COBBLESTONE APPEARANCE 

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  1. Heck’s disease/focal epithelial hyperplasia
    1. Multiple squamous papillomas, papules, nodules
    3. HPV – type 13 and 32
  2. Pysotomatitis Vegetans
    2. Inflammatory stomatitis associated with inflammatory bowel disease
      1. Crohn’s disease
      2. Ulcerative Colitis 
    3. Cereberiform tongue
      2. This is also seen MC in pemphigus Vegetans and less likely in Scrotal tongue 
    4. Fissured Tongue 
      1. Seen in scrotal tongue
      2. Also called plicated tongue
      3. Etiology = suffering from stress/ hereditary
      4. Associated with Merkelsson Rosenthal syndrome = Triad of
        1. Facial paralysis
        2. Cheilitis Granulomatosa
        3. Fissured tongue
  3. Darrier’s disease 

GHOST TEETH 

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  1. Large sized pulp chambers 
  2. Thin enamel and dentin
  3. Also called, Regional Odontodysplasia 
  4. Also called odontogenesis imperfecta 
  5. Also called odontogenic dysplasia 
  6. H/P
    1. UNMINERALIZED DENTIN quantity is more
      1. Wide predentin zone 
      2. Large areas of interglobular dentin 
    2. Presence of enameloid conglomerates
      1. Calcification seen in REE of unerupted teeth

DENTIN DYSPLASIA TYPE 1 

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  1. Extremely short roots
  2. Obliteration of Pulp chambers with osteodentin 
  3. Osteodentin – histologically looks like
    1. Cascades of dentin = one layer of dentin forms, it stops and then new layer of dentin forms on top of it
    2. Lava flowing around boulders
  4. Few pulpal remnants are left behind – crescent shaped pulpal remnants 

DENTINOGENESIS IMPERFECTA 

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  1. Not associated with osteogenesis imperfecta 
  2. Mutation in gene – DSPP – dentin sialo phospho protein 
  3. DSPP located on chromosome number 4 
  4. Revised shield classification
    1. Common traits seen in both types
      1. Flat DEJ line 
      2. Gene = DSSP

Type 1
Opalescent dentin type 		Type 2
Brandy white type 

Bulbous crowns are seen With cervical constriction Giving tulip shaped crownsWHY? Because of atypical dentin formation = obliteration of pulp chambers
Large sized pulp chambers Very thin dentin – hence, radiographically SHELL TEETH 

Radiographic Interpretation of Ameloblastoma 4m*** 2m**

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    1. Slow growing = identified late 
    2. Initially, pt has asymptomatic symptoms
    3. Later develops swelling due to buccolingual expansion and come to dentist 
    4. Unilateral
    5. Mandible = posterior = Ramus/body = mc 
    6. If it occurs in anterior region = desmoplastic type = aggressive and resembles fibro osseous lesion
    7. 20% of cases seen in maxilla = can involve sinus 
    8. Epicenter = odontogenic in origin = above IAC
    9. Size = large, diffuse
    10. Borders = well defined 
    11. Internal structure =
      1. Multilocular
      2. septa are small and round = honeycomb appearance 
      3. Septa are large and round = soap bubble appearance
      4. Septa are curved and round
    12. Displace IAC inferiorly 
    13. Root resorption = Knife edge resorption
    14. Lower border of mandible = thin egg shell appearance due to aggressive expansion

RADIOLUCENT LESIONS OF JAWS #9M #NTRUHS

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  1. Acute periapical abscess
    1. Swelling
    2. Vertical pain = tenderness on percussion
    3. Vestibular tenderness and obliteration = pathognomonic sign
    4. Widening of PDL = Only feature. It takes time for r/g features to develop, by that time acute has been converted into chronic
  2. Chronic Periapical abscess
    1. Carious tooth 
    2. Sinus tract = pus will come out
    3. Hence, there will be a breach in the continuity of lamina dura
    4. Diffuse, ill-defined radiolucency surrounding root apex
  3. Periapical Granuloma
    1. Granuloma is made up of granulation tissue. It is formed due to new vascularizations.
    2. May or maynot be corticated
    3. Size is less than 1.5 cm in diameter
    4. Well defined
  4. Periapical cyst
    1. Well defined 
    2. Surrounding corticated or sclerotic border
    3. Size is more than 1.5 cm 
  5. Infected Cyst
    1. Partially well defined 
    2. Corticated border = evident only in few areas
  6. PERIAPICAL CEMENTAL DYSPLASIA 2M*
    2. Site = mandibular anteriors
    3. Teeth = vital
    4. Multifocal 
    5. Appearing as periapical radiolucency
    6. RL = initial stage
    7. Mixed = intermediate stage
    8. RO = mature stage
  7. Phoenix abscess
    1. Acute exacerbated phases of chronic periapical abscess
    2. Pt complains that Every 6 months, swelling and pain
    3. Pulp is non vital
  8. Lateral periodontal Cyst

Ortho Case 4.2

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An 11-year-old female presented with a class II division 1 malocclusion on a moderate skeletal class II pattern with reduced vertical dimensions complicated by an increased overjet (11mm), increased overbite, generalized spacing and bi-maxillary proclination.

The aetiology of this malocclusion is multi-factorial.

The moderate skeletal class II discrepancy resulted in an increased overjet and class II molar relationship. The overjet was exacerbated by the presence of a lower lip trap. The generalized spacing was a result of an underlying dento-alveolar disproportion. This was compounded by bi-maxillary proclination, which arose due to resting soft tissue pressures and dento-alveolar compensation.

TREATMENT PLAN

• Integration of twin block functional and sectional lower fixed Herbst appliancee
• Continuation of functional appliance wear at night
only
• Use of headgear
• Inter-arch class II elastic traction following fixed
appliance placement

The prognosis for long-term stability of class II correction is good in this case, as the new maxillary incisor position will be controlled by the lower lip following the achievement of lip competence.