Embryology-Mandible-formation Origin of mandible: the first brachia arch 2 Time: 4th week of embryologic development 2 How: fusion of the

bilateral mandibular prominences. 2 Embryology-teeth-formation

From article 2

Teeth are formed through a process called odontogenesis: 2 - Each tooth develops from: o Ectodermal cells that develop into ameloblasts and other outer tooth regions 2 o Ectomesenchymal cells that form the odontoblasts and dental papillae 2 This process begins at the crown of the tooth and continues toward the root. 2 Odontogenesis has 4 stages: 2 - Bud 2 o During the 6th week of embryonic development: Mesenchymal cells thicken & form the primary dental lamina. 2 These cells begin to invaginate to form a tooth bud with an overlying cap 2 - Cap 2 - Bell 2 o By the 20th week the tooth bud appears bell shape with active ameloblastic and odontobastic cells. 2 Odontoblastic cells produce dentin 2 Ameloblastic cells produce tooth enamel 2 Production of enamel requires the complete formation of the underlying dentin 2 - Crown (apposition) stages 2 o Dentin and enamel production is completed during the crown phase 2 o The remaining ectomesenchymal cells surrounding a tooth create the dental sac, which contains : 2

The periodontal ligament 2 is a thin fibrous ligament that attaches the cementum of each tooth to the surrounding alveolar bone (lamina dura) 2 This highly vascularized connective tissue allows limited motion of each tooth during mastication and also serves to provide sensation 2 Cementum 2 o Secured to the mandible by these components, the teeth migrate into the oral cavity, and the development process is complete. 2 o Prior to completion of odontogenesis, both the primary and secondary dental laminae disappear. 1 Any remnants of these embryonic cells may give rise to both benign and malignant lesions later in life. 12 Odontogenic cysts and tumors develop during or after the formation of teeth. 1 o

Cysts: General information - Cyst is a pathologic cavity filled with fluid lined by epithelium, and surrounded by a definitive connective tissue wall. (Pharoah 2006, 384) - the cystic fluid either is secreted by the cells lining the cavity or derives from the surrounding tissue fluid. (Pharoah 2006, 384) - Cysts occur more often in the jaws than in any other bone because most cysts originates from the numerous rests of odontogenic epithelium that remains after tooth formation. (Pharoah 2006,
384)

Classification of Cysts: - Cysts are classified according to the cell origin: 2 o with the majority of cysts in the jaw arising from odontogenic sources. 2 o Trauma 2 o Surgery 2 True Cyst formation In the mandible: - Developmental or inflammatory factors stimulate proliferation of epithelial cells surrounding a tooth. 2 - As these cells grow, the central cells become removed from their nutrient supplied by adjacent vascular connective tissue and become necrotic. an epithelium-lined cavity or sac is formed. 2

Radiologic appearance - Radiographic appearance of cystic and cystic-like lesions are very similar, making definitive dx very difficult. 1 For differential pay attention to: o Patient medical history 1 o Location of the lesion within the mandible 1 o Its borders 1 o Internal architecture 1 o Effect on adjacent structures 1 - Well defined, lucent areas within the bone. 2, (Pharoah 2006, 384) -

Cysts usually are round or oval, resembling a fluid filled balloon. Some cysts may have a scalloped boundary. (Pharoah 2006, 384) Cysts sometimes cause displacement and resorption of teeth. (Pharoah 2006, 384) The area of tooth resorption often has a sharp, curved shape. (Pharoah 2006, 384) Cysts can expand the mandible, usually in a smooth, curved manner, and change the Buccal or lingual cortical plate into a thin cortical boundary. (Pharoah 2006, 384) Cysts may displace the inferior alveolar nerve canal in an inferior direction or invaginate the maxillary antrum, maintaining a thin layer of bone that separates the internal aspect of the cyst from the antrum. (Pharoah 2006, 384) Cysts that originate in bone usually have a periphery that is well defined and corticated (characterized by a fairly uniform, thin, Radiopaque line. However, a secondary infection or a chronic state can change this appearance into a thicker, more sclerotic boundary. (Pharoah 2006,
384)

Most cysts have sclerotic rim, severe underlying inflammation may result in a decreased degree of sclerosis. 2 Description of Cyst: primarily ellipsoid, radiolucent, clearly demarcated, may be odontogenic, non-odontogenic. 1 Term mineralization refers to the elaboration of mineralized products by the lesion itself, such products include enamel, dentin, and cementum or cementum-like calcified tissue. 1 .. produces varying degrees of opacity. 1 instead of mixed these authors use lesions with mineralization. 1 Cysts may occur centrally (within bone) in any location in the maxilla or mandible but are rare in the condyle and coronoid process. (Pharoah 2006, 384) Most often found in the tooth-bearing region. (Pharoah 2006, 384)

Clincial characteristics - Many odontogenic lesions of the mandible are asymptomatic, and are incidental findings. 1 if symptomatic they can range anywhere from mild pain to parasthesia, tooth displacement or tooth mobility. 1 - Signs & symptoms does not aid in differentiating between benign and aggressive 1 - the prevalent clinical features are swelling, lack of pain (unless the cyst becomes secondarily infected or is related to a non-vital tooth), and missing teeth, especially third molars. (Pharoah
2006, 384)

Cysts grow slowly. (Pharoah 2006, 384)

Cyst & Cyst like lesions of the mandible Cyst & Cyst like lesions of the mandible Odontogenic Non-odontogenic

Lesions w/o mineralization (described as radiolucent) Benign (most lesions) Locally aggressive

Lesions w mineralization benign Locally aggressive

Sources: 1) Cysts & Cystic lesions of the mandible: Clinical and radiologic-histopathologic review; Robert J Scholl, Helen M. Kellet, David P. Newmann, Alan G Lurie; scientific exhibit; RadioGraphics 1999: 19:1107-1124 2) Radiologic & Pathologic Characteristics of Benign and Malignant Lesions of the mandible; Dunfee, B; Sakai, Osamu; Pistey, Robert; Gohel, Anita; 2006; RadioGraphics; Vol 26, no. 6, pp 1750-1769 3)