Radiolucent Lesions Chapter 19

Traumatic or Inflammatory Lesions

Periapical Granuloma
Etiology-result of a necrotic pulp tissue
Method of transmission- not applicable
Characteristics-accumulation of granulated tissue that is focus at the apical area of a nonvital tooth. cannot be distinguished from radicular cyst
Implications-vitality testing is crucial as this tooth is nonvital.
treatment- endo or extraction is treatment of choice.
prognosis-good if removed.

Aneurysmal Bone Cyst
Etiology- considered a pseudocyst becasue it appears like a cyst but does not have epithelial lined lumen. lesion is benign and is blood filled
Method of transmission- not applicable
Characteristics-extraoral swelling with or without pain, "soap bubble" appearance, thinning and expansion of the cortical bone may be seen.
Implications-may cause the teeth to be displaced or loose.
treatment- excision and curettage are treatment of choice. Prognosis*-good

Traumatic Bone Cyst
Etiology-not a true cyst because it is not epithelial lined.
Method of transmission- not applicable
Characteristics-may cause extra oral swelling, pain not likely, root resorption, loss of lamina dura, cortical expansion, and cortical thinning is reported. often seen as scalloping between the teeth.
Implications-may continue to expand and increase in size when not detected early.
Treatment- involves opening the cyst. Once the blood cavity is emptied the bone will repair itself over time.
Prognosis- good

Periapical Cementoosseus Dysplasia
Etiology- unknown
method of Transmission- not applicable
Characteristics-occurs at the apex of VITAL teeth with a propensity for the anterior mandibular teeth, asyptomatic
Implications- this occurs in a vital tooth so if not tested properly end will be completed when not needed.
treatment-no treatment and surgery is not required.
Prognosis- great

Radicular Cysts (Apical periodontal cyst, Periapical cysts)
Etiology- associated with nonvital tooth and the common cause is caries, trauma such as fracture or injury to the tooth.
Method of Transmission- not applicable
Characteristics-found in any region of the mandible and maxilla but generally favors the maxillary anterior region at the apex of a non-vital tooth. a radiograph may show signs of root resorption.
Implications-failure to remove the radicular cyst completely results in recurrence
Treatment-removal by extraction, surgery with curettage, and root canal therapy

Infections

Osteomyelitis: Acute and Chronic
Etiology- osteomyelitis is a general term referring to inflammation in the bone. A periapical abscess is most often the cause of the acute form.
Method of transmission- staphylococci and streptococci are the bacteria most commonly involved.
Characteristics- lymphadenopathy, fever, and pain. evidence of necrotic bone are seen in chronic.
Implication-may have pain and lymphadenopathy and pain.
treatment-drainage and antibiotics re needed to treat for acute. Chronic is more difficult to manage because of necrosis. Surgery is indicated for chronic.
Prognosis-good

Developmental Cysts

Lateral Periodontal Cysts
Etiology- odontogenic, nonkeratinized developmental cysts believed to develop from the dental lamina remnants from within the bone
Method of transmission-not applicable
Characteristics-asymptomatic in most cases and is not usually noticed until seen on a radiograph. Unilocular is round or oval and is well delineated. Tooth is vital
Implications-should be identified as a lateral periodontal cyst
Treatment- surgical excision and pathologic review are treatments of choice. Vitality testing is important
Prognosis-excellent

Dentigerous Cyst
Etiology- arise from cystic changes in the dental follicle following the crown formation
Method of Transmission- not applicable
Characteristics- usually only evident of radiographs, with no symptoms of pain or discomfort reported. Well circumscribed, unilocular, and sometimes multilocular. completely radiolucent
Implications- delayed tooth eruption is a common theme.
Treatment- complete removal of the cysts is indicated since the recurrence is high.
Prognosis- excellent

Eruption Cyst
Etiology- sometimes called an eruption hematoma. caused by the accumulation of fluid or blood between the crown of an erupting tooth.
Method of transmission- not applicable
Characteristics-tissue may have a darker appearance and appear elevated. Smooth bluish swelling (dome-like) on the crest of the alveolar ridge.
Implications-failure of tooth eruption
Treatment-no treatment is necessary but for quicker eruption removal of overlying tissue.
prognosis-good.

