Bone Pathology

1. Bone Pathology Brent D. Martin D.M.D. Feb. 22, 2011

2. Paget’s Disease • Aka: Osteitis Deformans • Common, benign, and chronic • Gradual enlargement, distortion, and weakening of affected bones • Abnormal resorption and deposition of bone

3. Paget’s Disease • Usually polyostotic(more than 1 bone) • Adults age 40 and older • Bone pain —disease near joints can mimic arthritis

4. Paget’s Disease • Vertebrae, pelvis/femur, and skull are most commonly affected • Jaws affected in 20% of cases! (maxilla> mandible) • Hat, dentures “don’t fit” or “too tight”

5. Paget’s disease

6. Paget’s Disease • Radiographs: • Irregular, sclerotic bone • “cotton wool” apperance of bone • hypercementosis of teeth • Diagnosis: biopsy and blood studies

7. Paget’s disease

8. Paget’s disease

9. Paget’s Disease • Blood studies: elevated serum alkaline phosphatase • Treatment: • Analgesics • Drugs that reduce bone turnover: Bisphosphonates (same meds used to treat osteoporosis)

10. Paget’s Disease • Prognosis: Patients have an increased risk of developing osteosarcoma

11. Fibrous Dysplasia • Uncommon, benign, chronic bone disease • Replacement of bone by fibrous connective tissue intermixed with delicate bony trabeculae • Usually monostotic (affects only 1 bone)

12. Fibrous Dysplasia • Teenagers and young adults (usually under age 20) • Painless, gradual enlargement of the affected bone

13. Fibrous Dysplasia • Jaws are commonly affected (maxilla > mandible) • Radiographs: “ground or frosted glass” appearance that blends with surrounding normal bone • Biopsy to confirm diagnosis

14. Fibrous Dysplasia • Treatment: surgical reduction (cosmetic) • 25-50% will have regrowth, so treatment should be delayed as long as possible (preferably until growth has stabilized after adolescence)

16. Fibrous dysplasia

18. Cemento-ossifying fibroma • Uncommon, benign neoplasm of bone • Consists of fibrous connective tissue that produces calcifications resembling bone and/or cementum • Young adults (20s-30s)

19. Cemento-ossifying fibroma • Mandible >> maxilla • Molar/premolar location • Large lesions can cause significant expansion of the jaw! • Asymptomatic

20. Cemento-ossifying fibroma • Radiographs: Unilocular, well-defined radiolucency with varying amounts of radiopaque flecks/masses • May cause diverence of adjacent tooth roots • Diagnosis: biopsy and radiographic appearance

21. Cemento-ossifying fibroma

25. Cemento-ossifying fibroma

26. Cemento-ossifying fibroma • Treatment: Surgical removal • Usually “shells out” easily from surrounding bone • No recurrence

27. Osteoma • Uncommon, benign neoplasm of bone • Occurs in JAWS and SKULL only! • Young adults (under 20)

28. Osteoma • Mandible > maxilla • Condyle often affected • Can arise either within the bone or on the surface/cortex

29. Osteoma • On surface: asymptomatic mass (unless jaw movement is affected due to a lesion on the condyle) • Within bone: incidental radiographic finding • Radiographs: well-defined radiopaque mass

30. Osteoma

31. Osteoma

33. Osteoma • Diagnosis: biopsy and radiographic appearance • Treatment: surgical removal • No recurrence • Multiple osteomas associated with Gardner’s syndrome

34. Gardner’s syndrome • Multiple osteomas • Impacted and supernumerary teeth • Skin: epidermoid cysts

35. Gardner’s syndrome • Intestinal (colon) polyps—these become cancerous!! • 50% of these patients will develop colon cancer by age 30 (prophylactic colectomy is often done for these patients)

36. Epidermoid cysts

37. Gardner’s syndrome (colon polyp)

38. Cementoblastoma • Rare, benign neoplasm of cementoblasts • PDL origin • Kids and young adults (under 30) • Pain and swelling in 2/3 of cases

39. Cementoblastoma • Mandible > maxilla • Mandibular first molar most commonly affected • Vital tooth! • Lesion fused to root

40. Cementoblastoma • Radiographs: • Radiopaque mass that obscures the apex • Radiolucent rim around sclerotic mass • No PDL visible where tumor is fused to the root • Diagnosis: Characteristic radiographic features + biopsy

41. Cementoblastoma • Treatment: surgical removal of tooth (or affected root) with attached tumor • No recurrence

42. Cementoblastoma

45. Periapical cemental dysplasia • Common, benign lesion of bone • Lesion is composed of: • Cellular fibrous connective tissue • Varying amounts of calcifications resembling bone and/or cementum • Asymptomatic

46. Periapical cemental dysplasia • FEMALES!! (esp. blacks) • Age 30-50 • Anterior mandible— periapical region • Affected teeth are VITAL

47. Periapical cemental dysplasia • Progression over time: radiolucent mixed RL/RO  radiopaque • Diagnosis: Clinical setting (vital teeth) + characteristic radiographic appearance • Biopsy if unsure of diagnosis • Treatment: None other than routine radiographic follow-up