Osteomyelitis
Chronic diffuse sclerosing osteomyelitis is a
condition analogous to the focal form of the
disease.
Represents a proliferative reaction of the bone.
Entry for the infection is through diffuse
periodontal disease.
34. CLINICAL FEATURES
May occur at any age
Most common in older persons.
Especially in edentulous mandibular jaws or
edentulous areas
Presents no clinical indications of its presence
35. Exposure of the necrotic bone – Intraoral
view of exposed bone
36. An acute exacerbation of the dormant chronic
infection
Spontaneous formation of a fistula opening
onto the mucosal surface to establish drainage
vague pain
bad taste in the mouth.
37. RADIOGRAPHIC FEATURES
Diffuse sclerosis of bone.
Radiopaque lesion may be extensive - bilateral
The border between the sclerosis and the
normal bone is often indistinct.
38. TREATMENT
Lesion is usually too extensive to be removed
surgically,
Yet it frequently undergoes acute exacerbations
Antibiotic administration.
39. If a tooth is present in one of these sclerotic
areas and must be extracted the probability must
be recognized.
40. Garre's Osteomyelitis Of The Mandible
chronic osteomyelitis with proliferative periostitis,
Periostitis Ossificans
Nonsuppurative process in which there is
Peripheral sub periosteal bone deposition
Caused by mild irritation and infection.
41. Affects children and young adults
Generally involves the mandible.
The infectious process localizes in the
periosteum
42. A patient, aged 10 years, with
Garre’s osteomyelitis of the
mandible
43. Spreads only slightly into the interior of
the bone.
Bony thickening is visible in the
radiograph.
Garre’s osteomyelitis should be
distinguished from infantile cortical
hyperostosis, or Caffey's disease.
44. Caffey believed this disease to be of
infectious origin
Because of the accompanying high fever
Elevated sedimentation rate.
The disease is selflimiting and eventually
regresses.
46. TREATMENT
Unusually removal of the infected tooth
Curettage of the socket are curative.
Surgery should be done only if there is
obvious facial asymmetry after at least a 6-
month waiting period.
47. Osteomyelitis associated with systemic
diseases
In addition to nonspecific forms of osteomyelitis,
there are several specific types that accompany
certain systemic diseases.
They include tuberculosis, actinomycosis and
syphilis.
48. TREATMENT
Generally, treatment involves management of
the systemic pathosis, as well as local forms
of therapy.
Osteomyelitis of the mandible also has been
reported as a complication of sickle cell
anemia.