’

Dr. Eliza Dragan

Medic specialist Implantologie si Chirurgie Orala

Disciplina de Radiologie Dentara si Generala

Universitatea de Medicina si Farmacie ‘Gr.T.Popa
 A cyst is a pathologic cavity filled with fluid, lined by
epithelium, and surrounded by a definite connective
tissue wall.
 Odontogenic Cysts
 Radicular Cyst
 Residual Cyst
 Dentigerous Cyst
 Buccal Bifurcation Cyst
 Keratocystic Odontogenic Tumor
 Basal Cell Nevus Syndrome
 Lateral Periodontal Cyst
 Glandular Odontogenic Cyst
 Calcifying Cystic Odontogenic Tumor
 Chisturile odontogene

 Reprezintă 90%
dintre chisturile
scheletului facial

Reprezentare schematică a
chistului radicular apical, lateral
şi rezidual
 Chistul radicular ( periapical
)
 în 60% dintre cazuri sunt situate la maxilar
 cele mai frecvente, la incisivi şi canin
 Radicular Cyst

Axial (A) and coronal (B) CT images with use of a bone algorithm of a collapsing radicular cyst within the sinus. Note the unusual shape and the fact
that new bone is being formed from the periphery (arrows) toward the center. (Courtesy Drs. S. Ahing and T. Blight, University of Manitoba.)
Radicular Cyst
Chisturi radiculare- restante
 Residual Cyst

The epicenter of this infected residual cyst is above the inferior alveolar
nerve canal and has displaced the canal in an inferior direction (arrows).
Note that the cortical boundary is not continuous around the whole cyst.
Chistul dentiger -
pericoronar, folicular
 Se formează în jurul unor dinţi rămaşi în incluzie ;
 Sediu de predilecţie - M3 mandibular şi caninii
maxilari
 pot include tot dintele, dinţii din vecinătate în curs
de erupţie, evoluand către zonele spongioasei
limitrofe
 Chistul dentiger -
pericoronar, folicular

chist folicular 18 şi 48
(în curs de erupţie)

chist dentiger lateral la 38 - inclus

 Dentigerous cyst

A cyst surrounds the crown of a third molar

(arrows).
 Dentigerous cyst

The cyst has caused resorption of the distal root of the second molar
(arrow).
Dentigerous cyst

A cyst that involves the ramus of the

mandible.
 Dentigerous cyst

A dentigerous cyst that is expanding distally from the involved third

molar.
 Dentigerous cyst

This panoramic image reveals the presence of a large dentigerous cyst

associated with the left maxillary cuspid (arrow), which has been displaced.
Notice the displacement and resorption of other teeth in the left maxilla.
 Dentigerous cyst

B and C, Coronal and axial CT images of the same case showing

superior-lateral displacement of the cuspid, expansion of the
anterior wall of the maxilla, and expansion of the cyst into the nasal
 Dentigerous cyst

A and B, These panoramic films of the same case taken several years apart
demonstrate superior-posterior displacement of a maxillary third molar by a
dentigerous cyst.
Dentigerous cysts displacing teeth.

A, The third molar has been displaced to the inferior cortex. B, The
developing second molar has been displaced into the ramus by a cyst
associated with
Dentigerous cysts displacing
teeth.

Axial (C) and coronal (D) CT images with bone algorithm reveal a maxillary
third molar displaced into the space occupied by the maxillary antrum; note
the presence of a cortex between the cyst and the antrum.
 Buccal Bifurcation Cyst
It is a lesion with a specific location, classically the buccal surface of the mandibular first
molar and less frequently the mandibular second molar.

