Dr. Ossama EL-ShallChairman of Oral Medicine, Chairman of Oral Medicine,
Periodontology, Diagnosis & Periodontology, Diagnosis & Radiology Department, Faculty of Radiology Department, Faculty of Dental Medicine for girls, Al-Azhar Dental Medicine for girls, Al-Azhar
Changes inside the lesion: Changes inside the lesion: RL in cases of abscess cyst granulomaRL in cases of abscess cyst granuloma RO condensing osteitisRO condensing osteitis RL + RO RL + RO
Effects on the surrounding structures:Effects on the surrounding structures:1-May cause expansion, resorption, destruction or thinning of bone.2-Compressed adjacent tissues as max. sinus or nasal cavity 3-Displacement of teeth, divergence or resorption.4-Affection of lamina dura.
Bone destruction around Bone destruction around apex of tooth, mostly apex of tooth, mostly secondary to pulp secondary to pulp exposure due to caries or exposure due to caries or trauma.trauma.
Bacterial invasion of pulp Bacterial invasion of pulp produces toxic produces toxic metabolites which escape metabolites which escape to the periapical bone to the periapical bone through apical foramen through apical foramen and cause inflammation. and cause inflammation.
Ill defined RL area, widening of PM space, loss of LD
Periapical abscessPeriapical abscess
Acute: sever Acute: sever throbbing pain, tooth throbbing pain, tooth mobility, tenderness, mobility, tenderness, swelling, elevation of swelling, elevation of the tooth the tooth
Chronic: history of Chronic: history of acute case, acute case, asymptomatic, asymptomatic, fistula, dull pain fistula, dull pain
It is a localized It is a localized collection of pus at collection of pus at periapical areaperiapical areaIt may be acute or It may be acute or chronicchronic
Periapical GranulomaPeriapical GranulomaRadiographically, Radiographically, widening of PDL or widening of PDL or variable size of variable size of periapical RL may be periapical RL may be presentpresentLoss of lamina duraLoss of lamina duraAsymptomaticAsymptomaticNon vital toothNon vital toothHistory of sensitivity History of sensitivity to hotto hot
Radicular cystsRadicular cystsIt developed around apex It developed around apex
of a diseases tooth or of a diseases tooth or around an accessory around an accessory canal from the pulp canal from the pulp (lateral radicular cyst)(lateral radicular cyst)
The radiographic The radiographic appearance of a appearance of a clinically symptom-free clinically symptom-free cyst reveals a clear, RO cyst reveals a clear, RO borders that surround borders that surround the radiolucency. the radiolucency.
Rounded RL with RO Rounded RL with RO margin at periapical margin at periapical region.region.Apex of the tooth is Apex of the tooth is within the cystic cavity.within the cystic cavity.Adjacent teeth and Adjacent teeth and structures are displaced.structures are displaced.Infected cysts exhibits Infected cysts exhibits poorly demarcated poorly demarcated bordersborders
Small, clinically symptom-Small, clinically symptom-free radicular cyst that is free radicular cyst that is expanding towards the floor expanding towards the floor of maxillary sinusof maxillary sinus
with typical RO with typical RO boundariesboundaries
Infected radicular cyst, has Infected radicular cyst, has lost its typical radiographic lost its typical radiographic signs as a result of serous signs as a result of serous
infiltration of the infiltration of the surrounding tissue.surrounding tissue.
Lateral Periodontal CystLateral Periodontal CystArises directly from Arises directly from epithelial cells in epithelial cells in PDL on lateral PDL on lateral aspect of tooth. aspect of tooth. Origin: cell rests of Origin: cell rests of Mallasez or Mallasez or remnants of dental remnants of dental lamina.lamina.Tooth is VITAL.Tooth is VITAL.
Lateral Periodontal CystLateral Periodontal CystHow do you How do you differentiate this cyst differentiate this cyst from radicular cyst from radicular cyst which may develop in which may develop in this location?this location?Seen as a unilocular, Seen as a unilocular, well-defined well-defined radiolucency on radiolucency on lateral aspect of a lateral aspect of a vital tooth.vital tooth.
