Upload
kolanovschi-emanuel
View
234
Download
0
Embed Size (px)
Citation preview
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 1/66
TUMORI ODONTOGENEBENIGNE CU
ECTOMEZENCHIMSPECIFIC
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 2/66
TUMORI ODONTOGENE BENIGNE CECTOMEZENCHIM SPECIFIC
• Sunt tumori odontogene mixte• Derivate din e!uturi"e e#ite"ia"e și
$e%to&me'en%(ima"e im#"i%ate )nodontogene'*
• Re%a#itu"ea'* #ro"i+erarea ,i di+eren iereati!u"ar* )nt-"nite #e #ar%ur!u" +orm*rii din i"or
•
.n +un% ie de !tadiu" odontogeneti%re%a#itu"at/ !e #ot )n!o i de +ormareae!uturi"or dure0 !ma" / dentin*1
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 3/66
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 4/66
TUMORI BENIGNE 23E EPITE3IU3UI ODONTOGCU ECTOMEZENCHIM ODONTOGEN/ CU S2U F4
FORM2RE DE 5ESUTURI DURE $%"a!i6%are OM• Fi7rom ame"o7"a!ti% 899:;:• Fi7rodentinom ame"o7"a!ti% 8<=>;:•
Fi7roodontom ame"o7"a!ti% 8<8:;:• Odontom 8<?:;:
– Odontom/ ti#u" %om#"ex 8<?<;: –
Odontom/ ti#u" %om#u! 8<?>;:• Odontoame"o7"a!tom 89>>;:• Tumora odontogen* %a"%i6%ant* %(i!ti%*
89:>;:• Tumora dentino en* %u %e"u"e +antom*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 5/66
FIBROMU3 2ME3OB32STIC
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 6/66
FIBROMU3 2ME3OB32STIC•
Tumor* 7enign* %ir%um!%ri!* a"e %*reie!uturi e#ite"ia" ,i %on@un%tivre%a#itu"ea'* !tadii"e de A%a#i,onA ,iA%"o#otA a"e odontogene'ei
• rar* $< din tota"u" tumori"orodontogene&
• #a%ien i tineri/ v-r!ta medie de a#ari ie >ani $= !*#t*m-ni < ani&
• "o%a"i'at mai +re%vent "a nive"u" mandi7u"ei$9; din %a'uri&/ )n aria mo"ar* a a%e!teia/
)n ve%in*tatea unui dinte im#a%tat
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 7/66
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 8/66
FIBROMU3 2ME3OB32STIC
Zon* de radiotran!#aren * mu"ti;uni"o%u"ar* a!o%iat* unor din i %ueru# ie vi%ioa!*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 9/66
FIBROMU3 2ME3OB32STIC a!#e%tmi%ro!%o#i%
• %om#onenta e#ite"ia"*0 ,iruri/ %ordoane rami6%ate ,ian!tomo'ate/ )nmugurite/ a"%*tuite din %e"u"ee#ite"ia"e %o"umnare #a"i!adate/ !imi"are epiteliuluiintern al smalțului / %e )n%on@oar* %e"u"e e#ite"ia"e+u!i+orme di!#u!e "ax/ !imi"are reticulului stelat
• %om#onenta me'en%(ima"*0 !trom* re#re'entat*de e!ut %on@un%tiv em7rionar a"%*tuit din67ro7"a!te !te"ate %u #re"ungiri %ito#"a!mati%ede"i%ate di!#u!e )ntr o matri%e mixoid* $ e!ut!imi"ar papilei dentare &
• mito'e +oarte rare )n %e"u"e"e e#ite"ia"e !au !troma"e• 'one de (ia"ini'are ,i %a"%i6%*ri
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 10/66
FIBROMU3 2ME3OB32STIC
Tumor* e#ite"ia"* ,i me'en%(ima"* %e re%a#itu"ea'* %e"e mai#re%o%e !tadii a"e odontogene'ei $+ormarea "aminei dentare ,i
!tadiu" de %a#i,on&D3 "amina dentar*/ DP #a#i"a dentar*/ EO organu" !ma" u"ui
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 11/66
FIBROMU3 2ME3OB32STIC
Pro"i+erare e#ite"ia"* a"%*tuit* din in!u"e %u #o"ari'are inver!*