A, A panoramic image showing cysts related to the mandibular first

molars. The occlusal surface of each tooth has been tipped in relation to
the other teeth and adjacent teeth have been displaced.
 Buccal Bifurcation Cyst

B and C, Occlusal fi lms of the same case. Note the smooth curved
expansion of the buccal cortex and the displacement of the roots of the
first molars into the lingual cortical plate (arrows).
Keratochistul odontogenic -
chistul primordial
 Originea în reticulul organului adamantin şi rezultă
din degenerarea ţesuturilor germenului dentar.
 Conţinutul este cazeos-vâscos
 Cavitatea are către interior un epiteliu keratinizat, la
periferia sa având un strat subţire de ţesut
conjunctiv.
Keratochistul odontogenic -
chistul primordial

Chist primordial la nivel 38

Keratochist multicavitar
maxilar (mezial de 13 )
 Keratocystic Odontogenic Tumor

In panoramic image A a large keratocystic odontogenic tumor occupies the

ramus and body of the mandible; note the septa (black arrow), inferiorly
 Keratocystic Odontogenic Tumor

The keratocyst in B has a pericoronal position relative to the impacted

third molar and the distal margin has a scalloped shape.
Keratocystic Odontogenic Tumor

A, Cropped panoramic image of a

keratocystic odontogenic tumor
occupying the mandibular ramus; note
the septa (arrow).
 Keratocystic Odontogenic Tumor

B and C, Two axial CT images with bone algorithm of the same case
demonstrating very little expansion in the body (B) but significant
expansion in the upper ramus in C (arrows).
 Keratocystic Odontogenic Tumor

A large keratocystic odontogenic tumor (KOT) occupying most of the right

body and ramus of the mandible. A, Despite the large size, the buccal and
lingual cortical plates of the mandible have been expanded only slightly, as
can be seen
 Keratocystic Odontogenic Tumor

C, A KOT within the body of

the mandible; note the lack of
expansion and the cyst
scalloping between the roots
of the teeth.
 Keratocystic Odontogenic Tumor

A, This cropped panoramic

image reveals a large
keratocystic odontogenic tumor
occupying most of the ramus;
note the scalloping margin
(arrows).
 Keratocystic Odontogenic Tumor

B, This axial CT with soft tissue

window of the same case
showing perforation of the
medial cortex and contacting the
medial pterygoid muscle
(arrow).
Keratocystic Odontogenic Tumor
Sindrom Gorlin – Goltz

 entitate anatomo- clinică care asociază :

keratochist,nevi bazo-celulari, malformaţii scheletice
( blocuri vertebrale, polidactilie, sindactilie,coaste
bifide etc).
Sindrom Gorlin – Goltz
 Basal Cell Nevus Syndrome

B, Axial CT of the same case; note the small mandibular KOT (long arrow)
seen in the panoramic image and another small KOT (short arrow) in the
right mandible not seen in the panoramic fi lm. C, Another axial CT from
the same case revealing the large KOT in the left maxilla and two other
 Lateral Periodontal Cyst

A lateral periodontal cyst in the mandibular premolar region; note the

classic well defined cortical border.
 Glandular Odontogenic Cyst

A, Cropped panoramic image of a

glandular odontogenic cyst with a
multilocular appearance very similar
to an ameloblastoma. B, Axial CT
image detailing the multilocular
internal cystic structure.
Calcifying Cystic Odontogenic Tumor

A and B, Calcifying cystic odontogenic tumor (CCOT) related to the lateral

incisor.
Note the well-defined corticated border, internal calcifications, and
Calcifying Cystic Odontogenic Tumor

C, Axial CT image of a large CCOT invaginating into the maxillary sinus;

note the small calcifications along the posterior border (arrow).
 Nonodontogenic Cysts

 Nasopalatine Duct Cyst

 Nasolabial Cyst
 Dermoid Cyst
 Nasopalatine Duct Cyst

Two examples of nasopalatine

duct cysts.

