Leah Lampton Flashcards by Hazel Luscombe

What developmental odontogenic cysts are derived from dental lamina
4

Most common (%)

Keratocysts (5%)
Calcifying odontogenic cysts
Lateral periodontal cyst
Gingival cyst of adult/newborn

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What developmental odontogenic cysts are derived from reduced enamel epithelium
2

Most common (%)

Dentigerous cyst (20%)
Eruption cyst

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Where are inflammatory odontogenic cysts derived from

What are the inflammatory odontogenic cysts
3

Most common (%)

Epithelial cell rests of malassez

Periapical cyst
Radicular cyst (54%)
Paradental cyst

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Dentigerous cyst

Origin and location
Development
Specific symptoms (3)
Types (3)

Commonest type of developmental cyst formed by fluid accumulation between crown and REE of impacted teeth

Usually 3rd molars or Max canines, males, 10-30

Teeth fail to erupt so REE persists
Fluid accumulates over crown and REE forms epithelial lining

Root resorption of adjacent teeth, displacement, discharge

central variety
lateral variety
circumferential variety

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Dentigerous cyst

Radiographically
Histology
Inflamed histology(3)
Complications (3)

Unilocular radiolucency associated with crown of unarupted tooth with well defined sclerotic border unless infected

Cystic lining - 2-4 layers cuboidal epithelium with flat interface to wall
Connective tissue wall- loosely arranged fibrous wall which may contain small islands of inactive odontogenic epithelial rests

Inflamed dentigerous cyst- increased collagenisation of wall, infiltration of chronic inflammatory cells, epithelial hyperplasia with rete ridges and squamous lining

Complications - ameloblastoma, squamous cell carcinoma, mucoepidermoid carcinoma

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Eruption cyst

Origin and location
Development
Specific symptoms
Histology
Treatment

Soft tissue version of dentigerous cyst occurring due to separation of dental follicle from crown of erupting tooth within gingiva

Gingiva over erupting tooth

Separation of dental follicle from crown of erupting tooth

Swelling with bluish tinge over unerupted tooth

Cystic lining- non keratinised stratified squamous epithelium
Connective tissue wall- fibrous wall with inflammatory cells
Cystic cavity- yellow protein fluid, may contain blood

Most burst spontaneously, alternatively incision and drainage allows for eruption

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Keratocyst

Origin and location
Development
Associated genes or syndromes
Symptoms

Developmental cyst developing from undeveloped tooth, can be syndromic or sporadic and have a high reoccurrence rate

Tooth primordeum, males, 3rd decade, posterior mandible or maxilla

Tooth primordeum degenerates and undergoes cystic changes

Gorlin Coltz syndrome, mutated PTCH gene

Missing tooth

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Keratocyst

Radiographically
Histology

Multilocular radiolucent lesion

Cyst lining- 6-8 layers stratified squamous epithelium with flat interface, luminar surface has parakeratotic epithelium, basal layer shows basal palisading
Connective tissue wall- thick and friable, satellite cysts (reoccurrence)
Cystic cavity- transudate of serum, keratinous debris

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Gingival cyst of adult

Origin and location
Development
Symptoms
Histology

Uncommon cyst developing in gingiva from remanence of dental lamina located in superficial part of alveolar mucosa

Buccaly on canine or premolar region of mandible

Cystic degeneration of epithelial rests of serres in dental lamina

Small whitish bulge

Cystic epithelial lining with cavity filled with desquamated keratin

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Periodontal cyst

Origin and location
Development
Radiographically
Histology

Uncommon non keratinised developmental cyst located lateral to root of vital tooth

Dental lamina remanence

Proliferation of dental lamina remanence in jaw bone

Well defined Unilocular radiolucency lateral to involved teeth, with involved teeth vital

Glycogen rich clear cells

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Radicular cyst

Origin and location
Development
Symptoms (5)
Types (3)

Commonest odontogenic cyst developed through inflammation

First molars, pulp necrosis following caries or trauma

Inflammation of pulp and periradicular area causes apical periodontitis
Abscess formation
Periapical granuloma formation
Inflammation of epithelial cell rests of malassez leads to cystic transformation

Caries, trauma, previous pulpitis, mobility, discharging sinus

apical
lateral
residual

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Radicular cyst

Radiography
Histology

Well defined radiolucency around apex
Loss of lamina along adjacent root
Root resorption
Radiographic appearance identical to granuloma

Cystic lining- uniform layer sse derived from ECRoM which may desquamate into lumen
Connective tissue wall- mixed inflammatory cell infiltrate
Cystic cavity- may contain dystrophic calcifications, cholesterol clefts, RBCs

