Radiographic Interpretation of Ameloblastoma 4m*** 2m**

    1. Slow growing = identified late 
    2. Initially, pt has asymptomatic symptoms
    3. Later develops swelling due to buccolingual expansion and come to dentist 
    4. Unilateral
    5. Mandible = posterior = Ramus/body = mc 
    6. If it occurs in anterior region = desmoplastic type = aggressive and resembles fibro osseous lesion
    7. 20% of cases seen in maxilla = can involve sinus 
    8. Epicenter = odontogenic in origin = above IAC
    9. Size = large, diffuse
    10. Borders = well defined 
    11. Internal structure =
      1. Multilocular
      2. septa are small and round = honeycomb appearance 
      3. Septa are large and round = soap bubble appearance
      4. Septa are curved and round
    12. Displace IAC inferiorly 
    13. Root resorption = Knife edge resorption
    14. Lower border of mandible = thin egg shell appearance due to aggressive expansion


  1. Acute periapical abscess
    1. Swelling
    2. Vertical pain = tenderness on percussion
    3. Vestibular tenderness and obliteration = pathognomonic sign
    4. Widening of PDL = Only feature. It takes time for r/g features to develop, by that time acute has been converted into chronic
  2. Chronic Periapical abscess
    1. Carious tooth 
    2. Sinus tract = pus will come out
    3. Hence, there will be a breach in the continuity of lamina dura
    4. Diffuse, ill-defined radiolucency surrounding root apex
  3. Periapical Granuloma
    1. Granuloma is made up of granulation tissue. It is formed due to new vascularizations.
    2. May or maynot be corticated
    3. Size is less than 1.5 cm in diameter
    4. Well defined
  4. Periapical cyst
    1. Well defined 
    2. Surrounding corticated or sclerotic border
    3. Size is more than 1.5 cm 
  5. Infected Cyst
    1. Partially well defined 
    2. Corticated border = evident only in few areas
    1. Site = mandibular anteriors
    2. Teeth = vital
    3. Multifocal 
    4. Appearing as periapical radiolucency
    5. RL = initial stage
    6. Mixed = intermediate stage
    7. RO = mature stage
  7. Phoenix abscess
    1. Acute exacerbated phases of chronic periapical abscess
    2. Pt complains that Every 6 months, swelling and pain
    3. Pulp is non vital
  8. Lateral periodontal Cyst

Case History 2 – Diseases of bone and the maxillary sinus

A 60-year-old man has been treated for a T2N0M0 squamous-cell carcinoma by radical radiotherapy. He has a history of chronic alcoholism and was a heavy smoker. Six years after treatment, he develops a painful ulcer in the alveolar mucosa in the treated area following minor trauma. His pain worsens and the bone became progressively exposed. He is treated by a partial mandibular resection with graft.

  1. What diagnosis is most likely?
    The features suggest osteoradionecrosis. Recurrent carcinoma is possible but less likely.
  2. How does radiotherapy damage tissues and what structural features might be seen in the bone?
    Radiotherapy damages tissues by producing free radicals. DNA damage may prevent cell division and repair. Endoarteritis obliterans results in reduced vascular supply to the tissues. Bone may become necrotic, showing osteocyte death, sequestration and breakdown of the matrix. Infection may result in osteomyelitis
  3. What changes may arise in irradiated connective tissues 10 years after exposure?
    Mutations and other genetic damage may lead to neoplasia in irradiated tissues. Osteosarcoma can arise in this way.