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Radiolucent Lesions, Source of information - Coggle Diagram
Radiolucent Lesions
Periapical Granuloma PG
Periapical granuloma or dental granuloma (also called apical periodontitis) is the result of necrotic pulp tissue and by-products resulting from an inflammatory process that has damage the tissue at the apex of the tooth. Simpler term, caused by caries, trauma, or necrotic pulp tissue
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Any age group may be affected by a periapical granuloma, and there is equal gender distribution.
Intraoral: The periapical granuloma is the accumulation of granulation tissue that is focused at the apical area of a nonvital tooth. The tooth may be asymptomatic, but in most cases, complaints such as sensitivity or pain do exist until the tooth becomes completely nonvital. The tooth will test nonvital un most cases, depending upon the degree of damage to the pulp.
Dental implications: Vitality testing is crucial, since the tooth will test nonvital when obvious radiographic evidence is apparent. If the tooth nonvital, endodontic treatment is needed. The differentiation of the periapical granuloma and the radicular cyst can only be diagnosed or confirmed by histological examination.
Treatment and prognosis: Extraction of the nonvital tooth or endodontic treatment is usual procedure for granulomas. Apical curettage and apicoectomy may be performed. Antibiotic coverage may be needed to get the infection under control. The prognosis is good if all the granuloma is removed.
Aneurysmal Bone Cyst ABC
ABC is a A pseudo cyst. Benign, blood-filled expansile. Trauma or possible genetic etiology
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Peak age for aneurysmal bone cyst is in the second decade of life. Slight female propensity. Accounts for 1.5% of all nonodontogenic tumors. May be associated with hematomas as a causal agent.
Extraoral: Extraoral swelling is reported in extensive lesions. Intraoral: The patient usually notices swelling with or without pain. The radiographic features of an ABC include a unilocular or multilocular lesion, described as having a soap bubble appearance.
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Treatment and prognosis: Excision and curettage are treatment of choice. When the lesion is removed completely the prognosis is good. Cryotherapy, sclerotherapy, and radionuclide ablation, and en bloc resection may be used in certain cases.
Traumatic Bone Cyst TBC
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TBC may occur in any bone such as femur and humerus. The TBC is usually found in 10-20- year old age group. The most common site for a TBC s in the mandible. The TBC was originally though to be hematoma, probably induced by trauma which does not heal and subsequently liquifies and become a cyst.
Extraoral:TBC may cause extraoral swelling if the lesion is large enough or has existed long enough. Intraoral: Increased swelling in the mouth may be observed, but pain is not usually a factor. The lesions are discovered on a radiograph, with the patient reporting no pain or other symptoms. The radiograph appearance is that of a scalloped cyst with well-delineated radiolucent characteristic. Margins may be very sharp in area and in other ill defined.
Dental implications: The TBC may be continue to expand and increase in size when not detected in the early stages. the lesion must be drained to begin healing.
Treatment and prognosis: The usual treatment involves opening the cyst. Once the blood cavity is emptied, the bone will repair itself over time. The recurrence rates ranges from 12-48%
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Dentigerous Cyst DC
DC are developmental—more common in the mandible. Unerupted, undeveloped tooth.
These cyst arise from the cell rests of the dental lamina. The dentigerous cyst is the second most commonly occurring odontogenic cyst following the most common radicular cyst. However , dentigerous cyst are the most common occurring developmental cyst of the jaw, They are also know as follicular cyst and are found around the crown of unerupted third molars, canines and unerupted teeth.
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Intraoral: The DC is usually only evident on radiographs; with no symptoms of pain or discomfort reported. They are seen as well circumscribed, unilocular, and sometimes multilocular .
Dental implications: Delayed tooth eruption is a common theme. The DC can become quite large and has the potential to displace teeth and resorb roots. Dentigerous cysts continue to grow and expand; therefore early diagnosis is imperative
Treatment and prognosis: Complete removal of the cyst is indicated, since recurrence is high when not fully accomplished. Prognosis is excellent but the patient should be followed closely.
Eruption Cyst
Eruption cyst is Caused by the accumulation of fluid between the crown and the reduced enamel organ.
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The eruption cyst is not gender specific. Most occur in deciduous teeth and permanent molars of children. The eruption is usually painless and is found around unerupted tooth.
