MAKALAH

Textbook Reading
Tumor Jinak

diajukan untuk memenuhi tugas Dental Radilogi

Syed Abdul Kadir Al-Haddad (160110123004)

Cheong Tzen Yew (160110123027)
Rakenzon Adhi Sakti Santosa (160110123021)

FAKULTAS KEDOKTERAN GIGI

UNIVERSITAS PADJAJARAN
BANDUNG
2016
 FOREWORD

Praise be to Allah SWT author . which provides the power and the ability to
author for compiling this paper . With the permission of Allah the end of this task
can be completed properly.
This paper proposed to meet one of the tasks texbook Dental Radiology
Reading in Benign Tumor material .
Alhamdulillah, thanks to the guidance and instructions of lecturers , various
kinds of information , and help all parties can we solve this task .
The authors recognize that the content of the material in this paper is still full
of flaws. Based on it , the author is ready to accept criticism and advice that can
build up and make the paper better .
Final word may Allah SWT. Give the reward to all those who have provided
assistance.

Bandung, 16 June 2016

Author

i
 TABLE OF CONTENTS

FOREWORD ........................................................................................................... i

TABLE OF CONTENTS ....................................................................................... ii

TABLE OF FIGURES .......................................................................................... iv

CHAPTER I INTRODUCTION ....................................................................... 1

1.1 Background ................................................................................................... 1

CHAPTER II RADIOGRAPHIC IMAGING OF BENIGN TUMOR........... 2

2.1 Hyperplasia ................................................................................................... 2

2.1.1 Ease Mechanism.................................................................................. 2

2.1.2 Clinical Features.................................................................................. 3

2.1.3 Radiologic Examination ...................................................................... 3

2.1.4 Imaging Features ................................................................................. 4

2.2 Torus Palanitus .............................................................................................. 6

2.2.1 Disease Mechanism ............................................................................. 6

2.2.2 Clinical Features.................................................................................. 6

2.2.3 Imaging Features ................................................................................. 7

2.3 Torus Mandibularis ....................................................................................... 8

2.3.1 Disease Mechanism ............................................................................. 8

2.3.2 Clinical Features.................................................................................. 9

2.3.3 Imaging Features ................................................................................. 9

2.4 HYPEROSTOSIS ....................................................................................... 10

2.4.1 Disease Mechanism ........................................................................... 10

2.4.2 Clinical Features................................................................................ 11

ii
 2.4.3 Imaging Features ............................................................................... 12

2.5 DENSE BONE ISLAND ............................................................................ 13

2.5.1 Disease Mechanism ........................................................................... 13

2.5.2 Clinical Features................................................................................ 13

2.5.3 Imaging Features ............................................................................... 13

CHAPTER III AMELOBLASTOMA ............................................................. 14

3.1 Preface ......................................................................................................... 14

3.2 Types of Benign Ameloblastoma ................................................................ 14

3.3 Clinical Features.......................................................................................... 15

3.4 Radiographic Features ................................................................................. 16

3.5 Additional Imaging ..................................................................................... 23

3.5.1 Calcifying Epithelial Odontogenic Tumor ........................................ 24

3.6 Odontoma .................................................................................................... 25

CHAPTER IV CONCLUSION ........................................................................ 28

4.1 Conclusion .................................................................................................. 28

REFERENCES ...................................................................................................... iv

iii
 TABLE OF FIGURES

FIG. 2.1 Radiopaque shadows of torus palatinus........................................................ 8

FIG. 2.2 Torus palatinus on occlusal image................................................................ 8

FIG. 2.3 Radiopaque lesion in torus mandibularis.................................................... 10

FIG. 2.4 Periapical image of hyperostosis on buccal aspect ..................................... 12

FIG. 3.1 Unicystic ameloblastoma devel- oping occlusal to the left second
mandibular molar causing expansion of the mandibular body and ramus
to the sigmoid notch and condylar neck and inferior displacement of the
mandibular second molar and root resorption of the alveolar left first
molar. (Courtesy E. J. Burkes, DDS, Chapel Hill, N.C.) ........................... 17
FIG. 3.2 Multicular Ameloblastoma. A, A large lesion in the mandibular body
and ramus shows only a few rather straight septa. ..................................... 17
FIG. 3.3 Lateral radiograph of a resected mandibular specimen containing a
multilocular ameloblastoma; note the coarse curved septa. ....................... 18
FIG. 3.4 Another surgical specimen of an ameloblastoma ....................................... 18

