Dysplastic Diseases

Dysplastic diseases Nam e

Mono stotic FD*

Age

Site

Effect on surroun ding tissue

Radiographic features

More than polystotic type

Posterio r maxilla

-Expansion and thinnig of the outer cortex.

Ill defined well corticatd with variable internal structure (radiolucent, radiopaque, or mixed), it has the characterestic of ground-glass (extraoral), orange peel (intraoral), or cotton wool.

-Expand into the antrum. -Displace teeth of affect their eruption. -Root resorption is rare.

Different Treatmen ial t diagnosi s - Hyperparathyroidism (bilateral, no expansion). - Paget's disease (older age). - periapical cemental dysplasia (bilateral, older age).

-Most lesions, growth is complete at skeletal maturation; therefore orthodontic treatment and cosmetic surgery may be delayed until this time.

Notes

- Accounts for 70% of all cases. - Most common sites (in order) are the ribs, femur, tibia, maxilla, and mandible. -Affect one bone. -No skull involvment.

-Displace the ID canal superiorly.

Poly stotic FD*

Children less than 10 years.

Posterio r maxilla

-Expansion and thinnig of the outer cortex. -Expand into the antrum. -Displace teeth of affect their eruption. -Root resorption is rare.

Ill defined well corticatd with variable internal structure (radiolucent, radiopaque, or mixed), it has the characterestic of ground-glass (extraoral), orange peel (intraoral), or cotton wool.

- Hyperparathyroidism (bilateral, no expansion). - Paget's disease (older age). - periapical cemental dysplasia (bilateral, older age

-Most lesions, growth is complete at skeletal maturation; therefore orthodontic treatment and cosmetic surgery may be delayed until this time.

- Accounts for 30% of all cases. -↑ Cutaneous pigmentation (cafe au lait spots) -Affect multiple bones. -There is skull involvment.

-Displace the ID canal superiorly.

Periap Middle age ical CD Average (PCD)

39 yrs Black Females 9:1

-More in anterior mandibl e -Almost always at the apex of the root.

-Lamina dura of the teeth involves are lost. -Root resorption and hyperceme ntosis are rare. -Large lesion causes expansion. -May elevate the floor of the maxillary antrum.

Florid CD (FCD)

Average 42 yrs Black Female s

Bilateral and present in both jaws. Howeve r, when they are present in only one jaw, the mandibl e is the more commo n location.

-Displace the ID canal inferiorly and the maxillary antrum superiorly. -Enlarge the alveolar bone by displaceme nt of the buccal and lingual cortical bones. -Causes hyperceme ntoosis to the

Well defined round or oval shape centered over the apex of the tooth. Internatly it varies and depend on the maturity of the structure: Early: radiolucent. Then: mixed with radiopaque tissue composed of cementum (cementicles). Mature: radiopaque with radiolucent margin

Well defined with sclerotic borders, internally varies according to the maturity, from radiolucet, mixed, and rediopaque in late stages. It’s similar to PCD.

-Early lesion may mimic periapical rarifying ostitis (clinical,vital ity) -Mixed: cementoblas toma and odontoma (resorption) -Mature: dense bone island (no rediolucent periphery).

-Paget’s disease (involve all the mandible including below the ID canal, polystotic (involves other bones)). -Chronic sclerosing osteomyeliti s (CT is used for the differentiatio n).

if the teeth have been removed and if considerable atrophy of the alveolar ridge has occurred, these segments of cementum

-The same as FD but with cementum replacing the normal bone. -The involved teeth are vital. -Multiple and bilateral.

may reach the mucosal surface and perforate the mucosa when positioned under a denture removed surgicaly.

-FOD doesn’t require treatment -Because of the propensity to develop secondary infections in FaD, the patient should be encouraged to maintain an effective oral hygiene program to avoid odontogenic

-The lesion has a poor vascular supply, a condition that likely contributes to its susceptibility to infection. -it’s a PCD that affect two or more quadrents of the mouth, not a couple of teeth. -Teeth in the

involved teeth.

infections.

involved bone are vital unless other dental disease coincidentally affects them.

Paget

over 40 yrs Males

Occurs most often in the pelvis, femur, skull, and vertebra e and infreque ntly in the jaws (more in the maxilla) .

Enlargment of affected bone.

Has 3 stages:

-Swollen skull.

2) Granular or ground-glassappearing second stage.

Hypercementosis may appear (exuberant and irregular). -Teeth may become spaced or displaced in the enlarging jaw. -External root resorption may occur.

Cherubi

2-6 yrs

Affect

-Expansion

1) Early radiolucent resorptive stage.

3) denser, more radiopaque appositional late stage. Cotton wool appearance is specific for paget. **These stages are less apparent in the jaws.

-FD (younger age,unilater al) -FOD (above the ID canal). -Metabolic bone disease (don’t cause enlargment). **The 1)specific bone pattern changes, the 2)late age of onset, the 3)enlargemen t of the involved bone, and the

Always when we suspect paget’s disease, we have to take askull radiograph to see if there is any anterior and posterior demineralization.

4)extreme elevation of serum alkaline phosphatase aid in the differential diagnosis.

Well defined and

-CGCG

Currently Paget's disease usually is managed medically, using either calcitonin or sodium etidronate. Calcitonin relieves pain and reduces the serum alkaline phosphatase levels and osteoclastic activity. Sodium

-Abnormal resorption (by osteoclasts) and apposition (by osteoblasts) of osseous tissue in one or more bones. -Elevated levels of serum alkaline phosphatase. -Common in UK and australia.

etidronate covers bone surfaces and retards bone resorption and formation. Surgery may be required to correct deformities of the long bones and treat fractures. After skeletal

-Inherited

sm (Familial fibrous dysplasia )

the posterio r aspect both jaws but the mandibl e is more commo n affected .

of the jaws. -Anterior displaceme nt of the teeth. -Can enlarge into the maxillary sinus.

sometimes corticated, the internal structure resembles that of Centrat Giant Cell Granuoloma (CGCG) with fine, granular bone and wispy trabeculae forming a prominent multilocular pattern.

(unilateral). -FD (unilateral). -The 1)bilateral symmetry of cherubism, along with the 2)anterior displacemen t of teeth and 3)pronounce d multilocular appearance, help with the differential diagnosis.

growth has stopped, conservative surgical procedures, if required, may be done for cosmetic problems. Surgery also may be required to uncover displaced teeth, and orthodontic treatment may be needed.

*FD: fibrous dysplasia:

developmental abnormality that causes bilateral enlargement of the jaws. -Regress with age. -The most common presenting sign is a painless, firm, bilateral enlargement of the lower face. -"eyes raised to heaven" appearance.

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 the left maxilla and mandible. B, Note the expansion of the lateral aspect of the maxilla and mandible (arrow) and the increased bone density caused by an increase in the number of internal

A series of films showing a variety of internal patterns of fibrous dysplasia. A, A fingerprint pattern around the roots of the first 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.

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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 apart. Note the development of a solitary lesion of PCO in the apical region of the first molar extraction site. C and D, Solitary lesions in the posterior mandible.

FOD. A, Three mixed radiopaqueradiolucent lesions in the periapical regions throughout the jaws (arrows); note that 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 different case showing

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.

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A and B, Paget's disease showing exuberant irregular hypercementosis of the roots.

Paget's disease with an Paget's disease. A, Multiple altered trabecular pattern. radiopaque masses in the The trabeculae are aligned mandible that have a cottonwool appearance.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