Dysplastic diseases

Nam Age Site Effect Radiographic Different Treatmen Notes

e on features ial t
surroun diagnosi
ding s
tissue
Mono More than Posterio -Expansion Ill defined well - Hyperpara- -Most lesions, - Accounts for
stotic polystotic r and thinnig corticatd with thyroidism growth is 70% of all
type maxilla of the outer variable internal (bilateral, no complete at cases.
FD* cortex. structure expansion). skeletal - Most common
-Expand (radiolucent, - Paget's maturation; sites (in order)
into the radiopaque, or disease therefore are the ribs,
antrum. mixed), it has the (older age). orthodontic femur, tibia,
-Displace characterestic of - periapical treatment maxilla, and
teeth of ground-glass cemental and cosmetic mandible.
affect their (extraoral), orange dysplasia surgery may -Affect one
eruption. peel (intraoral), or (bilateral, be delayed bone.
-Root cotton wool. older age). until this -No skull
resorption time. involvment.
is rare.
-Displace
the ID canal
superiorly.
Poly Children Posterio -Expansion Ill defined well - Hyperpara- -Most lesions, - Accounts for
stotic less r and thinnig corticatd with thyroidism growth is 30% of all
than 10 maxilla of the outer variable internal (bilateral, no complete at cases.
FD* years. cortex. structure expansion). skeletal -↑ Cutaneous
-Expand (radiolucent, - Paget's maturation; pigmentation
into the radiopaque, or disease therefore (cafe au lait
antrum. mixed), it has the (older age). orthodontic spots)
-Displace characterestic of - periapical treatment -Affect multiple
teeth of ground-glass cemental and cosmetic bones.
affect their (extraoral), orange dysplasia surgery may -There is skull
eruption. peel (intraoral), or (bilateral, be delayed involvment.
-Root cotton wool. older age until this
resorption time.
is rare.
-Displace
the ID canal
superiorly.
Periap Middle -More in -Lamina Well defined round -Early lesion if the teeth -The same as
age anterior dura of the or oval shape may mimic have been FD but with
ical removed and if
Average mandibl teeth centered over the periapical cementum
CD 39 yrs e involves are apex of the tooth. rarifying considerable replacing the
(PCD) atrophy of the
Black -Almost lost. Internatly it varies ostitis normal bone.
alveolar ridge
Females always -Root and depend on the (clinical,vital has occurred, -The involved
9:1 at the resorption maturity of the ity) these teeth are vital.
apex of and structure: -Mixed: segments of -Multiple and
the root. hyperceme Early: radiolucent. cementoblas cementum bilateral.
ntosis are Then: mixed with toma and may reach the
 rare. radiopaque tissue odontoma mucosal
-Large composed of (resorption) surface and
lesion cementum -Mature: perforate the
causes (cementicles). dense bone mucosa
when
expansion. Mature: radiopaque island (no positioned
-May with radiolucent rediolucent under a
elevate the margin periphery). denture
floor of the removed
maxillary surgicaly.
antrum.
Florid Average Bilateral -Displace Well defined with -Paget’s -FOD doesn’t -The lesion has
CD 42 yrs and the ID canal sclerotic borders, disease require a
Black present inferiorly internally varies (involve all treatment poor vascular
(FCD) Female in both and the according to the the -Because of supply, a
s jaws. maxillary maturity, from mandible the condition that
Howeve antrum radiolucet, mixed, including propensity to likely
r, when superiorly. and rediopaque in below the ID develop contributes
they are -Enlarge late stages. It’s canal, secondary to its
present the alveolar similar to PCD. polystotic infections in susceptibility to
in only bone by (involves FaD, the infection.
one jaw, displaceme other patient -it’s a PCD that
the nt of the bones)). should be affect two or
mandibl buccal and -Chronic encouraged more
e is the lingual sclerosing to maintain quadrents of
more cortical osteomyeliti an effective the mouth, not
commo bones. s (CT is used oral hygiene a couple of
n -Causes for the program to teeth.
location. hyperceme differentiatio avoid -Teeth in the
ntoosis to n). odontogenic involved bone
the infections. are vital unless
involved other dental
teeth. disease
coincidentally
affects them.
Paget over 40 Occurs - Has 3 stages: -FD (younger Currently -Abnormal
yrs most Enlargment 1) Early radiolucent age,unilater Paget's resorption (by
Males often in of affected resorptive stage. al) disease osteoclasts)
the bone. 2) Granular or -FOD (above usually is and apposition
pelvis, -Swollen ground-glass- the ID managed (by
femur, skull. appearing second canal). medically, osteoblasts) of
skull, - stage. -Metabolic using either osseous tissue
and Hyperceme- 3) denser, more bone calcitonin or in one or more
vertebra ntosis may radiopaque disease sodium bones.
e and appear appositional late (don’t cause etidronate. -Elevated levels
infreque (exuberant stage. enlargment). Calcitonin of serum
ntly in and Cotton wool **The relieves pain alkaline
the jaws irregular). appearance is 1)specific and reduces phosphatase.
(more in -Teeth may specific for paget. bone pattern the serum -Common in UK
the become **These stages are changes, the alkaline and australia.
maxilla) spaced or less apparent in the 2)late age of phosphatase
onset, the
. displaced jaws. levels and
3)enlargemen
in the t of the osteoclastic
enlarging Always when we involved activity.
jaw. suspect paget’s bone, and the Sodium
-External disease, we have to 4)extreme etidronate
root take askull elevation of covers bone
resorption radiograph to see if serum surfaces and
may occur. there is any alkaline retards bone
anterior and phosphatase resorption
aid in the
posterior and
differential
demineralization. diagnosis. formation.
Surgery may
be required
to correct
deformities of
the long
bones and
treat
fractures.
Cherubi 2-6 yrs Affect -Expansion Well defined and -CGCG After skeletal -Inherited
sm the of the jaws. sometimes (unilateral). growth has developmental
posterio -Anterior corticated, the -FD stopped, abnormality
(Familial r aspect displaceme internal structure (unilateral). conservative that causes
fibrous both nt of the resembles that of -The surgical bilateral
dysplasia jaws but teeth. Centrat Giant Cell 1)bilateral procedures, if enlargement of
) the -Can Granuoloma symmetry of required, the jaws.
mandibl enlarge into (CGCG) with fine, cherubism, may be done -Regress with
e is the granular bone and along with for cosmetic age.
more maxillary wispy trabeculae the problems. -The most
commo sinus. forming a 2)anterior Surgery also common
n prominent displacemen may be presenting sign
affected multilocular t required to is a painless,
. pattern. of teeth and uncover firm, bilateral
3)pronounce displaced enlargement of
d teeth, and the lower face.
multilocular orthodontic -"eyes raised
appearance, treatment to heaven"
help with the may be appearance.
differential needed.
 diagnosis.
*FD: fibrous dysplasia: Results from a localized change in normal bone metabolism
that leads to the replacement of all the components of cancellous bone by fibrous tissue
containing varying amounts of abnormal-appearing bone. No sexual predilection except for
McCune-Albright syndrome, which affects females almost exclusively. More commonly are
unilateral. Patients with jaw involvement first may complain of unilateral facial swelling or an
enlarging deformity of the alveolar process. Pain and pathologic fractures are rare. If
extensive craniofacicl lesions have impinged on nerve foramina, neurologic symptoms such
as anosmia (loss of the sense of smell), deafness, or blindness may develop.

