Transcript 牙放seminar第一組

牙放seminar第一組
2.1.1-1 Periapical granuloma
2.1.2-4 Nasopalatine duct cyst
2.1.1-2 Radicular cyst
2.1.2-5 Eosinophilic granuloma
2.1.1-3 Surgical defect
2.2-1 Dental follicle
2.1.1-4 Periapical abscess
2.2-2 Pericoronitis
2.1.1-5 Osteomyelitis
2.2-3 Paradental cyst
2.1.2-1 Cementoma
2.2-4 Dentigerous cyst
2.1.2-2 Periodontitis
2.2-5 Muralameloblastoma
2.1.2-3 Trauma bone cyst
2.2-6 Adenomatoid Odontogenic Tumor
2.1.1-1
these is well-defined oval or round radiolucences without
corticated outline located at mesial root of the tooth 36 extending
to the furcation area , measuring approximately 1x1cm in
dimension. PDL widening of the mesial root of 36 is also noted.
Periapical Granuloma
•Clinical features:
asymptomatic
pain and sensitivity can develop
•病理特徵:
Periapical Granuloma 的 granulation tissue 是由三個東西組成 :
- 發炎組織 : lymphocyte 、PMN、plasma cell
-血管
-Fibrous tissue : 在發炎組織和血管的外面
•看不到epithelium lining , 沒有表皮包圍 , 只有granulation tissue 。
2.1.1-2
there is a well-defined
unilocular round shaped
periapical radiolucence
with a corticated margin
over the tooth #23
between the adjacent teeth,
extending from the distal
aspect 22 to mesial aspect
of 23, measuring 2cm in
diameter. The radiopaque
border is continuous with
the lamina dura of the
associated tooth.
Radicular cyst
•外圍是non-keratinized stratified squamous
epithelium
•有rete process增生
•hyaline body
•foamy cells
•fibrous wall會有 heavy deposits of cholesterol
crystals
Periapical granuloma 和 Radicular
cyst的不同點 :
• periapical granuloma 比
cyst常見
• Radicular cyst 比較常發
生在 upper jaw bone.
• Radicular cyst X-ray 片上
可以看到完整的lamina
dura
• Granuloma 沒有治療就會
演發成radicular cyst
• Radicular cyst發生在
nonvital tooth
2.1.1-3
Surgical Defect
• 病灶不會擴大，所以應該也不會對其他牙齒或者組織造
成任何影響
• 這是根尖切除術之後，手術的地方骨頭組織再生失敗造
成的
• 骨頭組織被fibrous tissue所取代，很常發生在apical的地方
• 在X光片下，是well-defined, radiolucence的
• 牙齒自己本身也不會有任何症狀，除非是照X光片，否
則是不會被察覺的
• 根尖切除術的術後結果；有可能會pain, hemorrhage,
swelling, ecchymosis, paresthesia, maxillary sinus
perforation。
2.1.1-4
There is ill-defined unilocular shaped radiolucence without a corticated
margin on periapcial area of tooth 14, and with a periodontal pocket on the
distal side. This maybe a combination syndrome of both endo. and perio.
with progression, the abscess may extend through the medullary spaces
away from the apical area resulting in osteomyelitis, or it may perforate the
cortex and spread diffusely through the overlying soft tissue
Apical absess
•arise as the initial periapical pathosis or from an acute
exacerbation (phoenix abscess) of a chronic periapical
inflammatory lesion.
•In the early stage, the periapical periodontal ligament
fibers may exhibit acute inflammation but no frank
abscess formation.
•best termed acute apical periodontitis.
Clinical Features
•painful tender swelling of varying size and position
•tenderness to pressure in buccal sulcus
•fever and malaise
•erythema and possibly draining sinus, intraoral or extraoral
•unresponsive to thermal and electrical stimuli
•positive percussion test
Differential diagnosis
•Periapical granuloma:
根尖處牙周膜肥厚(raiolucency)
Well-defined with a corticated radiopaque line or zone of
sclerotic bone.
