The Radiology of Dysplastic Diseases

The Radiology of Dysplastic
Diseases
The Radiology of Fibro-Osseous Diseases
The Radiology of Fibro-Calcific Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic
Diseases
A. Ruprecht D.D.S., M.Sc.D., F.R.C.D.(C)
Gilbert E. Lilly Professor of Diagnostic Sciences
Professor and Director of Oral and Maxillofacial Radiology
Professor of Radiology
Professor of Anatomy and Cell Biology
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The Radiology of Dysplastic Diseases
Fibrous Dysplasia
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
•
•
most common in younger patients
(prepubescent)
no sex predilection in general*
osteosarcomatous change unusual
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
•
Monostotic Fibrous Dysplasia (70%)
Polyostotic Fibrous Dysplasia (30%)
Jaffe type (less severe type)
 McCune-Albright type (more severe type)

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The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Monostotic Fibrous Dysplasia
involves one bone
 no extraskeletal involvement,
except, perhaps, skin pigmentation
 most frequent sites: ribs, femur,
tibia, maxilla, mandible

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The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Monostotic Fibrous Dysplasia
maxilla:
mandible said to be 2:1
bone lesion growth usually ends
with somatic growth
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The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Fibrous Dysplasia in Jaws
not common
 more maxilla than mandible
 more posterior than anterior
 unilateral involvement
 craniofacial involvement leads to
anosmia, deafness or blindness

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The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Radiologic Features
relative radiolucency depends upon age
 usually “unilocular”, may have septa
 radiopaque appearances:
ground glass on extraoral views
orange peel on intraoral views
thumb-print on intraoral views

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The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Radiologic Features
continuous with surrounding bone
 situated within bone, not appositional
 cortex thinned, displaced, but usually
continuous
 has been described as being to
radiology what syphilis is to internal
medicine, i.e. the great imposter

© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Polyostotic Fibrous Dysplasia
involves multiple bones
 most frequently involved bones:
femur, skull, tibia
 increased skin pigmentation
(café-au-lait spots)
 often monomelic, perhaps all the bones

© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Polyostotic Fibrous Dysplasia
skin and bone lesions usually unilateral
 may cause fractures and severe
deformities
 bone lesion growth usually ends with
somatic growth

© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Polyostotic Fibrous Dysplasia
•
Jaffe type (less severe type)
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Polyostotic Fibrous Dysplasia
•
McCune-Albright type (more severe type)
 various endocrine disturbances:
precocious puberty,
20q13.2
goiter,
hyperthyroidism,
hyperparathyroidism
Cushing’s syndrome,
acromegaly
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Fibrous Dysplasia
•
Polyostotic Fibrous Dysplasia

Albright type (more severe type)
 various endocrine disturbances
 mostly females
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
Cherubism
Familial Fibrous Dysplasia
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
Cherubism
•
•
•
•
rare
inherited (autosomal dominant)
limited to jaws, fullness like cherub
develops in early childhood
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The Radiology of Dysplastic Diseases
Cherubism
•
•
•
bilateral involvement of mandible
sometimes followed by bilateral
involvement of the maxilla
unilateral cases have been reported
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Cherubism
•
Radiologic Features
bilateral radiolucent cyst-like lesions
 begins in third molar-ramus area
 extends posteriorly and anteriorly
 occasionally into condyle
 maxilla usually after mandible

© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Cherubism
•
Radiologic Features
causes enlargement of jaws
 cortex remains intact
 encroach upon maxillary sinuses
 displacement of developing teeth
 early exfoliation of deciduous teeth

© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Cherubism
•
Differential Interpretation
nevoid basal cell carcinoma syndrome
 bilateral dentigerous cysts

