HYPERPLASIA

Rakenzon Adhi Sakti Santosa

160110120121
 CLINICAL FEATURES
• Characteristics:
• Insidious onset and grow slowly.
• Painless
• Do not metastasizes.
• Not life-threatening.
• Not invasive.
• Benign tumors are usually detected by enlargement of the jaws during
radiology examination.
 RADIOLOGIC EXAMINATION
• Preliminary diagnosis:
• Panoramic
• Intra-oral
• Occlusal
• Central Bone Lesions:
• Computed Tomographic (CT)
• Soft Tissue Lesions:
• Magnetic Resonance Imaging (MRI)
 IMAGING FEATURES
• Location:
• The location of particular neoplasm is important to establish diagnosis.
• Periphery and Shape:
• Borders of benign tumors usually smooth, well-defined, sometimes
corticated.
• Sometimes radiolucent of soft tissue or capsule-shape form.
• Internal Structure:
• Completely Radiopaque
As a result of residual bone, reactive bone formation, or calcified materials.
• Completely Radiolucent
As a result of soft tissue enlargement.
• Mixture of Radiopaque and Radiolucent
• Effect of the Surroundings
• Benign tumors exerts pressure of neighboring structures, resulting in the
displacement of the teeth or bony cortices.
• The root of the teeth may be resorbed by either benign or malignant tumors,
but resorption are more commonly by benign process.
 TORUS PALATINUS HYPERPLASIA
• Disease mechanism:
• Hyperostosis that occurs in midline of hard palatum.
• Clinical Features:
• Bony nodule extends of the hard palate.
• Bulk reaches downwards into oral cavity.
• Flat, nodular, mushroom-like lesions.
• Imaging Features:
• Radiopaque shadows in the periapical or panorcamic images,
• Radiopaque shadows with well-defined border and lobulated outline.
• Internal aspect is homogenously radiopaque.
 TORUS MANDIBULARIS
HYPERPLASIA
• Disease Mechanism:
• Hyperostosis that protrudes from lingual aspect of alveolar mandibular
alveolar aspect, usually near the premolars.
• Clinical Features:
• Can be single or multiple, bilateral or unilateral.
• The lesions appear like torus palatinus.
• Imaging Features:
• Radiopaque shadows in periapical image, and usually superimposed of three
teeth.
• Less dense and less well-defined at posterior rather than anterior.
• On occlusal images, it appears homogenously radiopaque.
 HYPEROSTOSIS
• Disease Mechanism:
• Small regions of osseous of hyperplasia of cortical bone.
• Clinical Features:
• Most commonly on the buccal surface of maxillary alveolar.
• Imaging Features:
• Most common in maxillary alveolar process.
• Overlap the root of adjacent teeth.
• Well-defined and curved border.
• The internal structure is homogenously radiopaque.
 DENSE BONE ISLAND
• Disease Mechanism:
• Localized growth of compact bone.
• Clinical Features:
• Asymptomatic.
• Imaging Features:
• More common in mandibula.
• Occur in premolar-molar area.
• Usually well-defined, but sometimes blend with surrounding structures.
• Has no regular shape.
• Usually radiopaque depends on location and thickness.
 REFERENCE
• White, S. C., & Pharoah, M. J. 2014. Oral radiology: principles and
interpretation. Elsevier Health Sciences.
BENIGN
AMELOBLASTOMA
Syed Abdul Kadir Al- Haddad
160110123004
Ameloblastoma
 Ameloblastoma Preameloblasts

‰ Benign neoplasm of preameloblasts

-- Epithelial rests of dental lamina
-- Basal cells of alveolar mucosa
-- Cyst lining epithelium

‰ GALP:
-- None
-- Any age, usually 30-50 years
-- Posterior mandible
-- Most common of “aggressive”
odontogenic tumors
 Ameloblastoma
Radiographic/Clinical Features
‰ Multilocular (soap bubble)
radiolucency
-- May be unilocular
‰ Well demarcated borders
‰ Expands, thins cortex
‰ Asymptomatic
 Ameloblastoma
Radiographic Features

‰ May extend far into ramus

‰ May fill maxillary sinus
‰ May be huge
Ameloblastoma
 Ameloblastoma
Radiographic Features