FIG. 3.5 A large multilocular lesion in the right mandibular ramus. ........................ 19

FIG. 3.6 A cropped panoramic image showing small loculations that are more
common in the anterior mandible. .............................................................. 19
FIG. 3.7 An axial CT image with bone algorithm showing a large
ameloblastoma; note the smaller loculations in the anterior mandible
(black arrows) and the larger loculations in the posterior mandible
(white arrows). ............................................................................................ 20
FIG. 3.8 An occlusal film demonstrating expansion of the lingual cortex with
maintenance of a thin outer shell of bone (arrow). ..................................... 22
FIG. 3.9 An example of the desmoplastic type of ameloblastoma; note the
internal irregular bone formation in this axial CT image. .......................... 23
FIG. 3.10 Panoramic radiograph of sharply demarcated cystoids radiolucency that
include calcified radiopacities. This is accompanied by displacement of
adjacent impacted teeth. ............................................................................. 24
FIG. 3.11 Periapical radiograph showing an already progressive CEOT above the
crown of tooth 35. ....................................................................................... 25
FIG. 3.12 The periapical radiograph of a partially luxated tooth 11 with a half-
moon-shaped radiolucency on the distal surface, including variously
dense radiopacities. This is readily identified as a calcifying

iv
 odontogenic cyst. Approximately 2 years later, a compound odontoma
had developed. ............................................................................................ 26
FIG. 3.13 Compound odontoma that has displaced tooth 35. ..................................... 26

FIG. 3.14 Complex odontoma on left mandibular angle. ........................................... 27

FIG. 3.15 Complex odontoma on right mandibular angle. ......................................... 27

v
 CHAPTER I

INTRODUCTION

1.1 Background

Benign tumors are a new growth of tissue that are localized and do not have the

ability to infiltrate , invade , and can spread to other places . Benign tumors are a

mass of abnormal tissue growth is excessive and uncoordinated growth of normal

tissue even though the stimuli that trigger these changes have been stopped .

Benign tumors that grow in the oral cavity has the characteristics of growing

slowly , after reaching a certain size settle down and do not develop again . These

tumors grow urged the normal cells but not invaded and did not metastasize , but

over time will grow big . Examination to determine the benign tumors in the oral

cavity are now many techniques to help diagnose .

Photos of intraoral and extraoral radiographs can be done to enforce the

diagnosis . Results of periapical and panoramic radiographs will show the state

actually happened oral cavity .

1
 CHAPTER II

RADIOGRAPHIC IMAGING OF BENIGN TUMOR

2.1 Hyperplasia

2.1.1 Ease Mechanism

A benign tumor represents a new uncoordinated growth that generally has the

following characteristics. Benign tumors are slowly growing and spread by direct

extension and not by metastases. They tend to resemble the tissue of origin

histologically. For example, an ameloblastoma, a tumor thought to be derived

from odontogenic epithelium, often is composed of cells that resemble

ameloblasts. It is thought that benign tumors have unlimited growth potential.

Hamartomas often are included in the category of benign tumors. However,

hamartomas are overgrowths of disorganized normal tissue that have a limited

growth potential. For example, an odontoma is a hamartoma of dental tissue

(disorganized enamel, dentin, and pulp tissues) derived from the dental follicle

that stops growing at approximately the same time as other normal dental tissues.

Hyperplasia refers to a growth formed by an increase in the number of cells of a

tissue but differs from a hamartoma in that the tissue is in a normal arrangement.

Hyperplasia is generally thought to be a reaction to a stimulus, such as

inflammation. Therefore, hyperplasias have limited growth potential and tend to

regress when the stimulus is removed.

2
 3

2.1.2 Clinical Features

Benign tumors typically have an insidious onset and grow slowly. These

tumors usually are painless, do not metastasize, and are not life-threatening unless

they interfere with a vital organ by direct extension. Benign tumors are usually

detected clinically by enlargement of the jaws or are found during a radiographic

examination. Sometimes the radiologic examination is performed to try to

discover the reason for the lack of development of a tooth.

