Dental Pathology Quiz: Cysts and Fibromas
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Questions and Answers

What indicates a more likely presence of a nasopalatine duct cyst in relation to the dimension of the incisive canal?

  • Maximal dimension greater than 6 mm (correct)
  • Maximal dimension between 4 mm and 6 mm
  • Maximal dimension less than 3 mm
  • No specific dimension relates to a cyst

    • What effect does a large nasopalatine duct cyst have on neighboring teeth?

  • It prevents the eruption of teeth
  • It strengthens the roots of nearby teeth
  • It displaces teeth and may resorb their roots (correct)
  • It causes teeth to become hypercementosed

    • What type of cyst is typically centered around a tooth root?

  • Dentigerous cyst
  • Nasopalatine duct cyst
  • Radicular cyst (correct)
  • Periapical cyst

    • What indicates the presence of a nasopalatine duct cyst based on the condition of the lamina dura?

    <p>Effacement of the lamina dura without root resorption</p> Signup and view all the answers

    What type of appearance is commonly observed in the incisive canal associated with a nasopalatine duct cyst?

    <p>Well-defined corticated lucent widening</p> Signup and view all the answers

    What is a key radiographic feature of ossifying fibroma?

    <p>Well-defined borders with possible lucent margin</p> Signup and view all the answers

    How does ossifying fibroma commonly affect adjacent anatomical structures?

    <p>Causes tooth displacement and root resorption</p> Signup and view all the answers

    Which of the following differentiates ossifying fibroma from fibrous dysplasia?

    <p>Well-defined borders</p> Signup and view all the answers

    What is a common characteristic of the internal density of ossifying fibroma?

    <p>It exhibits substantial variability</p> Signup and view all the answers

    Which lesion is characterized by a lack of surrounding lucent margin, unlike ossifying fibroma?

    <p>Cemento-osseous dysplasia</p> Signup and view all the answers

    What type of outline does an ossifying fibroma generally present with?

    <p>Corticated and well-defined</p> Signup and view all the answers

    Which feature can sometimes be observed in the expanded cortices of ossifying fibroma?

    <p>Focal regions of cortical absence</p> Signup and view all the answers

    What commonly distinguishes the root resorption behavior in ossifying fibroma from other lesions?

    <p>Root resorption is rare</p> Signup and view all the answers

    What is a characteristic feature of mature lesions in the context provided?

    <p>Opaque lesions with a surrounding lucent margin</p> Signup and view all the answers

    How is cemento-osseous dysplasia different from ossifying fibroma?

    <p>Cemento-osseous dysplasia can be multiple.</p> Signup and view all the answers

    Which type of lesion is characterized by a ground-glass appearance?

    <p>Cemento-osseous dysplasia</p> Signup and view all the answers

    What describes the age-related behavior of ossifying fibromas?

    <p>More aggressive in younger patients</p> Signup and view all the answers

    Which condition is most commonly seen in females according to the provided content?

    <p>Cemento-osseous dysplasia</p> Signup and view all the answers

    What is a primary feature of a bone island?

    <p>No surrounding lucent margin</p> Signup and view all the answers

    What distinguishes a cemento-ossifying fibroma from a cemento-osseous dysplasia?

    <p>Cemento-ossifying fibroma has more of a mass effect.</p> Signup and view all the answers

    What is noted about root resorption in the context of chronic periapical inflammatory lesions?

    <p>It is rare.</p> Signup and view all the answers

    Which age group is most commonly affected by ameloblastoma?

    <p>Third to sixth decades</p> Signup and view all the answers

    What is the typical presentation of ameloblastoma on radiological examination?

    <p>Multilocular lesion with irregular borders</p> Signup and view all the answers

    What is a characteristic appearance of the internal septa in ameloblastoma?

    <p>Thick and curved</p> Signup and view all the answers

    Which lesion typically features internal septa that are much finer than those seen in ameloblastoma?

