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Radiolucent Lesions, Burkhart, N., Delong, L. (2020). Radiolucent Lesions.…
Radiolucent Lesions
Developmental Cysts
Lateral Periodontal Cyst
Characteristics: Not usually noticed until seen radiographically. Is usually unilocular, round or ovoid, and as well delineated.
Dental implications: should be identified as lateral periodontal cyst since it is necessary to rule out any more serious types of cysts or tumors.
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Treatment/prognosis: search for excision and pathologic reviewer treatment of choice. Vitality testing is important to avoid unnecessary endodontic treatment. Radiographic follow-up is needed periodically. Prognosis is excellent.
Etiology: Non-keratinized developmental cysts believed to develop from dental lamina remnants from within bone.
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Primordial Cyst
An older term that was sometimes used in conjunction with the odontogenic keratocyst. Since the odontogenic her to cyst is diagnosed in most cases, the term is no longer used.
Median palatine Cyst
Located in the same vicinity as the nasopalatine cyst but is more ethically center toward the midline of the hard palate. Lined by stratified squamous epithelium and surrounded by dense connective tissue. Classified as a rare fish roll cyst and is believed to develop from and entrapped epithelium along the embryonic line of fusion and the two lateral maxillary processes the fuse to make the hard palate. Patient may complain of pain and expansion of the pallet when the system pinches the nasopalatine nerve.
Dentigerous Cyst
Characteristics: usually only evident on radiographs with no symptoms of pain or discomfort reported. Radiographically looks well circumscribed, unilocular, and sometimes it multilocular
Dental implications: delayed tooth eruption is a common theme. Assist can become quite large and potentially displays teeth and resort roots. Early diagnosis is imperative.
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Treatment/prognosis: complete removal of the cyst is indicated, since the recurrence is high when this is not fully accomplished.
Etiology: arise from a cystic change in the dental follicle following crown formation on the follicle separates from the crown of the tooth.
Eruption Cyst
Characteristics: tissue may have a darker parents and appear elevated. Peers as a smooth bluish swelling on the crest of the alveolar ridge. Radiographically looks like a large follicular space.
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Treatment/prognosis: no treatment as necessary. Removal of the overlying tissue could facilitate a quick eruption, however.
Etiology: called about the accumulation of fluid or blood between the crown of interrupting tooth and the reduced enamel organ due to trauma.
Odontogenic Keratocyst
Characteristics: Occur most often in the posterior manipular region and can occupy most of the Ramis in some cases. In late stages, the cyst may become large enough to displace teeth and extend through the cancellous bone into the oral cavity. Pretty graphically, the lesions can be multilocular Oregon law killer, well circumscribed, and radiolucent with a scalped appearance.
Dental implications: microscopic interpretation is unique once a specimen is submitted. The association with nevoid BCC syndrome is especially important in a diagnosis, and assist have very aggressive behavior. Therefore, prompt treatment is required. multiple OKCs should alert the practitioner to the possibility of nevoid basal cell carcinoma.
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Treatment/prognosis: recurrence can be high. Careful removal of the entire cyst is crucial, and a capsule must be removed in tact so that daughter cells do not remain. Decompression allows assist to shrink for definitive surgical removal. Thinwall is often difficult to separate from bone and remove in one piece which allows daughter cells to remain.
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Static Bone Cyst
Characteristics: asymptomatic usually discovered in a Panorex. Radio graphically, is seen as a radiolucency in the posterior mandible below the mandibular canal. Is sharply circumscribed, oval, radiolucent lesion with a sclerotic border.
Dental implications: usually diagnosed clinically by using radiographs however when the location is appears in the mandibular Kanell a biopsy may be needed to rule out pathology.
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Treatment/prognosis: the cyst is noted and followed long-term, if any changes occur, they are noted in the patient’s record. Other cysts should be considered if cyst occurs above the mandibular canal.
