BDS12031-Radiographic interpretation of odontogenic benign tumors.pdf

BDS12031 Radiographic Interpretation of Odontogenic Benign Tumors Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various odontogenic benign tumors with different tissue origins. Objectives: By the endTitle of the the student should be able to...

BDS12031 Radiographic Interpretation of Odontogenic Benign Tumors Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various odontogenic benign tumors with different tissue origins. Objectives: By the endTitle of the the student should be able to: Subject Goestutorial, Here • • • • • Recognize the general characteristics of benign odontogenic tumors. Describe the clinical and radiographic features of benign odontogenic tumors of epithelial origin. Describe the clinical and radiographic features of benign odontogenic tumors of mesenchymal origin. Describe the clinical and radiographic features of benign odontogenic tumors of mixed origin. Differentiate between various benign odontogenic tumors. • What does “ oma” mean? • What is the difference between “tumor” and “ neoplasm”? • What are the main differences between “benign” and “malignant” neoplasms? • What is the difference between benign neoplasm, hamartoma, and hyperplasia? Tumors Malignant Benign Odontogenic Non-odontogenic Odontogenic Non-odontogenic Benign Odontogenic Tumors General Features Clinical Features • Slowly growing • Painless swelling • Normal covering mucosa • • • • • • • • • Radiographic Features Teeth bearing area Well-defined Corticated Bone expansion Displacement of cortices Root resorption Teeth displacement Root divergence Hindering of eruption Classification of Odontogenic Tumors 1971 1992 2005 2017 WHO Classification of Odontogenic Tumors 2017 Epithelial Ameloblastoma Squamous odontogenic tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Mesenchymal Mixed Odontogenic fibroma Ameloblastic fibroma Odontogenic myxoma Primordial odontogenic tumor Cementoblastoma Odontoma Cemento-ossifying fibroma Dentinogenic ghost cell tumor Epithelial • • • • Ameloblastoma Squamous odontogenic tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Ameloblastoma Epithelial • Disease mechanism Benign locally invasive odontogenic epithelial tumor • Clinical features 20-50 y Paresthesia Ameloblastoma • Radiographic features • Location: mandible 80 % maxilla 20% molars & ramus 70%, premolars 20%, anterior 10% • Shape & periphery: well-defined corticated – ill-defined • Internal structures: RL unilocular or multilocular thick curved septa soap bubble – honey comb Impacted tooth • Effects on surrounding structures: expansion - root resorption Epithelial Ameloblastoma Epithelial Ameloblastoma • Metastasizing (malignant) ameloblastoma • Currently considered as benign tumor not malignant Epithelial Epithelial • • • • Ameloblastoma Squamous odontogenic tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Squamous odontogenic tumor Epithelial • Disease mechanism Benign locally invasive epithelial odontogenic tumor • Clinical features rare Wide age range Squamous odontogenic tumor • Radiographic features • • • • Location: posterior mandible anterior maxilla Shape & periphery: well-defined –triangular - semicircular Internal structures: unilocular RL Effects on surrounding structures: root divergence Epithelial Squamous odontogenic tumor Epithelial Epithelial • • • • Ameloblastoma Squamous odontogenic tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Calcifying epithelial odontogenic tumor Epithelial • Disease mechanism CEOT – Pindborg tumor Benign locally invasive epithelial odontogenic tumor • Clinical features 8-92 Y average 42 y Calcifying epithelial odontogenic tumor • Radiographic features • Location: posterior mandible • Shape & periphery: well-defined ill-defined • Internal structures: RL or Mixed Unilocular or multilocular Impacted tooth (half of cases) • Effects on surrounding structures: expansion Epithelial Calcifying epithelial odontogenic tumor Epithelial Epithelial • • • • Ameloblastoma Squamous odontogenic tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Adenomatoid odontogenic tumor Epithelial • Disease mechanism AOT Benign odontogenic epithelial tumor, non aggressive • Clinical features 2nd decade, 16Y Females > Males Adenomatoid odontogenic tumor • Radiographic features • Location: anterior maxilla > anterior mandible • Shape & periphery: well-defined - corticated • Internal structures: RL or mixed • unilocular impacted tooth • Effects on surrounding structures: teeth displacement Epithelial Adenomatoid odontogenic tumor Epithelial Mesenchymal • • • • Odontogenic fibroma Odontogenic myxoma/myxofibroma Cementoblastoma Cemento-ossifying fibroma Odontogenic fibroma • Disease mechanism Central odontogenic fibroma Benign odontogenic mesenchymal tumor Simple type- WHO type • Clinical features Painless swelling 11-39 y Mesenchymal Odontogenic fibroma • Radiographic features • • • • Location: posterior mandible Shape & periphery: well-defined, corticated - scalloped Internal structures: RL unilocular – sometimes multilocular Effects on surrounding structures: ±bone expansion Mesenchymal Odontogenic fibroma Mesenchymal Mesenchymal • • • • Odontogenic fibroma Odontogenic myxoma/myxofibroma Cementoblastoma Cemento-ossifying fibroma Odontogenic myxoma Mesenchymal • Disease mechanism Benign locally invasive odontogenic mesenchymal tumor • Clinical features Females > males Young age Paresthesia