Central odontogenic
myxoma
No capsulated,
No metastasize
scalloped between roots,
25% recurrence,
10-30y,
unilocular (if small) or
multilocular (if large),
well corticated,
(Tennisracket
/stepladder Pattern),
straight septa,
displace roots and cortices.
Central odontogenic fibroma Cemento-ossifying fibroma fibroma of bone Fibrosarcoma
(fibro-cemento-osseous tumors)
simple type =  fibrous tissue +  Fibrous tumor + abnormal bone Non odontogenic malignant fibroblast tumor,
cells. and cementum like tissues, Fibroblast benigne pathologic fracture, Male=
WHO type =  cells, dysplastic  bone  ossifying fibroma. tumor, Female,
dentin, Cementumcementifying aggressive, infiltrate bone marrow spaces,
cementum, fibroma. produce more collagen
osteoid. Female >Male, fibers, tooth → floating in space,
Juvenile ossifying fibroma: PDL space widening
Very aggressive form, 1-20y.
Young adult, 20y (14y), 40y,
Mandible >1 Maxilla, posterior area,
unilocular, Round. unilocular or
multilocular (if large),
well defined, ill defined
well corticated, well corticated + Non Corticated
RL rim, (sunray- hair on end),
R.Lmixed
(wispy, stretched cotton tufts, RL, Mixed (residual or reactive
large heavy snow flaks (may bone) RL,
have cementicles))R.O (later)
displace roots, cortices. displace cortices Absorbs cortices,
perforate cortices,
invade soft tissue
1
 Unicystic multicystic Ameloblastoma Ameloblastic fibroma Ameloblastic Fibroodontomas Ameloblastic carcinoma
ameloblastioma Malignantameloblastoma
Mural unicystic. dental organ, or 50% un erupted tooth, Ameloblastic fibroma + Male > Female, scalloping
Dentigerous cyst lining, dentigerous cyst lining, scattered enamel and dentin, borders,
Aggressive Male=Female, Bodily tooth movement,
10% recurrence, Men, black, unerupted tooth, loss of lamina dura.
Rare,
Mandible > Maxilla. Posterior area,
20-30 y. 3-80y, 5-20y. 10-60 y,
unilocular, Unilocular (early), multilocular (late),
well defined, well corticated. corticated,
large, R.L, RL or Mixed (Honeycomb, RL, RL Mixed ( R.L), RL or Mixed (Honeycomb,
soap-bubble) soap-bubble),
RO septa, RO Enamel and dentin. RO Thick bony septa

displace and resorbe cortices, (thin eggshell cortex)(invading soft tissue), root resorption,

2
 CoC/ Gorlins cyst: CEOT ( Pindborg tumor):
benign tumor, odontogenic epithelium origin, 1-3 cm,
displace roots, cortices (may resorbe).
benign tumor (WHO),
Uncommon, less aggressive,
Central 40y. Female, maxilla. Male>Female,
Peripheral:
10-19y and 30-50y,
during 70y.
Mandible > Maxilla, 2 mandible: 1 maxilla,
12345/12345, posterior area,
Pericoronal to impacted teeth,
unilocular unilocular (round)
or multilocular,
Well defined,
RL  Mixed RL Mixed
(dysplastic dentine) (RO foci of mineralization within amyloid
salt & pepper pattern R.O like materials,
driven snow)
Well corticated, variable cortication,

Osteoma Osteoid osteoma Giant osteoid osteoma Gardners syndrome osteomas

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 (Osteoblastoma)
benign tumor, Benign osteoblast tumor, Rare Gardners syndrome: AHereditary
Small, Rare, Benign osteoblast tumor, familial multiple polyposis =
Cartilage Or Periosteal Origin, unknown etiology, Tooth bearing areas, Multiple
lingual side of ramus, inferior border, Newly formed trabeculae Condyle, *osteamas *enostosis *unerupted
condyle, coronoid, at outer cortex. Spin supernumerary teeth *polyps of
Types *severe bone pain More aggressive, intestine (small, large) *sebaceous
1-Ivory Osteoma (Compact Bone), removed by cysts *subcutaneous fibromas.
Male predominance Antinflammatory drug, * Less painful, NB. Polyps will be malignant.
2- Cancellous osteoma (Endosteal & The osteoma:
Periosteal) female predominance. 2 Male : 1 female may occurs alone, may not occurs.
3- Combination. Developed before polyps.
5 or more enostosis = syndrome.
Any age,  40y, 10-25y, 20-30y, at 20y,
Mandible > Maxilla. rare in jaws, Frontal bones, jaws,
mandibular body,
Single Or multiple unilocular Unilocular (oval/round), Unilocular (oval/round), Multiple unilocular
(like in Gardner's Syndrome). 1-5 cm.
Well defined
well corticated. May corticated,
R.O = Mixed *RL- Mix- RO nidus, RLMixRO,
*RL rim (soft tissue capsule).

