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Copyright © 2004 by A. Ruprecht
The
Radiologyof
Benign NeoplasmsA. Ruprecht D.D.S., M.Sc.D., F.R.C.D.(C,), Dip. A.B.O.M.R.
Professor and Director of Oral and Maxillofacial RadiologyProfessor of Radiology
Professor of Anatomy and Cell BiologyThe University of Iowa
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The Radiology of Benign Neoplasms
Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Poorly DefinedWell Defined
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Corticated
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Space Occupying vs. Non-Space Occupying
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Space Occupying
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
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Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
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Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
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Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
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Cyst orBenign Neoplasm Benign Neoplasm Malignant Neoplasm
The Radiology of Benign Neoplasms
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The
Radiologyof
Benign Neoplasms
I. Odontogenic
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• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
The Radiology of Benign Neoplasms
Odontogenic
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• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
The Radiology of Benign Neoplasms
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Dental Lamina Ameloblastoma
Enamel organ Adenomatoid
Odontogenic Tumor
Root sheath of Hertwig Ameloblastic fibroma
Dental Lamina
Odontoma
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Ameloblastoma
• Age: 20 - 50 years (predominantly 30s and 40s)
• Mandible:Maxilla = 85:15• 60% mandibular molar-ramus area
The Radiology of Benign Neoplasms
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Ameloblastoma
10%
10%
3%2%
15%60%
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Ameloblastoma
• Unilocular• Multilocular (coarse septa)
Soap bubble
Honeycomb
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Ameloblastoma
• Displacement or resorption of teeth• Extends beyond radiographic limits• Superior aspect often lost
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Keratocyst -> Ameloblastoma
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Copyright © 2004 by A. Ruprecht July 26, 1973
The Radiology of Benign Neoplasms
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Simple Bone Cyst -> Ameloblastoma
The Radiology of Benign Neoplasms
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Copyright © 2004 by A. Ruprecht February 5, 1966
The Radiology of Benign Neoplasms
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Copyright © 2004 by A. Ruprecht December 29, 1967
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Recurrent Ameloblastoma
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Recurrent Ameloblastoma
• radiolucent areas• circular pattern
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Squamous odontogenic tumor(SOT)
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Squamous odontogenic tumor (SOT)
• Age: 10s - 60s years (mean of 40)• Mandible:Maxilla = 1:1• alveolar process area• from rests of Malassez?
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• radiolucent• well-circumscribed• semilunar• associated with roots of teeth
Squamous odontogenic tumor (SOT)
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• locally invasive• recur with conservative treatment• excision is treatment of choice
Squamous odontogenic tumor (SOT)
The Radiology of Benign Neoplasms
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Adenomatoid odontogenic tumor(AOT)
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Adenomatoid odontogenic tumor(AOT)
• 10-20 (18 years of age)• anterior maxilla or mandible• radiolucent or with radiopaque foci• may mimic dentigerous cyst
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Calcifying epithelial odontogenic tumor (CEOT)
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Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor)
• 10-90 (mean 40)• maxilla:mandible = 1:2• ramus-molar region
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Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor)
• usually associated with impacted teeth• unilocular or multilocular• radiolucent or with radiopaque foci
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Clear cell odontogenic tumor
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Clear cell odontogenic tumor
• rare• 60 years of age• females• maxilla or mandible
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Clear cell odontogenic tumor
• radiolucent• poorly circumscribed• locally aggressive
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Melanotic neuroectodermal tumor of infancy
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Melanotic neuroectodermal tumor of infancy (MNTI)
• rare• young, usually first year of life• anterior maxilla• moderately well circumscribed,
around apical area of roots
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• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
The Radiology of Benign Neoplasms
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• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
The Radiology of Benign Neoplasms
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• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
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• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
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• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
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• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
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• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Compound odontoma
Complex odontoma
Odontogenic
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Ameloblastic fibromaAmeloblastic fibro-odontomaCompound odontomaComplex odontoma
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–>Compound Odontoma Ameloblastic Fibroma–>Ameloblastic Fibro-odontoma –>Complex Odontoma
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Ameloblastic Fibroma
primitive myxoid connective tissue
resemblance to dental pulp
strands of odontogenic epithelium 2 cells wide
Ameloblastic Fibro-odontoma
primitive myxoid connective tissue
resemblance to dental pulp
strands of odontogenic epithelium 2 cells wide
cells differentiate to produce enamel and dentin
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Ameloblastic Fibro-odontoma
prominent enamel matrix often seen before final maturation of hard tissue
enamel and dentin in the form of compound or complex odontoma
Compound Odontoma
Complex odontoma
prominent enamel matrix often seen before final maturation of hard tissue
enamel and dentin in the form of compound or complex odontoma
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• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
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Odonto-ameloblastoma
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Odonto-ameloblastoma
• rare• young, first decade• ameloblastoma component• odontoma component
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• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
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• Mesenchymal
Odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
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• Mesenchymal
Odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
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Odontogenic fibroma• Central odontogenic fibroma• Peripheral odontogenic fibroma
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Central odontogenic fibroma
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Central odontogenic fibroma
• rare• all age groups• radiolucent• usually unilocular
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Peripheral odontogenic fibroma
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• Mesenchymal
Central odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
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Odontogenic myxoma
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Odontogenic myxoma
• 10-50 years (15-35, mean 30)• maxilla:mandible 1:1 • may be infiltrative and aggressive
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Odontogenic myxoma
• “tennis racket” appearance
(neither coarse nor fine septa)• cortical expansion• root displacement rather than resorption
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• Mesenchymal
Central odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
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Benign cementoblastoma
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Benign cementoblastoma
• second or third decade, usually before 25• continuous with root , which is resorbed• pulp vitality unrelated
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Benign cementoblastoma
• radiopaque mass• surrounded by radiolucent line• surrounded by radiopaque line
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• Mesenchymal
Central odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
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Cementifying fibromaOssifying fibroma
Cemento-ossifying fibroma
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Cementifying fibroma
• all age groups, mainly around 40• radiolucent, mixed, radiopaque• usually unilocular
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