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Nasopalantine Duct Cyst
Characteristics: swelling in elevation of external services around nose and lips may occur. Patient may complain of pain, tenderness, or swelling. Drainage may be noted in the maxillary incisors region. Radio graphically, it’s in between the maxillary central incisors.
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Treatment/prognosis: complete surgical removal as needed. Prognosis is good with a low recurrence rate after complete removal.
Globulomaxillary Cyst
Characteristics: the location and the pear-shaped configuration of the globulomaxillary cyst give it a classic type of presentation. However, biopsy is necessary.
Dental implications: the vitality of the teeth involved, such as the lateral and cuspid, must be evaluated. Endodontic therapy should be administered when necessary.
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Treatment/Prognosis: surgical removal of the tree of choice and prognosis is good depending upon the type of cyst. Occurrence is rare. Any resemblance to the OKC should be evaluated frequently because of the higher recurrence rate. Treatment depends upon the microscopic evaluation.
Etiology: It is thought that the majority represent multiple types of cysts such as a periapical or lateral periodontal cyst, laterally Placed radicular cysts, central giant cell tumor’s, examiners, and OKC as well as others.
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Neoplasms
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Odontogenic Myoxma
Characteristics: radiographically tumors can be unilocular or multilocular, and the radiolucencies may have a scalloped appearance. Also have been described as having a “step-ladder“ or “honey-combed“ appearance.
Dental implications: enlarged dental follicles or the dental papilla of a developing tooth may be mistaken for the myxomas upon microscopic examination. Tooth displacement may occur.
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Treatment/prognosis: surgical removal 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 not encapsulated.
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Ameloblastic Fibroma
Characteristics: patient usually experiences no pain with any swelling that may occur. Has potential for extensive growth causing John expansion. Radiographically the lesion can be unilocular or multilocular. Normally well defined and usually associated with an uneruptured tooth
Dental implications: generally, the ameloblastic fibroma is asymptomatic.
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Treatment/prognosis: conservative excision is the treatment of choice. Recurrence is in approximately 20% of cases. Some recur as ameloblastic fibrosarcomas.
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Langerhans Cell Disease
Characteristics: poor healing is common. Dermatologic conditions may be evident, and all bones of the body may be affected. Lymphadenopathy may be present. Radio graphically, the bone lesions resemble a “pinched-out” appearance with sharply demarcated lesions.
Dental implications: lesions that occur periapically can be confused with periapical cysts or granulomas. Tooth vitality would still be present.
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Treatment/prognosis: treatment depends on involvement of the disease and the age of the patient. Conservative surgical treatment is sometimes the only treatment. Chemotherapy may be needed in case of more extensive disease involvement. Additionally bone marrow transportation may be done. The more widespread the disease, the poor the prognosis.
Etiology: unknown. In some cases a neoplastic transformation is believed responsible for this disease. And immune response has also been implicated.
Infections
Osteomyelitis
Characteristics: Lymphadenopathy, fever, and pain or often symptoms of osteomyelitis especially in the acute form. Radiographically, the chronic form shows more evidence necrotic bone and diffuse radiolucent lesions that appear modeled with a sclerotic appearance.
Dental implications: addressing the cause is paramount. Correct antibiotic is needed to treat infection therefore identification of specific organism through laboratory tests is crucial.
Etiology: periapical abscess is most often the cause of the acute form. Fractures, trauma, and surgery including extractions, can also allow bacteria to enter the bone.
Treatment/prognosis: drainage and antibiotics are needed to treat the acute form. The chronic form is more difficult because of necrosis surgery is indicated with antibiotic coverage.
MoT: The acute form of osteomyelitis may have several infectious organisms involved in the disease process.
Burkhart, N., Delong, L. (2020). Radiolucent Lesions. In GENERAL AND ORAL PATHOLOGY FOR THE DENTAL HYGIENIST {462-488}. S.I.: JONES & BARTLETT LEARNING