•Radicular cyst:
與periapical granuloma類似，無法以radiolucency區別。
•Osteomyelitis:
poor-defined “moth-eaten” radiolucency
2.1.1-5
Osteomyelitis, periapical
•Osteomyelitis就是骨髓的發炎
•好發位置在posterior body of mandible，上顎是很少見的
•其重要的特徵就是會有sequestra的產生。
•分為 acute以及chronic
2.1.2-1
There is a well-defined
monolocular round shaped
radiolucence without a
corticated margin at the
apical area of both
mandibular central
incisors(tooth24,25)extending
from the mesial aspect of
tooth 26 to the periapical area
of tooth 24,measuring
approximately 1 cm in
diameter .the adjacent teeth
are typically vital and not
resorbed with an intact
periapical ligament space.
Cemetoma , periapical
cemento-osseous dysplasia ,
stage 1
•Middle-aged adults (typically black women )
•Monolocular , often multiple
•Early stage : radiolucent ,not corticated
•Intermediate stage : radiopacity within the apical
radiolucencies
•Late stage : densely radiopaque but surrounded by a thin
radiolucent line
•Traumatic ( solitary ) bone cyst
•Radicular cyst
•Periapical granuloma
2.1.2-2
•There is a continuous irregular radiolucence with a poor defined margin
along the apical area of the right maxillary posterior teeth (tooth 2,3,4and
5),and a well-defined round shaped radiolucence without a corticated
margin at the periapical area of tooth 4 ,with a superior margin at the
apex os the root and a inferior margin near the midle one-third of the
root,measuring approximately 1 cm in diameter.Severe bone destruction
can be observed around the roots of the teeth.
Periodontitis
•Eosinophilic granuloma
•Traumatic (solitary ) bone cyst
•Periapical granuloma
•Radicular cyst
2.1.2-3
There is a well-defined monolocular scalloped-shape
radiolucence without a cortical margin between the root of the 35
and 37 extending from the distal of 35 to the root tip of 37
squeezing along the root outline，measuring approximately 4 × 2
cm in diameter. The involved teeth from 35 to 37 are still alive
with lamina dura.
Trauma bone cyst
•well-defined (corticated)
radiolucence
•asymptomatic
•under 20 years old
•60% male
•common in the mandibular
premolar and molar areas
•margin along the root，
not push
•vital teeth
•scallop(several teeth)
•empty or fluid filled cavity
lateral periodontal cyst
Same-• male prefer
• asymptomatic
• corticated round radiolucency
• along the lateral root surface
• in alveolar bone
Different-• old ages
• often in mandibular premolar-canine-lateral incicor
area(rarely in molars)
• some are botryoid round lucency(botryoid odontogenic
cyst)
aneurysmal bone
cyst(ABC)
same—
• well defined
• unilocular radiolucency
different—
• large blood-filled spaces
• often described as "soap bubble"
• teeth moved and roots resorption
odontogenic
keratocyst(OKC)
Same—
• scalloping
• asymptomatic
different–
• wide age range
• multiple(about10%)
• teeth moved and roots
resorption
glangular odontogenetic
cyst(GOC)
same—
• painless
• scalloping
different—
• usually anterior mandible
• middle aged
• teeth moved and roots
resorption
2.1.2-4
There is a well-defined monolocular round shaped radiolucence
with a corticated margin at midline of anterior maxilla ,measuring
approximately 2x4 cm in diameter.Upper central incisors are
separated apart.
Nasopalatine duct cyst
(Incisive Canal Cyst)
•40~60 years old ; ♂＞♀
•site: midline, anterior maxilla
•Unilocular, round or oval, welldefined, well corticated (unless
infected)
•It may cause palatal expansions
•smooth cortical border
•arises from epithelial remnants
of the nasopalatine duct
• usually present in the midline of the anterior maxilla near
the incisive foramen
• many are inflamed
• pain, pressure, drainage and swelling can occur
Differential Diagnosis :
• periapical granuloma
• radicular cyst
2.1.2-5
There is a round-shaped monocular radiolucence without
corticated margin between the edentulous area,measurely
approximately 3X5 cm in diameter,extending from tooth44 and
tooth47 , Destruction of the periodontal bone (loose teeth)without
otherwise affecting the teeth (e.g. root resorption).