Intraoral: The tissue of the eruption cyst may have a darker appearance and appear elevated. The eruption cyst is often seen as a smooth bluish swelling (drome like ) on the crest of the alveolar ridge.
Dental implications: The only dental implication is that failure of the tooth to erupt; therefore the cyst may be opened to hasten the event. Most eruption cyst are left to dissipate on their own.
Treatment and prognosis: No treatment is necessary; however, on occasion, removal of the overlying tissue could facilitate a quicker eruption. The tooth eventually erupts through the tissue, and the cyst disappears
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Static Bone Cyst SBC
Not a true cyst, pseudo cyst. Bone defect in the mandible that surrounds the salivary gland tissue.
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It is believed to be entrapment of the salivary gland tissue; the cyst is not epithelial lined. Seen in adults but may be present at birth.
Intraoral: The static bone is asymptomatic and is usually discovered when a Panorex film taken. . If the lesion is above the mandibular canal, a biopsy should be taken and other cysts that are found in this region must be considered.
The SBC is usually diagnosed clinically by using radiographs; however, when the location is superior to the mandibular canal, canal, a biopsy may be needed to rule out pathology.
Treatment and prognosis: The SBC is noted and followed long term, and if any changes occur, they are noted in the patient's record.
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Odontogenic Myxoma OM
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Swelling may occur. 10- to 30-year-old age group. Equal in males and females, rare in those over 50 years of age. Equal in males and females. Although benign, they exhibit rapid growth.
Extraoral: Depending on the size of the myxoma, swelling may occur in isolated areas. The histological characteristics are pulp-like material. The material is highly gelatinous making removal difficult. Tumor can become large causing tooth displacement.
Radiographically, the tumors can be unilocular or multilocular, and radiolucencies have a scalloped appearance.
Dental implications: Enlarged dental follicle or the dental papilla of a developing tooth may be mistaken for the myxomas upon microscopic examination. They can be confused with other myxoid jar neoplasms. Tumor can be so large that is causes tooth displacement.
It is removed surgically, usually with a wide margin of normal bone. The highly gelatinous material makes removal difficult with curettage, and recurrence rate is as high as 25% because tumor is none capsulated. Fragments are difficult to remove.
Ameloblastic Fibromas AF
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Usually under 20 years of age in unerupted teeth. Rare, benign tumor, usually under the age of 20 but can occur in third or fourth decades as well. The cells are tall columnar with islands of odontogenic epithelium set in an immature matrix resembling the dental papilla or developing dental pulp. No gender predilection.
Extraoral: some external swelling may be present. Intraoral: The patient usually experiences no pain with swelling that may occur. Radiographically the lesion may be multilocular or unilocular. It is normal well defined and usually associated with unerupted tooth
Dental implications: Generally, the ameloblastic fibroma is asymptomatic.
Treatment and prognosis.: Conservative excision is the treatment of choice. Recurrence is approximately 20% of cases. Some recur as ameloblastic fibrosarcoma, which have been reported in previous benign pf OF
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Radicular Cyst (Apical Periodontal Cyst, Periapical Cyst)
The radicular cyst is always associated with the root of a nonvital tooth, and the common causes are caries, trauma such as fracture or injury to the tooth, or periodontal disease.
The radicular cyst is the most commonly occurring inflammatory cyst of the jaws, with most reported in the maxillary region. Radicular cysts most often are discovered during routine dental examination of radiographs. Radicular cyst are mostly found in adults. Developmental cyst found mostly in children. Radicular cyst are derived from rests of Malassez, found in the developing tooth structure of the periodontal ligament.
Intraoral: The radicular cyst may be found in any region of the mandible and maxilla, but it generally favors the maxillary region at the apex of a nonvital tooth. The patient may experience no pain and is usually not aware of the cyst
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Treatment and prognosis: Treatment usually involves several options: removal by extraction, surgery with curettage, and root canal therapy. Treatment may also include surgery and apicectomy. Antibiotic coverage may be needed to get the infection under control. the prognosis is good with complete removal.
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Source of information
Delong, L. & Burkhart, N. (2019). General and Oral Pathology for the Dental Hygienist, Third Edition. Philadelphia: Wolters Kluwer.