??seminar???

1
??seminar???
2.1.1-1 Periapical granuloma 2.1.2-4
Nasopalatine duct cyst 2.1.1-2 Radicular cyst
2.1.2-5 Eosinophilic
granuloma 2.1.1-3 Surgical defect
2.2-1 Dental follicle 2.1.1-4 Periapical
abscess 2.2-2 Pericoronitis 2.1.1-5
Osteomyelitis 2.2-3
Paradental cyst 2.1.2-1 Cementoma
2.2-4 Dentigerous cyst 2.1.2-2
Periodontitis 2.2-5
Muralameloblastoma 2.1.2-3 Trauma bone cyst
2.2-6 Adenomatoid Odontogenic Tumor
2
2.1.1-1
these is well-defined oval or round radiolucences
without corticated outline located at mesial root
of the tooth 36 extending to the furcation area ,
measuring approximately 1x1cm in dimension. PDL
widening of the mesial root of 36 is also noted.
3
Periapical Granuloma

• Clinical features
• asymptomatic
• pain and sensitivity can develop
• ????
• Periapical Granuloma ? granulation tissue
  ????????
• - ???? lymphocyte ?PMN?plasma cell
• -??
• -Fibrous tissue ???????????
• ???epithelium lining , ?????? , ??granulation
  tissue ?

4
2.1.1-2
there is a well-defined unilocular round shaped
periapical radiolucence with a corticated margin
over the tooth 23 between the adjacent teeth,
extending from the distal aspect 22 to mesial
aspect of 23, measuring 2cm in diameter. The
radiopaque border is continuous with the lamina
dura of the associated tooth.
5
Radicular cyst

• ???non-keratinized stratified squamous
  epithelium
• ?rete process??
• hyaline body
• foamy cells
• fibrous wall?? heavy deposits of cholesterol
  crystals

6
Periapical granuloma ? Radicular cyst????

• periapical granuloma ?cyst??
• Radicular cyst ?????? upper jaw bone.
• Radicular cyst X-ray ?????????lamina dura
• Granuloma ?????????radicular cyst
• Radicular cyst???nonvital tooth

7
2.1.1-3
8
Surgical Defect

• ??????,??????????????????????
• ?????????,????????????????
• ?????fibrous tissue???,?????apical???
• ?X???,?well-defined, radiolucence?
• ??????????????,????X??,?????????
• ??????????????pain, hemorrhage, swelling,
  ecchymosis, paresthesia, maxillary sinus
  perforation?

9
2.1.1-4
There is ill-defined unilocular shaped
radiolucence without a corticated margin on
periapcial area of tooth 14, and with a
periodontal pocket on the distal side. This maybe
a combination syndrome of both endo. and perio.
with progression, the abscess may extend through
the medullary spaces away from the apical area
resulting in osteomyelitis, or it may perforate
the cortex and spread diffusely through the
overlying soft tissue
10
Apical absess

• arise as the initial periapical pathosis or from
  an acute exacerbation (phoenix abscess) of a
  chronic periapical inflammatory lesion.
• In the early stage, the periapical periodontal
  ligament fibers may exhibit acute inflammation
  but no frank abscess formation.
• best termed acute apical periodontitis.

11
Clinical Features

• painful tender swelling of varying size and
  position   
• tenderness to pressure in buccal sulcus   
• fever and malaise   
• erythema and possibly draining sinus, intraoral
  or extra-oral   
• unresponsive to thermal and electrical stimuli  
• positive percussion test

12
Differential diagnosis

• Periapical granuloma
• ????????(raiolucency)
• Well-defined with a corticated radiopaque
  line or zone of sclerotic bone.
• Radicular cyst
• ?periapical granuloma??,???radiolucency???
• Osteomyelitis
• poor-defined moth-eaten radiolucency

13
2.1.1-5
14
Osteomyelitis, periapical

• Osteomyelitis???????
• ?????posterior body of mandible,???????
• ??????????sequestra????
• ?? acute??chronic

15
2.1.2-1
There is a well-defined monolocular round shaped
radiolucence without a corticated margin at the
apical area of both mandibular central
incisors(tooth24,25)extending from the mesial
aspect of tooth 26 to the periapical area of
tooth 24,measuring approximately 1 cm in diameter
.the adjacent teeth are typically vital and not
resorbed with an intact periapical ligament
space.
16
Cemetoma , periapical cemento-osseous dysplasia ,
stage 1

• Middle-aged adults (typically black women )
• Monolocular , often multiple
• Early stage radiolucent ,not corticated
• Intermediate stage radiopacity within the
  apical radiolucencies
• Late stage densely radiopaque but surrounded by
  a thin radiolucent line

• Traumatic ( solitary ) bone cyst
• Radicular cyst
• Periapical granuloma

17
2.1.2-2

• There is a continuous irregular radiolucence with
  a poor defined margin along the apical area of
  the right maxillary posterior teeth (tooth
  2,3,4and 5),and a well-defined round shaped
  radiolucence without a corticated margin at the
  periapical area of tooth 4 ,with a superior
  margin at the apex os the root and a inferior
  margin near the midle one-third of the
  root,measuring approximately 1 cm in
  diameter.Severe bone destruction can be observed
  around the roots of the teeth.