2.1.3 Radiologic Examination

Once the clinician has made a preliminary diagnosis of the presence of a tumor,

a full radiologic examination should be performed to document the extent and

characteristics of the lesion. This examination may entail further images, such as

panoramic, intra- oral, or occlusal images. For central bone lesions, the addition of

computed tomographic (CT) imaging is essential for assessing the three-

dimensional characteristics of the entity. If the lesion originates in soft tissue or

has extended from bone into the surrounding soft tissue, magnetic resonance

imaging (MRI) may be required.

A thorough radiologic examination provides information regarding the extent

of the lesion. On one hand, sometimes the characteristics are so specific that a

preliminary diagnosis of the type of benign tumor can be made. On the other

hand, the imaging characteristics of the lesion may fail to indicate the type of

tumor. A thorough workup also indicates the most favorable biopsy site. In most
 4

cases, the radiologic examination should be completed before the biopsy

procedure.

2.1.4 Imaging Features

The following general features suggest the presence of a benign neoplasm.

1. Location

Because many tumors have a specific anatomic predilection, the location of a

particular neoplasm is important in establishing the differential diagnosis. For

example, odontogenic lesions occur in the alveolar processes above the inferior

alveolar nerve canal, where tooth formation occurs. Vascular and neural lesions

may originate inside the mandibular canal, arising from the neurovascular tissues.

Cartilaginous tumors occur in jaw locations where residual cartilaginous cells lie,

such as around the mandibular condyle.

2. Periphery and Shape

Benign tumors enlarge slowly by formation of additional internal tissue and, as

a result, the borders of benign tumors appear relatively smooth, well defined, and

sometimes corticated. If the tumor produces a calcified product, such as abnormal

tooth material or abnormal bone, the most mature part of the tumor is in the

central region with the most immature aspect at the periphery. Sometimes a

radiolucent band of soft tissue or capsule results at the periphery where the

calcified product has not yet formed; this band separates the more mature internal

radiopaque portion from the surrounding normal bone.

3. Internal Structure
 5

The internal structure may be completely radiolucent or radiopaque or may be

a mixture of radiolucent and radiopaque tissues. If the lesion contains radiopaque

elements, these structures usually represent residual bone, reactive bone

formation, or a calcified material that is being produced by the tumor. Curved

septa that are characteristic in ameloblastoma represent residual bone trapped

inside the tumor that has remodeled into curved septa by internal cystic structures.

An ameloblastoma does not produce bone. An osteoblastoma often has an internal

granular radiopaque pattern produced by the abnormal bone that is actually being

manufactured by the tumor. Often the internal pattern is characteristic for specific

types of tumors and may help with the diagnosis. A totally radiolucent internal

structure is not as useful as an aid to the diagnosis.

4. Effects on surroundings structures.

The manner in which a tumor affects adjacent tissues may suggest a benign

behavior. For example, a benign tumor exerts pressure on neighboring structures,

resulting in the displacement of teeth or bony cortices. If the growth is slow

enough, there is adequate time for the outer cortex to remodel in response to the

pressure, result- ing in an appearance that the cortex has been displaced by the

tumor. This appearance is caused by simultaneous resorption of bone along the

inner surface (endosteal) of the cortex and deposition of bone along the outer

cortical surface by the periosteum. Through this remodeling process, the cortex

maintains its integrity and resists perforation, although faster growing tumors may

exceed this process resulting in perforation of the cortex. Benign tumors may also
 6

cause bodily displacement of nearby teeth. The movement of teeth adjacent to

benign tumors is slow because these lesions grow slowly.

The roots of teeth may be resorbed by either benign or malignant tumors, but

root resorption more commonly is associated with benign processes. The benign

tumors especially likely to resorb roots are ameloblastomas, ossifying fibromas,

and central giant cell granulomas. Benign tumors tend to resorb the adjacent root

surfaces in a smooth fashion. Bone dysplasias such as fibrous dysplasia do not

usually resorb teeth. When root resorption is associated with malignant tumors,

the resorption is usually in smaller quantities causing thinning of the root into a

“spiked” shape.

2.2 Torus Palanitus

2.2.1 Disease Mechanism

Torus palatinus is a bony protuberance (hyperostosis) that occurs in the middle

third of the midline of the hard palate.

