ODONTOGENIC TUMORS.pptx

TUMORS

1. MALIGNANT ODONTOGENIC TUMORS DR DAVIS NADAKKAVUKARAN READER MALABAR DENTAL COLLEGE

2. CONTENTS CLASSIFICATION ODONTOGENIC CARCINOMAS ODONTOGENIC SARCOMAS

3. INTRODUCTION Odontogenic tumors present cellular proliferations with a wide range of biological potentials & behaviors They may be hamartomas ,benign or malignant neoplasms Hamartomas - dysmorphic cellular proliferations native to an organ in which they arise ,gain certain size before ceasing proliferation Treatment is enucleation or curettage Benign neoplasms- dysmorphic cellular proliferations native to an organ in which they arise , which also elaborate cytokines necessary for tissue invasion but not those for metastasis

4. Treatment is curative surgery or en-bloc resection Malignant neoplasms- dysmorphic cellular proliferations native to an organ in which they arise , which also elaborate cytokines necessary for tissue invasion and those for metastasis This requires en-bloc resection ,chemotherapy and/radiotherapy

5. CLASSIFICATION A) BENIGN 1) ODONTOGENIC EPITHELIUM WITHOUT ODONTOGENIC ECTOMESENCHYME - AMELOBLASTOMA -SQUAMOUS ODONTOGENIC TUMOR -CALCIFYING EPITHELIAL ODONTOGENIC TUMOR -ADENOMATOID ODONTOGENIC TUMOR 2)ODONTOGENIC EPITHELIUM WITH ODONTOGENIC ECTOMESENCHYME WITH OR WITHOUT HARD TISSUE FORMATION - AMELOBLASTIC FIBROMA -AMELOBLASTIC FIBRODENTINOMA -AMELOBLASTIC FIBRO-ODONTOMA

6. -ODONTOAMELOBLASTOMA -CALCIFYING ODONTOGENIC CYST -COMPLEX ODONTOMA -COMPOUND ODONTOMA 3) ODONTOGENIC ECTOMESENCHYME WITH OR WITHOUT INCLUDED ODONTOGENIC EPITHELIUM - ODONTOGENIC FIBROMA -MYXOMA -CEMENTOBLASTOMA B) MALIGNANT 1)ODONTOGENIC CARCINOMAS -MALIGNANT AMELOBALSTOMA -PRIMARY INTRAOSSEOUS CARCINOMANI -CLEAR CELL ODONTOGENIC CARCINOMA - GHOST CELL ODONTOGENIC CARCINOMA

7. 2) ODONTOGENIC SARCOMAS -AMELOBLASTIC FIBROSARCOMA -AMELOBLASTIC FIBRODENTINOSARCOMA -AMELOBLASTIC FIBRO-ODONTOSARCOMA

8. PRIMARY INTRAOSSEOUS CARCINOMA Arises from the residual odontogenic epithelium

9. The tumors are more common in the mandibular molar area can occur anywhere in either jaw no sex predilection, produces some enamel but mostly dentin. present as an asymptomatic jaw expansion may resorb tooth roots, displace developing teeth, and displace the inferior alveolar canal.

10. Radiographic features Location : occur in posterior aspect of mandible epicenter is usually occlusal to developing tooth or toward the alveolar crest. Periphery : tumor is usually well defined and sometimes corticated Internal structure : mixed majority radiolucent. Small lesions may appear as enlarged follicles with only one or two small discrete radioopacities .

11. Ameloblastic fibro- odontoma is pericoronal to the impacted maxillary third molar and

12. Ameloblastic fibroodontoma located superior to the crown of an erupting mandibular permanent first molar in a 6 year

13. AMELOBLASTIC FIBRO-DENTINOMA It ia a tumor similar to that of ameloblastic fibroma in which the calfying component consists only of dentin matrix and dentinoid maerial .

14. ODONTOMA PATHOGENESIS Odontomas are actually mixed odontogenic hemartomas of aborted tooth formation Odontomas represent an attempt to duplicate tooth formation but in a distorted fashion They arise from both odontogenic epithelium, which produces enamel, and odontogenic mesenchyme, which produces dentin via odontoblast differentiation.

