treatment planning and seminar

8/13/2019 Treatment Planning and Seminar

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Treatment Planning And Seminar

Khalil S. Husain 200912265

Alan Jamil 200820265


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Case Senario

8 year old boy presented with bilateral painlessswelling of both cheeks, noted by his mom over the last

5 months. O/E: migrated retained primary with spacing,

no permanent teeth erupted. OPG: radiolucency

bilateral body, angle and ramus of the mandible.


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Differential Diagnosis

Aneurysmal bone cyst

Ameloblastoma

Odontogenic keratocyst

Central giant cell granuloma

Central Odontogenic Fibroma

Primary bone neoplasm

Acute osteomyelitits of the Jaws

Brown Tumor Odontogenic Myxoma

Cherubism


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Odontogenic Keratocyst

Swelling is the most common presenting complaint;however,

Asyptomatic and found incidentally on dental X-rays.

Usually Unilateral

multiple = Gorlin Goltz syndrome

Gorlin Goltz Syndrome

Multiple Odontogenic Keratocyst

Basal Cell Carcinoma

Skeletal, dental, opthalmic and Neurological Abnormalities

Intracranial ectopic calcification of falx cerebri

Facial Dysmorphism

Multiple = Ehlers danlos Syndrome: hereditary disorder of

the CT related to collagen metabolism


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Ameloblastoma

Rare, benign tumor of Odontogenic epithelium

most common type of Odontogenic Epithelial

Tumor

Mandible > Maxilla

Presence of unerupted teeth, painless,

unilateral

Sound of bone cracks when palpated and this

phenomenon is referred to as "Egg Shell

Cracking" or crepitus, an important diagnosticfeature


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Aneurysmal bone cyst

Osteolytic bone neoplasm characterized by severalsponge-like blood or serum filled, generally non-

endothelialized spaces of various diameters.

thought to be a reactive process secondary to trauma or

vascular disturbance Aneurysmal cysts of the jaws produce firm swellings which

have been described as painful

Both mandible and maxilla were involved, particularly the

molar regions. Swelling was usually present and there wasfrequently a history of rapid growth. Radiologically, they

often appeared as multilocular radiolucencies with

expansion and thinning of the cortical plates.


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Central Giant Cell Granuloma

A benign condition of the jaws. It is twice as likely to affectwomen and is more likely to occur in 2040 year old

people

More common in the mandible and often cross the midline.

CGCG lesions are found more commonly in the anterior ofthe maxilla and the mandible in younger people (before

age 20).

large lesions that expand the cortical plate and

can reabsorb roots and move teeth. painful and cause paresthesia


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Central Odontogenic Fibroma

It is more common in adults, with the average age being40.

It is twice as likely to affect women than men.

It is usually found either in the anterior maxilla or the

posterior mandible.

Radiographically it presents with either radiolucency or

mixed radiolucency/opaque.


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Acute osteomyelitits of the

Jaws

inflammation of the bone marrow.

Sever Pain

Swelling

Trismus

Heat and Tenderness

Dysphagia

Fever

Cervical lymphadenopathy


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Brown Tumor

The brown tumoris a bone lesion that arises in settingsof excess osteoclast activity, such as hyperparathyroidism.

It is not a true neoplasm. However, it may mimic a true

neoplasm

bone deposition followed by additional resorption canexpand beyond the usual shape of the bone, involving

the periosteum thus causing bone pain.

characteristic brown coloration results from

hemosiderin deposition into the osteolytic cysts.


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Odontogenic Myxoma

an uncommon benign odontogenic tumor arising fromembryonic connective tissue associated with tooth

formation.

found in patients ranging in age between 10 and 50 years

specifically between 25 and 35 years of age Mandible > Maxilla

Painless, slowly enlarging expansion of the jaw with

possible tooth loosening or displacement

"soap bubble" or "honeycomb" appearance


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Cherubism

Cherubism is a rare disease of autosomal dominantinheritance

characterized by painless, frequently symmetrical,

enlargement of the jaws as a result of the replacement of

bone with fibrous tissue. The disease is also called familial fibrous dysplasia of the

jaws.

Cherubism is usually diagnosed in children aged 2 to 7

years, with the observation of exacerbation of itsmanifestations within the first 2 years after diagnosis and

of stabilization or even regression after puberty.

Boys are more affected than girls at the proportion of 2 : 1.


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Radiographic Appearance

Expansion of the buccal and lingual cortical plates is seenon occlusal and postero-anterior views

Mandibular body and rami are frequently involved

Enlargement of the maxilla is at the expense of the

maxillary sinuses


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Radiographic Apperance

It is almost always bilaterally symmetrical with an epicentrein the ramus of the mandible or tuberosity of maxilla.

Lesions are usuallywell-defined, expansile, with fine

trabeculae forming a multilocular pattern


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Biopsy

Biopsy and histopathologic examination are not required inmost cases to establish the diagnosis of cherubism.

However, when performed, numerous osteoclast-like

multinucleated giant cells in a moderately loose fibrous

stroma are present.


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Treatment

Self-limiting condition that improves over time

Treatment depends on the individual patients functional

and esthetic needs

Early surgical intervention is contraindicated because it

appears to predispose to recurrences, investigators preferto wait until the end of puberty

Treatment, if necessary, consists of recontouring the bone

for cosmetic reasons after the lesions have stabilized in

size. Surgery is only indicated in cases characterized by

impaired speech, chewing or swallowing difficulties, or with

the presence of major deformities that may cause

psychological problems for the patient.


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