Radiographic Interpretation Midterm - Benign Tumors I

Benign Tumors

• slow growing

• painless

• smooth, well defined, corticated borders

• can displace teeth and displace the mandibular canal or sinus floor

CBCT

used for central bone lesions

MRI

used for soft tissue or lesions with extension from bone

Hyperplasias

• not a true tumor

• have limited growth potential

• normal tissue arrangement

• develop in response to a stimulus sometimes

Torus mandibularis

occurs on the lingual aspect of the mandibular alveolar process

Torus palatinus and torus mandibularis

• more common in women

• appear as dnese radiopaque

• well defined border and convex or lobulated outline

Hyperostoses

• found on the buccal surface of the maxillary alveolar process

• solitary or multiple

• nodular, pedunculated, or flat

• well defined smooth border

• homogeneous and radiopaque

Enostosis/Dense Bone Island

• localized growths of compact bone within cancellous bone

• no radiolucent margin

• abut directly against normal bone

• static and have a radiopaque pattern

• can cause external root resorption

• multiple enostoses may indicate Gardner Syndrome

Odontogenic Epithelial Tumors

Ameloblastoma, Calcifying Epithelial Odontogenic tumor, and Adenomatoid Odontogenic Tumor

Mixed Odontogenic Tumors

• Odontoma

• Ameloblastic Fibroma

• Ameloblastic Fibro-Odontoma

Mesenchymal Tumors

• odontogenic myxoma

• benign cementoblastoma

• central odontogenic fibroma

Ameloblastoma

• most common odontogenic tumor

• aggressive and locally invasive

• men

• 20-50 years of age

• molar-ramus region of the mandible

Ameloblastoma

Early stage is slow growing and asymptomatic. Later stages involve facial asymmetry and swelling.

Ameloblastoma

• well defined corticated borders

• maxillary lesions less defined

• can be totally radiolucent or multilocular

• coarse, curved septa that creates a soap bubble pattern or a Honeycomb pattern

• can cause root resorption and tooth displacement

Ameloblastoma

surgical resection because inadequate removal can lead to recurrence

Calcifying Epithelial Odontogenic Tumor (Pindbord Tumor)

• rare

• less aggressive

• produces a mineralized substance with amyloid-like material

• jaw expansion that is hard on palpation

• more common in the mandible

• can be associated with unerupted/impacted tooth

Calcifying Epithelial Odontogenic Tumor

• well defined corticated

• numerous scattered radiopaque foci that are donut or crescent shaped

• tooth displacement and prevention of eruption

Calcifying Epithelial Odontogenic Tumor

• local excision that is more conservative than ameloblastoma

Adenomatoid Odontogenic Tumor

• rare 2% of all odontogenic tumors

• nonaggressive, slow-growing

• most common in 2nd decade

• females

• central tumors can be follicular, meaning associated with a tooth crown, or extrafollicular.

• maxilla

Adenomatoid Odontogenic Tumor

• well defined corticated or sclerotic border

• two-thirds have radiopaque foci that are pebble-like

• tooth displacement and can inhibit tooth eruption

• some expansion, but outer cortex is maintained

Adenomatoid Odontogenic Tumor

Conservative Surgical Excision with low recurrence

Odontoma

• composed of mature dentin, cementum, enamel, pulp

• not a true tumor, but a hamartoma

• most common odontogenic tumor

• 2nd decade of life

Complex Odontoma

• heterogenous mass of dental tissue, mostly in the mandibular first and second molar areas

Compound Odontomas

• organized tooth-llike structures mostly in the anterior maxilla associated with the crown of an unerupted canine

• more common than the other type of odontoma

Odontomas

• radiolucent rim with sclerotic border

• radiopaque lesion

• can interfere with tooth eruption and may cause expansion if large

• do not continue to grow or increase in size

Odontomas

simple excision with no recurrence

Ameloblastic Fibroma

• neoplastic proliferation of both odontogenic epithelium and mesenchymal tissue

• no enamel, cementum, or dentin

• painless, slow-growing expansion and displacement of teeth

• younger individuals

Ameloblastic Fibroma

• well defined, corticated

• premolar-molar region of the mandible

• occlusal to an unerupted tooth

• usually unilocular and totally radiolucent

Ameloblastic Fibroma

conservative surgical enucleation and mechanical curettage with low recurrence

Ameloblastic Fibro-Odontoma

• scattered calcifications of enamel and dentin

• associated with unerupted tooth

• occurs in 2nd decade

Ameloblastic Fibro-Odontoma

• well defined, sometimes corticated

• mixed density, but mostly radiolucent

• posterior mandible

Ameloblastic Fibro-Odontoma

conservative enucleation with low recurrence rate

Odontogenic Myxoma

• rare

• age 10-30

• invade maxillary sinus

• slow growing

• expansion

• molar and premolar regions of the mandible

Odontogenic Myxoma

• well defined borders

• multilocular with curved and straight, coarse or fine septa

• tennis-racket like pattern

• displaces teeth but DOES NOT resorb roots

  • SCALLOPING between roots instead

• MRI recommended

Odontogenic Myxoma

resection with generous amount of surrounding bone advised due to 25% recurrence rate

Benign Cementoblastoma

• slow-growing tumor of cementum-like tissue

• bulbous growth around and attached to apex of tooth root

• males

• 12-65 but more often in younger

• associated tooth is vital and painful

• mandible

Benign Cementoblastoma

• well defined, corticated

• well-defined radiolucent band

• radiopaque with a wheel-spoke pattern

• external root resorption

• can expand and perforate cortical plate without periosteal reaction

Benign Cementoblastoma

• simple excision and extraction of associated tooth

• rare recurrence rate

Central Odontogenic Fibroma (Simple Type)

• mature fibrous tissue with sparsely scattered odontogenic epithelial rest

Central Odontogenic Fibroma (WHO Type)

• more cellular, more epithelial rest, with calcifications resembling dysplastic dentin, cementum, or osteoid

Central Odontogenic Fibroma

• affects 11-39

• females

• swelling and tooth mobility

• can have a cleft or depression in the palatal mucosa where tumor expansion would be affected

• more common in the mandible and anterior maxilla region

Central Odontogenic Fibroma

• well defined periphery

• small lesions are unilocular while larger are multilocular

• fine and straight septa or granular septa

• totally radiolucent or unorganized calcifcations

• can displace or resorb roots with minimum expansion

Central Odontogenic Fibroma

• simple excision with low recurrence rate