Eosinophilic Granuloma
Benign proliferation of
Langerhans cells.
Usually adolescents and
young adults.
Localized or multiple
lesions.
In the jaws, more than
75% in mandible.
Round, monolocular, not
corticated.
Destruction of the
periodontal bone (loose
teeth)without otherwise
affecting the teeth
Periodontitis
Radicular cyst
Squamous cell carcinoma
Metastatic tumors (ill defined)
Malignant salivary gland tumors
2.2-1
＊ There is a well-defined,
unilocular, round-shaped
radiolucence with a wellcorticated margin above
tooth22,surrouing crown
of an impacted tooth,
extending from distal
aspect of tooth 21 to
mesial aspect of tooth 24
and from the half part of
the tooth 22’s root to
alveolar bone above tooth
22. The height of the
radiolucence is about to
its width.
Dental follicle
在牙齒成長時期晚期(cap stage+bell stage)的支持組織；
牙齒萌發後轉變為periodontium上的纖維組織。
※ dentigerous cyst：
同：組成都有reduced enamel epithelium
異：後者的reduced enamel epithelium有異常增生的
現象，cyst會聚積液體不斷擴大。
＊ Dentigerous cyst有構成cyst的三個要素，是一個病理上
的構造；dental follicle只是牙齒發育時期的正常組織。
Dental follicle
※ Impaction of upper canine-- 全部牙齒發生率
No.1
※ Upper canine 阻生牙發生原因：
1. 牙弓空間不足，兩側恆齒較早萌發。
2. Lat. Incisor的牙根偏歪。
3. 乳齒的canine因蛀牙太早離開牙弓。
4. 牙胚位置不正確
5. 有dentigerous cyst或是tumor阻礙萌發
2.2-2
This radiograph is part of a panoramic one. There is a radiolucence
locating at distal aspect of tooth 38, extending from distal of the tooth 38’s
crown to the ramus of mandibular bone, measuring about 1 cm. Its height
is approximately the length of tooth 38’s crown. It’s well-defined, surrouned
by nearby soft tissue (gingiva) and the crown of tooth 38.
Pericoronitis口病特徵:
位在左側第三臼齒的遠心面外側
成因是因為下顎智齒在長成的時候牙弓已經
沒有太多的空間，牙冠生長受到上方牙齦肉的
阻礙
reduced enamelepithelium沒有辦法與oral
mucosa結合形成junctional epithelium，使牙
齦肉與牙齒無法緊密結合
Pericoronitis口病特徵:
智齒的清潔不夠徹底的話，就會導致該處牙齦
發炎，並且引起劇烈疼痛
病人有咬合困難的問題 。嚴重一點的話，發
炎的牙齦內有pus的產生，引起不適的味覺體驗。
引起的痛覺，可能會轉移到喉嚨，耳朵，口底
等處
Differential diagnosis:
Paradental cyst:
同:同樣是發生在第三下顎臼齒的遠心面外
側或facial aspect，與部份阻生的牙齒有
關。
異:它所形成的是cyst，要形成cyst有3要
素，分別是cavity，epithelium，wall。
而pericoronitis並非cyst。
Differential diagnosis:
Dentigerous (follicular) cyst :
同:與阻生牙的機率成正比，也易發生於第
三臼齒 。
異:是一種cyst，要形成cyst有3要素，分別
是cavity，epithelium，wall。鈣化好的
牙冠(crown )，被cyst給包住 。發生的
地點除智齒外，也有可能發生在upper
canine。
治療:
局限性的 ：用溫的鹽水來漱口，並時時確
保沒有食物在gingival flap內。
急性的：發生了嚴重的疼痛及發炎，就要
採取手術的方式，將智齒拔除或是
切掉gingival flap 。
2.2-3
There is a small well-defined unilocular oval shaped radiolucence
with corticated margin in the distal of the tooth 48 extending from
distal cervical margin of the tooth 48 down to superior wall of
inferior alveolar canal and up to the 1/4 ramus, measured
approximately 1x1 cm in diameter.
