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Oral Pathology:  Bone Case #1

 

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Patient: 25 year old man

Chief Complaint:
Patient requests a routine examination.

Medical History:
No abnormalities are identified.

Dental History:
No abnormalities are identified.

Clinical Findings:
Tooth #32 is unerupted and displaced by a well circumscribed radiolucent lesion associated with the crown of the tooth.

There are no clinical images available for this case.

Radiographs
lesion radiograph lesion radiograph

 

There are no lab reports available for this case.

There are no charts available for this case.

Summary:
This lesion is a well-circumscribed radiolucent lesion with a corticated border surrounding the crown of an unerupted third molar.

Lesions to Include/Exclude:
Exclude primary diseases of bone because they are located in multiple areas of the skeleton.

Exclude inflammatory diseases because they will be associated with a source or focus for an inflammatory response, such as a non-vital tooth, periodontal disease, or fracture. Inflammatory lesions may be symptomatic.

Exclude malignant neoplasms because they are poorly circumscribed and may cause pain and/or paresthesia.

Exclude benign non-odontogenic tumors because they will not be intimately associated with the crown of an unerupted tooth.

The history and radiographic features of the lesion in this case are strongly suggestive of an odontogenic cyst or benign odontogenic tumor.

The most likely diagnosis of this lesion is dentigerous cyst, which is defined as a cyst arising from the reduced enamel epithelium surrounding the crown of an unerupted tooth.

Always include certain benign odontogenic tumors in the differential diagnosis when a lesion appears similar to a dentigerous cyst. In this case include ameloblastoma, ameloblastic fibroma, and central odontogenic fibroma. Also include lesions with a variable radiolucent-radiopaque appearance, including adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, calcifying odontogenic cyst, and ameloblastic fibro-odontoma.

Exclude the following benign odontogenic tumors:

Exclude periapical cemental dysplasia because it is located in the periapical region of one or more teeth.

Exclude odontoma and benign cementoblastoma because these lesions are radiopaque.

Management:
Treatment for this lesion is surgical excision because that will provide a definite microscopic diagnosis and may be curative. Microscopically the lesion consisted of a wall of fibrous connective tissue lined by nonkeratinized stratified squamous epithelium. It was diagnosed microscopically as dentigerous cyst.

Prognosis:
Complete excision results in cure. Recurrence is not expected, but the patient should receive follow-up of the area.