2.2.2 Clinical Features

Torus palatinus, the most common hyperostosis, occurs in about 20% of the

population, although various studies have shown marked differences in racial

groups. It develops about twice as often in women as in men and more often in

Native Americans, Eskimos, and Norwegians. Although it may be discovered at

any age, it is rare in children. It usually begins developing in young adults before
 7

30 years of age and is thought to arise through interplay of genetic and

environmental factors. The base of the bony nodule extends along the central

portion of the hard palate, and the bulk reaches downward into the oral cavity.

The size and shape of a torus palatinus can vary, and these lesions have been

described as flat, lobulated, nodular, or mushroom-like. Normal mucosa covers

the bony mass and may appear pale and sometimes ulcerated when traumatized.

Patients often are unaware of this hyperplasia, and patients who do discover it

may insist that it occurred suddenly and has been growing rapidly.

2.2.3 Imaging Features

On maxillary periapical or panoramic images, a torus palatinus appears as a

dense radiopaque shadow below and attached to the hard palate. It may be

superimposed over the apical areas of the maxillary teeth, especially if the torus

has developed in the middle or anterior regions of the palate. The image of a

palatal torus may project over the roots of the maxillary molars, but this image

usually moves in its position relative to the roots of the teeth if another film is

taken with a different horizontal or vertical angulation of the central ray. The

border of the radiopaque shadow usually is well defined and may have a convex

or a lobulated outline. The internal aspect is homogeneously radiopaque.

 8

FIG. 2.1 Radiopaque shadows of torus palatinus

FIG. 2.2 Torus palatinus on occlusal image

2.3 Torus Mandibularis

2.3.1 Disease Mechanism

Torus mandibularis is a hyperostosis that protrudes from the lingual aspect of

the mandibular alveolar process, usually near the premolar teeth.

 9

2.3.2 Clinical Features

They are less tori occur less often on the lingual surface of the mandible than

on the palate, with the former occurring in about 8% of the population. These tori

develop singly or multiply, unilaterally or bilaterally (usually bilaterally), and

most often in the premolar region. The size also varies, ranging from an

outgrowth that is just palpable to one that contacts a torus on the opposite side. In

contrast to torus palatinus, torus mandibularis develops later, being first

discovered in middle-aged adults. However, it has the same gender predilection as

torus palatinus. In women, the occurrence of torus mandibularis correlates with

that of torus palatinus, but this apparently is not the case in men. As with torus

palatinus, torus mandibularis may occur more often in individuals of Asian

ancestry.

Genetic and environmental factors seem to be involved in the development of

torus mandibularis, but masticatory stress is reported as an essential factor

underlying its formation. The high prevalence among Eskimos and other subarctic

peoples who make extraordinary chewing demands on their teeth seems to support

this suggestion. Also, a patient with a torus mandibularis has, on average, more

teeth present than a patient without a torus.

2.3.3 Imaging Features

In periapical images, a torus mandibularis appears as a radiopaque shadow,

usually superimposed on the roots of premolars and molars and occasionally over

a canine or incisor. It usually is superimposed over about three teeth. Mandibular

 10

tori are sharply demarcated anteriorly on periapical images and are less dense and

less well defined as they extend posteriorly . There is no margin between the

periphery of the torus and the surface of the mandible because the torus is

continuous with the mandibular cortex. On occlusal images, a mandibular torus

appears as radiopaque and homogeneous.

FIG. 2.3 Radiopaque lesion in torus mandibularis

2.4 HYPEROSTOSIS

2.4.1 Disease Mechanism

In addition to tori, other hyperostoses or exostoses may occur at other sites in

the jaws. These are usually small regions of osseous hyperplasia of cortical bone

and occasionally internal cancellous bone and usually occur on the surface of the

alveolar process.
 11

2.4.2 Clinical Features

Hyperostoses may develop most commonly on the buccal surface of the

maxillary alveolar process, usually in the canine or molar area. They may also

occur on the palatal surface or crest and less commonly on the mandibular

alveolar process. Occasionally, they grow on the crest under a pontic of a fixed

bridge. They are less tori occur less often on the lingual surface of the mandible

than on the palate, with the former occurring in about 8% of the population. These

tori develop singly or multiply, unilaterally or bilaterally (usually bilaterally), and

most often in the premolar region. The size also varies, ranging from an

outgrowth that is just palpable to one that contacts a torus on the opposite side. In

contrast to torus palatinus, torus mandibularis develops later, being first

discovered in middle-aged adults. However, it has the same gender predilection as

torus palatinus. In women, the occurrence of torus mandibularis correlates with

that of torus palatinus, but this apparently is not the case in men. As with torus

palatinus, torus mandibularis may occur more often in individuals of Asian

ancestry.