15. Clinical & radiographic features two general types. which forms multiple small toothlike structures, is called the compound odontoma . occur slightly more often anterior to the mental foramen forms an amorphous calcified mass and is called the complex odontoma occur more often posterior to the mental foramen Most are incidental radiographic findings observed on a dental examination. Or radiographic findings discovered when a tooth fails to erupt, a primary tooth fails to exfoliate, or an expansion of bone is observed Most occur in children and young adults

16. Radiography Location : compound odontoms occur in anterior maxilla in association with the crown of an unrupted canine. complex odontomas found in mandibular first and second molar area. Periphery : borders are well defined and may be smooth or irregular. Lesions may have corticated border and immediately inside and adjacent to cortical border in a soft tissue capsule.

17. Internal structure : lesions are largely radioopaque.compound odontomas have a number of tooth like structures or denticles that look like deformed teeth. Complex odontomas contain a irregular mass of calcified tissue Dilated odontoma has a single calcified structure with a more radiolucent central portion that has an overall form like a donut.

18. Effect on surrounding structures : can interfere with normal eruption of teeth. Mostly associated with abnormalities such as impaction, malpositioning , diastema , aplasia ,malformation devitilization of adjacent teeth. Large complex odontomas may cause expansion of the jaw with maintainence of cortical boundary. Differential diagnosis : cemnto osseous fibromas, periapical cemental dysplasia

19. Treatment The odontoma and the lesions on its usual differential list are curable with enucleation and curettage calcified masses are not adherent to bone and can be enucleated from the bony cavity with hand curettes. In larger compound or complex odontomas - take an intraoperative radiograph to ensure that all of the small calcified masses have been removed. Spontaneous osteogenesis in these young patients will result in bone regeneration in 9 to 12 months.

20. Compound odontoma showing small radiopaque masses preventing eruption of central incisors

21. Compound odontoma showing small toothlets .

22. Compound odontoma exhibiting a prominent peripheral radiolucency bordered by a radiopaque line.

23. Compound odontoma consisting of small toothlets

24. AMELOBLASTIC ODONTOMA Simultaneous occurrence of ameloblastoma and composite odontoma Any age Mostly children Mostly mandible Expansible lesion of bone produces facial deformity Mild pain , delayed eruption

25. Radiographic features Central destruction of bone with expansion of cortical plates Presence of numerous radioopaque masses with no resemblance to formed teeth Otherwise single radioopaque Treatment : resection of jaw preserving inferior border of mandible.

26. CALCIFYING ODONTOGENIC CYST Both cystic and neoplastic variants Less common lesion They occupy a spectrum ranging from a cyst to odontogenic tumor , with characteristics of cyst alone or those of a solid neoplasm WHO presently classify it as benign tumor . Lesion may manuacture calcified tissue identified as dysplastic dentin and in some instances associated with an odontoma . Peaks at 10 to 19 yrs mean age 36 yrs Usually appears slow growing painless swlling o the jaw

27. In some cases the expanding lsion may destroy the cortical plate and the cystic mass may become palpable as it extends into soft tissue. Aspiration often yields a viscous granular, yellow fluid.

28. Radiographic feature Location : 75% in bone with equal distribution between the jaws. Mostly anterior to first molar , especially associated with cuspids and incisors, where the cyst manifest as a pericoronal radiolucency. Periphery and shape : well defined corticated with acurved cyst like shape to illdefined and irrgular .

29. Internal structure : may be completely radiolucent , may show evidence of small foci of calcified material that appears as white flecks or small smooth pebbles., or it may show even larger solid amorphous masses. Effects on surrounding structures : associated with atooth and impedes its eruption Displacement of teeth and resorption of roots may occur Perforations of cortical paltes may be seen radiographically with enlarging lesions.

30. Differential diagnosis : dentigerous cyst, adenamatoid odontogenic tumor ameloblastic fibroodontoma Management : enucleation curretage

31. REFERENCES Shafer’s textbook of oral pathology White & Pharoah , oral radiology principles and interpretation. Textbook of oral medicine and oral diagnosis and oral radiology Ravikiran ongole , praveen B N.