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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
Ramon Syndrome
(Cherubism, Gingival Fibromatosis, Epilepsy,
Mental deficiency, Hypertrichosis, Stunted Growth)
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The Radiology of Dysplastic Diseases
Ramon Syndrome
•
2 kindreds
2 siblings
3 siblings and 1cousin
•
inherited (AR)
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
Osteitis Deformans
Osteodystrophia Deformans
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
Common in
•
•
•
•
Central Europe
United Kingdom
Australia
New Zealand
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
Less common in
•
•
Scandinavia
United States
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
2,500,000 cases in the USA, but
only 5% are serious enough to
require specific treatment.
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
A specific isoenzyme of alkaline
phosphatase is high in these
patients.
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
The concentration of
hydroxyproline in the urine is
increased.
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
Calcitonin from the parafollicular
cells of the thyroid gland is
important in treatment.
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
Pagetoid bone may undergo
change into osteosarcoma.
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The Radiology of Dysplastic Diseases
Paget Disease of Bone
•
Radiologic Features
changes in the skull and pelvis are
important
 cotton-wool appearance of bone
 osteoporosis circumscripta
 linear pattern in the bone
 sinuses not diminished in size

© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Paget Disease of Bone
•
Radiologic Features
radiopaque appearances:
ground glass on extraoral views
orange peel on intraoral views
 hypercementosis
 periapical cemento-osseous dysplasia
 osteosarcomatous change possible

© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
Periapical Cemento-Osseous Dysplasia
Periapical Cemental Dysplasia
Periapical Fibrous Dysplasia
Periapical Osteofibrosis
Cementoma
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The Radiology of Dysplastic Diseases
Periapical Cemento-Osseous Dysplasia
•
•
•
•
•
Age: 38.2 (20-68)
Sex predilection: 94% female
Racial predilection: 76% negroid
23% caucasoid
1% mongoloid
Lesions: 33% solitary (1 tooth)
66% multiple (2+ teeth)
Location: 91% mandible
64% anterior mandible
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Periapical Cemento-Osseous Dysplasia
•
Radiologic Features
anterior mandible commonly
 single or multiple teeth
 with tooth or residual
 no root resorption or displacement

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The Radiology of Dysplastic Diseases
Periapical Cemento-Osseous Dysplasia
•
Radiologic Features
lamina dura lost or intact
 radiolucent (Stage I)
 mixed radiolucent-radiopaque (Stage II)
 radiopaque (Stage III)
 asymmetrical hypercementosis

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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
Florid Cemento-Osseous Dysplasia
Florid Osseous Dysplasia
Chronic Sclerosing Osteomyelitis
Gigantiform Cementoma
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The Radiology of Dysplastic Diseases
Florid Cemento-Osseous Dysplasia
•
•
•
•
•
Age: 38.2 (20-68)
Sex predilection: 94% female
Racial predilection: 76% negroid
23% caucasoid
1% mongoloid
in at least 2 quadrants, symmetrically
maybe in all four quadrants
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The Radiology of Dysplastic Diseases
Florid Cemento-Osseous Dysplasia
•
•
•
radiolucent (Stage I)
mixed radiolucent-radiopaque (Stage II)
radiopaque (Stage III)
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
Focal Cemento-Osseous Dysplasia
Focal Osseous Dysplasia
Gigantiform Cementoma
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The Radiology of Dysplastic Diseases
Focal Cemento-Osseous Dysplasia
•
Age: 38.2 (20-68)
Sex predilection: 94% female
Racial predilection: 76% negroid
23% caucasoid
1% mongoloid
•
in 1 quadrant
•
•
© 2006 A. Ruprecht. All rights reserved.
The Radiology of Dysplastic Diseases
Focal Cemento-Osseous Dysplasia
•
•
•
radiolucent (Stage I)
mixed radiolucent-radiopaque (Stage II)
radiopaque (Stage III)
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
Miscellaneous
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The Radiology of Dysplastic Diseases
First a bit of philosophy...
The world is divided into two groups of people.
One of these groups believes that the world is
divided into two groups of people, and the
other doesn’t.
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The Radiology of Dysplastic Diseases
Alveolo-Osseous Induction Effect
Sclerosing Osteitis
Osteosclerosis
Enostosis
Who Knows?
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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The Radiology of Dysplastic Diseases
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