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Mesenchymal
TumorsGroup II DFDCelso, Chalaki, Concepcion, Derakshanfard
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Odontogenic Myxoma
an uncommon benignodontogenic tumor arising
from embryonic connective
tissue associated with tooth
formation
This is a benign neoplasm
that may be infiltrative and
aggressive
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Odontogenic Myxoma
Clinical FeaturesMean age of occurrence is 30 years old
With no gender predilection
Lesions may be seen in either jaws
Mandible 63% Maxilla 37%
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Odontogenic Myxoma
In the maxilla: it can be found anywhere inthe maxilla and constantly involve the
maxillary sinus
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Odontogenic Myxoma
In the mandible: lesions aregenerally found in the molar and
premolar region. Which may
extend to the ascending ramus
and the condylar region
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Odontogenic Myxoma
Clinical FeaturesThese are painless, slow
growing which cause root
dilaceration and in some
cases root resorption
Generally associated with
retained or missing teeth
Causes cortical expansion and
eventual perforation, and results to
tumefaction and facial deformity
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Odontogenic Myxoma
Radiographic Features It may appear as a well-circumscribed or a
diffuse radiolucent lesion
Often, it is multiloculated and has a
honeycomb pattern
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Odontogenic Myxoma
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Odontogenic Myxoma
HistopathologyThis tumor is composed of bland, relatively
acellular myxomatous connective tissue
Benign fibroblasts and myofibroblasts with
variable amounts of collagen are found in amucopolysaccharide matrix
Odontogenic rests are absent
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Odontogenic Myxoma
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Odontogenic Myxoma
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Odontogenic Myxoma
Differential DiagnosisAmeloblastoma
Central Hemangioma
Giant Cell Granuloma
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Odontogenic Myxoma
Treatment and PrognosisSurgical excision
For small unilocular lesions enucleation
and curettage followed by chemical bone
cautery can be done
Prognosis is very good.
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CENTRAL
ODONTOGENIC
FIBROMA
Anne Celso
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CENTRAL ODONTOGENIC
FIBROMACLINICAL FEATURES
-benign odontogenic neoplasm occurring within the
jaws
-the lesion is central in bone and has persistent
progressive growth
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CENTRAL ODONTOGENIC
FIBROMA
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CENTRAL ODONTOGENIC
FIBROMA
CLINICAL FEATURES-more common in adults, with the average
age being 40.
-twice as likely to affect women than men
-usually found either in the anterior maxilla orthe posterior mandible
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CENTRAL ODONTOGENIC
FIBROMA
RADIOGRAPHIC APPEARANCE-appear as a loculated radiolucent area that
may be associated with unerupted or displaced teeth
-uni or multilocular radiolucency involving
periodontal and crestal bone adjacent to dental roots
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CENTRAL ODONTOGENIC
FIBROMA
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CENTRAL ODONTOGENIC
FIBROMA
MICROSCOPIC APPEARANCE-In the simple type, the lesion is composed of
a mass of mature fibrous tissue containing few
epithelial rests.
-In the World Health Organization type,
mature connective tissue contains abundant rests
and calcific deposits of what is regarded as dentin or
cementum.
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CENTRAL ODONTOGENIC
FIBROMA
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CENTRAL ODONTOGENIC
FIBROMA
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CENTRAL ODONTOGENIC
FIBROMA
DIFFERENTIAL DIAGNOSIS-Desmoplastic fibroma
-Fibromyxoma
-Hyperplastic follicular sac
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CENTRAL ODONTOGENIC
FIBROMA
TREATMENT-enucleation or excision
PROGNOSIS
-recurrence is very uncommon
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BenignCementoblastoma
Anne Celso
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BENIGN CEMENTOBLASTOMACLINICAL FEATURES
-aka true cementoma-benign neoplasm and forms a mass of
cementum-like tissue as an irregular or round massattached to the roots of a tooth
-often involving the mandibular molars or
premolars-involved tooth usually has a vital pulp
-usually occurs in people under the age of 25
-asymptomatic
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BENIGN CEMENTOBLASTOMA
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BENIGN CEMENTOBLASTOMA
CLINICAL FEATURES-have unlimited growth potential
-behave in a locally aggressive manner
resulting in bony expansion, root resorption,
displacement of adjacent teeth, and jaw deformity
-higher predilection for males
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BENIGN CEMENTOBLASTOMA
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BENIGN CEMENTOBLASTOMA
RADIOGRAPHIC APPEARANCE-appears as a well-defined, markedly
radiopaque mass, with a radiolucent peripheral
"line", which overlies and obliterates the tooth root
-there is usually apparent external resorption
of the root where the tumor and the root join.
