Odontogenic Tumors PDF

thth Thank ODONTOGENIC you TUMORS Dr.LAVANYA THOTA Assistant Professor Oral Medicine and Radiology Dept. OF MDS College of Dentistry, Alzulfi. Majmaah University  Specific learning objective  Classification  Ori...

thth Thank ODONTOGENIC you TUMORS Dr.LAVANYA THOTA Assistant Professor Oral Medicine and Radiology Dept. OF MDS College of Dentistry, Alzulfi. Majmaah University  Specific learning objective  Classification  Origin of each lesion  Radiographic features  Differential diagnosis FORMAT  Introduction  Classification  Differential diagnosis of each lesion  Treatment of each lesion DDX important only 3 differentialdiagnosis Wechould know diseases 3 INTRODUCTION  Odontogenic tumors arise from the tissues of the odontogenic apparatus.  They comprise a complex group of lesions of diverse radiographic appearance & clinical behavior.  Classification of odontogenic tumors MCQS  A)Epithelial tumors  C) Mixed tumors epithilium connectivetiss 1. Ameloblastoma (DD of multilocular Remenge's radiolucencies) 1. Ameloblastic fibroma CEOT epithilium 2. Ameloblastic fibro-odontoma 2.Calcifying epithelial odontogenic tumor epithilitm 3. Adenomatoid odontogenic tumor 3. Compound odontoma canine 4.Squamous odontogenic tumor epithilium 4. Complex odontoma B) Mesenchymal tumors (already completed in other lectures) 1. Odontogenic myxoma (In multilocular radiolucencies – 2 ) o 2. Central odontogenic fibroma (In multilocular radiolucencies – 2 ) V 3. Central cemento – ossifying fibroma (In Fibro – osseous lesion – 2) 4.Benign cementoblastoma CALCIFYING EPITHELIAL ODONTOGENIC TUMOR – CEOT CEOT  Also known as pindborg tumor.  ORIGIN: Remnants of the cells in stratum intermedium layer of enamel organ.  Clinical features:  Occurs in 30-50 years of age.  Commonest site is mandibular molar area.  50% tumors are associated with an unerupted or embedded tooth.Gotcompletly  Most patients are asymptomatic.  It’s a painless slow growing mass. nothin thebone outside appearsassmallgingivalswelling Insidebon  Extraosseous-non specific ,sessile gingival masses commonly seen in anterior gingiva. Radiographic Features of CEOT  The border of the tumor may have a well defined cyst like cortex (border).  In some the boundary may be irregular & ill defined.  The internal aspect may appear unilocular or multilocular with numerous scattered radioopaque foci.  The characteristic finding is the radiopacities close to the crown a  Scattered flecks of calcification – driven snow appearance I CEOT  May have a developing tooth below the lesion suggesting an unerupted tooth. CALCIFYING EPITHELIAL ODONTOGENIC TUMOR – CEOT  Differential diagnosis: PDI  Lesions with completely radiolucent internal structure may mimic dentigerous cyst or ameloblastomas. Dwe differentiatebetweenthesediseases weshould can't do biopsy  The location of CEOT & age of the pt help in differential diagnosis.  TREATMENT & PROGNOSIS:  Careful excision of the tumor with margin of normal tissue.  CEOT shows some potential of recurrence(15%) & aggressiveness. CodontoginaKeratocyte high recurrencetumor ADENOMATOID ODONTOGENIC TUMOR – AOT uncommon there Adenomed and  Its an uncommon tumor & occurs mostly in association with an the unerupted maxillary cuspid (Canine).  CLINICAL FEATURES:  Common in younger age group of below 20years age.  Predilection for occurrence in females.  More common in maxilla & usually in the anterior region. maxi Canine  Patient is asymptomtic as it is a painless swelling. isag.PE smailgisiatpgm  Peripheral lesions – painless gingival colored masses.  Radiographic features: AOT  The tumor has well defined corticated or sclerotic border.  The internal structure of the tumor may be completely radiolucent or contain faint radiopaque foci or may show dense cluster of ill-defined radiopacities.  The tumor may cause displacement of adjacent teeth.  The lesion may inhibit the eruption of an involved tooth.  Differential diagnosis: AOT  Odontogenic keratocyst which is considered Ghostlike as tumor : when the tumor is completely radiolucent & has a follicular relationship with an impacted tooth.(Odontogenic keratocyst is commonly seen in mandibular posteriors and has thin radiopaque border a scalloped outline  When lesion is more radioopaque it may appear like CEOT & adenomatoid fibro- odontoma.(Both occur in the posterior Mandible).  Treatment & prognosis: Klgcleanthearesfhion sina.at  Conservative excision or enucleation.  Recurrence is rare with good prognosis.  Mixed tumore origins MESENCHYMAL ORIGIN ODONTOGENIC TUMORS AMELOBLASTIC FIBROMA  Also known as Soft mixed odontogenic tumor, Soft mixed odontoma, Fibroadamantoblastoma.  