Odontogenic myxoma Mesenchymal • Radiographic features • Location: posterior mandible • Shape & periphery: well-defined – ill defined - scalloped • Internal structures: multilocular RL honey comb – tennis racket- straight septa • Effects on surrounding structures: minimal expansion Odontogenic myxoma Mesenchymal Mesenchymal • • • • Odontogenic fibroma Odontogenic myxoma/myxofibroma Cementoblastoma Cemento-ossifying fibroma Cementoblastoma • Disease mechanism Benign odontogenic mesenchymal tumor • Clinical features Young age Pain Mesenchymal Cementoblastoma Mesenchymal • Radiographic features • • • • Location: mandibular premolars-1st molar Shape & periphery: well-defined – corticated – RL rim Internal structures: RL - mixed - RO Effects on surrounding structures: bone expansion – root obscuring Cementoblastoma Mesenchymal Mesenchymal • • • • Odontogenic fibroma Odontogenic myxoma/myxofibroma Cementoblastoma Cemento-ossifying fibroma Cemento-ossifying fibroma • Disease mechanism Benign odontogenic mesenchymal tumor Previously cemento fibro-osseous lesion • Clinical features Young age Painless swelling Mesenchymal Cemento-ossifying fibroma • Radiographic features • • • • Location: mandibular premolars - molars Shape & periphery: well-defined – corticated – RL rim Internal structures: RL - mixed - RO Effects on surrounding structures: bone expansion Mesenchymal Cemento-ossifying fibroma Mesenchymal Mixed • • • • Ameloblastic fibroma Primordial odontogenic tumor Odontoma (Compound type - Complex type) Dentinogenic ghost cell tumor Ameloblastic fibroma • Disease mechanism Benign odontogenic mixed tumor • Clinical features 15-16 y Mixed Ameloblastic fibroma Mixed • Radiographic features • Location: mandibular molars • Shape & periphery: well-defined – corticated – cap like • Internal structures: RL – unilocular or multilocular impacted tooth • Effects on surrounding structures: bone expansion – root resorption Ameloblastic fibroma Mixed Mixed • • • • Ameloblastic fibroma Primordial odontogenic tumor Odontoma (Compound type - Complex type) Dentinogenic ghost cell tumor New Primordial odontogenic tumor Mixed • Disease mechanism benign mixed odontogenic tumor comprised of a loose connective tissue with a similar morphology with dental papilla and exhibiting in its periphery the presence of a columnar epithelium • Clinical features 1st, 2nd decades Primordial odontogenic tumor • Radiographic features • • • • Location: posterior mandible Shape & periphery: well-defined – corticated Internal structures: RL - impacted tooth Effects on surrounding structures: bone expansion Mixed Primordial odontogenic tumor Mixed Mixed • • • • Ameloblastic fibroma Primordial odontogenic tumor Odontoma (Compound type - Complex type) Dentinogenic ghost cell tumor Odontoma • Disease mechanism Disturbance in tooth follicle formation Hamartoma? Compound: normal arrangement of dental structures Complex: haphazard arrangement of dental structures • Clinical features 1st, 2nd decades Lack of tooth eruption Painless swelling (complex) Mixed Odontoma (compound) Mixed • Radiographic features • • • • Location: anterior maxilla Shape & periphery: well-defined – corticated – RL rim - denticles Internal structures: RL – mixed - RO Effects on surrounding structures: hindering of teeth eruption Odontoma (compound) Mixed Odontoma (complex) Mixed • Radiographic features • Location: mandibular molars • Shape & periphery: well-defined – corticated – RL rim • Internal structures: RL – mixed - RO impacted tooth • Effects on surrounding structures: bone expansion – hindering of teeth eruption Odontoma (complex) Mixed Mixed • • • • Ameloblastic fibroma Primordial odontogenic tumor Odontoma (Compound type - Complex type) Dentinogenic ghost cell tumor Dentinogenic ghost cell tumor • Disease mechanism Solid benign variant of ghost cell spectrum (variant of calcifying odontogenic cyst) • Clinical features Young & middle age Mixed Dentinogenic ghost cell tumor Mixed • Radiographic features • Location: maxilla = mandible incisor-canine region • Shape & periphery: well-defined corticated • Internal structures: RL or mixed unilocular or multilocular impacted tooth • Effects on surrounding structures: bone expansion – root resorption Dentinogenic ghost cell tumor Mixed WHO Classification of Odontogenic Tumors 2017 Epithelial Mesenchymal Mixed Ameloblastoma Odontogenic fibroma Ameloblastic fibroma Odontogenic myxoma Primordial odontogenic tumor Cementoblastoma Odontoma Cemento-ossifying fibroma Dentinogenic ghost cell tumor Squamous odontogenic tumor Calcifying epithelial odontogenic tumor Adenomatoid odontogenic tumor Reading material: • Oral Radiology: Principles and Interpretation (7th Ed.) by White, S. C. and Pharoah, M. J, published by Mosby Elseiver. Aim: The aim of this tutorial is to orient the student with the clinical and radiographic features of various odontogenic benign tumors with different tissue origins. Objectives: By the endTitle of the the student should be able to: Subject Goestutorial, Here • • • • • Recognize the general characteristics of benign odontogenic tumors. Describe the clinical and radiographic features of benign odontogenic tumors of epithelial origin. Describe the clinical and radiographic features of benign odontogenic tumors of mesenchymal origin. Describe the clinical and radiographic features of benign odontogenic tumors of mixed origin. Differentiate between various benign odontogenic tumors.