4
 Hodgkin's lymphoma:
lymphoid tissue malignant tumor,
arise from lymph node or extranodal
origin.
20-25% of lymphoma,
mainly nodal origin, characterized by
presence of Reed-Sternberg cells.
2 peaks 20y-60y.
painless L.N. enlargement, fever, night
sweat, weight loss, itch,
The traditional division between Hodgkins
and non-Hodgkins lymphomas has been
challenged but remains of clinical
importance.
Non Hodgkin's lymphoma:
lymphoid tissue malignant tumor,
75% arise from lymph node.
common at L.N (5 cases at non-nodular area),
70-80 % of lymphoma,
90% B cell lymphoma,
10% T cell lymphoma,
10-80y, types
1-Low grade 2-intermediate grade 3-high
grade,
painless swelling, lymphadenopathy, fever,
night sweats, weight loss, Soft tissue spaces
growing habit.
unilocular (Round) or multilocular,
ill defined, non corticated.
RL ( rare Mixed).
Finger like extensions, invasive,
May periosteal reaction.
Rapid tooth, loosening  exfoliated, appear
float in air, PDL space widening, Loss of
adjacent lamina dura& cortices, , Pathologic
fracture.
5
Burkitt's lymphoma (Mrican jaw lymphoma):
high grade B-cell lymphoma, types
1-American form: no jaw involvement
2-African form: common with AIDS, related to
Epestin-Barr virus, jaw involvement,
children,
Male>female,
Rapid tumor (24 hour doubling time),
Facial deformity,
Paresthesia,
tooth loose.
Multiple = be coalesce large.
Ill defined, Non corticated,
RL,
gross balloon like alveolar expansion,
Rapid tooth, loosening  exfoliated, appear float in
air, PDL space widening, loss of adjacent lamina
dura & cortices, Pathologic fracture.
All tumors and cysts are unilateral.

punched out or scooped out

*Histocytosis X (alveolar lesion start at midroot, ice cream scoop appearance)
*Plasma cell tumor/ plasmacytoma /Multiple Myeloma:

Sun ray, Hair on end

New bone specules formed at periosteum perpendicular to original cortex
Skull: sickle cell anemia, thalasemia.
Involved bone with tumor: osteosarcoma, fibrosarcoma, chondrosarcoma, ± Ewing sarcoma.

Lamina dura loss

Locally: malignant tumors, CGCG, Fibrous dysplasia.
Generally: Systemic bone diseases (Osteoporosis, Hyperparathyroidism)
Thick lamina dura: Osteopetrosis.

Periodontal ligament space

Thick, wide (generalized): Osteopetrosis, Scleroderma. Periodontitis: Ehler Danoles, Dawon, Papilon Le Fever,Cohen, Chediak Higashi,
Kindlers syndromes
Thin (localized): Fibrous dysplasia area, non functional teeth.

Cross the midline. Central giant cell granuloma,

-Any lesion of bone destruction that has ill-defined borders and lack of peripheral bone sclerosis should be suspect to be malignant.

Osteoclast Osteoclast
function activity
 parathyroid Hyperparathyroidism.  
 Glucocorticoid (cortisole) Cushings  
syndrome.
Unknown cause  Pagets disease. 
Hereditary  Osteopetrosis. 

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 Gas detector Charged couple device CCD CMOS
Large metallic chamber divided into many Direct CCD: Thin wafer of silicon chip divided
small chambers of 1 mm dimensions, having Thin wafer of silicon chip divided into 2 dimensional into 2 dimensional array of pixels,
Xenon or Xenon-Krypton gases under pressure. array of pixels, each pixel (20-70 microns) connected each pixel connected directly to a
Gas ionization directly to a readout and amplifying electronic circuit. transistor.
By X ray Indirect CCD:
Proportional to radiation dose. Like direct CCD +intensifying screen that may be
Converted into electrical charges. connected directly to the silicon chip or indirectly by lens
or fiberoptic.
Flat panel detector FPD Photostimuable phosphor plate PSP Xeroradiography
Direct FPD: 1- bar code layer. Xeroradiographic plate:
Selenium plate divided into pixels, each pixel 2- backing layer. Thin layer of selenium on a
(less than 100 microns) connected directly to a 3- support layer. luminum support.
thin film transistor. 4- conductive layer.
5- reflective layer.
Indirect FPD: 6-phosphor layer,(Barium flurohalide family or
Like direct FPD + intensifying screen Europium-doped Barium flurohalide).
connected directly to the selenium plate. 7- protective layer.
All are solid state detectors except PSP.

