OTHER BONE DISEASES

PART 1
DONE BY : FATIMA ALSAYED JAFFAR
20102050074

1. FIBROUS DYSPLASIA

 DISEASE MECHANISM :
Localized

change in normal bone

metabolism that result in the Replacement
of cancellous bone by fibrous tissue
containing varying amount of abnormal
appearing bone .

 CLINICAL FEATURES:
solitary lesions in 70% of all cases
Polyostotic lesions found in children younger
than 10 yrs old .
Most common sites : rib > femur > tibia >
maxilla > mandible.
No sexual difference except in maccune albright
syndrome F>>M.
Asymptomatic or mild symptoms .
Discovered incidentally.
unilateral facial swelling in Jaw involvement, or
enlarging of alveolar process.

 CLINICAL FEATURES:

IMAGING FEATURES:
LOCATION :

Maxilla>> mandible
In the posterior aspect
Unilateral

IMAGING FEATURES:
PERIPHERY :

most commonly ill defined periphery , with

gradual blending with normal bone .

IMAGING FEATURES:
PERIPHERY :

Lesions may have sharp well defined and

even corticated margins

Sagittal cone beam CT of

the mandible

Well defined with almost

corticated

IMAGING FEATURES:

INTERNAL STRUCTURE :

internal aspect of bone may be

radiopaque ,radiolucent or mixed compared
with normal bone.

IMAGING FEATURES:

INTERNAL STRUCTURE :

it is more radiopaque in the maxilla and

base of the skull.

IMAGING FEATURES:

INTERNAL STRUCTURE :

early lesions may be more radiolucent , and

it changes with time.

Same case in 18 years interval

IMAGING FEATURES:

INTERNAL STRUCTURE :
The short thin irregular trabeculae creates
variable radiopaque patterns
1. granular (ground glass appearance)

IMAGING FEATURES:

INTERNAL STRUCTURE :

2. resembling a surface of an orange .

IMAGING FEATURES:

INTERNAL STRUCTURE :

3. wispy arrangement cotton wool .

IMAGING FEATURES:

INTERNAL STRUCTURE :

4. fingerprint(swirling) pattern.

IMAGING FEATURES:

INTERNAL STRUCTURE :

5. radiolucent appearance resembling cysts.

IMAGING FEATURES:

EFFECT ON SURROUNDING STRUCTURES:

No effect if small
Expansion with thinned intact outer cortex.

IMAGING FEATURES:

EFFECT ON SURROUNDING STRUCTURES:

Expand into the antrum occupying part of the

maxillary sinus .

Coronal CT showing the lateral

wall of the maxilla expanding
into the antrum

IMAGING FEATURES:

EFFECT ON SURROUNDING STRUCTURES:

Bone surrounding the teeth altered without
effecting the dentation.
Distinct lamina Dura disappears .
ID canal displacement in superior direction .

IMAGING FEATURES:

EFFECT ON SURROUNDING STRUCTURES:

Hypercementosis of teeth.
Root resorption

DIFFERENTIAL DIAGNOSIS:
1. HYPERPARATHYROIDISM :
hyperparathyroidism

Fibrous dysplasia

Bilateral

unilateral

Dont cause bone

expansion

Do cause bone
expansion

Radiopaque
teeth in contrast
to a radiolucent
jaw

DIFFERENTIAL DIAGNOSIS:
2. PAGETS DISEASE :
Pagets disease

Fibrous dysplasia

Older age groups

In young children

Whole jaw effected

esp:mn

unilateral

Almost the whole

mandible affected in
pagets

DIFFERENTIAL DIAGNOSIS:

3. PERIAPICAL CEMENTAL DYSPLASIA:

periapical cemental
dysplasia

Fibrous dysplasia

Bilateral

unilateral

Older age groups

Young patients

4. spontaneous healed simple bone

cyst

DIFFERENTIAL DIAGNOSIS:
5. OSTEIOMYELITIS:
osteiomyelitis

Fibrous dysplasia

Bone laid on outer cortex by the

periosteum.

