hard tissue lesions
DESCRIPTION
HARD TISSUE LESIONS . Dr Norzalina Ghazali BDentSc , BA (Ire), MClinDent (Child Dental Health) (Mal) Lecturer Faculty of Dentistry Universiti Sains Islam Malaysia (USIM) 20/12/2013. HARD TISSUE OF THE BODY. Bone, cementum , dentin and enamel - PowerPoint PPT PresentationTRANSCRIPT
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HARD TISSUE LESIONS
Dr Norzalina GhazaliBDentSc, BA (Ire), MClinDent (Child Dental Health) (Mal)LecturerFaculty of DentistryUniversiti Sains Islam Malaysia (USIM)20/12/2013
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HARD TISSUE OF THE BODY• Bone, cementum, dentin and enamel• Bone, cementum and dentin – similar in their composition &
formation• They are specialized connective tissues and collagen
(principally Type I)
Bone
Inorganic 67%
Hydroxyapatite
Organic 33%
Noncollagenous proteins
5%
Collagen 28%
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HARD TISSUE LESIONS• Most diseases arising in the jaws are of odontogenic origin,
but both non-odontogenic and systemic disorders may affect the jaws
Can be:-• Developmental• Inflammatory• Infection• Tumours/ malignancies • Genetic• Metabolic
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CYSTS OF THE JAWS• Cysts – is a pathological cavity having fluid or semi-fluid
contents which has not been created by the accumulation of pus, and the majority are lined wholly or in part by epithelium
• Symptoms: (1) Swelling, displacement or loosening of teeth, pain (if
infected)(2) Expansion of bone – may result in an ‘eggshell cracking’
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Classification (WHO 1992)
Cysts
Epitelial cysts
Odontogenic
Developmental
Dentigerous, odontogenic keratocyst,
eruption, lateral periodontal cyst,
glandular odontogenic cyst,
gingival cyst
Inflammatory
Radicular (apical and
lateral), residual
cyst, paradental
cyst
Non-odontogenic
Nasopalatine cyst, nasolabial
cyst
Non-epithelial cysts
Solitary bone cyst,
aneurysmal bone cyst
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WHO Classification of Tumours (2005)
• OKC is currently designated as a keratocystic odontogenic tumor (KCOT) and is defined as a benign uni-or multicystic, intraosseous tumor of odontogenic origin, with a characteristic lining of parakeratinized stratified squamous epithelium with the potential for aggressive, infiltrative behavior
• Although they are benign, KCOTs are locally aggressive and have a tendency to recur after treatment; reported recurrence rates range from 3% to 60%
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Gorlin-goltz syndrome
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Cysts in children
In children:• The most common cysts were DC (44%), followed by EC (21%),
TBC (18%), and RC (17%)• The mean ages were 11, 4.3, 14, and 8 years for DC, EC, TBC,
and RC, respectivelyIn adult:• The most common cysts were RC (63%), followed by DC (18%),
OKCT (10%), and non-odontogenic cyst (9%)• The mean age groups were 42, 50, and 46 years for RC, DC,
and OKCT, respectivelyManor E. et al.,
Int J Med Sci 2012; 9(1):20-26
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Radiographic findings• Margins – well-defined with peripheral cortication (radio-
opaque margin)• Shape – round/ ovoid radiolucencies because most cysts grow
by hydrostatic mechanisms• Locularity – unilocular or multilocular appearance because of
ridges in the bony wall• Effects on adjacent structures – displacements of a tooth or
the inferior dental canal, roots resorption (rare), bony expansion
• Effect on unerupted teeth – may become enveloped by any cyst
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ODONTOGENIC TUMOURS• Are lesions derived from the epithelial and/ or mesenchymal
remnants of the tooth-forming apparatus • Asymptomatic, may cause jaw expansion, movement of teeth,
root resorption, and bone loss
Biologic classificationBenign – no recurrence potential• Adenomatoid odontogenic tumour, squamous odontogenic
tumour, cementoblastoma, periapical cemento-osseous dysplasia, odontoma
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Benign – some recurrence potential• Cystic ameloblastoma, calcifying epithelial odontogenic
tumour, central odontogenic fibromaBenign aggressive• Ameloblastoma, odontogenic myxoma, odontogenic ghost cell
tumourMalignant• Malignant ameloblastoma, ameloblastic carcinoma, primary
intra-osseous carcinoma, ameloblastic fibrosarcoma
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Odontoma • Are mixed odontogenic tumours – composed of both epithelial
and mesenchymal dental hard tissues• Compound – appear as separate, small, tooth-like structures,
probably produced by localised, multiple budding-off from the dental lamina, found in anterior region, painless swelling
• Complex – appear as amorphous accumulations/ masses of hard tissue (cauliflower-like mass), common in posterior regions
Clinical signs: • Retained deciduous tooth, an impacted tooth, alveolar
swelling, generally no symptoms
