Dysplastic diseases

Nam Age Site Effect Radiographic Different Treatmen Notes

e on features ial t
surroun diagnosi
ding s
tissue
Mono More than Posterio -Expansion Ill defined well - Hyperpara- -Most lesions, - Accounts for
stotic polystotic r and thinnig corticatd with thyroidism 70% of all
type maxilla of the outer variable internal (bilateral, no growth is cases.
FD* complete at
cortex. structure expansion).
(radiolucent, skeletal - Most common
-Expand radiopaque, or - Paget's maturation; sites (in order)
into the mixed), it has the disease therefore are the ribs,
antrum. characterestic of (older age). femur, tibia,
orthodontic maxilla, and
ground-glass
-Displace - periapical treatment mandible.
(extraoral), orange
teeth of cemental and cosmetic -Affect one
peel (intraoral), or
affect their dysplasia surgery may bone.
cotton wool.
eruption. (bilateral, be delayed
older age). until this -No skull
-Root time. involvment.
resorption
is rare.

-Displace
the ID canal
superiorly.

Poly Children Posterio -Expansion Ill defined well - Hyperpara- -Most lesions, - Accounts for
stotic less r and thinnig corticatd with thyroidism 30% of all
maxilla of the outer variable internal (bilateral, no growth is cases.
FD* than 10 complete at
cortex. structure expansion).
years. (radiolucent, skeletal -↑ Cutaneous
-Expand radiopaque, or - Paget's maturation; pigmentation
into the mixed), it has the disease therefore (cafe au lait
antrum. characterestic of (older age). spots)
orthodontic
ground-glass
-Displace - periapical treatment -Affect multiple
(extraoral), orange
teeth of cemental and cosmetic bones.
peel (intraoral), or
affect their dysplasia surgery may
cotton wool. -There is skull
eruption. (bilateral, be delayed
older age until this involvment.
-Root time.
resorption
is rare.
 -Displace
the ID canal
superiorly.

Periap Middle -More in -Lamina Well defined round -Early lesion if the teeth -The same as
ical age anterior dura of the or oval shape may mimic FD but with
have been
mandibl teeth centered over the periapical cementum
CD Average removed and if
e involves are apex of the tooth. rarifying replacing the
considerable
39 yrs lost. Internatly it varies ostitis normal bone.
(PCD) atrophy of the
-Almost and depend on the (clinical,vital
Black always -Root -The involved
maturity of the ity) alveolar ridge
Females at the resorption has occurred, teeth are vital.
structure:
9:1 apex of and -Mixed: these
the root. hyperceme Early: radiolucent. cementoblas segments of -Multiple and
ntosis are toma and cementum bilateral.
rare. Then: mixed with odontoma
radiopaque tissue may reach the
(resorption) mucosal
-Large composed of
surface and
lesion cementum -Mature:
perforate the
causes (cementicles). dense bone mucosa
expansion. island (no
Mature: radiopaque rediolucent when
-May with radiolucent periphery). positioned
elevate the margin under a
floor of the denture
maxillary removed
antrum. surgicaly.

Florid Average Bilateral -Displace Well defined with -Paget’s -FOD doesn’t -The lesion has
CD 42 yrs and the ID canal sclerotic borders, disease require a
present inferiorly internally varies (involve all treatment
Black and the according to the the poor vascular
(FCD) Female in both maxillary maturity, from mandible -Because of supply, a
s jaws. antrum radiolucet, mixed, including the condition that
Howeve superiorly. and rediopaque in below the ID likely
r, when propensity to contributes
late stages. It’s canal,
they are -Enlarge develop
similar to PCD. polystotic
the alveolar secondary to its
(involves
present bone by infections in susceptibility to
other
in only displaceme FaD, the infection.
bones)).
one jaw, nt of the patient
the should be -it’s a PCD that
buccal and -Chronic
mandibl encouraged affect two or
lingual
e is the sclerosing to maintain more
cortical
more osteomyeliti an effective quadrents of
bones.
s (CT is used oral hygiene the mouth, not
commo -Causes for the program to a couple of
n hyperceme differentiatio avoid teeth.
location. ntoosis to n). odontogenic
-Teeth in the
the
 involved infections. involved bone
teeth.
are vital unless
other dental
disease
coincidentally

affects them.

Paget over 40 Occurs - Has 3 stages: -FD (younger Currently -Abnormal

yrs most Enlargment age,unilater Paget's resorption (by
often in of affected 1) Early radiolucent al) disease osteoclasts)
Males the bone. resorptive stage. usually is
pelvis, -FOD (above managed and apposition
-Swollen 2) Granular or the ID (by
femur, medically,
skull. ground-glass- canal). osteoblasts) of
skull, using either
appearing second osseous tissue
and calcitonin or
- stage. -Metabolic in one or more
vertebra sodium
Hyperceme- bone bones.
e and 3) denser, more etidronate.
ntosis may disease
infreque radiopaque Calcitonin
appear (don’t cause -Elevated
ntly in appositional late relieves pain
(exuberant enlargment). levels of serum
the jaws stage. and reduces
and alkaline
(more in **The the serum
irregular). phosphatase.
the Cotton wool 1)specific alkaline
maxilla) -Teeth may appearance is bone pattern -Common in UK
. specific for paget. changes, the phosphatase
become and australia.
2)late age of levels and
spaced or
**These stages are onset, the osteoclastic
displaced
less apparent in the 3)enlargemen activity.
jaws. t of the Sodium
in the
involved
enlarging
bone, and the etidronate
jaw.
covers bone
Always when we 4)extreme
-External surfaces and
suspect paget’s elevation of
root serum
retards bone
disease, we have to
resorption alkaline
take askull resorption
may occur. phosphatase
radiograph to see if aid in the and
there is any differential formation.
anterior and diagnosis. Surgery may
posterior be required
demineralization.
to correct
deformities of
the long
bones and
treat
fractures.