Internal resorbtion & displacing

and thinning the outer cortex

Original cortex may be identified

within the expanded portion.

The outer cortex remain the most

outer surfas

Sequestra identification

No Sequestra found

DIFFERENTIAL DIAGNOSIS:
6. OSSIFYING FIBROMA :
Ossifying fibroma

Fibrous dysplasia

cause teeth
displacement

dont cause teeth

displacement

Convex extension of the

neoplasm into the
antrum

Keeps the original

antrum shape .

7. osteogenic sarcoma:
The disease must show malignant
features

MANAGEMENT :
The lesion growth usually stop at skeletal
maturation
Ortho tx and cosmetic surgery delayed till
that time

2. PERIAPICAL

OSSEOUS
DYSPLASIA

 DISEASE MECHANISM :

PCD is a localized(near apex of tooth) change in

bone metabolism, where resorption of normal
cancellous bone occur and replacement with
fibrous tissue and amorphous bone.
Early
phase

Normal one
resorption

Radiolucent

Mixed
phase

Abnormal
Bone
developmen
t

Mixed
radiolucent
and
radiopaque

Maturatio
n phase

Abnormal
bone
dominate
the lesion

radiopaque

 CLINICAL FEATURES :
Mean age = 39 yrs
Teeth are vital
Usually an incidental radiographic finding
F:M 9:1
3:1 African: Caucasian
Lesion may cause notable expansion of the
alveolar process

IMAGING FEATURES:
LOCATION :

Apices of mandibular anterior teeth

Maxillary teeth may be affected rarely .
Mostly Multiple & bilateral
Solitary lesions arise occasionally

IMAGING FEATURES:
PREPHRY & SHAPE :

Well defined
Round, oval or irregular shape centered over
the apex of teeth
May have radiolucent border surrounded by
sclerotic bone

IMAGING FEATURES:
PREPHRY & SHAPE :

Multiple lesions with

sclerotic border

IMAGING FEATURES:

INTERNAL STRUCTURE :

Varies from lucent to mixed density to

opaque as the lesion matures
Early lesions appear as apical radiolucencies
Mixed stage lesions have irregular
amorphous opacities within the lucency.

Same lesion in different stages

IMAGING FEATURES:

INTERNAL STRUCTURE :

Mature lesions are uniformly radiopaque,

often with a lucent rim or margin.
Why ?

IMAGING FEATURES:

INTERNAL STRUCTURE :

POD may have abnormal trabecular structure

resembling fibrous dysplasia

IMAGING FEATURES:

EFFECT ON SURROUNDING STRUCTURES:

Lost of the lamina dura of adjacent teeth
PDL space either less apparent or wider
Root resorption is rare
Hyper cementation of adjacent teeth

IMAGING FEATURES:

EFFECT ON SURROUNDING STRUCTURES:

Surrounding bone may become sclerotic
Occasionally, large lesions may cause
expansion of the jaws
Elevation of the
Maxillary sinus floor

DIFFERENTIAL DIAGNOSIS:

1.PERIAPICAL RAREFYING OSTEITIS :

In early stages of POD its indistinguishable
radiographicly from per apical rarefying
osteitis.
Tooth vitality can help in this situation where
teeth associated with POD usually vital and
PRO not

PRO

POD

DIFFERENTIAL DIAGNOSIS:
2. BENIGN CEMENTOBLASTOMA:

It causes resorption of the root attached to

it .
Its tissue capsule is better defined .
Its internal stx has unique pattern like
radiating.
Causes concentric(spherical) expansion .

benign cementoblastoma

POD

DIFFERENTIAL DIAGNOSIS:
3. ODONTOMAS:

Internal stx of tooth like tissue esp: enamel

Soft tissue capsule more uniform in width

odontomas

POD

DIFFERENTIAL DIAGNOSIS:
4. DENSE BONE ISLAND:

Identification of the soft tissue capsule in POD

DBI

POD

5. CEMENTO OSSIFYING FIBROMA:

growing mass that cause teeth displacement

MANAGEMENT:
No TX is required unless got exposed and 2 nd infected.