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Fibro osseous neoplasms:
Cemento ossifying fibroma

Location and aetiology
Histology
Radiography

Uncommon benign slow growing neoplasm causing painless swelling in mandible molar or premolar region

70-80% mandibular, age 20-40, females

Bone and cementum like areas surrounded by cellular fibrous tissue

Sharply defined encapsulated well circumscribed radiolucent lesion with varying amounts of radiopaque material, associated displacement or root fusion of adjacent teeth

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Fibro osseous neoplasms:
Cemento ossifying fibroma

Variant - juvenile ossifying fibroma
Treatment

Juvenile ossifying fibroma is an agressive varient of COF found in under 15s

Regular lesions- enucleated
Large tumours- may require local resection and bone grafting if jaw distorted

Recurrence rare but densely mineralised lesions are relatively avascular and can develop into chronic osteomyelitis following dental extraction

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Cemento osseous dysplasia

Aetiology
Management
Types (3)

A non neoplastic disturbance of growth and remodelling of bone and cementum, it is the most common fibro osseous lesion of jaw

90% in females, particularly african decent, 30-50

Do not require treatment except for cosmetic reasons

periapical cemento osseous dysplasia (PA tissues)
florid cemento osseous dysplasia (multiple teeth in more than one quadrant)
focal cemento osseous dysplasia (single lesion on one tooth)

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Periapical cemento osseous dysplasia

Location
Clinical features (2)
Histology (3)
Radiography (3 stages)

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Cemento osseous dysplasia affecting the periapical tissues of one or more teeth with the histological features of cemento ossifying fibroma but without a sharply defined margin

Typically seen mandibular incisor region

Asymptomatic, affected teeth vital

Islands of bone within connective tissue stroma
Cellular fibrous tissue containing woven bone trabeculae and islands of dense cementum like bone
Progressive calcification leads to formation of solid bony mass

Initially a localised radiolucency around roots of tooth resembling PA granuloma
Intermediate stage with target like appearance due to mineralisation starting centrally
Lesion grows to 8-10mm and becomes densely radiopaque with defined masses of cementum

Florid cemento osseous dysplasia

Clinical features (3)
Histology (4)
Radiography(2)

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Cemento osseous dysplasia affecting multiple teeth in more than one quadrant

Frequently symmetrical, asymptomatic, affected teeth vital

Sheets or fused masses of relatively acellular cementum like tissue
Some patients develop associated solitary bone cysts
Cellular fibrous tissue containing woven bone trabeculae
Progressive calcification leads to formation of solid bony mass with resting and reversal lines

Target like appearance with central sclerosis
Lesion surrounded by outer zone of sclerosis

Focal cemento osseous dysplasia

Location
Histology (2)
Radiography (2)

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Cemento osseous dysplasia forming a single lesion on one tooth

Typically post mandible

Cellular fibrous tissue containing woven bone trabeculae and islands of dense cementum like bone
Progressive calcification leads to formation of solid bony mass with resting and reversal lines

Well circumscribed with sharp defined margin
Varying amounts of radiopaque material

Non neoplastic genetic diseases:
Cherubism

Clinical features (3)
Histology (active vs quiescent lesion)
Radiography
Genetics (2)

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Rare genetic condition affecting bones of usually lower jaw in which bone replaced by multilocular cyst like tissue growths making cheeks appear round and swollen

Firm painless bilateral swellings in jaws
Develops early childhood and regresses with skeletal maturation
Teeth frequently displaced or loosened

Loose fibrous tissue containing clusters of multinucleate giant cells

active lesion: cellular lesion with many giant cells
quiescent lesion: bone deposition within cellular stroma

Lesions appear radiographically as multilocular cysts

Autosomal dominant condition caused by mutated SH3BP2 gene
Twice as common in males

Fibrous dysplasia

Genetics
Radiography
Monostotic fibrous dysplasia
Polystotic fibrous dysplasia

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Fibrous dysplasia is a growth distance of bone caused by somatic mutation in GNAS1 gene occurring in embryo and is associated with albrights syndrome It causes fibroblasts and osteoblasts to grow excessively

Radiographically margins merge with surrounding normal bone

Monostotic- causes enlargement of one bone M=F
Polystotic- widespread and may be associated with endocrine abnormalities

What is the most common benign tumours (2)

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Ameloblastoma

Odontomes

What benign odontogenic tumours are of epithelial origin

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Ameloblastoma
Squamous odontogenic tumour
Calcifying epithelial odontogenic tumour (pindborg tumour)