    <p>Giant cell granuloma</p> Signup and view all the answers

    Which of the following features can be associated with a unicystic ameloblastoma?

    <p>Unilocular appearance with lucency</p> Signup and view all the answers

    Which structure may be displaced as a result of ameloblastoma involvement?

    <p>Adjacent teeth</p> Signup and view all the answers

    What distinguishes ossifying fibroma from ameloblastoma when both have internal septa?

    <p>Ossifying fibroma's internal septa are larger and less distinct</p> Signup and view all the answers

    When ameloblastoma is large, what issue may it cause in adjacent structures?

    <p>Painless swelling</p> Signup and view all the answers

    What is the typical appearance of an osteoma on radiological images?

    <p>Well-defined, focal, opaque prominence</p> Signup and view all the answers

    Where are osteomas most commonly found in the mandible?

    <p>Medial aspect of the ramus</p> Signup and view all the answers

    Which of the following is NOT a type of osteoma?

    <p>Cortical osteoma</p> Signup and view all the answers

    Which syndrome should be considered when multiple osteomas are present?

    <p>Gardner syndrome</p> Signup and view all the answers

    What type of osteoma presents as homogeneous and isodense with cortical bone?

    <p>Ivory osteoma</p> Signup and view all the answers

    What is a common characteristic of larger osteomas?

    <p>They displace adjacent soft tissues</p> Signup and view all the answers

    Which of the following statements about osteomas is false?

    <p>Osteomas can present as hypodense lucent areas.</p> Signup and view all the answers

    Where do osteomas most commonly occur within the skull?

    <p>Paranasal sinuses</p> Signup and view all the answers

    Where are adenomatoid odontogenic tumors most commonly seen?

    <p>Maxillary canine region</p> Signup and view all the answers

    What is a common radiological feature of odontogenic myxomas?

    <p>Well-defined, corticated, multilocular lesion</p> Signup and view all the answers

    Which of the following lesions is most commonly found in the posterior mandible?

    <p>Ameloblastic fibro-odontoma</p> Signup and view all the answers

    What type of radiological appearance is associated with odontomas?

    <p>Corticated border with lucent band</p> Signup and view all the answers

    Which odontogenic tumor is characterized by potential displacement of teeth but typically no root resorption?

    <p>Odontogenic myxoma</p> Signup and view all the answers

    Cementoblastomas are most commonly located in which region of the jaw?

    <p>Mandibular first molar region</p> Signup and view all the answers

    What distinguishes an odontogenic myxoma from other multilocular lesions?

    <p>The presence of flat or straight septa</p> Signup and view all the answers

    What symptom is commonly reported with cementoblastomas?

    <p>Pain</p> Signup and view all the answers

    Which differentiation would make it less likely that a lesion is a dentigerous cyst?

    <p>Margins not at the CEJ</p> Signup and view all the answers

    Which lesion is associated with altered eruption or impaction of adjacent teeth?

    <p>Odontoma</p> Signup and view all the answers

    Signup and view all the answers

    Study Notes

    Differential Diagnosis of Radiolucent Lesions-2

    • Non-odontogenic cysts and cyst-like lesions - Simple bone cyst
      • Usually in those less than 20 years old.
      • Almost all occur within the mandible.
      • Unknown etiology.
      • Most are asymptomatic and often identified radiologically.

    Simple Bone Cyst - Radiological Features

    • Unilocular well-defined corticated lucency.
    • Corticated border is often delicate in appearance.
    • Some regions may not demonstrate the presence of a cortex but remain well defined.
    • Borders may be scalloped.
    • Usually no expansion, although larger lesions may demonstrate minimal expansion.
    • This lesion often scallops between the roots of teeth.
    • Lamina dura is usually preserved.
    • Tooth displacement and root resorption is rare.