Double emulsion Film Intensifying screen

1-protective (overcoat) layer. 1-plastic base.
2- emulsion layer. 2-reflective layer. May not found.
3- adhesive layer., 3- phosphor layer.(calcium tungestate, Rare earth,
4- plastic base. Yttrium)
5- adhesive layer. 4-protective (overcoat) layer.
6- emulsion layer.(silver halide).
7-protective (overcoat) layer.

7
 Radiation
Natural (background) (3.6 mSv/y) Atrificial (17% of annual E)
External (16% of annual Internal Medical Others
E) diagnosis &
treatment
(11%) Consummer
Cosmic Terrestrial Radon Others Denta Non & industerial Strontium Iodine 131 Nuclear
(8%) (8%) (0.3%) dental products , 90 power
l sources (3
Radon  Water %) Β ɣ
products  soil Food Ca teeth, thyroid
α ray Nut bone

8
 1-True anteroposterior Not used in dentistry
2- Cephalometric
Anteroposterior
3- Modified anteroposterior TMJ (bone mediolateral)
(town’s view for TMJ)
4- Submentovertex (SMVor base of the skull, sphenoidal sinuses
Anteroposterior views

basal projection) determine the angulation of condylar head long axis –

corrected lateral tomography

5- Transorbital TMJ view TMJ (bone mediolateral)

Open mouth
-Open mouth maximally for better
condylar head and neck assessment.
-If mouth not opened maximally only
assess condylar neck
6- Tangential view for parotid parotid gland
gland
Posteroanterior views

1- Postero-anterior of the skull skull vault, primarily the frontal sinuses and bones
(occipitofrontal (OF).

2- Cephalometric posteroanterior
skull
3- Posteroanterior of mandible Mandibular posterior parts
(PA mandible)

4- Cephalometric posteroanterior
jaws

9
5- Standard occipitomental (0° Middle third facial skeleton,
OM) Modified posteroanterior Closed mouth: assess maxillary, frontal, ethmoid sinuses.
(water view for sinus) Opened mouth: assess maxillary, frontal, ethmoid, and sphenoid sinuses.
Mouth Open & Closed

6- Reverse towne’s (TMJ view) TMJ (bone mediolateral)

posteroanterior 15-20

Open mouth -Open mouth maximally for better condylar

head and neck assessment.
-If mouth not opened maximally only assess
condylar neck

7- 30° Occipitomental (30° OM) Middle third facial skeleton, and coronoid
process.

8- Rotated postero-anterior parotid gland and the ramus of the mandible, Submasseteric infection
(Rotated PA)

10
 1- True lateral skull (dead
lateral)
2- Cephalometry lateral skull
Lateral views
3- Lateral Oblique
6- Transcranial (lateral
oblique 25)
mouth open &closed
2- Cephalometry transcranial
skull vault and facial skeleton from the lateral aspect.(cranium, cranial base, sella turcica, sphenoid, frontal maxillary
sinuses)
1- Lateral oblique of mandibular body mandibular body and molars
2- Lateral oblique of mandibular ramus ramus, third molar, angle, condyle.
3- Cephalometric lateral oblique of mandible (body & ramus) by ruler 45 °, 60 °)
4- Lateral oblique mandibular molars of one side
5- Lateral oblique Maxillary and mandibular molars of one side
6- Lateral oblique Bimolar (upper and lower molars of both sides at one film)
7- Lateral oblique Maxillary and mandibular canine of one side
TMJ , joint space, condylar head
shape, condylar range and type of
movement.
Open mouth: range of condylar
movemement & comparison of it.
Closed mouth: Joint space size,
disk position and shape, condylar
position in fossa, comparison.
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 4- Lateral TMJ views
3- Transpharyngeal (infracranial/ Sagittal view of
Macqueen-Dell/ parma) condylar medial pole

Open mouth

4- corrected tomography
5- corrected lateral tomography
6- arthrography.

Open mouth techniques (transpharyngeal, transorbital, reverse town)

Open and closed mouth techniques (transcranial, waters )

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