Genetic and environmental factors seem to be involved in the development of

torus mandibularis, but masticatory stress is reported as an essential factor

underlying its formation. The high prevalence among Eskimos and other subarctic

peoples who make extraordinary chewing demands on their teeth seems to support

this suggestion. Also, a patient with a torus mandibularis has, on average, more

teeth present than a patient without a torus.

 12

2.4.3 Imaging Features

Recognition of mandibular tori relies on their appearance and location. Their

presence bilaterally reinforces this impression, although they can occur

unilaterally. On mandibular its more common than mandibular or palatine tori,

may attain a large size, and may be solitary or multiple. They are nodular,

pedunculated, or flat prominences on the surface of the bone. They are covered

with a normal mucosa and are bony hard on palpation. Published studies suggest a

male predominance and an increase in frequency with age. As with the tori

described previously, they appear to be more prevalent in Native Americans. The

periphery of a hyperostosis is usually well defined and smoothly contoured with a

curved border. However, some may have poorly defined borders that blend into

the surrounding normal bone. The internal aspect of a hyperostosis usually is

homogeneous and radiopaque. Although large hyperostoses can have an internal

cancellous bone pattern, they most often consist only of cortical bone.

FIG. 2.4 Periapical image of hyperostosis on buccal aspect

 13

2.5 DENSE BONE ISLAND

2.5.1 Disease Mechanism

DBIs are the internal counterparts of exostoses. They are localized growths of

compact bone that develop within the cancellous bone.

2.5.2 Clinical Features

DBIs are asymptomatic.

2.5.3 Imaging Features

DBIs are more common in the mandible than in the maxilla. They occur most

often in the premolar-molar area, although their existence does not correlate with

the presence or absence of teeth. The periphery is usually well defined but

occasionally blends with the trabeculae of the surrounding bone. There is no trace

of a radiolucent margin or capsule as the radiopaque DBI abuts directly against

normal bone. The internal aspect of DBIs usually is uniformly radiopaque without

any characteristic pattern, but some- times there may be patches of more

radiolucent areas depending on form and thickness. Rarely, a DBI is located

periapical to a tooth root and is associated with external root resorption. The tooth

most often involved is the mandibular first molar. In all circumstances, the tooth

is vital, and the root resorption appears to be self-limiting. In very rare cases,

DBIs can inhibit the eruption of a tooth and even displace a tooth.
 CHAPTER III

AMELOBLASTOMA

3.1 Preface

Ameloblastoma is a rare, benign tumor of odontogenic epithelium

(ameloblasts, or outside portion, of the teeth during development) much more

commonly appearing in the lower jaw than the upper jaw. It was recognized in

1827 by Cusack. This type of odontogenic neoplasm was designated as

an adamantinoma in 1885 by the French physician Louis-Charles Malassez. Ivey

and Churchill finally renamed it to the modern name ameloblastoma in 1930

Ameloblastoma is a rare, benign tumor of odontogenic.

3.2 Types of Benign Ameloblastoma

Ameloblastomas may be divided into the solid/multicystic type, the unicystic

type, and the desmoplastic type. The unicystic variant may develop as a single

entity or may form from the epithelial lining of a dentigerous cyst, called a mural

(within the wall) ameloblastoma. The existence of peripheral (soft tissue location)

forms of this neoplasm is well documented.

14
 15

3.3 Clinical Features.

There is a slight predilection for this lesion to occur in men, and it develops

more often in blacks. Although it may be found in the young (age 3 years) and in

individuals older than 80 years, most patients are between 20 and 50 years, with

the average age at discovery about 40 years.

Ameloblastomas grow slowly, and few, if any, symptoms occur in the early

stages. The tumor is frequently discovered during a routine dental examination.

Usually the patient eventually notices gradually increasing facial asymmetry.