    Simple Bone Cyst - Differential Diagnosis

    • Keratocystic odontogenic tumor (KCOTs) usually demonstrate more corticated margins and are more likely to cause root resorption and tooth displacement than simple bone cysts (SBCs).
    • Radicular cyst - Apical lamina dura is effaced. Usually demonstrates a tear-drop morphology at the root apex. SBC borders often scallop between the roots.
    • The radicular cyst, unless small or deflated, is expansile.

    Nasopalatine Duct Cyst; Incisive Canal Cyst

    • Usually asymptomatic until large, when swelling is the most common first clinical feature.
    • This swelling is classically fluctuant.

    Nasopalatine Duct Cyst - Radiological Features

    • Well-defined, lucent, corticated lesion centered at the incisive canal.
    • Often asymmetric.
    • Expansile when sufficiently large, it may also expand into the nasal cavity and maxillary sinus, elevating the cortical floors.
    • The expanded maxillary cortices are often thinned with focal regions of effacement.
    • Displaces teeth and resorbs roots when sufficiently large.

    Nasopalatine Duct Cyst - Differential Diagnosis

    • Large incisive canal - Maximal dimension of the canal/foramen of more than 6 mm is more likely to reflect a cyst.
    • Morphology and size vary in normal incisive canals.
    • Evidence of expansion, tooth displacement, or resorption favors the presence of a nasopalatine duct cyst.
    • Radicular cyst - centered upon a root, usually apically.

    Fibrous Dysplasia

    • Benign condition of bone where there is abnormal remodeling with presence of dysplastic fibrous tissue and varying amounts of immature bone.
    • Most common benign bone disorder syndrome.
    • Can be monostotic or polyostotic.
    • Can be associated with McCune-Albright syndrome.
    • May present with painless facial swelling and asymmetry.
    • Larger lesions may impinge on nerves.

    Fibrous Dysplasia - Radiological Features

    • Solitary lesions are almost always limited to one bone.
    • Borders are often described as ill-defined.
    • Often hyperdense to normal bone, but some may present with focal regions of increased density as well as focal regions which are hypodense and lucent compared with normal bone.
    • Ground-glass internal appearance is most frequently seen.
    • Expansion is an important feature, unless the lesion is extremely small.
    • There is often thinning and alteration of the cortical architecture, sometimes with focal regions where the cortex is absent.
    • The architecture of the lamina dura of the teeth is often altered and may be indistinct. Teeth are often displaced.
    • Root resorption is rare.
    • Mandibular canal will classically deflect the canal superiorly.

    Fibrous Dysplasia - Differential Diagnosis

    • Chronic osteomyelitis
    • Demonstrates periosteal response and sequestra.
    • Ossifying fibroma - More tumor-like growth and expansion where the normal morphology is not preserved.
    • There may be surrounding lucent margin.
    • Osteogenic sarcoma- more aggressive bone growth usually with speculation.
    • Paget disease - Usually older age group and usually bilateral.

    Cemento-osseous Dysplasia

    • Benign focal change of normal bone to fibrous tissue and metaplastic bone and/or cementum-like material.

    • Most often identified in the 40 year age group.

    • Three subtypes have been described

    • Periapical osseous dysplasia (periapical cemental dysplasia).

    • Florid osseous dysplasia (occurs in multiple lesions of the jaw).

    • Focal cemento-osseous dysplasia.

    • It's a mixed lesion both lucent (due to resorption) and opaque.

    Cemento-osseous Dysplasia - Radiographic Features

    • Immature lesions are usually lucent, with sclerotic margins
    • In time, internal focal opacity (s) appear and increase in size as the lesion matures over years. These opacities are usually homogeneous.
    • Mature lesions present as opaque lesions demonstrating a surrounding lucent margin (band) with sclerotic borders.
    • Occasionally, these lesions can be internally homogeneous, demonstrating a ground-glass appearance.

    Cemento-osseous Dysplasia - Differential Diagnosis

    • Early/immature lesions

      • Chronic periapical inflammatory lesion
      • When there are no internal opacities, these lesions can be radiologically almost identical.