---------------------------------------------------------------------------------------------------

A, Unilateral fibrous dysplasia involving

A series of films showing the left maxilla and mandible. B, Note the
a variety of internal patterns expansion of the lateral aspect of the
of fibrous dysplasia. maxilla and mandible (arrow) and the
A, A fingerprint pattern increased bone density caused by an
around the roots of the first increase in the number of internal
molar (arrow). Note the
change in the lamina dura
around the molars into the
abnormal bone pattern.
B, A granular or groundglass
pattern (arrow).
C, A cotton wool pattern.
Note the almost circular
radiopaque regions
(arrows).
D, An orange-peel pattern.

------------------------
 PCD: radiolucent stage.
The lamina dura around the
central incisor has been lost
in A, but the periodontal
membrane space can still be
seen in B.

Example of PCD in the

maxilla.
A, Mixed lesion.
B, Mature lesion.
A and B, Portions of
panoramic views of the
same patient taken 3 years
FOD.
apart. Note the development
A, Three mixed
of a solitary lesion of PCO in
radiopaque-radiolucent
the apical region of the first
lesions in the periapical
molar extraction site.
regions throughout the
C and D, Solitary lesions in
jaws (arrows); note that
the posterior mandible.
although the right third
molar is horizontally
impacted, the lesion still
has a periapical
relationship.
B, A composite of
periapical films of the same
case. Note the appearance
of the lesions involving the
mandibular incisors
(Not apparent in the
panoramic film), which
appear identical to
periapical cemental
dysplasia.
C, An occlusal film of the
left mandibular lesion
showing expansion of the
medial cortical plate
(arrow).
D, A panoramic film of a
A case of cherubism.
A, A panoramic image showing four lesions
in the
maxilla and mandible. Note that the
epicenters of the lesions are in the
maxillary tuberosity and mandibular
ramus; also note the anterior displacement
of the unerupted maxillary first molars.
The internal structure contains ill-defined
septa.
 ------------------

A and B, Paget's disease

showing exuberant irregular
hypercementosis of the roots.

Paget's disease. A, Multiple

radiopaque masses in the
mandible that have a cotton-
wool appearance.

Paget's disease with an

altered trabecular pattern.
The trabeculae are aligned
in linear striations, which
follow an approximately
horizontal direction in the
mandible but are randomly
oriented in the maxilla.
A case of Paget's disease involving the
skull, maxilla, and mandible.
A, A lateral view of the skull showing an
increase in density and dimension between
the internal
and outer cortex of the skull. A cotton wool
pattern can be seen.
B, A lateral view of the jaws of the same
patient showing the increase in jaw size and
density. There is a subtle linear orientation
of the trabeculae of the mandible.
 Done By:
Abdallah Awadi