Inflammation of the Inflammation of the gingival tissues around gingival tissues around the crown of the tooththe crown of the toothAssociated with third Associated with third molarmolarNo radiographic No radiographic changes, but may be changes, but may be found in sever caseafound in sever casea
3- Osteomyelitis3- OsteomyelitisThe word “osteomyelitis” originates from the ancient Greek The word “osteomyelitis” originates from the ancient Greek words osteon (bone) and muelinos (marrow) and means infection words osteon (bone) and muelinos (marrow) and means infection of medullary portion of the bone.of medullary portion of the bone.
It is an acute & chronic inflammatory process in the medullary It is an acute & chronic inflammatory process in the medullary spaces or cortical surfaces of bone that extends away from the spaces or cortical surfaces of bone that extends away from the initial site of involvement.initial site of involvement. It is the inflammation of the bone as a result of spread of It is the inflammation of the bone as a result of spread of inflammatory process to involve bone marrow, cortex cancellous inflammatory process to involve bone marrow, cortex cancellous parts and periosteumparts and periosteum
Suppurative osteomyelitisSuppurative osteomyelitisSource of infection is usually an adjacent focus of infection associated with teeth or with local trauma.
It is a polymicrobial infection, predominating anaerobes such as Bacteriods, Porphyromonas or Provetella.
Staphylococci may be a cause when an open fracture is involved.
Mandible is more prone than maxilla as vascular supply is readily compromised.
panoramic radiograph of suppurative
osteomyelitis at the right side of mandible.
ACUTE SUPPURATIVE OSTEOMYELITISOrganisms entry into the jaw, mostly mandible, compromising the vascular supply
Medullary infection spreads through marrow spaces
Thrombosis in vessels leading to extensive necrosis of bone
Lacunae empty of osteocytes but filled with pus , proliferate in the dead tissue
Suppurative inflammation extend through the cortical bone to involve the periosteum
Stripping of periosteum comprises blood supply to cortical plate, predispose to further bone necrosis
Sequestrum is formed bathed in pus, separated from surrounding vital bone
Acute suppurative osteomyelitis
CLINICAL FEATURESEARLY :
Severe throbbing, deep- seated pain.Swelling due to inflammatory edema.Gingiva appears red, swollen & tender.
LATE :Distension of periosteum with pus.
FINAL: Subperiosteal bone formation cause swelling to become firm.
In mandible, premolar & molar regions are affected.
Bone sclerosis is associated with non-vital or vital tooth.
No expansion of the jaw.
RADIOLOGYLocalized but uniform increased RO related to tooth. Widened periodontal ligament space or peri-apical area.Sometimes an adjacent radiolucent inflammatory lesion may be present.
Proliferative periosteitis Also known as “ Periostitis ossificans” & “Garee’s osteomyelitis”.
It represents a periosteal reaction to the presence of inflammation.
Affected periosteum forms several rows of reactive vital bone that parallel each other & expand surface of altered bone.
More common at mandibular first molar area, in young persons
“ “Garee’s osteomyelitis”.Garee’s osteomyelitis”.
CLINICAL FEATURESAffected patients are primarily children & young adults.Incidence is mean age of 13 years.No sex predominance is noted.Most cases arise in the premolar & molar area of mandible.Hyperplasia is located most commonly along lower border of mandible.Most cases are uni-focal, multiple quadrants may be affected.
PROLIFERATIVEPROLIFERATIVE PERIOSTITIS
RADIOLOGYRadiopaque laminations of bone roughly parallel each other & underlying cortical surface.
Laminations may vary from 1-12 in number.Best seen by occlusal film
Radiolucent separations often are present between new bone & original cortex.