Cherubi 2-6 yrs Affect -Expansion Well defined and -CGCG After skeletal -Inherited
sm the of the jaws. sometimes (unilateral). growth has developmental
posterio corticated, the stopped, abnormality
(Familial r aspect -Anterior internal structure -FD conservative
both displaceme resembles that of (unilateral). that causes
fibrous
jaws but nt of the Centrat Giant Cell surgical bilateral
dysplasia -The
the teeth. Granuoloma procedures, if enlargement of
) 1)bilateral
mandibl (CGCG) with fine, required, the jaws.
-Can may be done
e is granular bone and symmetry of
enlarge into for cosmetic -Regress with
more wispy trabeculae cherubism,
the problems. age.
commo forming a along with
maxillary Surgery also
n prominent the -The most
sinus. may be
affected multilocular 2)anterior common
. pattern. required to
displacemen presenting sign
t uncover is a painless,
displaced firm, bilateral
of teeth and enlargement of
teeth, and
3)pronounce the lower face.
orthodontic
d
treatment
multilocular -"eyes raised
may be to heaven"
appearance, appearance.
needed.
help with the
differential
diagnosis.

*FD: fibrous dysplasia: Results from a localized change in normal bone metabolism
that leads to the replacement of all the components of cancellous bone by fibrous tissue
containing varying amounts of abnormal-appearing bone. No sexual predilection except for
McCune-Albright syndrome, which affects females almost exclusively. More commonly are
unilateral. Patients with jaw involvement first may complain of unilateral facial swelling or an
enlarging deformity of the alveolar process. Pain and pathologic fractures are rare. If
extensive craniofacicl lesions have impinged on nerve foramina, neurologic symptoms such
as anosmia (loss of the sense of smell), deafness, or blindness may develop.

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A, Unilateral fibrous dysplasia involving

the left maxilla and mandible. B, Note the
expansion of the lateral aspect of the
maxilla and mandible (arrow) and the
increased bone density caused by an
increase in the number of internal
 A series of films showing
a variety of internal patterns
of fibrous dysplasia.
A, A fingerprint pattern
around the roots of the first
molar (arrow). Note the
change in the lamina dura
around the molars into the
abnormal bone pattern.
B, A granular or groundglass
pattern (arrow).
C, A cotton wool pattern.
Note the almost circular
radiopaque regions
(arrows).
D, An orange-peel pattern.

------------------------

PCD: radiolucent stage.

The lamina dura around the
central incisor has been lost
in A, but the periodontal
membrane space can still be
seen in B.

Example of PCD in the

maxilla.
A, Mixed lesion.
B, Mature lesion.
A and B, Portions of
panoramic views of the
same patient taken 3 years
apart. Note the development
of a solitary lesion of PCO in
the apical region of the first
molar extraction site.
C and D, Solitary lesions in
the posterior mandible.
FOD.
A, Three mixed radiopaque-
radiolucent lesions in the
periapical regions
throughout the jaws
(arrows); note that although
the right third molar is
horizontally
impacted, the lesion still
has a periapical
relationship.
B, A composite of periapical
films of the same case.
Note the appearance of the
lesions involving the
mandibular incisors
(Not apparent in the
panoramic film), which
appear identical to
periapical cemental
dysplasia.
C, An occlusal film of the
left mandibular lesion
showing expansion of the
medial cortical plate
(arrow).
D, A panoramic film of a
different case showing
 A case of cherubism.
A, A panoramic image showing four lesions
in the
maxilla and mandible. Note that the
epicenters of the lesions are in the
maxillary tuberosity and mandibular
ramus; also note the anterior displacement
of the unerupted maxillary first molars.
The internal structure contains ill-defined
septa.

------------------

A and B, Paget's disease

showing exuberant irregular
hypercementosis of the roots.

Paget's
Paget's disease. A, disease with an
Multiple
radiopaque massesaltered trabecular pattern.
in the
The trabeculae
mandible that have a cotton- are aligned
wool appearance.in linear striations, which
follow an approximately
horizontal direction in the
mandible but are randomly
oriented in the maxilla.
A case of Paget's disease involving the
skull, maxilla, and mandible.
A, A lateral view of the skull showing an
increase in density and dimension between
the internal
and outer cortex of the skull. A cotton wool
pattern can be seen.
B, A lateral view of the jaws of the same
patient showing the increase in jaw size and
density. There is a subtle linear orientation
of the trabeculae of the mandible.

Done By:
Abdallah Awadi