Odontogenic Keratocyst (OKC)
Etiology- develops from the lamina dura or its remnants.
Method of transmission- snot applicable
Characteristics- occurs most often in the posterior of mandibular regions and can occupy most of the ramus in some cases. the cyst may become large enough to displace teeth. Has very aggressive features.
Implications-microscopic interpretation is unique once a specimen is submitted.
Treatment-careful removal of the entire cyst is crucial and the capsule must be removed intact to that daughter cell do not remain.
Prognosis- recurrence is high

Calcifying Odontogenic Cysts (Gorlin Cyst)
Etiology-believed to be derived from the reduced enamel epithelium.
Method of Transmission- not applicable
Characteristics- may be found as masses within the tissue, almost always within the gingiva. When they occur they may resemble a gingival cyst or a peripheral giant cell granuloma.The appearance of ghost cells when viewed microscopically.
Implications- definitive diagnosis is important to rule out aggressive lesions.
Treatment- surgical excision
Prognosis- good

Globulomaxillary Cyst
Etiology- represents a fissural cysts that arose from the epithelium that was thought to be trapped when the globular portion of the median nasal process fused with the maxillary process.
Method of Transmission-no applicable
Characteristics- may be inverted pear shaped lesion because of its location; Circumscribed and radiolucent; found between the maxillary lateral incisor and canine.
Implications-vitality of the lateral and cuspid must be evaluated.
Treatment-surgical removal is the treatment of choice.
Prognosis-recurrence is rare.

Glandular Odontogenic Cyst
Etiology- it is a locally aggressive odontogenic cysts.
Method of Transmission- not applicable
Characteristics-swelling and expansion are noted; pain/discomfort, infection and paresthesia.
Implications- follow up in important since recurrance is very high.
Treatment-most are treated conservatively with enucleation, curettage, cystectomy, and excision.
Prognosis- recurrence rate of 50%

Nasopalatine Duct Cyst
Etiology- arises from epithelial remnants of the embryologic structure of the nasopalatine ducts.
Method of transmission- not applicable
Charcteristics-pt may complain of pain, tenderness, and swelling and drainage may be noted in the maxillary incisor region.
Implications- not radiographically diagnostic and must be removed and biopsied.
Treatment- completed surgical removal is needed.
Prognosis- good and the recurrence rate is low with complete removal.

Static Bone Cyst
Etiology- not a true cyst; it is a defect in the mandible that surrounds salivary gland tissue.
Method of transmission- not applicable
Characteristics-asymptomatic and is usually discovered on a PAN. results from lingual mandibular critical bone erosion
Implications- usually diagnosed clinically by radiographs; when the location is superior to the mandibular canal a biopsy may be needed.
Treatment-noted in patients chart and followed long term.
Prognosis- good

Neoplasms

Source
DeLong, L., & Burkhart, N. W. (2019). General and oral pathology for the dental hygienist (3rd ed.). Philadelphia: Wolters Kluwer. pg 462-488

Adenomatoid Odontogenic Tumor
etiology- encapsulated benign epithelial odontogentic tumor.
Method of Transmission-not applicable
Characteristics-as the tumor expands and increases in size there may root displacement, swelling in the facial area.
Implications-facial symmetry is one of the first signs to be noticed
Treatment-complete removal
Prognosis-Excellent

Odontogenic Myxoma
etiology- derived from odontogenic ectomesenchyme
method of transmission- not applicable
Characteristics- swelling may occur in isolated areas, may be unilocular or multi and may have scalloped appearance
Implications- enlarged dental follicles of developing tooth may be mistaken for myxomas upon microscopic exam.
Treatment- surgically removed
Prognosis- recurrence rate is high

Ameloblastic Fibroma
Etiology-odontogenic ectomesenchyme and odontogenic epithelium
Method of transmission- not applicable
Characteristics-no pain with any swelling. has the potential for extensive growth; well defined and usually associated with unerupted teeth
Implications-asymptomatic
Treatment- conservative excision
prognosis- recurrence is seen in approx 20% of cases

Langerhans Cell Disease
Etiology-unknown
Method of transmission- not applicable
Characteristics-poor healing is common, lymphadenpathy may be present, cranial bones may b e involved, may involve rashes and erythmatic lesions. Premature loosening and exfoliation of primary teeth
Implications-tooth vitality is still present
treatment-conservative surgical treatment
Prognosis-more favorable when the disease states develop in older young children.