Radiolucent lesionsRadiolucent lesions1-1-Lesions related to tooth apexLesions related to tooth apex2-2-Lesions related to side of rootsLesions related to side of roots3-3-Lesions related to crown of unerupted or Lesions related to crown of unerupted or
impacted toothimpacted tooth4-4-Unilocular lesions in midline of maxilla.Unilocular lesions in midline of maxilla.5-5-Unilocular lesions lateral to midline of Unilocular lesions lateral to midline of
maxilla.maxilla.6-6-Solitary RL lesion with either well or ill- Solitary RL lesion with either well or ill-
defined margins.defined margins.7-7-Multilocular RL lesion with either well or ill-Multilocular RL lesion with either well or ill-
defined margins.defined margins.8-8-Multiple but separate RL with well-defined Multiple but separate RL with well-defined
Ill-defined marginIll-defined margin1-Residual infection1-Residual infection2-bone loss due to PD2-bone loss due to PD3-Myloma3-Myloma4-carcinoma4-carcinoma5-Ameloplastoma5-Ameloplastoma6-metastasis6-metastasis7-osteomylitis7-osteomylitis8-odontoenic fibroma8-odontoenic fibroma
77-Multilocular RL lesion with -Multilocular RL lesion with either well or ill-defined margins.either well or ill-defined margins.
Well-definedWell-defined1-Ameloblastoma 1-Ameloblastoma 2-Odontogenic keratocyst2-Odontogenic keratocyst3-Central g. cell granuloma3-Central g. cell granuloma4-Odontogenic myxoma4-Odontogenic myxoma5-Central hemangioma5-Central hemangioma6-Fibrous dysplasia6-Fibrous dysplasia7-Cherubism7-Cherubism8-Anneyrsmal bone cyst8-Anneyrsmal bone cyst9-Central fibroma9-Central fibroma10-Traumatic bone cyst10-Traumatic bone cyst
1-Cementoma1-Cementoma2-Sclerosing osteitis2-Sclerosing osteitis3-Odontoma3-Odontoma4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma
2-2-Mixed lesions not Mixed lesions not necessarily contacting a tooth.necessarily contacting a tooth.1-Ostemylitis1-Ostemylitis2-F.D2-F.D3-Paget’s disease3-Paget’s disease4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma5-Sarcoma5-Sarcoma6-calcifying cyst6-calcifying cyst7-Odontoma7-Odontoma8-Cementoma8-Cementoma
Cyst;Cyst; is a pathological cavity contains fluid or is a pathological cavity contains fluid or semi-solid materialssemi-solid materials
Cysts can be true or pseudo according its lining tissues:Cysts can be true or pseudo according its lining tissues:
True cysts:True cysts: cysts which lined with epithelium cysts which lined with epitheliumPseudo-cysts:Pseudo-cysts: cysts which cysts which notnot lined with lined with
epithelium but lined with connective tissue epithelium but lined with connective tissue membrane membrane
Radicular cystsRadicular cysts It developed around apex of It developed around apex of
a diseases tooth or around a diseases tooth or around an accessory canal from the an accessory canal from the pulp (lateral radicular cyst)pulp (lateral radicular cyst)
The radiographic The radiographic appearance of a clinically appearance of a clinically symptom-free cyst reveals a symptom-free cyst reveals a clear, clear, RORO borders that borders that surround the radiolucency. surround the radiolucency.
Rounded Rounded RLRL with with RORO margin at periapical margin at periapical region.region.Apex of the tooth Apex of the tooth isis within within the cystic cavity.the cystic cavity.Adjacent teeth and Adjacent teeth and structures are displaced.structures are displaced.Infected cysts exhibits Infected cysts exhibits poorly demarcated poorly demarcated bordersborders
Small, clinically symptom-Small, clinically symptom-free radicular cyst that is free radicular cyst that is expanding towards the floor expanding towards the floor of maxillary sinusof maxillary sinus
with typical RO with typical RO boundariesboundaries
Infected radicular cyst, has Infected radicular cyst, has lost its typical radiographic lost its typical radiographic signs as a result of serous signs as a result of serous
infiltration of the infiltration of the surrounding tissue.surrounding tissue.
