Bone Diseases & others Flashcards

Question

How does **Fibrous dysplasia** affects the Surrounding structures?

Answer 1

* **May have no effect** ( especially if it hasn’t reached the cortical outlines) * **Expansion and thinning of cortical walls** * **Displacement of teeth** ( espically in advanced cases) * One of the few entities that cause **SUPERIOR displacement** of the mandibular canal

Answer 2

**Fibrous dysplasia on the right mandible.** Note the superior displacement of the IAN Canal This is not odontogenic ( as they are usually above the canal) **Anything below th canal ►think of it as originiating from the bone itself**

Answer 3

Fibrous Dysplasia in the left of the maxillae. Always compare both side left and right * We see granular/glass appearance of the bone ( blue arrow) and compare it to the contralateral maxillae. The trabucular pattern has changed signficantly. * Also compare the maxillary sinus space. The left maxillary sinus appears radiopaque. * That is because the maxillae has been enlarged to the point where it is pushing the floor of the maxillary sinus superiorly and reducing the total volume of the sinus. * The purple arrows indcate the displaced floor of the maxillary sinus.

Answer 4

**FD** Note the normal left maxillary sinus and the obliterated space of the right maxillary sinus ( blue arrows). **A ground glass appearing entity** (humogenous radiopaque lesion) has obliterated the space secondary to expansion of the right maxilla. These findings are consistent and quiet common in **advanced cases Firbous dysplasia**

Answer 5

**Generalized FD** * Metabolic bone diseases (hyperparathyroidism) (any disease that incrase trabacular bone density) * Paget's disease **Localized FD** * Osteomyelitis * Osteosarcoma

Answer 6

* Consultation with an OMFR is advisable. Monitoring of the area is also advised. * Typically treatment is not needed unless there are clinical symptoms or patients present with cosmetic concerns if clinical symptoms are severe * Implants and surgical intervention should be avoided when possible as these areas are void of blood supply

Answer 7

Dysplastic lesions that are confined to the jaws.

Answer 8

1) Periapical COD 2) Focal COD ( not covered) 3) Florid COD Two types of COD instead of three Perapical COD & Florid COD

Answer 9

cancellous bone is replaced with fibrous tissues & cementum‐like material.

Answer 10

* Typically **asymptomatic**, almost always captured as incidental finding * Generally, no bony expansion but is not uncommon in the florid type

Answer 11

• Commonly seen in middle‐aged patients female predilection * more commonly seen in the **Black population** * also frequently seen in **Asian population**

Answer 12

* Usually **well‐defined borders** in perapical type (may be ill‐defined in florid type). * **Early lesions show radiolucent features** in the periapical area of the teeth _As times progresses, the lesion matures =_t**he entity may become radiopaque.** ‐ as a result there is also **an intermideate mixed phase** **• The lesions mature from the center outwards** ‐ as a result, **_a radiolucent rim surrounding the lesion is commonly noted._** • Typically **the periodontal ligament space** of affected areas are intact but my not be _visualized_ because _they are superimposed over the region._

Answer 13

Early Periapical COD well defined radiolucency surrounding the apeces of these two central When looking at such cases, it is also imporant to: 1. look at the crowns to look for carious lesions. If there is no restorations or no evidence of caries, it is likely that these lesions are arising from the bone and not secondary to pulpal involvement. 2. It also important to look at the PDL and Lamina dura, typically in COD lesions they should be visisulized and intact ( but because this is a 2D image and this area may superimpose on this region and obsecure the visulizing of the lamina dura and the PDL) **what’s the difference between COD and Inflammatory lesion?** COD won’t have effect on the PDL space itself, because it orginates from the bone! Vitality testing can help us differntiate between inflmmatory lesion and something that happeing inside of the bone.