What are the benign odontogenic tumours of epithelial and ectomesenchyme origin
4

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Odontomes
Ameloblastic fibroma
Adenomatoid odontogenic tumour
Calcifying odontogenic cyst

What is a benign odontogenic tumour of ectomesenchyme origin
1

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Cementoblastoma

What are the malignant odontogenic carcinomas | 2

Primary intra osseous carcinoma | Clear cell odontogenic carcinoma

Ameloblastoma ``` Aetiology and location Symptoms (4) Radiology Histology Forms (follicular, plexiform) Treatment ```

Benign tumour of odontogenic epithelium, most common true neoplasm 3rd-5th decade usually L mandible Asymptomatic, tooth movement, root resorption, cyst formation Uni or multi-cystic Neoplastic odontogenic epithelium set within connective tissue stroma - peripheral epithelial margins have polarised cells resembling preameloblasts - cells in centre have loose stellate appearance Follicular- islands of neoplastic epithelium within stroma Plexiform- lace like strands of epithelium separated by stroma Unicystic- enucleated Conventional- excision

Squamous odontogenic tumour Aetiology Symptoms (4) Radiography Treatment

Very rare benign locally infiltrative odontogenic neoplasm of epithelial origin Males 20-40 Asymptomatic, slow growing, tooth mobility, displacement Simple triangular radiolucency between roots of vital teeth Curettage and extraction of involved teeth

Calcifying epithelial odontogenic tumour ``` Aetiology and location Clinical features (2) Radiography Histology Treatment ```

A benign odontogenic neoplasm arising from epithelium which is slow growing but invasive Middle age and elderly adults, usually mandibular molar region Slowly enlarging painless mass, contains amyloid Well defined radiolucency with speckled calcifications Sheets of polyhedral odontogenic epithelial cells with amorphous hyalinised areas in between Excision with small margin

Odontomes ``` Aetiology Clinical features (2) ``` Types (compound, complex) Radiography Treatment

A benign developmental malformation linked to tooth development, a dental hamartoma. Most common odontogenic tumour Seen in Young people under 20 Asymptomatic, unerupted teeth Compound- composed of multiple small tooth like structures embedded in connective tissue and surrounded by capsule usually in ant maxilla Complex- irregular mass of dental tissues generally in post mandible Mixed radiopaque and radiolucent appearance Enucleation

Ameloblastic fibroma ``` Aetiology and location Clinical features (3) Radiography Histology (2) Treatment ```

Benign fibroma of ameloblastic tissue Young people and children May be destructive to growing facial bones, painless swelling, associated with impacted teeth Well defined cystic multi or unilocular radiolucency Branching cords and islands of epithelium Fine cellular stroma Excision with small margin

Adenomatoid odontogenic tumour ``` Aetiology and location Clinical features (2) ``` Radiography Histology Treatment

Benign odontogenic tumour Females 10-20 usually in ant maxilla Slow growing swelling, often associated with impacted canine Cystic radiolucency with speckled mineralisation around wall Epithelial cells form sheets and duct like structures giving tumour gland like structure Enucleation

Calcifying odontogenic cyst ``` Aetiology and location Clinical features (3) ``` Radiography Histology

Rare lesion which is a proliferation of odontogenic epithelium with scattered nests of ghost cells and calcifications 10-30, usually anterior mandible or maxilla Asymptomatic, displacement, impaction Unilocular cystic radiolucency that may have calcified ghost cells Histologically cysts lined by ameloblast like epithelium with ghost cells and dentine in wall

Cementoblastoma ``` Aetiology and location Clinical features (3) ``` Radiography Histology Treatment

A benign neoplasm of ectomesenchymal origin of cementum, forming a mass of cementum on tooth root Usually males under 25- mandibular molar and premolar area Vital tooth, slow growing, sometimes painful Radiopaque lesion attached to tooth root Sheets of cementum and osteoid in pagetoid pattern Extraction of tooth and enucleation and curettage of bony cavity

Primary intra osseous carcinoma Aetiology and location Radiography Histology

Rare epithelial odontogenic malignancy Elderly usually mandible Ragged irregular radiolucency Sheets of squamous cell carcinoma with keratin pearl formation, cellular atypia and increased mitosis

Clear cell odontogenic carcinoma Aetiology and location Radiography Histology

Rare odontogenic tumour which is invasive, aggressive and frequently reoccurs and metastasises Elderly, more often females, post mandible Radiolucency with poorly defined margins Sheets of infiltrating clear cells

Leah Lampton Flashcards

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