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BENIGN CEMENTOBLASTOMARADIOGRAPHIC APPEARANCE
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BENIGN CEMENTOBLASTOMA
MICROSCOPIC APPEARANCE-presents cementum-like tissue with
numerous reversal lines
-prominent basophilic reversal lines may give
a pagetoid appearance to the lesion
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BENIGN CEMENTOBLASTOMA
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BENIGN CEMENTOBLASTOMA
DIFFERENTIAL DIAGNOSIS- Severe hypercementosis
-Chronic focal sclerosing osteomyelitis
-Cementoblasts
-Osteoblastoma
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BENIGN CEMENTOBLASTOMA
TREATMENT-removal of the tumor, along with the affected
tooth and curettage or peripheral ostectomy
-enucleation of the tumor through
apicoectomy following root canal treatment
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BENIGN CEMENTOBLASTOMA
PROGNOSIS-an excellent prognosis is usually achieved
after complete removal of the tumor.
-recurrence and continued growth are
possible if lesional tissues are left behind after initial
surgery
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CENTRALODONTOGENIC
FIBROMA
Zivar Chalaki
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Cementifying fibroma
Is a benign neoplasm of bone that has the potential for
excessive growth, bone destruction, and recurrence.it is
clinically and microscopically similar to ossifying fibroma.
Composed of a fibrous connective tissue stroma in which
new bone is formed, it is classified as one of the benign
fibroosseous lesion of the jaws.
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Etiology and pathogenesisIs of undetermined cause.
Although chromosome translocations have been identified in a
few cases of cementifying fibroma , genetic studies have been
insufficient to determine the molecular mechanisms that
underlie the development of this tumor.
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Clinical feature Uncommon lesion that tends to occur during 3rd and 4th
decades of life
In women more than men
Is a slow-growing, asymptomatic, and expansile lesion.
Maybe seen in the jaws and craniofacial bones
Lesion of the jaws characteristically arise in the tooth bearing regions
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Clinical feature Most often in the mandibular premolar ,molar area
The slow but persistent growth of the tumor may ultimately
produce expansion and thinning of the buccal and lingual
cortical plates, although perforation and mucosal ulceration
are rare.
The most important radiographic feature of this lesion is the
well_circumscribed, sharply defined border.
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Clinical feature
Cementifying fibroma, cementoossifying fibroma, and
psammomatoid ossifying fibroma are terms occasionally
used when the bony islands in these lesions are round or
spheroidal.
These tumors occur in similar age groups and locations,
exhibit comparable clinical characteristics, and have the
same biologic behavior.
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Histopathology Is composed of fibrous connective tissue with well
differentiated spindled fibroblast.
Cellularity is uniform but may vary from one lesion to the
next.
Collagen fibers are arranged haphazardly , although a
whorled, storiform pattern may be evident.
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Histo pathology Bony spheroids , trabeculae, or islands are evenly distributed
throughout the fibrous stroma.
Bone is immature and often surrounded by osteoblasts;
osteoclasts are infrequently seen.
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Treatment and prognosis Surgical removal using curettage or enucleation .
The lesion can typically be separated easily from the
surrounding normal bone.
Recurrence is described only rarely after removal.
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Treatment and prognosis
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Cemento-OsseousDysplasias
Mohsen Derakshanfard
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Cemento-Osseous Dysplasias
Includes
Periapical Cemental Dysplasia (PCD)
Florid cemento-osseous dysplasia (aka Florid
Osseous Dysplasia, FCOD, FOD)
Focal Cemento-osseous dysplasia (aka Focal
osseous dysplasia, FCOD, FOD)
This lesion appears to arise from the periodontal ligament and containsvarious amounts of fibrous tissue, cementum, and bone.
All of these lesions represent the same
histopathological process, but are distinguished
by the location and extent of lesions in the jaws.
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Radiographic featuresPCD is a localized change in bone metabolism. It occurs at the apices of lower
anterior teeth
This lesion passes through three stages in its maturation.
The osteolytic stage occurs first and is characterized by localized dental periapicalradiolucencies similar in appearance to those that occur with a dental abscess.
The next period is termed the cementoblastic stage. During this time cementoblastsbecome more active and produce spicules of cementum, which produce a mixed
radiolucent/radiopaque appearance.
The final or mature stage consists of an abnormally large amount of calcificationthat appears as a dense periapical radiopacity surrounded by a thin radiolucentborder.