Dentigerous cyst Dentigerous cyst Most common site, around Most common site, around the third molar and the the third molar and the midline of the maxillamidline of the maxilla
Radiographically it Radiographically it appears as well appears as well demarcated unilocular, demarcated unilocular, radiolucent area, radiolucent area, surrounding a crown of surrounding a crown of unerupted tooth. unerupted tooth.
It is usually attached to the crown at CEJIt is usually attached to the crown at CEJIt may appears lateral to the crown.It may appears lateral to the crown.It may displace the affected tooth from its location It may displace the affected tooth from its location
Always associated Always associated with crown of an with crown of an impacted or impacted or unerupted (normal or unerupted (normal or supernumerary) supernumerary) tooth.tooth.Due to accumulation Due to accumulation of fluid between of fluid between layers of reduced layers of reduced enamel epithelium or enamel epithelium or between epithelium between epithelium and crown.and crown.
Coronal Dentigerous cyst surrounding lateral Coronal Dentigerous cyst surrounding lateral incisor with displaced of canine and retention of incisor with displaced of canine and retention of deciduous canine.deciduous canine.Tooth 22 appears enlarged and overexposed.Tooth 22 appears enlarged and overexposed.Tooth 23 is displaced in the vistibular direction.Tooth 23 is displaced in the vistibular direction.
Odontogenic KeratocystOdontogenic KeratocystOriginate before tooth development from a remnants Originate before tooth development from a remnants of epithelium has the capacity to produce keratin.of epithelium has the capacity to produce keratin.it appears as it appears as unilocularunilocular or or multilocularmultilocular well-defined well-defined RL lesion with an ability for root divergence and RL lesion with an ability for root divergence and cortical expansion both buccal & lingual. cortical expansion both buccal & lingual.
Most common site is mandibleMost common site is mandibleCan cause severe bone destruction.Can cause severe bone destruction.Can displace teeth and cause root resorption.Can displace teeth and cause root resorption.Should be followed for recurrence for 5-10 years.Should be followed for recurrence for 5-10 years.Final diagnosis must confirmed with Final diagnosis must confirmed with histopathologic biopsyhistopathologic biopsy
Lateral Periodontal CystLateral Periodontal CystArises directly from Arises directly from epithelial cells in PDL epithelial cells in PDL on lateral aspect of on lateral aspect of tooth.tooth.
Origin: cell rests of Origin: cell rests of Mallasez or remnants Mallasez or remnants of dental lamina.of dental lamina.
Lateral Periodontal CystLateral Periodontal CystHow do you How do you differentiate this differentiate this cyst from radicular cyst from radicular cyst which may cyst which may develop in this develop in this location?location?Seen as a Seen as a unilocular, well-unilocular, well-defined defined radiolucency on radiolucency on lateral aspect of a lateral aspect of a vital tooth.vital tooth.
Or incisive canal cyst, Or anterior maxillary cystIt forms in incisive canal, causing swelling of incisive papillaIt may enlarge and extend posteriorly, where it called Median palatine cystIt may extend anteriorly, between central incisors, diverge them and destroy the labial cortical plate, (median alveolar cyst)
Typical nasopalatine cyst as seen in a panoramic Typical nasopalatine cyst as seen in a panoramic radiograph.radiograph.It appears as a typical heart-shape without It appears as a typical heart-shape without displacement of roots of central incisorsdisplacement of roots of central incisors
Soft tissue cystSoft tissue cystSwelling of nasolabial fold in the noseSwelling of nasolabial fold in the noseFlaring the ala of the noseFlaring the ala of the nose
Symphyseal area of the mandibleSymphyseal area of the mandibleWell defined RL area.Well defined RL area.Divergence of the rootsDivergence of the rootsVital teeth with intact LD Vital teeth with intact LD
Traumatic bone cystTraumatic bone cystPseudocystsPseudocysts
Usually affect mandibleUsually affect mandibleWell or ill defined RL areaWell or ill defined RL areaScalloped outlinesScalloped outlinesDisplaced of the rootsDisplaced of the roots
Aneurysmal bone cystAneurysmal bone cystPremolar molar areas of mandiblePremolar molar areas of mandibleWell defined RL area, smooth outlinesWell defined RL area, smooth outlinesThining of inferior border of the mandibleThining of inferior border of the mandibleSoab bubble appearanceSoab bubble appearance
Other names: Stafne’s defect, Stafne’s cyst, Other names: Stafne’s defect, Stafne’s cyst, static bone cavity, latent bone cyst.static bone cavity, latent bone cyst.