#eri+eri%* di!#u!e ar7ore!%ent )ntr o !trom* mixoid* !imi"ar*#a#i"ei dentare
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 12/66
FIBROMU3 2ME3OB32STIC
e"emente e#ite"ia"e!imi"are muguri"or dentari
di!#u!e )ntr o !trom*!imi"ar* #a#i"ei dentare
%e"u"e !troma"ee%tome'en%(im
a"e
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 13/66
FIBROMU3 2ME3OB32STIC diagno!ti% di+eren ia"
• 2ME3OB32STOMU3 – a!#e%t !imi"ar a" %om#onentei e#ite"ia"e – !troma %on@un%tiv* a ame"o7"a!tomu"ui e!te
a"%*tuit* din e!ut %on@un%tiv matur/ !*ra% )n%e"u"e ,i 7ogat )n 67re de %o"agen• FO3ICU3 DENT2R HIPERP32ZIC
• di+eren iere radio"ogi%*• 'on* de radiotran!#aren * %e )n%on@oar* un
dinte %are nu a eru#t $FDH&• "e'iune radiotran!#arent* maxi"ar* %u
%ara%ter ex#an!iv $F2&
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 14/66
Radiogra6e %u denti ia mixt* )n %are !e remar%* 'one
radiotra!#arente #roeminente )n @uru" mo"ari"or < +o"i%u"identari
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 15/66
FIBROMU3 2ME3OB32STIC• tratament0 enu%"eere urmat* de
%(iureta@• "e'iunea e!te 7ine )n%a#!u"at* ,i
#oate 6 u,or !e#arat* de e!utu"o!o! adia%ent
• re%uren e"e !e datorea'* ex%i'ieiin%om#"ete ini ia"e a unei "e'iunimu"ti"o%u"are
• rar F2 !e #oate ma"igni'a 67ro!ar%om ame"o7"a!ti%
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 16/66
FIBRODENTINOMU32ME3OB32STIC
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 17/66
FIBRODENTINOMU3 2ME3OB32STI
• re#re'int* tumori %u (i!tomor+o"ogie!imi"ar* 67romu"ui ame"o7"a!ti% )n%are %e"u"e"e !troma"e #rodu%dentin*
• "e'iune de grani * )ntre 67romu"ame"o7"a!ti% $F2& ,i 67roodontomu"ame"o7"a!ti% $FO2&0
– Poate 6 #rivit %a un F2 %are +ormea'* și dentin* !au %a un FO2 %are +ormea'*
doar dentin*/ +*r* !ma"
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 18/66
FIBRODENTINOMU3 2ME3OB32STI
Pro"i+erare de e#ite"iuame"o7"a!ti% / %u %e"u"e
%o"umnare #o"ari'ateinver! $2& )ntr o !trom*
me'en%(ima"*em7rionar* %u +ormare
de dentin* $ & $B&
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 19/66
FIBROODONTOMU32ME3OB32STIC
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 20/66
FIBROODONTOMU3 2ME3OB32STIC• Tumor* 7enign* %u mor+o"ogia 67romu"ui
ame"o7"a!ti% "a %are !e adaug* arii de+ormare a dentinei ,i a !ma" u"ui
$re%a#itu"ea'* !tadiu" tardiv de %"o#ot a"odontogene'ei&• .nt-"nit mai rar de%-t 67romu" ame"o7"a!ti%• J-r!ta medie de a#ari ie ? >< ani• In%iden * !imi"ar* "a am7e"e !exe• 3o%a"i'at mai +re%vent )n regiunea
#o!terioar* a mandi7u"ei
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 21/66
FIBROODONTOMU3 2ME3OB32STIC• C"ini%0
–
+re%vent a!im#tomati% $rar e!te durero!& – de!%o#erit datorit* "i#!ei eru# iei unui dinte – tume+a% ie a maxi"aru"ui )n regiunea unui dinte
im#a%tat –
%re,tere "ent* )n tim#• Radio"ogi%0
– "e'iune de dimen!iuni mari/ uni"o%u"ar*/ 7inede"imitat*/ %u 'one radiotran!#arente ,i radioo#a%e/a!o%iat* de o7i%ei unui dinte im#a%tat