    • Mature lesions

      • Bone island – No surrounding lucent margin
      • Odontoma
      • Cementoblastoma
      • Irregular root resorption, usually painful.
      • Ossifying fibroma- the ossifying fibroma has more of a mass effect, especially on the affected dentition.
      • Cemento-osseous dysplasia is often multiple; ossifying fibroma is a solitary lesion
      • other lesions such as chronic osteomyelitis.

    Ossifying Fibroma - Cemento-ossifying Fibroma

    • Composed of fibrocellular tissue with varying amounts of mineralized bone/cementum-like material
    • Can be aggressive to be more aggressive in younger patient
    • More often seen in females
    • Much less common than cemento-osseous dysplasia and fibrous dysplasia

    Ossifying Fibroma - Radiographic Features

    • Tumour-like mixed-density expansile lesion
    • Well-defined borders, which may be corticated
    • A surrounding lucent margin may be present
    • Internal density varies substantially.
    • The pattern of the mineralised material also varies
    • Typically shows a ground glass appearance (similar to fibrous dysplasia) or homogeneous opacities (similar to cemento-osseous dysplasia).

    Ossifying Fibroma - Differential Diagnosis

    • Fibrous dysplasia - Borders are less well defined and there is no surrounding lucent margin
    • Expansion is not tumour-like.
    • Root resorption is rare
    • Cemento-osseous dysplasia are usually multifocal. Less tumour-like growth, especially in relation to teeth
    • Other lesions like giant cell lesions
    • Lesions with internal calcifications
    • include calcifying cystic odontogenic tumors, adenomatoid odontogenic tumours, and rare calcifying epithelial odontogenic tumours.

    Ameloblastoma

    • Benign tumour involving the jaws, more common in the third to sixth decades.
    • Most commonly in the posterior mandible and maxilla.
    • Usually asymptomatic until it causes painless swelling.
    • Large lesions may involve adjacent structures.

    Ameloblastoma - Radiological Features

    • Presents as a multilocular lesion with well-defined corticated or sclerotic borders
    • Internal septa are classically thick and curved
    • Some may demonstrate classic "soap bubble" appearance
    • The cystic locules vary in size
    • The unicystic ameloblastoma is unilocular and often demonstrates extreme expansion

    Ameloblastoma - Differential Diagnosis

    • Giant cell granuloma
    • Odontogenic myxoma
    • Aneurysmal bone cyst
    • Keratocystic odontogenic tumour
    • Dentigerous cyst

    Calcifying Epithelial Odontogenic Tumor - Pindborg Tumor

    • Asymptomatic until expansion is noted
    • Commonly seen in posterior mandible, many associated with unerupted teeth
    • Locally invasive epithelial odontogenic tumor with amyloid-like material, where there may be calcific foci

    Calcifying Epithelial Odontogenic Tumor- Radiological Features

    • May be unilocular or multilocular
    • May demonstrate variable internal calcifications
    • Borders are also variable, ranging from well-defined cortex to poorly defined destructive margins

    Calcifying Epithelial Odontogenic Tumor - Differential Diagnosis

    • May resemble unilocular lucent lesions (cystic lesions, multilocular lesions) or lesions demonstrating internal calcifications.

    Ameloblastic Fibroma

    • Rare, most occurring in first and second decades of life.
    • Asymptomatic unless large enough to cause expansion or interfere with tooth development/eruption.
    • Most are seen within the posterior mandibular alveolar process.

    Ameloblastic Fibroma - Radiological Features

    • Well-defined, usually corticated lesion.
    • Usually unilocular, May be multilocular, usually when larger.
    • Larger lesions cause expansion with cortical thinning.
    • May interrupt tooth development/eruption or displace teeth.

    Ameloblastic Fibroma - Differential Diagnosis

    • Dentigerous cyst
    • Keratocystic odontogenic tumor
    • Ameloblastoma
    • Giant cell granuloma
    • Other lesions (e.g., aneurysmal bone cyst, odontogenic myxoma).

