copyright © 2004 by a. ruprecht the radiology of benign neoplasms a. ruprecht d.d.s., m.sc.d.,...
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Copyright © 2004 by A. Ruprecht
The
Radiologyof
Benign NeoplasmsA. Ruprecht D.D.S., M.Sc.D., F.R.C.D.(C,), Dip. A.B.O.M.R.
Professor and Director of Oral and Maxillofacial RadiologyProfessor of Radiology
Professor of Anatomy and Cell BiologyThe University of Iowa
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Poorly DefinedWell Defined
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Corticated
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Space Occupying vs. Non-Space Occupying
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Space Occupying
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Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Well defined Corticated Space occupying Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Displacement of teeth Directional resorption of teeth Displacement of anatomical structures
The Radiology of Benign Neoplasms
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Copyright © 2004 by A. Ruprecht
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Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
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Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
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Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
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Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
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Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Copyright © 2004 by A. Ruprecht
Displacement of periosteum
Internal structure: trabeculae & calcification
Unilocular / multilocular
The Radiology of Benign Neoplasms
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Copyright © 2004 by A. Ruprecht
Cyst orBenign Neoplasm Benign Neoplasm Malignant Neoplasm
The Radiology of Benign Neoplasms
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The
Radiologyof
Benign Neoplasms
I. Odontogenic
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• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
The Radiology of Benign Neoplasms
Odontogenic
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• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
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Dental Lamina Ameloblastoma
Enamel organ Adenomatoid
Odontogenic Tumor
Root sheath of Hertwig Ameloblastic fibroma
Dental Lamina
Odontoma
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• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Ameloblastoma
• Age: 20 - 50 years (predominantly 30s and 40s)
• Mandible:Maxilla = 85:15• 60% mandibular molar-ramus area
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Ameloblastoma
10%
10%
3%2%
15%60%
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Ameloblastoma
• Unilocular• Multilocular (coarse septa)
Soap bubble
Honeycomb
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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Ameloblastoma
• Displacement or resorption of teeth• Extends beyond radiographic limits• Superior aspect often lost
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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Keratocyst -> Ameloblastoma
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht July 26, 1973
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht March 8, 1974
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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Simple Bone Cyst -> Ameloblastoma
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht February 5, 1966
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht December 29, 1967
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht July 19, 1968
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht January 11, 1969
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht July 14, 1969
The Radiology of Benign Neoplasms
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Recurrent Ameloblastoma
The Radiology of Benign Neoplasms
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Recurrent Ameloblastoma
• radiolucent areas• circular pattern
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Squamous odontogenic tumor(SOT)
The Radiology of Benign Neoplasms
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Squamous odontogenic tumor (SOT)
• Age: 10s - 60s years (mean of 40)• Mandible:Maxilla = 1:1• alveolar process area• from rests of Malassez?