– rar "e'iuni"e #ot 6 mu"ti"o%u"are – o#a%it* i"e #ot 6 di+u'e !au nodu"are/ #re'ent-ndu
!e !u7 +orma unei arii uni%e !au a mai mu"tor
de#o'ite mi%i/ di!#er!ate
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 22/66
FIBROODONTOMU3 2ME3OB32STIC
Radiogra6e %e
eviden ia'* )nmaxi"aru" anterior o"e'iune mixt* %u 'oneradiotran!#arente ,i
radioo#a%e/ %are )m#iedi%* eru# iain%i!ivu"ui %entra"
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 23/66
FIBROODONTOMU3 2ME3OB32STIC
Radiogra6e $2& ,i tomogra6e %om#uteri'at* $B& a unei"e'iuni radiotran!#arente de dimen!iuni mari %e
%on ine 'one radioo#a%eK a" doi"ea mo"ar e!te di!"o%at ,iim#a%tat
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 24/66
FIBROODONTOMU3 2ME3OB32STIC a!#e%t mi%ro!%o#i%
• "e'iunea e!te )ntotdeauna de"imitat* de o %a#!u"* 7ine +ormat*• 'one"e radiotran!#arente !unt re#re'entate de e!uturi moi
e#ite"ia"e ,i e%tome'en%(ima"e !imi"are 67romu"ui ame"o7"a!ti%• 'one"e radioo#a%e !unt datorate #rodu%erii de dentin* și !ma" 0
–
dentina #oate "ua +orma unui materia" eo'ino6" %e %on inetu7u"i !au a unei ma!e eo'ino6"e omogene %e in%"ude rare%e"u"e $dentin* di!#"a'i%*&K )ntotdeauna )n!* o vom g*!iadia%ent e#ite"iu"ui ,i +ormea'* !u#ortu" #e %are !e de#unesmalțul $#a"id 7a'o6"& #rodu! "a @on% iunea dintre e#ite"iu ,i
dentin* de %*tre %e"u"e"e e#ite"ia"e %are ! au di+eren iat )name"o7"a!te• e!uturi"e dentare !unt di!#u!e de'ordonat/ +*r* a re+a%e
!tru%tura dinte"ui norma"
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 25/66
FIBROODONTOMU3 2ME3OB32STIC
Tumora %om7in* e!uturi"e moi a"e F2 %udi+eren ierea %e"u"ar* %e re%a#itu"ea'* !tadiu"tardiv de %"o#ot a" odontogene'ei/ in%"u'-nd
+ormarea !ma" u"ui ,i dentineiD dentina/ DP #a#i"a dentar*/ E !ma" u"
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 26/66
FIBROODONTOMU3 2ME3OB32STIC
B indu%erea ini ia"* a matri%eidentiniene ,i a !ma" u"ui )n e!utu"e#ite"ia" e%tome'en%(ima"#ro"i+erant/ !imi"ar F2
2 dentin* ,i !ma" 7ine+ormate
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 27/66
FIBROODONTOMU32ME3OB32STIC
arii !imi"are67romu"uiame"o7"a!ti% %ontigue%u arii!imi"areodontomu"
ui $+ormarea dentineiLi!ma" u"ui&
De#unere dentinian* a7undent* De#unere dentinian* redu!*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 28/66
FIBROODONTOMU3 2ME3OB32STIC
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 29/66
FIBROODONTOMU3 2ME3OB32STIC• Diagno!ti% di+eren ia"0
– ame"o7"a!tomu"0 a!#e%t !imi"ar a" %om#onenteie#ite"ia"e dar !troma are a!#e%t de e!ut%on@un%tiv imatur )n FO2K ame"o7"a!tomu" nu+ormea'* !ma" !au dentin*K
– odontoame"o7"a!tomu" e!te ne)n%a#!u"at/in6"trativ
– +o"i%u" dentar (i#er#"a'i%0 radio"ogi%• Tratament
– identi% %u a" F2 enu%"eere %om#"et* a "e'iunii – e!utu" tumora" re!tant #oate 6 !ur!* de re%idive
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 30/66
ODONTOMU3
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 31/66
ODONTOMU3•