Swelling of the cheek, gingiva, or hard palate has been reported as the chief

complaint in 95% of untreated maxillary ameloblastomas. The mucosa over the

mass is normal, but teeth in the involved region may be displaced and become

mobile. In most cases patients with ameloblastomas do not have pain, paresthe-

sia, fistula, ulcer formation, or tooth mobility. As the tumor enlarges, palpation

may elicit a bony hard sensation or crepitus as the bone thins. If the lesion

destroys overlying bone, the swelling may feel firm or fluctuant. As it grows, this

tumor can cause bony expansion and sometimes erosion through the adjacent

cortical plate with subse- quent invasion of the adjacent soft tissues.

An untreated tumor may grow to great size and is more of a concern in the

maxilla, where it can extend into vital structures and reach into the cranial base.

Tumors that develop in the maxilla may extend into the paranasal sinuses, orbit,

nasopharynx, or vital struc- tures at the base of the skull. Recurrence rates are
 16

higher in older patients and in those with multilocular lesions. As seen with other

jaw tumors, local recurrence, whether detected radiographically or histologically,

may have a more aggressive character than the original tumor.

3.4 Radiographic Features

1. Location. Most ameloblastomas (80%) develop in the molar- ramus region

of the mandible, but they may extend to the symphyseal area. Most lesions

that occur in the maxilla are in the third molar area and extend into the

maxillary sinus and nasal floor. In either jaw this tumor can originate in an

occlusal position to a developing tooth (Fig. 22-11).

2. Periphery. The ameloblastoma is usually well defined and fre- quently

delineated by a cortical border. The border is often curved, and in small

lesions the border and shape may be indistinguishable from a cyst (Fig.

22-12). The periphery of lesions in the maxilla is usually more ill defined.
 17

FIG. 3.1 unicystic ameloblastoma devel- oping occlusal to the left

second mandibular molar causing expansion of the mandibular
body and ramus to the sigmoid notch and condylar neck and
inferior displacement of the mandibular second molar and root
resorption of the alveolar left first molar. (Courtesy E. J. Burkes,
DDS, Chapel Hill, N.C.)

FIG. 3.2 multicular Ameloblastoma. A, A large lesion in

the mandibular body and ramus shows only a few rather
straight septa.
 18

FIG. 3.3 Lateral radiograph of a resected mandibular specimen

containing a multilocular ameloblastoma; note the coarse curved
septa.

FIG. 3.4 Another surgical specimen of an

ameloblastoma
 19

FIG. 3.5 A large multilocular lesion in the right

mandibular ramus.

FIG. 3.6 A cropped panoramic image showing small loculations that are more
common in the anterior mandible.
 20

FIG. 3.7 An axial CT image with bone algorithm showing a large

ameloblastoma; note the smaller loculations in the anterior mandible
(black arrows) and the larger loculations in the posterior mandible
(white arrows).

3. Internal Structure. The internal structure varies from totally radiolucent

(see Fig. 22-11) to mixed with the presence of bony septa creating internal

compartments. These septa can be straight but are more commonly coarse

and curved and originate from normal bone that has been trapped within

the tumor. Because this tumor frequently has internal cystic components,

these septa are often remodeled into curved shapes providing a honeycomb

(numerous small compart- ments or loculations) or soap bubble (larger

compartments of vari- able size) patterns. Generally the loculations are

larger in the posterior mandible and smaller in the anterior mandible. In

 21

the desmoplastic variety the internal structure can be composed of very

irregular sclerotic bone resembling a bone dysplasia or bone-forming

tumor.

4. Effects on Surrounding Structures. There is a pronounced ten- dency for

ameloblastomas to cause extensive root resorption. Tooth displacement is

common. Because a common point of origin is occlusal to a tooth, some

teeth may be displaced apically. An occlusal radiograph may demonstrate

cystlike expansion and thinning of an adjacent cortical plate leaving a thin

“eggshell” of bone. Computed tomographic (CT) images often reveal

regions of perforation of the expanded cortical plate as a result of the

inability of the production of periosteal new bone to keep up with the rate

of growth of the expanding ameloblastoma. Unicystic types of

ameloblastoma may cause extreme expansion of the mandibular ramus,

and often the anterior border of the ramus is no longer visible in the

panoramic image.
 22

FIG. 3.8 An occlusal film demonstrating expansion

of the lingual cortex with maintenance of a thin
outer shell of bone (arrow).
 23

FIG. 3.9 An example of the desmoplastic type of ameloblastoma; note the

internal irregular bone formation in this axial CT image.