Part of submandibular salivary gland Part of submandibular salivary gland develops or lies in a deep, well-defined develops or lies in a deep, well-defined depression on lingual surface of mandible. depression on lingual surface of mandible. Occasionally, glandular tissue may be Occasionally, glandular tissue may be included centrally within the bone.included centrally within the bone.
Radiographically, seen as Radiographically, seen as a well-defined a well-defined radiolucency near lower radiolucency near lower border and angle of border and angle of mandible, below the mandible, below the inferior alveolar canal.inferior alveolar canal.Patients are Patients are asymptomatic; asymptomatic; discovered during discovered during routine radiographic routine radiographic exam.exam.May be unilateral or May be unilateral or bilateral.bilateral.
Radiolucent lesionsRadiolucent lesions1-1-Lesions related to tooth apexLesions related to tooth apex2-2-Lesions related to side of rootsLesions related to side of roots3-3-Lesions related to crown of unerupted or Lesions related to crown of unerupted or
impacted toothimpacted tooth4-4-Unilocular lesions in midline of maxilla.Unilocular lesions in midline of maxilla.5-5-Unilocular lesions lateral to midline of Unilocular lesions lateral to midline of
maxilla.maxilla.6-6-Solitary RL lesion with either well or ill- Solitary RL lesion with either well or ill-
defined margins.defined margins.7-7-Multilocular RL lesion with either well or ill-Multilocular RL lesion with either well or ill-
defined margins.defined margins.8-8-Multiple but separate RL with well-defined Multiple but separate RL with well-defined
Ill-defined marginIll-defined margin1-Residual infection1-Residual infection2-bone loss due to PD2-bone loss due to PD3-Myloma3-Myloma4-carcinoma4-carcinoma5-Ameloplastoma5-Ameloplastoma6-metastasis6-metastasis7-osteomylitis7-osteomylitis8-odontoenic fibroma8-odontoenic fibroma
77-Multilocular RL lesion with -Multilocular RL lesion with either well or ill-defined margins.either well or ill-defined margins.
Well-definedWell-defined1-Ameloblastoma 1-Ameloblastoma 2-Odontogenic keratocyst2-Odontogenic keratocyst3-Central g. cell granuloma3-Central g. cell granuloma4-Odontogenic myxoma4-Odontogenic myxoma5-Central hemangioma5-Central hemangioma6-Fibrous dysplasia6-Fibrous dysplasia7-Cherubism7-Cherubism8-Anneyrsmal bone cyst8-Anneyrsmal bone cyst9-Central fibroma9-Central fibroma10-Traumatic bone cyst10-Traumatic bone cyst
1-Cementoma1-Cementoma2-Sclerosing osteitis2-Sclerosing osteitis3-Odontoma3-Odontoma4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma
2-2-Mixed lesions not Mixed lesions not necessarily contacting a tooth.necessarily contacting a tooth.1-Ostemylitis1-Ostemylitis2-F.D2-F.D3-Paget’s disease3-Paget’s disease4-Ossifying or cementifying fibroma4-Ossifying or cementifying fibroma5-Sarcoma5-Sarcoma6-calcifying cyst6-calcifying cyst7-Odontoma7-Odontoma8-Cementoma8-Cementoma
Odontogenic TumorsOdontogenic TumorsThey develops as neoplasias from the dental lamina. They are usually benign but several of them have the tendency towards malignant transformation.
Because growth occurs only slowly, asymptomatically and without any changes in mucosal appearance,
The existence of such lesions in their early stages is usually detected only by chance, or after the development of some structural deformation.