    Odontoma

    • Asymptomatic; associated with unerupted teeth
    • Often contributes to altered eruption or impaction of adjacent teeth.
    • May contribute to the malformation of the adjacent teeth.

    Odontoma - Radiographic Features

    • Opacity of variable internal appearance with surrounding lucent margin (lucent band/zone) and a corticated border
    • Internal density is variable, depending on the proportion of the various dental tissues.
    • Often affects the position, development and eruption of the adjacent teeth which are occasionally malformed

    Odontoma - Differential Diagnosis

    • Cemento-osseous dysplasia
    • Mature lesions may resemble complex odontoma
    • CODs are often multiple and borders are usually sclerotic.
    • Ossifying fibroma - Odontomas are usually denser with variable presence of enamel.

    Cementoblastoma

    • Occurs more commonly in males, most often younger than 25 years old.
    • Most commonly seen at the mandibular first molar region centered apically.
    • Pain is commonly reported. The pulp status of the involved tooth is usually normal.

    Cementoblastoma - Radiological Features

    • Well-defined, largely opaque lesion with a surrounding lucent margin (band) and a corticated/slightly sclerotic border, centered at the apical aspect of a tooth root.
    • Internal opaque architecture varies from being unstructured to a sunburst/'spokes of a wheel' appearance.
    • Root resorption is commonly seen.
    • Expansile when sufficiently large.

    Cementoblastoma - Differential Diagnosis

    • Mature periapical osseous dysplasia
    • Bone island
    • Hypercementosis
    • Reactive sclerosis related to a periapical inflammatory lesion

    Osteoma

    • Benign, slow-growing, mature bony prominence at the periosteal surface.
    • Three types can be seen
      • Compact bone (ivory osteoma)
      • Cancellous bone
      • Combination of compact and cancellous bone
    • Most commonly occurring within the paranasal sinuses

    Osteoma - Radiological Features

    • Well-defined, focal, opaque prominence of variable bony appearance.
    • Internally, it varies from being homogeneous and isodense with cortical bone (ivory osteoma) to those with variable internal cancellous bone appearance and varying thickness of the overlying cortical bone.

    Osteoma - Differential Diagnosis

    • Osteochondroma of the mandibular condyle and coronoid process - Osteochondromas demonstrate more irregular morphology with more heterogeneous, sometimes sclerotic, internal appearances.
    • Other lesions (e.g., sesile bony prominence with smooth periosteal surface; internally homogeneous and isodense with cortical bone; ethmoid osteoma; sphenoid osteoma; stylohoid ligamentous ossification).

    Sialoliths

    • Well-defined opacity with variable size, morphology and internal architecture.
    • Most commonly seen within the duct of the submandibular salivary gland.

    Malignant Tumours Involving the Jaws

    • Most demonstrate poorly defined invasive borders.
    • Occasionally, multiple "punched-out" lucencies with slightly more defined borders may be seen.
    • Most commonly associated with multiple myeloma.

    Malignant Tumors - radiographic features

    • Internal appearances- Usually lucent. May occasionally be residual bone remnants within, osteoblastic metastatic lesions, multiple sclerotic foci, and osteogenic sarcomas.
    • Maxillary or mandibular cortices- When a malignant lesion extends to or is centered at a bony boundary, there is usually cortical destruction, often with irregular edges.
    • Periosteal response at the involved cortex- Most do not demonstrate a periosteal response, unless there is secondary infection.

    Malignant Tumor - Differential Diagnosis

    • Hypercementosis
    • Reactive sclerosis related to a periapical inflammatory lesion.

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    Differential Diagnosis of Radiolucent Lesions-2 PDF

    Description

    Test your knowledge on dental pathology focusing on nasopalatine duct cysts and ossifying fibromas. This quiz covers their characteristics, effects on surrounding teeth, and radiographic features. Ideal for dental students and professionals looking to refresh their understanding of these conditions.

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