Answer 14

Early & mature Periapical COD **Preapical radiographs of the anterior mandible of the same patient at different times.** Note the differnece in density between the two radiolecency: Note the internal structure of the radiopacity is quite radiolucent ( purple arrow) The Preapical radiographs of the same region taken at a later time shows a more radiopaque internal structure (pink arrow). This reflect the maturing of the COD lesion. The lesion with Pink arrow can be described as well‐defined mixed radiolucent/radiopaque entity. ( because you have radioleucent part and radipaque part)

Answer 15

Periapical COD Sagital cross section of the anterior Mandible. Mixed radiolucent/radiopaque area (green circle)

Answer 16

A very mature Periapical COD ( purple arrow) Well‐defined radiopacity in the periapical region. Sometimes you may or may not be able to differentiate a very thin radiolucent line as in this case. you might include ddx of other lesions which might present with radiopacity in the preapical region There are certain tests you can do clinically to differentiate too. or do clinical tests

Answer 17

mature Periapical COD You see a nice radiolucent rim and radiopaque center  so mixed radiolucent/radiopaque entity in the periapical region of tooth #31  most likely diagonsis would be Periapical COD.

Answer 18

mature Periapical COD You can have these lesions in endentulous areas as well. So this is is an endeulous area, but if there was a tooth here, this would be in the periapicel region or near it with mixed radiolucent/radiopaque entity  the differential diagonsis of this area could include Periapical COD.

Answer 19

mature Periapical COD Coronal cross section of the posterior mandible in the region of the premolar ~ mixed radiolucent/radiopaque entity, the center is radiopaque and the periphery is radiolucent.

Answer 20

Periapical COD green arrow Simple bone cysts may develop in regions of COD ( periapical or florid type) So look for areas void of trabucular bone and has scalopping of the lesion. red arrow

Answer 21

Widespread form of periapical COD ## Footnote There is some discreppency on how to consider a lesion a florid COD Some people say the radiopacity entities have to be on at least 2 qudarants And other says if you have the radiopacity entities crossing the midline of the bone. If it is in 3 quadrant ► then you can defentitly say it’s the Florid type, but even if you see itone bone and it has crossed the midline ► you may consider it Florid COD

Answer 22

Florid COD Multiple regions of COD. Notice the wide areas of scelortic/radiopaque areas on mandible and also on maxillae

Answer 23

Florid COD ## Footnote Two periapical radiographs of the left and right posterior mandible of the same patient.  In this case, note **the areas of radiolucency and radiopacity are rather ill defined but widepsread** to affect most of the teeth. Most of the teeth noted here are restored.  So even if the radiographs suggest a cemento‐osseous process, it is important to keep an eye for these teeth in term of vitality and prevent a periapical infections which would otherwise **secondarily infect** the altered bone of COD.

Answer 24

Florid COD Axial section of the mandible. * Notice **mixed radiolucent/radiopaque entity on the patient right side**. And **on the left the area is more radiopaque centrally and has a thin radioluceny around it.** * The arrows indicate **well‐defined radiopacities immedietly surrounded by radiolucent rims.** * Note that **the radiolucent rim on the left side is thin when compared to the lesion on the right. This likely means that the lesion on the left is more mature** ( more time has passed for the entity to produce more woven bone).

Answer 25

Florid COD ## Footnote  **Rarefying osteitis** (radiolucent lesions) ( it would differentiate in the more early stages of the COD ( the radiolucent stage)  **Condensing osteitis** (considered in the differential when the lesion is more mature and more radiopaque lesions)  **Cementoblastoma** ( benign neoplasm of the cementum so we should be able to see certain features that reflect benign neoplastic lesions )  **Dense bone islands** ( a common differential when considering COD)

Answer 26

* **Paget's disease** ( t generalized areas) * **Osteomyelitis** ( localized area because we have mixed radioluecent/radiopaque areas)

Answer 27

* Typically, no treatment is required **unless these regions show clinical/radiographic evidence of secondary infection** * Ex if patient complain of some pain of that area –\> we want to follow up that region * **Surgery** within the dense bone has a high risk of causing **osteomyelitis** * **Patients should be seen regularlyfor preventive treatment** Want tooth supported rather than tissue supported RPD and CD