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Radiographically: • Compound – appear as numerous tiny teeth in a single focus,
typically in a tooth-bearing area• Complex – appear as amorphous opaque masses
Treatment:• Enucleation• No potential of recurrence
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Ameloblastoma • Is defined as a benign, locally invasive epithelial odontogenic
neoplasm of putative enamel organ origin WHO, 2005
• Is a lesion of adults, rare in children• In children – usually cystic and appear as odontogenic cysts• Most common – mandibular molar-ramus area
Biologic subtypes:• Solid ameloblastoma• Unicystic ameloblastoma• Peripheral ameloblastoma• Malignant ameloblastoma• Ameloblatic carcinoma
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Clinical signs:• As a slow-growing, painless swelling, and causing expansion of
the cortical bone, perforation of the lingual and/or buccal plates and infiltration of soft tissue
• There is often delay in the diagnosis because of its slow-growing nature
Radiographically:• A multilocular radiolucency was the most frequently
encountered. It also presented with root resorption and was associated with unerupted teeth
• May be unilocular• Well-defined and sclerotic margins due to slow growing
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Treatment:• Is primarily surgical – range from enucleation, enucleation
followed by application of Carnoy’s solution, marsupialization followed by surgery, and resection
• There was lack of consensus over the most appropriate treatment for ameloblastomas especially in children
• A recurrence rate of 80% for unicystic ameloblastoma treated conservatively
Ghandhi et al. (2006)• Enucleation of unicystic ameloblastoma resulted in the highest
recurrence rate; and the lowest recurrence rate was associated with resection of the tumour
Lau and Samman (2006)
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• The conservative management is usually performed due to the benign nature of the ameloblastomas despite reported recurrence rates
• Several factors are taken in to consideration in the treatment of ameloblastoma in children; these include size, location, duration, mural component, psychological impact, control of possible recurrence and scope for follow-up
• A conservative surgical enucleation of unicystic ameloblastoma with careful follow-up rather than partial or complete jaw resection appears to constitute appropriate therapy
• This is to prevent any interruption in growth and development
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NON-ODONTOGENIC TUMOURS
Primary – benign• Osteoma• Osteochondroma• Cemento-ossifying fibroma• Central giant cell granuloma• Hemangioma
Primary – malignant• Osteosarcoma• Chondrosarcoma• Langerhans’ cell histiocytosis
Metaststic• Carcinoma
Rare in children
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Giant cell granuloma • Commonly seen in young people• Mandible, anterior to the 1st molars• Frequently only a painless swelling, produce a purplish soft
tissue swelling• Radiographically: rounded cyst-like radiolucent area, often
loculated or with a soap-bubble appearance, teeth displacement or occasionally root resorption
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Hemangioma of bone• Rare tumours of bone, commonly in the mandible• Clinically, cause progressive painless swelling which when the
overlying bone is resorbed may become pulsatile• Teeth may be loosened• Bleeding from the gingival margins involved by the tumour• Radiographically, there is a rounded or pseudoloculated
radiolucent area with ill-defined margind or a soap-bubble apperance
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Osteosarcoma• Highly malignant, the most common primary neoplasm of
bone but overall is rare especially in the jaws• Body of the mandible is a common site, as firm swelling which
grows noticeably in a few months and becomes painful • Teeth may be loosened, may be paraesthesia or loss of
sensation in the mental nerve area• Radiographically, irregular bone destruction noted
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Langerhans’ cell histiocytosis• Is a disorder characterized by a proliferation of cells exhibiting
phenotypic characteristics of Langerhans cells• 3 forms are recognised:• Eosinophilic granuloma (chronic localized): Solitary or multiple
bone lesions• Hand-Schuller-Christian (chronic disseminated): Bone lesions,
exophthalmos, diabetes insipidus• Letterer-Siwe (acute disseminated): Bone, skin, internal organs
affected
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• Skull, mandible, ribs, vertebrae, and long bones are often involved
• Oral changes – initial presentation• Tenderness, pain & swelling, loosening of teeth, gingival
tissues are often inflamed, hyperplastic & ulcerated• Radiographically, exhibit solitary or multiple radiolucent
lesions which often affect the alveolar bone causing the teeth to appear as if they were floating in space