Note the uniform periodontal

membrane space around all the
apices.
 Nasopalatine Duct Cyst

A, Axial CT image of a nasopalatine duct cyst positioned palatal to both

maxillary central incisors (arrows). B, Coronal CT image of the same case.
 Nasopalatine Duct Cyst

A nasopalatine canal cyst viewed from two perspectives: (A) a standard

occlusal view and (B) from the lateral aspect, which is created by placing the
film outside the mouth against the cheek and directing the x-ray beam at a
Chistul nazo-palatin

 Se dezvoltă la nivelul canalului nazo-palatin

Chistul nazo-palatin
 Nasolabial Cyst

A nasolabial cyst shown in an axial CT image with a soft tissue algorithm.

Note the well-defi ned periphery and the erosion of the labial aspect of the
 Dermoid Cyst

A CT scan of a dermoid cyst

showing an encapsulated mass on
the left and several soft tissue
loculations.
(From Hunter TB, Paplanus HS,
Chemin MM et al: AJR Am J
Roentgenol 141:1239-1240, 1983.)
 Chisturi neodontogene

 chisturi fisurare de linie mediană

 Chist median mandibular

 Rx-transparenţă mărginită de lizereu calcar, situată

pe linia mediană, sub apexurile incisivilor
Chistul fisural globulo-
maxilar
 Este situat la unirea mugurelui nazal intern
( globular ) cu al maxilarului.
 Este situat între apexurile incisivului lateral superior
şi canin
 Rx- radiotransparenţă sub formă de picătură, cu
lizereu inconstant, cu divergenţă a rădăcinilor
incisivului lateral şi canin.
Chistul fisural globulo-
maxilar
 Cystlike Lesions

 Simple Bone Cyst

 Simple Bone Cyst

A panoramic fi lm demonstrating an SBC (A), an occlusal fi lm (B), and a

periapical film (C). The occlusal film shows that no expansion has occurred
in the buccal or lingual cortical plates.
Except for the superior border, the borders are ill defi ned and the lesion has
scalloped around the teeth and thinned the inferior border of the mandible,
 Simple Bone Cyst

A, A simple bone cyst has a multilocular

appearance in this lateral oblique view of the
mandible. B, The periapical view appears to
show internal septa (arrows) because of the
scalloping of the endosteal surface of the
cortical plates, as seen in the inferior cortex
(arrows) in A and of the endosteal surface of
 Simple Bone Cyst

A simple bone cyst in which the lamina dura is maintained on most root
surfaces involved with the lesion except for the mesial surface of the distal
root tip of the first molar.
 Simple Bone Cyst

A and B, A simple bone cyst extending from the first bicuspid posteriorly
to the base of the ramus and occupying most of the mandible.
Considering the extent of the lesion, very little expansion of the buccal or
lingual cortical plates has occurred, as can be seen in the axial CT image
 Simple Bone Cyst

A simple bone cyst (arrow) positioned

in the anterior of the mandible.

Note that the superior aspect of the

peripheral cortex is better defined than
the inferior border and that evidence
exists of some expansion of the
mandible ’ s lingual cortex, which in
part may due to muscle attachment at
the genial tubercles.
 Chistul osos trumatic-Ivy

 Nu posedă membrană, nu are

lizereu calcar şi nici conţinut
lichidian.
 Este o lacună ( aspect osteolitic ) -
cavitatea creată este goală şi are
diametrul de aproximativ 1 cm ) ;
uneori cavitatea este mai mare,
policiclică.
 Ca etiologie probabilă-rezorbţie a
unui hematom intraosos-
posttraumatic
 Chistul osos anevrismal

 Localizat în oase cu
ţesut spongios
abundent
 Rx – transparenţă
rotundă, cu contururi
nete, cu lizereu calcar
subţire, cu septuri
calcare ( ca în
ameloblastom )
DANISIA HABA
Disciplina de Radiologie Generala si Dentara
FACULTATEA DE MEDICINA DENTARA
UMF “GR.T.POPA”IASI
A torus palatinus (arrowhead) in an A coronal CT image.
occlusal image
Mandibular torus

Mandibular tori usually are

seen as dense radiopacities
(arrows)
Mandibular torus

An axial CT image with bilateral

mandibular tori
Mandibular torus

An occlusal radiograph shows an unusual case of

mandibular tori (arrows) where the
number and size are not symmetric between the
Dense Bone Island

A periapical fi lm of a region of hyperostosis on the buccal

aspect of the maxillary alveolar process, seen as an region of
slight increase in radiopacity overlapping the roots of the
molars (arrows).
Dense Bone Island

Another example overlapping an edentulous ridge.