Re#re'int* o "e'iune a!o%iat* +re%vent unuidinte im#a%tat/ a"%*tuit* din dentin*/ !ma" /e!ut #u"#ar ,i %ement %e %on!tituie 6e din i
7ine +orma i $odontom %om#u!&/ 6e ma!e!o"ide/ neregu"ate $odontom %om#"ex&
• %ea mai +re%vent* tumor* 7enign*odontogen*0 : : din tota"u" tumori"orodontogene
•
diagno!ti%at* )n @uru" v-r!tei de >: ani• de!%o#erit atun%i %-nd un dinte nu eru#e "amomentu" a,te#tat
• e!te %on!iderat hamartom ,i nu #ro"i+erareneo#"a'i%*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 32/66
ODONTOMU3 COMP3E•
Hamartom a"%*tuit din e!uturi dentare $!ma" /dentin*/ uneori %ement& %u di!#o'i ie a"eatorie nu !e #ot re%unoaLte #rin%i#ii"e ar(ite%tura"e a"edinte"ui1 3a #eri+erie !e identi6%* #re'en a
+o"i%u"u"ui 67ro!1• "o%a"i'at mai +re%vent )n regiunea #o!terioar* a
mandi7u"ei• nedurero!/ %re,te "ent #-n* %-nd maturea'*
%om#"et• ma@oritatea au diametru" 9 %m $maxim %m&• #oate di!"o%a din ii adia%en i ,i #oate da na,tere
unei tume+a% ii maxi"are vi'i7i"e %"ini%
ODONTOMU3 COMP3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 33/66
ODONTOMU3 COMP3E• o#a%itate !+eri%* !au ova"ar* %u a!#e%t 6n radiar "a
#eri+erie/ )n%on@urat* de o 'on* radiotran!#arent* mai"arg* )n %a'u" "e'iuni"or a ate )n %ur! de de'vo"tare
• nu !e o7!erv* din i +orma i )n aria de o#a%itate
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 34/66
ODONTOMU3 COMP3E a!#e%tmi%ro!%o#i%
• 3a #eri+erie %a#!u"* a"%*tuit* din e!ut%on@un%tiv "ax $em7rionar& %u %ordoane ,i in!u"ede e#ite"iu odontogen
• Centra" +ormare neregu"at* de dentină ,i smalț +*r* a re%on!titui mor+o"ogia dinte"ui norma"
– ma!* de dentin* %u tu7u"i vi'i7i"i/ %e de"imitea'*!#a ii rotund ova"are )n %are !e identi6%* !ma"$7a'o6"/ mare #arte !e #ierde "a de%a"%i6ere&/e#ite"iu ame"o7"a!ti% ,i e!ut %on@un%tiv
– "ame"e ondu"ante/ #"i%aturate de dentin* tu7u"ar*!au di!#"a'i%* $+*r* tu7u"i&/ a%o#erite de !ma" K
)ntre "ame"e !e g*!e!% !#a ii de %"iva@ %e %on ine#ite"iu ame"o7"a!ti% ,i e!ut %on@un%tiv
•
3a #eri+erie/ #e ver!antu" Aradi%u"arA a" ma!e"or
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 35/66
ODONTOMU3 COMP3E
2!#e%t ma%ro!%o#i% %u #rimordiu" dentar )n%on@urat de o ma!*ti!u"ar* dur*K a!#e%te mi%ro!%o#i%e de an!am7"u ,i deta"iu %ure eaua de dentin* %are de"imitea'* !#a ii %e %on in e#ite"iu
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 36/66
ODONTOMU3 COMP3E
Stru%turi dentare %u di!#o'i ie neregu"at*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 37/66
ODONTOMU3 COMP3E
Stru%turi dentare %u di!#o'i ie neregu"at*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 38/66
ODONTOMU3 COMPUS•
Hamartom a"%*tuit din e!uturi dentare %are re%on!tituiegro!ier ar(ite%tura dinte"ui/ %u +ormare de din i miniatura"i$odontoi'i&1 3a #eri+erie !e re%unoa,te #re'en a +o"i%u"u"ui67ro!1
• "o%a"i'at mai +re%vent )n regiunea anterioar* a maxi"aru"ui• nedurero!/ %re,te "ent #-n* %-nd maturea'* %om#"et• ma@oritatea au diametru" > < %m $maxim %m&• tume+a% ie a maxi"aru"ui vi'i7i"* %"ini% )n >: din %a'uri• "o%a"i'at dea!u#ra %oroanei unui dinte im#a%tat/ )m#iedi%-nd