AmeloblastomaAmeloblastomaBenign but locally invasive neoplasm.Benign but locally invasive neoplasm.Arises from epithelial remnants of Arises from epithelial remnants of dental lamina or dental organ.dental lamina or dental organ.Cells do not differentiate enough to Cells do not differentiate enough to form enamel.form enamel.Extreme expansion of bone, Extreme expansion of bone, Resorption of adjoining roots. Resorption of adjoining roots. May cause perforation of cortical bone.May cause perforation of cortical bone.Average age at discovery: 35-40 years.Average age at discovery: 35-40 years.
Ameloblastoma (Cont.)Ameloblastoma (Cont.)Occasionally develops in the wall of Occasionally develops in the wall of dentigerous cyst (mural dentigerous cyst (mural Ameloblatoma).Ameloblatoma).80% in mandible. ¾ of these in 80% in mandible. ¾ of these in molar-ramus area.molar-ramus area.Pain and paresthesia not common.Pain and paresthesia not common.Extremely high recurrence rate.Extremely high recurrence rate.
Ameloblastoma (Cont.)Ameloblastoma (Cont.)Most often a well-corticated multilocular Most often a well-corticated multilocular radiolucency. radiolucency. ““Honey-comb”, “soap-bubble” or “tennis-Honey-comb”, “soap-bubble” or “tennis-racket” appearance.racket” appearance.May be a well-corticated unilocular lesion May be a well-corticated unilocular lesion resembling a cyst.resembling a cyst.
Honeycomb-like Honeycomb-like small ameloblastoma small ameloblastoma
at early stage with at early stage with evidence of root evidence of root
Appears as a follecular Appears as a follecular cystic cavity cystic cavity surrounding a crown of surrounding a crown of a tooth.a tooth.In early stages appears In early stages appears as a hat upon the as a hat upon the occlusal surface of occlusal surface of affected toothaffected tooth
Most common site, lower premolar molar regionWell defined RL, may be corticated, unilocular or sometimes multilocularInhibition of eruption of involved tooth or displaced apically
More advanced case of ameloblastic fibroma demonstrates how the follicular sac is opened.Note also the displacement of the tooth bud of lower 8 in the ascending ramus.
Odontogenic myxomaOdontogenic myxomaIt is a benign, mucous-It is a benign, mucous-containing tumor that containing tumor that originates from the tooth originates from the tooth bud.bud.It appears as a soap bubble-It appears as a soap bubble-like appearance.like appearance.Cyst like unilocular or Cyst like unilocular or multilocular with mant septa multilocular with mant septa giving tennis racket apperancgiving tennis racket apperancIt cause tooth displacementIt cause tooth displacement
CementomaCementomaUsually appears at lower Usually appears at lower anterior area.anterior area.First appears as fibrous First appears as fibrous tissue stage, which may tissue stage, which may confused with a confused with a granuloma (vitality test).granuloma (vitality test).The second stage is The second stage is characterized with characterized with accumulation of calcified accumulation of calcified materials.materials.The third stage consists of The third stage consists of radio-opaque materials. radio-opaque materials. Early stageEarly stage
Slow growing Slow growing neoplasm composed neoplasm composed of cementum.of cementum.Usually solitary Usually solitary lesion seen as a lesion seen as a growth on root of growth on root of tooth. tooth. Most common in Most common in mandible, premolar mandible, premolar or 1or 1stst molar (80%). molar (80%).
Appears as a well Appears as a well defined RO area defined RO area with a thin RL band with a thin RL band around itaround itMay cause external May cause external root resorptionroot resorption
Another case remaining after tooth extraction.It surrounded by the radiographic signs of chronic inflammation.Periapical cemental dysplasia related to 4 tooth
Composed of Composed of enamel and dentin.enamel and dentin.Enamel and dentin Enamel and dentin are laid down in an are laid down in an orderly fashion so orderly fashion so that the mass has that the mass has some similarity to some similarity to normal teeth.normal teeth.Appears like a Appears like a bunch of small bunch of small teeth.teeth.
