ODONTOGENIC CYSTS AND TUMORS

OMKAR S. SAKPAL3RD YEAR BDSROLL NO 73

INTRODUCTION

CYST :- A cyst is defined as pathological cavity lined by epithelium filled with fluid, semifluid or gaseous contents.

ODONTOGENIC CYTS :- Odontogenic cysts are a group of jaw cysts that are formed from tissues involved in Odontogenesis (tooth development).

CALCIFYING ODONTOGENIC CYST

• Definition :- A rare, well-circumscribed, solid or cystic lesion derived

from odontogenic epithelium that resembles follicular

ameloblastoma but contains ‘ghost cells’ and spherical calcifications.

• Also known as Gorlin Gold Cyst.

• Calcifying Odontogenic cyst can be classified mainly into two types:-

a) Cystic lesion

b) Solid neoplastic lesion

CLINICAL FEATURES The calcifying odontogenic cyst is not a

common lesion. AGE :- predilection for persons in the

second and third decades of life. SEX :- occurs in both genders with

almost equal frequency. In Asians there is a predilection for the

maxilla. In whites there is 62% predisposition in

the mandible.

RADIOGRAPHIC FEATURES

Occurs centrally in the jaws, may present as a painless expansile lesion.

The lesions may present as radiolucencies or radiolucencies with foci of opacification – especially when associated with odontomas.

The lesions that occur peripherally (extraosseous) on the gingiva present as painless swellings or nodules.

HISTOLOGIC FEATURES Fibrous connective tissue wall is lined by

odontogenic epithelium.

The cyst lining shows proliferation to the point

that it resembles ameloblastoma.

Within this proliferation of epithelium cells

undergo ghost cell keratinization.

Presence of ghost cells within proliferative

epithelium is the essential characteristic

feature for diagnosis.

Dystrophic calcification of the ghost cells may

be seen.

HISTOLOGIC FEATURES The cyst is often found in association

with an odontoma which is

juxtapositioned to the proliferative

lining epithelium or intermixed with

the ghost cells. This is termed as

‘DENTINOID’.

When this material is formed in

abundance and the lesion is ‘solid’

rather than ‘cystic’, the lesion may be

termed a ‘Dentinogenic Ghost Cell

Tumor’.

The ghost cells contains nuclear

remnants, remnants of cytoplasmic

organelles, and numerous

tonofilaments.

TREATMENT

Enucleation or thorough curettage.

Peripheral lesions – conservative excision.

The removal of the tumor may require block excision or segmental resection, depending upon its size or anatomic extent.

Recurrence following conservative treatment is seen.

ODONTOMA

INTRODUCTION• Odontomas are composed of all matured components of dental hard and

soft tissue : enamel, dentin and pulp.

• Because of their limited slow growth and well differentiation, they are

considered as hamartomas rather than true neoplasm.

• Odontomas are the most common benign odontogenic tumors.

• Odontomas constitute 22% of all odontogenic tumors.• They are broadly classified in to:-

Complex Compound odontoma odontoma

ODONTOMASCompound Odontoma Complex Odontoma It is a collection of small

radio-opaque masses, some or all may be like tooth like structures called DENTICLES.

Tends to occur in 62% in maxilla.

Mostly associated with the crown of unerupted canine.

Composed of haphazardly arranged dental hard and soft tissue with no resemblance to normal tooth.

Tends to occur in 70% in posterior mandibular area.

CLINICAL FEATURES They are usually asymptomatic and are

discovered during routine radiographic

examination.

Age- 2nd to 3rd decade of life.

Slight predilection for occurrence in males

(59%) compared with females (41%).

Occur most commonly in maxilla than

mandible.

Right side is affected more than left side.

It causes expansion of bone leading to facial

asymmetry.

RADIOGRAPHIC FEATURES

• Often situated between the roots of teeth.

• It may appear as an irregular mass of calcified

material surrounded by narrow radiolucent

band with smooth outer periphery.

• Early lesions are radiolucent with smooth well

defined borders.

• Large odontomas cause expansion of the jaw.

• Complex odontomas- sunburst radioopacities

HISTOLOGIC FEATURES Normal-appearing enamel or

enamel matrix, dentin, pulp tissue and cementum.

The connective tissue capsule around the odontoma is similar in all respects to the follicle surrounding a normal tooth.

Presence of ‘ghost cells’ in odontomas.

Compound odontoma

Complex odontoma

TREATMENT

The treatment of the odontoma is surgical removal.

No expectancy of recurrence.