18
Periodontitis

• Eosinophilic granuloma
• Traumatic (solitary ) bone cyst
• Periapical granuloma
• Radicular cyst

19
2.1.2-3
There is a well-defined monolocular
scalloped-shape radiolucence without a cortical
margin between the root of the 35 and 37
extending from the distal of 35 to the root tip
of 37 squeezing along the root outline,measuring
approximately 4 2 cm in diameter. The involved
teeth from 35 to 37 are still alive with lamina
dura.
20
Trauma bone cyst

• well-defined (corticated) radiolucence
• asymptomatic
• under 20 years old
• 60 male
• common in the mandibular premolar and molar
  areas
• margin along the root,not push
• vital teeth
• scallop(several teeth)
• empty or fluid filled cavity

21
lateral periodontal cyst

• Same--
• male prefer
• asymptomatic
• corticated round radiolucency
• along the lateral root surface
• in alveolar bone
• Different--
• old ages
• often in mandibular premolar-canine-lateral
  incicor area(rarely in molars)
• some are botryoid round lucency(botryoid
  odontogenic cyst)

22
aneurysmal bone cyst(ABC)

• same
• well defined
• unilocular radiolucency
• different
• large blood-filled spaces
• often described as "soap bubble"
• teeth moved and roots resorption

23
odontogenic keratocyst(OKC)

• Same
• scalloping
• asymptomatic
• different
• wide age range
• multiple(about10)
• teeth moved and roots resorption

24
glangular odontogenetic cyst(GOC)

• same
• painless
• scalloping
• different
• usually anterior mandible
• middle aged
• teeth moved and roots resorption

25
2.1.2-4
There is a well-defined monolocular round shaped
radiolucence with a corticated margin at midline
of anterior maxilla ,measuring approximately 2x4
cm in diameter.Upper central incisors are
separated apart.
26
Nasopalatine duct cyst(Incisive Canal Cyst)

• 4060 years old ?gt?
• site midline, anterior maxilla
• Unilocular, round or oval, well-defined, well
  corticated (unless infected)
• It may cause palatal expansions
• smooth cortical border
• arises from epithelial remnants of the
  nasopalatine duct

27

• usually present in the midline of the anterior
  maxilla near the incisive foramen
• many are inflamed
• pain, pressure, drainage and swelling can occur

28
Differential Diagnosis

• periapical granuloma   
• radicular cyst  

29
2.1.2-5
There is a round-shaped monocular radiolucence
without corticated margin between the edentulous
area,measurely approximately 3X5 cm in
diameter,extending from tooth44 and tooth47 ,
Destruction of the periodontal bone (loose
teeth)without otherwise affecting the teeth (e.g.
root resorption).
30
Eosinophilic Granuloma

• Benign proliferation of Langerhans cells.
• Usually adolescents and young adults.
• Localized or multiple lesions.
• In the jaws, more than 75 in mandible.
• Round, monolocular, not corticated.
• Destruction of the periodontal bone (loose
  teeth)without otherwise affecting the teeth

31
Periodontitis Radicular cyst Squamous cell
carcinoma Metastatic tumors (ill defined)
Malignant salivary gland tumors 
32
2.2-1
There is a well-defined, unilocular,
round-shaped radiolucence with a well-corticated
margin above tooth22,surrouing crown of an
impacted tooth, extending from distal aspect of
tooth 21 to mesial aspect of tooth 24 and from
the half part of the tooth 22s root to alveolar
bone above tooth 22. The height of the
radiolucence is about to its width.
33
Dental follicle
?????????(cap stagebell stage)?????????????perio
dontium???????

• ? dentigerous cyst
• ?????reduced enamel epithelium
• ????reduced enamel epithelium??????
• ??,cyst??????????
• Dentigerous cyst???cyst?????,??????
• ???dental follicle??????????????

34
Dental follicle

• ? Impaction of upper canine-- ??????? No.1
• ? Upper canine ???????
• 1. ??????,?????????
• 2. Lat. Incisor??????
• 3. ???canine??????????
• 4. ???????
• 5. ?dentigerous cyst??tumor????