eru# ia norma"*• #oate 6 "o%a"i'at )ntre r*d*%ini"e din i"or %are au eru#t/
di!"o%-nd din ii norma"i adia%en i• ex!iten a !a #oate 6 indi%at* de a7!en a unui dinte
#ermanent
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 39/66
ODONTOMU3 COMPUS•
radio"ogi% !e o7!erv* o 'on* radiotran!#arent* uni"o%u"ar* %e%on ine o %o"e% ie de !tru%turi radioo#a%e a!em*n*toare din i"or
Reten ia dinte"ui de%idua" ,ia7!en a eru# iei dinte"ui #ermanent
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 40/66
ODONTOMU3 COMPUS a!#e%tmor+o#ato"ogi%
• Diagno!ti%u" !e #oate #une de o7i%eimacroscopic 0 numero,i din i miniatura"i de+orm* %oni%* de"imita i de o %a#!u"* 67roa!*
Microscopic:• !e %on!tat* #re'en a mai mu"tor din idi!mor6%i dar %are au !tru%tur* norma"*/ %u
e!utu" %on@un%tivo va!%u"ar #u"#ar !ituat
%entra" ,i dentina )n%on@urat* de !ma"$%oroan*& ,i %ement $r*d*%in*&• din ii !unt !e#ara i de o matri%e %on@un%tiv*
"ax*/ em7rionar*/ %u %ordoane ,i in!u"e de
e#ite"iu odontogen
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 41/66
ODONTOMU3 COMPUS
Numero,i din i %oni%i de +orm*neregu"at*
Odontom %om#u! )n %are
ma%ro!%o#i% !eremar%* #re'en a%aninu"ui
de%idua"/ a%a#!u"ei 6r7oa!e
,i a din i"or
miniatura"i1Radio"o i% !e
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 42/66
ODONTOMU3 COMPUS
Din i !e% iona i !u7 diver!ein%iden e/ in%"uLi )ntr o !trom*67roa!*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 43/66
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 44/66
ODONTOMU3Com#ortament 7io"ogi%• tumori %u %reLtere extrem de "ent*• odat* )n%(eiat #ro%e!u" de %a"%i6%are %re,terea !e
o#re,te• !e %om#ort* de o manier* !imi"ar* din i"or tind !*
eru#* dar/ datorit* anoma"ii"or !tru%tura"e/ !e %aria'*+oarte uLor iar %om#"i%a ii"e a#ar ra#id in ama ia #u"#eiLi +ormare de a7%e!e
• #o!i7i" tran!+orm*ri %(i!ti%e1 Tratament0
- am7e"e +orme !unt 7ine )n%a#!u"ate ,i #ot 6 enu%"eateu,or din e!utu" o!o! adia%ent
- #ot !* a#ar* re%idive doar )n %a'u" odontoame"or%om#"exe %are nu au +o!t re'e%ate %om#"et
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 45/66
ODONTO2ME3OB32STOMU3
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 46/66
ODONTO2ME3OB32STOMU3• Tumor* extrem de rar* %e %om7in* %ara%teri!ti%i"e
ame"o7"a!tomu"ui %u %e"e a"e odontomu"ui• ma@oritatea au +o!t diagno!ti%ate )n #rime"e trei
de%ade de via *• a+e%tea'* %u +re%ven * ega"* mandi7u"a ,i maxi"aru"/
ma@oritatea "e'iuni"or 6ind "o%a"i'ate #o!terior• !emene"e %"ini%e in%"ud tume+a% ie o!oa!*/ re!or7 ieradi%u"ar*/ di!"o%area din i"or ,i uneori durere
• radio"ogi%0 – !e o7!erv* o "e'iune radiotran!#arent* uni !au
mu"ti"o%u"ar* 7ine de"imitat* %on in-nd o %antitatevaria7i"* de materia" radioo#a%
– ma@oritatea !unt a!o%iate unor din i %are nu au eru#t/ #e%are )i di!"o%uie,te
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 47/66
ODONTO2ME3OB32STOMU33e'iune
ex#an!iv* "anive"u"
maxi"aru"uiunui 7*r7at