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• radiolucent• well-circumscribed• semilunar• associated with roots of teeth
Squamous odontogenic tumor (SOT)
The Radiology of Benign Neoplasms
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• locally invasive• recur with conservative treatment• excision is treatment of choice
Squamous odontogenic tumor (SOT)
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
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Adenomatoid odontogenic tumor(AOT)
The Radiology of Benign Neoplasms
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Adenomatoid odontogenic tumor(AOT)
• 10-20 (18 years of age)• anterior maxilla or mandible• radiolucent or with radiopaque foci• may mimic dentigerous cyst
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Calcifying epithelial odontogenic tumor (CEOT)
The Radiology of Benign Neoplasms
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Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor)
• 10-90 (mean 40)• maxilla:mandible = 1:2• ramus-molar region
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Calcifying epithelial odontogenic tumor (CEOT, Pindborg tumor)
• usually associated with impacted teeth• unilocular or multilocular• radiolucent or with radiopaque foci
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Clear cell odontogenic tumor
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Clear cell odontogenic tumor
• rare• 60 years of age• females• maxilla or mandible
The Radiology of Benign Neoplasms
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Clear cell odontogenic tumor
• radiolucent• poorly circumscribed• locally aggressive
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial
Ameloblastoma
Squamous odontogenic tumor
Adenomatoid odontogenic tumor
Calcifying epithelial odontogenic tumor
Clear cell odontogenic tumor
[Melanotic neuroectodermal tumor of infancy]
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Melanotic neuroectodermal tumor of infancy
The Radiology of Benign Neoplasms
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Melanotic neuroectodermal tumor of infancy (MNTI)
• rare• young, usually first year of life• anterior maxilla• moderately well circumscribed,
around apical area of roots
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Compound odontoma
Complex odontoma
Odontogenic
The Radiology of Benign Neoplasms
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Ameloblastic fibromaAmeloblastic fibro-odontomaCompound odontomaComplex odontoma
The Radiology of Benign Neoplasms
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–>Compound Odontoma Ameloblastic Fibroma–>Ameloblastic Fibro-odontoma –>Complex Odontoma
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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Ameloblastic Fibroma
primitive myxoid connective tissue
resemblance to dental pulp
strands of odontogenic epithelium 2 cells wide
Ameloblastic Fibro-odontoma
primitive myxoid connective tissue
resemblance to dental pulp
strands of odontogenic epithelium 2 cells wide
cells differentiate to produce enamel and dentin
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Ameloblastic Fibro-odontoma
prominent enamel matrix often seen before final maturation of hard tissue
enamel and dentin in the form of compound or complex odontoma
Compound Odontoma
Complex odontoma
prominent enamel matrix often seen before final maturation of hard tissue
enamel and dentin in the form of compound or complex odontoma
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial with induction
Ameloblastic fibroma
Ameloblastic fibro-odontoma
Odonto-ameloblastoma
Odontogenic
The Radiology of Benign Neoplasms
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Odonto-ameloblastoma
The Radiology of Benign Neoplasms
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Odonto-ameloblastoma
• rare• young, first decade• ameloblastoma component• odontoma component
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Epithelial• Epithelial with induction/Mixed
(epithelial and mesenchymal)• Mesenchymal
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Mesenchymal
Odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Mesenchymal
Odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Odontogenic fibroma• Central odontogenic fibroma• Peripheral odontogenic fibroma
The Radiology of Benign Neoplasms
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Central odontogenic fibroma
The Radiology of Benign Neoplasms
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Central odontogenic fibroma
• rare• all age groups• radiolucent• usually unilocular
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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Peripheral odontogenic fibroma
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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• Mesenchymal
Central odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
The Radiology of Benign Neoplasms
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Odontogenic myxoma
The Radiology of Benign Neoplasms
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Odontogenic myxoma
• 10-50 years (15-35, mean 30)• maxilla:mandible 1:1 • may be infiltrative and aggressive
The Radiology of Benign Neoplasms
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Odontogenic myxoma
• “tennis racket” appearance
(neither coarse nor fine septa)• cortical expansion• root displacement rather than resorption
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Mesenchymal
Central odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
The Radiology of Benign Neoplasms
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Benign cementoblastoma
The Radiology of Benign Neoplasms
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Benign cementoblastoma
• second or third decade, usually before 25• continuous with root , which is resorbed• pulp vitality unrelated
The Radiology of Benign Neoplasms
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Benign cementoblastoma
• radiopaque mass• surrounded by radiolucent line• surrounded by radiopaque line
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
• Mesenchymal
Central odontogenic fibroma
Odontogenic myxoma
Benign cementoblastoma
Cementifying fibroma
Odontogenic
The Radiology of Benign Neoplasms
Copyright © 2004 by A. Ruprecht
Cementifying fibromaOssifying fibroma
Cemento-ossifying fibroma
The Radiology of Benign Neoplasms
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Cementifying fibroma
• all age groups, mainly around 40• radiolucent, mixed, radiopaque• usually unilocular
The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms
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The Radiology of Benign Neoplasms