Answer 28

Classified as **a benign neoplasm** ## Footnote Because _it acts like a benign neoplasm_. Once you examine it under microscope, you’ll see features _resmeble_ **benign fibrous osseous lesions.** You’ll see: ** Fibrous connective tissues  cementum like material  even altered bone material (woven bone)**

Answer 29

There are two types: **classic and juvenile form** -**juvenile** seen in younger patients and tend to be more aggressive in nature ( both radiographically and clinically aggressive features) • Young adults and females affected mostly • Bony expansion and displacement of teeth can be seen in many cases ( not suprising since it acts like a neoplasm) • _More commonly_ seen i**n the mandible and in posterior regions**

Answer 30

* **Well‐defined, round or oval lesion** * **Periphery of the lesion is corticated** and may **exhibit a radiolucent periphery** (sometimes referred to as **a soft tissue capsule**) * Internally, the lesion is typically **granular or radiopaque** but may show variations (**mixed radiolucent/radiopaque**) * _Strong tendency to_ **displace teeth and cortical outlines**

Answer 31

Cropped Panaromic showing **a case of** Cemento‐ossifying Fibroma * Appreciate the **radiolucent rim** indicated by the black arrows. * Also note the internal structure of the trabucular bone and compare it to adjacent unaffected areas. It is **more granular and radopaque** compared to adjacent areas. * Another important feature to appreciate is **the displacement of the anterior teeth** **(diverging roots)** * These features are usually seen **in lesions with benign neoplastic characterstics.**

Answer 32

**Cemento‐ossifying Fibroma** ## Footnote Note **the internal granular appearance of the trabucular bone** ( black arrows) The purple arrows shows the wall of the expanded buccal/facial and lingual cortical plates caused by the neoplastic entity. This was a confirmed cased of **ossifying fibroma\*** mainly because of two things: **1. siginficant cortical expansion on buccal and lignual side 2. altered trabacular pattern.** **ddx of fibrous dysplasia b**ut you should look for a radiolucent rim if you can and if not, they maybe considered under the same differential diagosnsis. Note that may help you in differentiating : **** The **maxilla** is affected more in **_Fibrous dysplasia_** **** The **mandible** is affected more in **_Ossifying fibroma_**

Answer 33

Cemento‐ossifying Fibroma Axial section of the mandible * The granular radiopacity immediately surrounded by a radiolucent rim ( purple arrow) * **Also note the extent of the expansion of the buccal and lingual cortical plates, a feature which is common of ossifying fibroma.** * This is more clear radiographically where we see a radiolucent rim surrouding a mixed radiolucent/radiopaque center and there is a siginficant expansion of the buccal and lingual plates. ► **very common in ossifying fibroma**

Answer 34

* Surgical excision ( need to send to **biopsy** in order to confirm the diagosnsis of that) * Wider resection with bone maybe necessary in soma larger or more clincally aggressive cases.

Answer 35

**Cleido-Cranial Dysplasia** **Treatment:** For children, facial reconstructive surgery on the bones of the face to reshape the forehead or cheekbones. Spinal fusion procedures to support the spinal column. Lower leg surgery to correct knock knees (knees that bend inward toward the center of the body)

Answer 36

Gardner's Syndrome Synonym: Familial Multiple Polyposis. Remember this:  GarDENse Bone Island.  GARDEN-FOREST:  F- Familial adenomatous polyposis.  O- Osteomas.  RE- Retinal epithelial hypertropy.  ST- Supernumerary teeth. Treatment: Because people with Gardner’s syndrome have a higher risk of developing colon cancer, treatment is usually aimed at preventing this. Medications such as an NSAID (sulindac) or a COX2 inhibitor (celecoxib) may be used to help limit the growth of colon polyps. Treatment also involves close monitoring of the polyps with lower GI tract endoscopy to make sure they do not become malignant (cancerous). Once 20 or more polyps and/or multiple higher risk polyps are found, removal of the colon is recommended in order to prevent colon cancer. If dental abnormalities are present, treatment may be recommended to correct problems.