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Radiographic Features
Location
Apices of mandibular anterior teeth
Multiple or solitary
Shape and Borders
Well defined Round, oval or irregular shape
May have a sclerotic border
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Periapical cemental dysplasia (earlystage)
Multiple radiolucencies at the apices of the mandibular anterior teeth.
In periapical cemental dysplasia, the teeth are vital unless otherwise
involved with caries or trauma.
The radiolucencies should not be misdiagnosed as inflammatory
apical lesions (granulomas, cysts, abscess) in which the teeth are
nonvital and maybe symptomatic.
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Periapical cemental dysplasia (early
stage)
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Periapical cementaldysplasia (earlystage).
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Periapical cemental dysplasia(calcified stage).
Each radiopacity is surrounded by a radiolucent border at the apices
of mandibular incisor teeth.
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Effects on adjacent structures
May efface the lamina dura of adjacent teeth
Root resorption is rare
Surrounding bone may become sclerotic
Occasionally, large lesions may cause
expansion of the jaws
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Periapical cemental dysplasia
(MATURE stage)
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Periapical Cemental Dysplasia
Clinical Features
Teeth are vital
Usually an incidental radiographic finding
F:M 9:1
3:1 African: Caucasian
Frequent in Asians Mean age = 39 yrs
In most cases, multiple lesions are present that are asymptomatic.
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DentinomaMohsen Derakshanfard
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Histologic description
This lesion contains varying amounts of fibrous connective
tissue, cementoblasts, and cemental tissue depending on the stage ofthe lesion.
Treatment
Periodic radiographic observation is appropriate. The teeth are vitaland should not be treated by extraction or endodontic therapy.Electrical, thermal, and mechanical stimulation of the teeth can aidthe clinician who is attempting to rule out dental infection duringthe osteolytic or cementoblastic stages.
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dentinomaThis type is quite rare, is composed of connective tissue,
odontogenic epithelium, and abnormal dentin associated
with coronary portions of unerupted permanent teeth. Its
radiographic appearance is radiopaque mass in close
proximity to the crown of an unerupted tooth.
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Clinical feature
Age and sex
it seen in px younger than 36 years with an average of age 26 years with no sex
predilection for occurrence
It is often associated with an impacted tooth;however, extraosseous cases can occur. Pain,
swelling, and mucosal perforation have been reported.
Site
it is predominately seen in mandible. especially in molar area and frequently is associatedwith an impacted tooth.
The tumor is located, usually in intraosseous structures, although there are reports that say
they have found in the soft tissues. Causes increased bone volume expansion. May or may
not be pain.
Symptomes
patient notices a swelling over a variable period of time with pain.
Sign
perforation of mucosa and subsequent infection may be present. There may be redness of
overlying mucosa with discharge.
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Radiographic featuresThe radiographic picture may be extremely variable. It may
appear as a radiolucency, a radiolucency with small radiopaqueflecks, or a solitary radiopaque mass.
Internal structure
the lesion offers a radiolucency, specific limits,withinwhich are irregular radiopaque mass that may vary in size andextension.
it contain either a large, solitary, opaque mass or numerous smallerirregular radiopaque masses of calcified material which may varyconsiderably in size
Bone
It may cause local destruction of bone.
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Histopathological featuresThe connective tissue stroma resembles dental papilla. Masses
of irregular Dentin(whichhas been termed as dentinoid or
osteodentine) with demonstrable dentinal tubules are present.
Undifferentiated odontogenic epitheliumis present and
enamel is absent. If enamel were present the lesion would be
called a complex composite odontoma.
Dentinoma. Histological section showing
a tumor composed mostlyof dentin dysplasia
,poorly calcified.
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Pathology
Microscopically, the dentinoma mayresemble ameloblastic fibroma.Epithelial tissue that composesit often takes the form of fine strands, consisting of roundor cuboidal cells are arranged in one or two layers. The
connective tissue resembles that of the dental papilla by thetype and degree of cellularity.
Among the connective tissue andodontogenic epithelium shows a poorly
organized dentin deposition which gives sometimes anaspect of osteodentin or interglobular dentin. Somecells, like odontoblasts-often present around the isletsof dentine. In the dentin frequentlypoorly mineralized mesenchymal cells can be seen inside.
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managementSurgical incision with through curettage of area and
enucleation .
A careful excision with removal of all tumor
formation, is sufficient for control. It should
be detailed in the eventual removal of fibrouscapsule, since at the expense of it, when
left remains, recurrence occurs, although this is unusual.