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Hard tissue lesions - Coggle Diagram
Hard tissue lesions
Neoplasms
Ameloblastoma
Etiology: Arise from epithelial or mesenchymal remnants of tooth forming tissues. They may also be formed from the epithelial lining of an odontogenic cyst.
Characteristics: slow growing, locally Invasive and aggressive. Soap bubble radiographic appearance and well-defined scalloped margins are characteristic features.
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Dental implications: it can break through the cranial cavity by expansion, making it life-threatening. When discovered in the maxilla, they can result in death due to direct extension into vital structures. The lesions also become more difficult to manage when they spread through the bone into the soft tissues.
Treatment and prognosis: excision is the course of action. The tumor requires wide excision with clear margins to lessen the chance of recurrence. Careful radiographic follow up as necessary to ensure early detection of any recurrence. Good prognosis one timely treatment is rendered, but ameloblastoma’s may recur, and untreated ameloblastoma can result in death.
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Ossifying fibroma
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Characteristics: radiographic lesions appear as well defined, unilocular, radio Lucent with radiopaque calcifications. Diverging roots may be evidence, or the lesion may appear dents or calcified. Large ossifying fibroma’s may cause swelling and facial asymmetry. Most often slow growing, painless, and expansile.
Dental implications the lesion is removed, and a complete diagnosis is made after the specimen is viewed microscopically.
Treatment and prognosis: surgically removed. It is rare to have a recurrence, and they do not become malignant. Excellent prognosis.
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Osteosarcoma
Etiology: it is a malignancy of mesenchymal cells that produce astroid or immature bone.Have been found and painters who at one time painted radium watch dials and wetted their brushes with saliva.
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Characteristics: symmetrical widening of the PDL of one or several teeth often seen. Typical sunburst and spiking sane radiographically. Pain and swelling.
Dental implications: tooth liability, swelling, pain. The patient may complain of nasal obstruction and paresthesia. The growth can affect the trigeminal nerve. Fractures may be observed as well. Early radiographic evidence may be a widening of the PDL space.
Treatment and prognosis: chemotherapy and surgical removal of the affected bone are the treatments of choice, with negative margins of attained around the periphery of the specimen. Poor rates of survival are correlated with the inability to obtain clear or negative margins during surgery. Survival varies, and reports are approximately 20% for five years, depending upon the extent of the lesion at the time of treatment.
Chondrosarcoma
Etiology: some evidence of a genetic predisposition. Post radiation chondrosarcoma has been seen an individuals receiving more than 7000 rad dosages during radiation treatment
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Characteristics: the most common oral site is the maxilla followed by the mandible. Maxillary involvement manifest as a painless swelling of the affected bone, with possible alteration of the overlying mucosa. The patient may complain of headache, nasal problems, vision problems, and separation and/or loosening of the teeth.
Dental implications: may cause teeth to become mobile. Monitor the patient periodically for signs of recurrence is crucial.
Treatment and prognosis: white surgical excision is the treatment of choice. MRI scans are the most reliable tour in diagnosing the extent of the lesion. These tumors are radioresistant so radiation therapy is not a treatment option. The five-year survival rate for patients with high-grade tumor’s is 15%. But the outlook for patients with low-grade tumor’s is more favorable. If the turmeric hers, it is usually found 5 to 10 years post surgery.
Ewing sarcoma
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Characteristics: unusually large mass or swelling usually present. Intraorally the lesions usually involve pain, swelling, numbness, and often tooth mobility. One may also encounter a soft tissue mass in the affected area. The ramus of the mandible is the most common intraoral location for this timer. Destruction of alveolar bone and alteration of the overlying in gingiva. Growing tumor may cause facial asymmetry. The lesion appears radio graphically as a moth eaten radiolucency or as an infection in the bone.
Dental implications: any hard tissue grows should be evaluated and diagnosed her biopsy and additional warranted tests.
Treatment and prognosis: surgery, radiation, and chemotherapy are the standard treatment. Survival rate of 60 to 80%. Survival rate has continued to improve. The most common site for meta-stasis are the lungs and bones
Variations of normal
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Exostosis
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Characteristics: the growths tend to occur along the facial aspect of the maxilla and mandible. Manifest as lobulated, uneven solid bony growth. The posterior region is affected most often. Appear as a normal color unless the area has been traumatized
Dental implications: it is important to determine if there are any direct causes associated with the development of the excess bone, such as bruxism. Growths may need to be removed adventures were other dental appliances are required.
Treatment and prognosis: no treatment recommended unless the growth interferes with dentures or there is continuous injury to the site producing chronic inflammation. It usually presents no problems and is left alone unless the area becomes highly irritated or other disease states are suspected.
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Citations:
General and Oral Pathology for the Dental Hygienist, Chapter 17