Dense Bone Island

An example occurring on the crest of

the
 Dense Bone Island

A larger dense bone island between the bicuspids; note the normal-
ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

A large lesion in the mandibular body

and ramus shows only a few rather
straight septa.
ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

Lateral radiograph of a resected mandibular specimen

containing a multilocular ameloblastoma; note the
coarse curved septa
ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

Another surgical specimen of an ameloblastoma

ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

A large multilocular lesion in the right mandibular ramus.

ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

A cropped panoramic image showing small loculations that

are more common in the anterior mandible
 ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

An axial CT image with bone algorithm showing a large ameloblastoma;

note the smaller loculations in the anterior mandible (black arrows) and
ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

An example of the desmoplastic type of ameloblastoma;

note the internal irregular bone formation in this axial CT image.
ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

An occlusal fi lm demonstrating expansion of the lingual

ODONTOGENIC EPITHELIAL TUMORS
Ameloblastoma

Root resorption of the premolars and canine adjacent to a

radiolucent ameloblastoma in the left mandible.
Calcifying Epithelial
Odontogenic Tumor

Periapical fi lms of a recurrent ameloblastoma of the right

maxilla. Note the sclerotic margins of the small cystic lesions
 Granulom central cu celule
gigante
 Rx - zonă transparentă,
mai frecventă întâlnită la
copii, în regiunea
posterioară a mandibulei şi
condilului, întrerupe
corticalele şi invadează
părţile moi
Mixomul odontogenic
(mixofibrom, fibromixom)
 Rx – transparenţă multiloculară , frecvent între
rădăcini dentare, cu lizereu radioopac intens.
Cementom (cementoblastom)
Odontomul
Odontoma
 Odontoma

An example in the anterior maxilla that

has interfered with the eruption of the
central incisor (C) and the lateral incisor Within the mandible.
 Odontoma

Within the mandible interfering with the

eruption of the fi rst premolar,
deciduous molar (d), and the fi rst molar
(m).

Within the anterior mandible interfering

with the eruption of the cuspid
 Fibrom ameloblastic

 tumoră rară , relativ asemănătoare cu un odontom

combinat cu un ameloblastom
 Neurinomul (schwannom)

 Rx –zonă
transparentă
rotundă / ovalară pe
traseul unui nerv, cu
contur net, uneori
condensat ; are
creştere lentă şi în
funcţie de localizare,
poate deforma
sinusul maxilar sau
orbita
Osteomul

 Rx – formaţiune opacă rotundă /ovalară, ataşată la

corticala osoasă; în evoluţie devine policiclic,
polilobat.
Hemangiomul osos
 Malformaţie arterio- venoasă, întâlnită rar la nivelul
maxilarelor.
 Poate fi cavernos sau capilar.
 Rx- o zonă osoasă cu lărgirea spaţiilor alveolare, cu
trabecule groase
 Osteomul osteoid

 Rx- o mică arie transparentă (sub 2 cm) numită nidus,

rotundă , care are în interior câteva focare radioopace
(calcare)
Osteoblastomul

 Tumoră agresivă, rară, şi care interesează, mai

frecvent, regiunea alveolară a mandibulei. Are
dimensiuni mai mari de 2 cm
 Rx- zonă transparentă numai cu calcificări sau masă
radioopacă înconjurată de un halou transparent şi
un lizereu opac, marginal
Osteoblastomul