Paradentalcyst
病理特徵
好發位置：mandibular third molar的lateral
root surface、靠近cervical margin
致病原因：uncertain.
involved by pericoronitis (usually
lower 3rd molar).
2.2-4
There is a well-defined unilocular oval shaped circumcoronal
radiolucence with a corticated border over the submerged
tooth 48 extending from retromolar area down to the
mandibular angle, measuring approximately 1 cm in diameter.
Features of Dentigerous Cyst
•Most common odontogenic cyst, next to radicular cyst.
•Etiology
•X-ray
•Site
•P’t ages: usually adolescents, 20~40 years old.
•Eruption cyst
•Effects on adjacent tooth
•Treatment
•Progonosis
•Ameloblastic change (neoplastic transformation)
Differential diagnosis
• Mural ameloblastoma
Differential diagnosis
• Adenomatoid Odontogenic Tumor (AOT)
Differential diagnosis
• Ameloblastic fibroma
Differential diagnosis
• Paradental cyst
2.2-5
There is a well-defined unilocular irregular shaped pericoronal
radiolucence without corticated margin associated with an unerupted 38
tooth extending from distal aspect of the unerupted tooth 37 up to
approximately 2/3 left ramus and from superior border of ramus down to
left mandibular angle, measured approximately 3x3 cm in diameter.
Muralameloblastoma
病理特徵
‧arises most commonly from a dentigerous cyst
‧most common site: Mandible posterior region
‧cause root resorption of the adjacent teeth
‧屬於unicystic ameloblastoma其中一種
tumor會侵入cystic wall(fibrous tissue)，往外增
生，癒後最差
Ameloblastoma
臨床上ameloblastoma分成三大類：
• conventional / multicystic type ( 86% )
• unicystic type ( 13% )
- luminal ameloblastoma
- intraluminal ameloblastoma
- mural (wall) ameloblastoma
• Peripheral (extraosseous) type ( 1% )
Ameloblastoma
• unicystic ameloblastoma 和 conventional
ameloblastoma 的比較：
conventional ameloblastoma
Unicystic ameloblastoma
Case比例 about 86% of all cases
about 13% of all cases
Shape
multilocular radiolucence
Unicystic radiolucence
發生位置
20% in maxilla
80% in mandible
56% in mandibular molar,
ramus region
90% in ramus region
發生年齡
40、50歲的時候診斷出來，發生 18-20歲
的平均年齡大約是39、40歲左右
recurrent 50-90%
rate
10-20%
2.2-6
There is a well-defined unilocular oval shaped
radiolucence with a corticated margin. It extend from
apex of tooth 21 to apex of tooth 25 and from 3mm
below alveolar crest to nasal spine level,measuring
approximately 3 x 3 cm in diameter. It causes tooth 21
and tooth 23 unerupted, tooth 21 malposition (root
slants to mesisal) and tooth 24 slanted to distal.
Adenomatoid Odontogenic
Tumor (AOT)
• 良性腫瘤.
• 發生在年輕人.(70% 2nd
decade)
• 好發區域：上顎前牙(側門齒－
犬齒－第一小臼齒)
• 經常包住一個沒有萌發的牙齒
• 生長緩慢，無痛，長太大會使
骨頭鼓起使臉不對稱
• 2/3的病例在裡面會有
Radiopacities發生
• 治療：手術切除
Difference Disease
• Dentigerous cyst
• Dental follicle
• Mural Ameloblastoma
Full radiolucence的話只能用採樣確認
THE END