35
2.2-2
This radiograph is part of a panoramic one. There
is a radiolucence locating at distal aspect of
tooth 38, extending from distal of the tooth 38s
crown to the ramus of mandibular bone, measuring
about 1 cm. Its height is approximately the
length of tooth 38s crown. Its well-defined,
surrouned by nearby soft tissue (gingiva) and the
crown of tooth 38.
36
Pericoronitis????

• ??????????????
• ??????????????????????????,??????????????
• reduced enamelepithelium?????oral
  mucosa????junctional epithelium,?????????????

37
Pericoronitis????

• ???????????,??????????,????????
• ?????????? ???????,???????pus???,??????????
• ?????,????????,??,????

38
Differential diagnosis

• Paradental cyst
• ??????????????????
• ??facial aspect,?????????
• ? ?
• ???????cyst,???cyst?3?
• ?,???cavity,epithelium,wall?
• ?pericoronitis??cyst?

39
Differential diagnosis

• Dentigerous (follicular) cyst
• ???????????,??????
• ??? ?
• ????cyst,???cyst?3??,??
• ?cavity,epithelium,wall?????
• ??(crown ),?cyst??? ????
• ??????,???????upper
• canine?

40
??

• ???? ????????,????
• ??????gingival flap??
• ??????????????,??
• ???????,???????
• ??gingival flap ?

41
2.2-3
There is a small well-defined unilocular oval
shaped radiolucence with corticated margin in the
distal of the tooth 48 extending from distal
cervical margin of the tooth 48 down to superior
wall of inferior alveolar canal and up to the 1/4
ramus, measured approximately 1x1 cm in diameter.
42
Paradentalcyst
???? ????mandibular third molar?lateral
root surface???cervical
margin ????uncertain.
involved by pericoronitis (usually
lower 3rd molar).

43
2.2-4
There is a well-defined unilocular oval shaped
circumcoronal radiolucence with a corticated
border over the submerged tooth 48 extending from
retromolar area down to the mandibular angle,
measuring approximately 1 cm in diameter.
44
Features of Dentigerous Cyst

• Most common odontogenic cyst, next to radicular
  cyst.
• Etiology
• X-ray
• Site
• Pt ages usually adolescents, 2040 years old.
• Eruption cyst
• Effects on adjacent tooth
• Treatment
• Progonosis
• Ameloblastic change (neoplastic transformation)

45
Differential diagnosis

• Mural ameloblastoma

46
Differential diagnosis

• Adenomatoid Odontogenic Tumor (AOT)

47
Differential diagnosis

• Ameloblastic fibroma

48
Differential diagnosis

• Paradental cyst

49
2.2-5
There is a well-defined unilocular irregular
shaped pericoronal radiolucence without
corticated margin associated with an unerupted 38
tooth extending from distal aspect of the
unerupted tooth 37 up to approximately 2/3 left
ramus and from superior border of ramus down to
left mandibular angle, measured approximately 3x3
cm in diameter.
50
Muralameloblastoma
???? ?arises most commonly from a dentigerous
cyst ?most common site Mandible posterior
region ?cause root resorption of the adjacent
teeth ???unicystic ameloblastoma????
tumor???cystic wall(fibrous tissue),??? ?,????
51
Ameloblastoma

• ???ameloblastoma?????
• conventional / multicystic type ( 86 )
• unicystic type ( 13 )
• - luminal ameloblastoma
• - intraluminal ameloblastoma
• - mural (wall) ameloblastoma
• Peripheral (extraosseous) type ( 1 )

52
Ameloblastoma

• unicystic ameloblastoma ? conventional
  ameloblastoma ???

conventional ameloblastoma Unicystic ameloblastoma
Case?? about 86 of all cases about 13 of all cases
Shape multilocular radiolucence Unicystic radiolucence
???? 20 in maxilla 80 in mandible 56 in mandibular molar, ramus region 90 in ramus region
???? 40?50????????,??????????39?40??? 18-20?
recurrent rate 50-90 10-20
53
2.2-6

• There is a well-defined unilocular oval shaped
  radiolucence with a corticated margin. It extend
  from apex of tooth 21 to apex of tooth 25 and
  from 3mm below alveolar crest to nasal spine
  level,measuring approximately 3 x 3 cm in
  diameter. It causes tooth 21 and tooth 23
  unerupted, tooth 21 malposition (root slants to
  mesisal) and tooth 24 slanted to distal.

54
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55
Adenomatoid Odontogenic Tumor (AOT)

• ????.
• ??????.(70 2nd decade)
• ????????(???-??-?????)
• ?????????????
• ????,??,??????????????
• 2/3????????Radiopacities??
• ??????

56
Difference Disease

• Dentigerous cyst
• Dental follicle
• Mural Ameloblastoma
• Full radiolucence?????????

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THE END