‰ Often associated with crown of unerupted tooth

‰ Often resorbs adjacent roots
‰ May push roots aside
‰ May push whole tooth
 Ameloblastoma
Treatment & Prognosis
‰ Enucleation: >50% recurrence rate
‰ En bloc resection: <15% recurrence rate
‰ ↑ Cystic > ↑ prognosis
‰ Main problem: local destruction
-- May invade through base of skull
-- May wrap around neck structures
‰ Rarely: piece breaks off @ surgery: aspirated
-- Ameloblastoma grows in bronchial tree
Ameloblastoma
Variants
‰ Unicystic ameloblastoma
-- Intraluminal ameloblastoma
-- Mural ameloblastoma

‰ Peripheral ameloblastoma
-- Extraosseous ameloblastoma

‰ Desmoplastic ameloblastoma
 Ameloblastoma
Variants

‰ Unicystic ameloblastoma
-- Intraluminal ameloblastoma
-- Mural ameloblastoma

‰ Peripheral ameloblastoma
-- Extraosseous ameloblastoma

‰ Desmoplastic ameloblastoma

‰ Ameloblastic carcinoma

‰ Malignant ameloblastoma
 Unicystic Ameloblastoma

‰ 15% of all ameloblastomas

‰ Degenerated “ basket weave” cyst lining
‰ Unilocular radiolucency only
‰ Resembles dentigerous cyst
‰ Younger persons
-- Avg. age = 23
years
‰ Much less aggressive
ameloblastoma
than regular
 Peripheral Ameloblastoma
Extraosseous Ameloblastoma

‰ 1% of all ameloblastomas
‰ Same histology as internal ameloblastoma
‰ Mass on gingiva
-- Sessile
-- Asymptomatic
‰ Minimal growth potential
-- < 1 cm. diameter
‰ May cup out underlying cortex
-- Saucerization

‰ Conservative surgical removal

‰ Almost no recurrence rate
 Desmoplastic
Ameloblastoma

‰ Dense fibrous stroma

-- Transforming growth
factor ß
‰ “Squished” epithelial islands
‰ --Mixed
Fromradiolucent/radiopaque
bone stimulation
‰ Moth-eaten radiolucency
‰ Usually not multilocular
‰ Maybe less aggressive
than regular ameloblastoma
Title Oral and Maxillofacial
Pathology
Authors Angela C. Chi, Douglas D.
Damm, Brad W. Neville, 
Carl M. Allen, Jerry Bouquot
Edition 3, revised
Publisher Elsevier Health Sciences,
2008
ISBN 1437721974,
9781437721973
Length 984 pages
Subjects Medical
 › Dentistry
 › General

Medical / Dentistry / Genera

l
 CALCIFYING EPITHELIAL
ODONTOGENIC TUMOR
• Also known as CEOT or Pindborg tumor
• Usually located within bone and produce a mineralized substance within
amyloid- like material
• Occur between age 30 and 50
• Male and female affected equally
• Recurrence is not common
• Has a distinctive microscopic appearance with epithelium that resembles
the stratum intermedium of the enamel organ
• Radiographically it appears as a well demarcated, cystoid radiolucency in
which an impacted tooth is enclosed initially
• In later stages, one observes expanding, calcified, or also spherical
radiopacities
• The compact bone and bordering lamellae of the maxilla are distended
and thinned
• The mandibular canal is displaced
 ODONTOMA
• Developmentally induced, tumor-like malformation of the dental lamella
• It is considered as a hamartoma and not a true tumor
• Consist either of a number of more or less developed teeth, or a
conglomerate of various dental tissues.
• The lesions are termed either as compound or complex odontomas
• Mostly seen in the place of a supernumerary tooth and also at the distal
end of the dental arch
• Radiographic signs vary depending upon the various stages of
development
• Not always those typical characteristic of an odontoma
 COMPOUND ODONTOMAS
• Compound odontomas are normally found at the anterior regions of the
jaw
• Less frequent at premolar and third molar regions
• Easily identified in a radiograph usually near a completely developed
tooth crown
• At early stage, it can be seen as a well demarcated osteolysis which is
then 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
 COMPLEX ODONTOMAS
• Contain all basic elements of a tooth but exist as an amorphic mass
• Found frequently at the angle of the mandible and in the area of
tuberosity
• Usually associated with displaced or impacted third molar
• Difficult to discern in a radiograph due to superimposition
• 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