Answer 37

**Osteopetrosis** **Osteomyelitis** is a complication in patients with **osteopetrosis** as can be seen in pan image! Treatment: Bone marrow transplant (to stimulate osteoclast formation).

Answer 38

Paget's disease stages ## Footnote Early Linear lines: The bone is being resorbed in a very distinct pattern \> linear patterns of trabeculation Middle -MAY see the "cotton wool" appearance (but this is more pronounced in the third stage) -the trabecular pattern may or may not be slightly affected Late - There is MORE bone deposition -the "cotton wool" appearance is very very clear in this stage! Also-hypercementosis and spacing of teeth.

Answer 39

Paget's Disease Also Known As: **Osteitis Deformans.** **Skeletal disorder involving osteoclasts** **_Treatment:_** Osteoporosis drugs (bisphosphonates) are the most common treatment for Paget's disease of bone

Answer 40

Cherubism **Treatment**: Usually not needed as the cyst-like lesions fill in with granular bone during adolescence- conservative surgical procedures may follow for cosmetic reasons.

Answer 41

Idiopathic Osteosclerosis AKA: Dense Bone Island  Not associated with any dysplastic, neoplastic, inflammatory or systemic disorder.  **Common incidental finding.**  Slow growing, typically stops growing by the time of skeletal maturity.  Peak prevalence in the third decade of life. ** No treatment required; monitoring is suggested.**

Answer 42

**PCOD** ## Footnote **Differentiating factor:** Radiolucent zone surrounding the radiopacities of COD lesions. No such radiolucent areas for idiopathic osteosclerosis.  Important: The root of the tooth #28 appears to be resorbed but is likely not. Look at the root of #29. These teeth are still undergoing development in a young patient.  Left is showing dense bone island.  Right is showing Periapical COD- this is intermediate stage, not fully mature. You should see a radiolucent rim.  Another more obvious radiographic feature: you see radiolucent areas surrounding in both images, the common feature is: because PCOD and dense bone island do not affect the PDL spaces – you should be able to see the PDL spaces.  Sometimes it’s not the case. Look for the PDL, look for radiolucent area surrounding possible central radiopacity, idiopathic osteosclerosis can cause resorption; PCOD hasn’t been associated with root resorption.

Answer 43

**_Hypercementosis_** ## Footnote  **Differentiating Factor:** A well-defined radiolucent border that is continuous with the PDL of the tooth, in the case of hypercementosis. This means that whatever is happening is within the confines of the tooth-bearing region. In this case, the cementum.  Hypercementosis- Cementum is overraeacting, so there’s enlargement of cementum.  If cementum is larger, it should be pushing the PDL out (black arrow). So the PDL is enlarged meaning you should be able to see a radiolucent rim around the area. And the radiolucent rim should be continuous with the PDL of the remaining root structure.

Answer 44

**Cementoblastoma** ## Footnote ** Differentiating Factor:** A well-defined radiolucent border that is continuous with the PDL of the tooth, similarly seen in the previous case of hypercementosis. (sometimes it is difficult to differentiate hypercementosis and cementoblastoma, in this case, the beige arrow indicates the resorbed root surface, which normally occurs in benign neoplastic cases, such as cementoblastoma.  Cementoblastoma is more of a heterogenous radiopacity- meaning you may see gaps, like radiolucent voids, in between the areas.  See radiolucent rim.  But more common feature include root resorption because it’s a neoplastic condition. It should act like a neoplasms in which it’s destroying some of the root structure.