It is a relatively uncommon neoplasm which is characterized by the simultaneous proliferation of both the epithelial & mesenchymal tissues IFwithout the formation of enamel or dentin. I  CLINICAL FEATURES: 3  Most commonly in the molar region of the mandible  Often occurs in younger individuals below 10yrs of age. 1-  Slight predilection for occurrence in males. -  Tumor enlarges by gradual expansion.  00from the dentist. - Pain, tenderness or mild swelling of the jaw may induce the patient to seek aid Radiographic Features Of Ameloblastic Fibroma  The tumor is more commonly unilocular (radiolucent) & may be multilocular with well defined corticated borders.  The lesion may cause expansion but cortical plate is intact.  The associated tooth may be inhibited from eruption or displaced in apical direction.  Ameloblastic fibroma: contd…  Differential diagnosis:  Ameloblastoma – the septa are more defined & coarse. soapbubbe honeycom If  Giant cell granuloma – seen with soft tissue involvement Moresoft tissue  Odontogenic myxoma – straight C thin etched septa giving aC tennis racket appearance.  TREATMENT:  Surgical enucleation with follow up.  oct AMELOBLASTIC FIBRO ODONTOMA  It is a mixed tumor with all the elements of an ameloblastic fibroma but with scattered collection of enamel and dentin. 1  Clinical features:-  Usually seen in children with an average age of ten years.  No significant gender predilection male or ferrotets  More frequently in the posterior aspect of the jaws.  Asymptomatic and associated with painless growth of the affected bone. Ameloblastic Fibro Odontoma – Radiographic Features  It presents as a well defined, uniformly smooth and corticated expansile radiolucency containing saying solitary radiopaque mass or multiple small radiopacities representing odontoma portion of a lesion.  Most often an associated impacted tooth is present. AMELOBLASTIC FIBRO ODONTOMA contd…  Differential diagnosisis:  Ameloblastic fibroma nelaeeoe.in sh  Developing odontoma. (will have a higher radio – density equal to enamel or dentin  Treatment: Conservative enucleation.  ODONTOMA  The term ODONTOMA by definition alone, refers to any tumor of odontogenic origin.  It is a growth in which both the epithelial & mesenchymal cells exhibit complete differentiation,with the result that functional ameloblasts and odontoblasts form enamel & dentin.  This enamel & dentin are laid down in abnormal pattern. sudden all of  This is considered more as a hamartomatous (sudden) malformation rather than a neoplasm. r  It is composed of more than 1 type of tissue & so is also called a composite odontoma.  Radiographically & histologically it is recognizable into 2 forms: 1)compound composite odontoma & 2)complex composite odontoma. et  ODONTOMA contd… 1) Compound composite odontoma: - In some odontomas the enamel & dentin are laid down such that it bears anatomic resemblance to normal teeth except that they are often smaller than typical teeth. Resemble of the density teeth 2) Complex composite odontoma:  The calcified dental tissues are simply an irregular mass bearing no morphologic similarity even to rudimentary teeth.  Etiology: trauma, infection or genetic transmission. not Resemble the tooth structure  ODONTOMA – CLINICAL FEATURES  Predilection (common) for occurrence in males.  Compound odontoma has predilection for occurrence in the anterior maxilla.  Complex odontomas has predilection for occurrence in posterior region of the jaws.  Both the tumors have been observed to occur more on the right side of the jaw. are we  Most odontomas are asymptomatic. as  Occasionally signs & symptoms of their presence consist of unerupted or impacted teeth, retained deciduous teeth, swelling & evidence of infection  ODONTOMA – RADIOGRAPHIC FEATURES  Well defined lesions with cortical border & immediately inside adjacent the compound cortical border is a soft tissue capsule.  Internal structure is radiopaque. usuallyMaxi  Compound odontomas – contain a number of tooth like structures or denticles that look like deformed teeth. randi Complex  Complex odontomas – contain irregular mass of calcified tissue. ODONTOMA – contd…  COMPLICATIONS –  Odontomas may interfere with normal eruption of the teeth.  Most are associated with abnormalities such as impaction,malpositioning,diastema,aplasia, malformation & devitalization of adjacent teeth. and npenpi.name  DIFFERENTIAL DIAGNOSIS:  Cemento-ossifying fibroma – has a radiolucent rim surrounding it and are attached to tooth  Periapical cemental dysplasia – involve multiple anterior teeth and seen in periapical region  TREATMENT – surgical excision.  Mesenchemaltumor CEMENTOBLASTOMA exccisffkkitfrfndto.tnbutnottruecemented Tandf.no ar y Mostly affected E Differential diagnosis: 1.osteosarcoma: Malignant neoplasm sun burst appearance is seen radigraphically. C 2.Osteoblastoma :Has no radiolucent rim surrounding it. Wecantseetheoutin ofRoot THANK YOU Good morning