Central HemangiomaCentral HemangiomaTumor characterized Tumor characterized by proliferation of by proliferation of blood vessels.blood vessels.Central hemangiomas Central hemangiomas of jaws uncommon.of jaws uncommon.50% occur in children 50% occur in children and teens.and teens.More common in More common in females and mandible.females and mandible.Well-defined or ill-Well-defined or ill-defined, unilocular or defined, unilocular or multilocular multilocular radiolucency.radiolucency.
Central Hemangioma Central Hemangioma (Cont.)(Cont.)
May cause expansion of bone May cause expansion of bone and resorption of teeth.and resorption of teeth.Early treatment is desirable in Early treatment is desirable in order to avoid profuse bleeding order to avoid profuse bleeding due to accidental trauma. due to accidental trauma. Aspiration prior to surgical Aspiration prior to surgical procedure is advised.procedure is advised.
Benign tumorsBenign tumorsGrowth of new tissues resemble to Growth of new tissues resemble to the originthe originGrowth by direct extensionGrowth by direct extensionInsidious onsetInsidious onsetRl + RO, Well defined bordersRl + RO, Well defined bordersTooth displacement, or root Tooth displacement, or root resorptionresorptionExpansion or thinning of cortical Expansion or thinning of cortical bone bone No metastasisNo metastasisNot life thearatingNot life thearating
Malignant tumorsMalignant tumorsGrowth a new tissue with Growth a new tissue with anaplasiaanaplasiaGrowth by infiltration and Growth by infiltration and destructiondestructionSudden onsetSudden onsetTotally RL, Ill defined bordersTotally RL, Ill defined bordersPunched out bordersPunched out bordersDestruction of alveolar bone, Destruction of alveolar bone, teeth floating or displaced teeth floating or displaced occlusallyocclusallyErosion and destruction of Erosion and destruction of cortical bone cortical bone MetastasisMetastasis
Radiographic features of Radiographic features of malignant tumorsmalignant tumors
Ill defined, invasive borders.Ill defined, invasive borders.Bone destructionBone destructionDestruction of cortical boundary like floor of Max.sinusDestruction of cortical boundary like floor of Max.sinusIrregular thickening of periodontal membrane space Irregular thickening of periodontal membrane space due to invasion of bonedue to invasion of boneDisplacing the developing teeth in occlusal direction.Displacing the developing teeth in occlusal direction.Bone destruction around teeth make teeth like floating Bone destruction around teeth make teeth like floating in spacein space
Clinical features of malignant Clinical features of malignant tumorstumors
Displaced teeth,Displaced teeth,Looseness of teeth in short timeLooseness of teeth in short timeUlcers unhealed for more than 3 monthsUlcers unhealed for more than 3 monthsFoul odorFoul odorFixed lymphadenopathyFixed lymphadenopathyExposure of boneExposure of boneSever painSever painSwellingSwelling
as females, exhibit a predilection for the mandible.
Radiographically, bone destruction as well as new bone formation (Osteoblastic) and osteolysis can be observed, along with perforation of the compact bone with spicules (sunrays effect), where the lesion borders on the soft tissues
Ill defined border, RL Appears as irregular areas of osteolysis and new osteoblastic bone formation at the
extraction site of lower 6.
Radiographic appearanceRadiographic appearanceAppears ill defined RL Or combined Rl + RO, area with no peripheral sclerosisAppears ill defined RL Or combined Rl + RO, area with no peripheral sclerosisIf it involve periosteum, it give Sunray or Hair-on-end speculate appearance, due If it involve periosteum, it give Sunray or Hair-on-end speculate appearance, due to radiating mineralized speculateto radiating mineralized speculateWidening of periodontal membrane spaceWidening of periodontal membrane spaceLoss of lamina duraLoss of lamina duraFloating teeth Floating teeth
Mixed form of ostiosarcoma: In addition to areas of new bone formation, osteolysis and destruction of the compact bone can be observed. Note the areas of spicules (arrows) and spontaneous fracture (arrow)