Answer 45

 For condensing osteitis, look for heavily restored or carious teeth. Condensing osteitis typically surrounds the initial rarefying osteitis lesion. The teeth in these cases are non-vital as they represent a condition that is secondary to pulpal necrosis.  Open necrosis, eventual PDL space widening and then once the infection reaches the bone, you have bone loss.  Now you have an overreaction or inflammatory reaction surrounding the initial inflammation.

Answer 46

**Focal Osteoporotic Marrow Defect** A large marrow defect that may mimic a cystic/neoplastic radiolucency in the jaw. common incidental finding a variation of normal anatomy within trabecular bone.

Answer 47

Simple Bone Cyst Also known as  1.) Solitary Bone Cyst.  2.) Traumatic Bone Cyst.  3.) Idiopathic Bone Cyst.  4.) Hemorhhagic Bone Cyst. Remember radiographic feature tend to Scalop between teeth  Treatment includes surgical curettage- spontaneous healing has been reported.

Answer 48

Sometimes, simple bone cysts should be differentiated from odontogenic keratocysts (OKCs)

Answer 49

brown tumor.

Answer 50

central giant cell granuloma CGCG

Answer 51

Aneurysmal Bone Cyst

Answer 52

**Mucositis** Thickening of the mucous of the sinus - normally we don’t see mucosa because it is very thin membrane 10 to 15 times thicker. Most common incidental findings that we can see on radiographs

Answer 53

**Sinusitis** Sinus mucosa becomes inflamed and thickened from infection or allergen, which may lead to ciliary dysfunction, retention of sinus secretions and blockage of sinus drainage ● 10% of maxillary sinusitis are related to dental infections

Answer 54

**Sinusitis** In this cone beam CT scan, we can see opacification of the sinus + sometimes we see gaseous bubbles. It is fluid that is forming inside the sinus.

Answer 55

**Sinusitis** Sinusitis can be secondary to oral antral communication (communication between maxillary sinus and oral cavity) this can happen due to extraction

Answer 56

``` Antral Pseudocyst (Retention Pseudocyst) ``` Localized, submucosal accumulation of fluid forming a sessile, domeshaped swelling along a sinus border ● Common incidental radiographic finding on panoramic ● Well-defined, non-corticated and dome shape radiopacity mostly along the floor of maxillary sinus

Answer 57

``` Antral Pseudocyst (Retention Pseudocyst) ```

Answer 58

``` Antral Pseudocyst (Retention Pseudocyst) ```

Answer 59

One of the ways to differentiate antral pseudocyst from radicular cyst is by the presence of cortication. ‐ Reticulosis is a cystic lesion that happens around the apex of the nonvital tooth. ‐ They have a round and domed shaped appearance too, but they are from a different origin 􀀀 happening inside the alveolar processes

Answer 60

**Antrolith** ## Footnote Deposition of mineral salts (calcium phosphate/carbonate/magnesium) around an exogenous or endogenous (due to blood, pus or mucous) nidus ● Pediatric and adult population ‐ **Small antroliths** – incidental radiographic finding ‐ **Large antroliths** – sinus obstruction, sinusitis, nasal discharge, pain ● Mostly adjacent to the floor of the maxillary sinus ● We see combination of radiopacity and radiolucency due to layers of calcification.

Answer 61

**Antrolith** ## Footnote Deposition of mineral salts (calcium phosphate/carbonate/magnesium) around an exogenous or endogenous (due to blood, pus or mucous) nidus We see a presence of radiopacity which is antrolith inside the maxillary sinus

Answer 62

**Foreign Body in Maxillary Sinus**

Answer 63

Foreign Body in Maxillary Sinus

Answer 64

**Periostitis** ## Footnote **•**Lamellar, periosteal reaction **from periapical inflammatory disease** •**Exudate** from infected tooth diffuses through the cortical bone, (elevation of periosteum) lifts and stimulates the periosteal lining to produce layer(s) of new bone **•Floor of maxillary sinus** •Inferior, buccal, lingual mandibular cortices

Bone Diseases & others Flashcards

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