3.5 Additional Imaging

If a preliminary diagnosis of ameloblastoma is made, then CT imaging is

highly recommended. CT imaging cannot only confirm the diag- nosis but also

will accurately demonstrate the anatomic extent of the tumor. Of importance is the

ability of CT imaging to detect perforation of the outer cortex and invasion into

the surround- ing soft tissues. If soft tissue invasion is extensive, magnetic

resonance imaging (MRI) will provide superior images of the nature and extent of

the invasion. CT examination is essential in the postsurgical follow- up

assessment of ameloblastoma.
 24

3.5.1 Calcifying Epithelial Odontogenic Tumor

Calcifying epithelial odontogenic tumor or CEOT is also known as Pindborg

tumor. These tumors usually are located within bone and produce a mineralized

substance within amyloid- like material. This tumor can occur between age 30 and

50. Male and female can be affected equally and recurrence is not common.

CEOT have a distinctive microscopic appearance with epithelium that resembles

the stratum intermedium of the enamel organ. Radiographically it appears initially

as a well demarcated, cystoid radiolucency in which an impacted tooth is

enclosed. In later stages, one observes expanding, calcified, or also spherical

radiopacities. The compact bone and bordering lamellae of the maxilla are

distended and thinned, and the mandibular canal is displaced.

FIG. 3.10 Panoramic radiograph of sharply demarcated cystoids radiolucency that

include calcified radiopacities. This is accompanied by displacement of adjacent
impacted teeth.
 25

FIG. 3.11 Periapical radiograph showing an

already progressive CEOT above the crown
of tooth 35.

3.6 Odontoma

The odontoma is a developmentally induced, tumor-like malformation of the

dental lamella. Due to its limited and slow growth, the lesion is considered as a

hamartoma and not a true tumor. The odontomas consist either of a number of

more or less developed teeth, or a conglomerate of various dental tissues.

According to this classification, the lesions are termed either as compound or

complex odontomas. They are mostly seen in the place of a supernumerary tooth

and also at the distal end of the dental arch. Depending upon the various stages of

development, the radiographic signs will also vary, and are not always those

typically characteristic of an odontoma.

Compound odontomas are normally found at the anterior regions of the jaw

and less frequent at premolar and third molar regions. They are easily identified in

a radiograph usually near a completely developed tooth crown. When observed

early on, it can be seen as a well demarcated osteolysis and later it is surrounded

by a broad zone of radiolucency. In the later stages, there will only be a narrow

zone of radiolucency that is no longer well demarcated.

 26

FIG. 3.12 The periapical radiograph of a partially luxated tooth 11 with a half-
moon-shaped radiolucency on the distal surface, including variously dense
radiopacities. This is readily identified as a calcifying odontogenic cyst.
Approximately 2 years later, a compound odontoma had developed.

FIG. 3.13 Compound odontoma that has displaced tooth 35.

For complex odontomas, they contain all basic elements of a tooth but exist as

an amorphic mass. Complex odontomas are found frequently at the angle of the

mandible and in the area of tuberosity. It is usually associated with displaced or

impacted third molar. Normally it is difficult to discern in a radiograph due to

 27

superimposition. Besides having hazy radiopacities near the occlusal surface of

displaced molar, larger spherical complex odontomas can also be surrounded by a

narrow layer of well demarcated radiolucency. Often, large complex odontomas

are surrounded by a serrated marginal contour and a broad zone of radiolucency.

FIG. 3.14 Complex odontoma on left mandibular angle.

FIG. 3.15 Complex odontoma on right mandibular angle.

 CHAPTER IV

CONCLUSION

4.1 Conclusion

Benign tumors are diseases that are harmful to all sufferers. The treatment is

administered in patients with tumors very dependent on the type of tumor , the

cause , also the location of the tumor to grow . If the tumor radiographic

examination in question did not have the possibility to spread , and the area is

very safe and does not cause damage to the surrounding tissue .

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 REFERENCES

White, S. C., & Pharoah, M. J. 2014. Oral radiology: principles and

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Whaites, E., & Drage, N. (2013). Essentials of Dental Radiography and

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