de >8 ani/ %u%re,tere#rogre!iv* )nu"time"e ><"uni $RMN&
3e'iune 7inede"imitat* "a un7*iat de 8 ani/
%on in-nd materia"minera"i'at/
di!"o%uind un dinte%are nu a eru#t $CT&
ODONTO2ME3OB32STOMU3
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 48/66
ODONTO2ME3OB32STOMU3 a!#e%t mor+o#ato"ogi%
•
Macroscopic: – ma@oritatea !unt ne)n%a#!u"ateK – #e !e% iune ar(ite%tur* mu"tinodu"ar* – %antitate varia7i"* de țesut dur !u7 +orm* de ma!e
mari/ "o7u"are !au !u7 +orma unor din i rudimentaridi!tri7ui i a"eatoriu
• Microscopic:• in!u"e ,i %ordoane de e#ite"iu odontogen similare celor
din ameloblastomul +o"i%u"ar/ re!#e%tiv #"exi+orm•
!trom* 67roa!*• e!ut %on@un%tiv mixoid (i#er%e"u"ar %u +ormare de
!tru%turi dentare minera"i'ate !imi"ar odontoamelor • Prog ostic: !imi"ar ame"o7"a!tomu"ui %omun $agre!iv
"o%a"&
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 49/66
ODONTO2ME3OB32STOMU3
Ma!e nodu"are deme'en%(im odontogen/
adia%ente unei #ro"i+er*rie#ite"ia"e %e )m7ra%*
a!#e%tu"ame"o7"a!tomu"ui
#"exi+orm
2rie de ame"o7"a!tom#"exi+orm adia%ent* unui
nodu" de me'en%(imodontogen
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 50/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4
TUMOR2 ODONTOGEN4
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 51/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4 $TOCC&
• Cara%teri'at* #rin #re'en a unei #ro"i+er*rie#ite"ia"e !imi"are ame"o7"a!tomu"ui/ %u%e"u"e +antom* %e !e #ot %a"%i6%a
•
interva" de a#ari ie 8< ani• #oate 6 intra !au extrao!oa!*• +re%ven a de di!tri7u ie ega"* "a nive"u"
maxi"aru"ui ,i mandi7u"ei• ma@oritatea "o%a"i'ate )n regiunea
%ore!#un'*toare in%i!ivi"or ,i %anini"or
TUMOR2 ODONTOGEN4
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 52/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4
C!i ic• TOCC extrao!oa!*0
– ma!* #roeminent*/ 7ine de"imitat*/ %u !u#ra+a * neted*,i %u"oare ro' ro,ie
– diametru" de maxim %m –
a!im#tomati%*• TOCC intrao!oa!*0 tume+a% ie o!oa!* nedureroa!*Ra"io!ogic• TOCC extrao!oa!*0 de+ormarea ,i de#"a!area din i"or
adia%en i• TOCC intrao!oa!*0
– radiotran!#aren * uni"o%u"ar* 7ine de"imitat* – )n : din %a'uri %on ine materia" radioo#a% –
)n!o it* de re!or7 ia;divergen a r*d*%ini"or dentare –
O 2 O O OG
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 53/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4
Radiotran!#aren * 7ine de"imitat*%u divergen a r*d*%ini"or ,i
di!"o%area unui %anin im#a%tat
TUMOR2 ODONTOGEN4
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 54/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4
Mi%ro!%o#ie0• %(i!t %u #erete 67ro! ta#etat de e#ite"iu !imi"ar %u a"
ame"o7"a!tomu"ui uni%(i!ti%• intrae#ite"ia" !unt #re'ente %e"u"e +antom* eo'ino6"e/
anu%"eate %e !e #ot %a"%i6%a• %e"u"e"e +antom* #ot (ernia #rin mem7rana 7a'a"*
a@ung-nd )n !troma adia%ent*/ de%"an,-nd o rea% iein amatorie de %or# !tr*in
• )n !troma 67roa!* adia%ent* %e"u"e"or 7a'a"e e#ite"ia"e!e #oate +orma dentin* di!#"a'i%*
• dentina ,i %e"u"e"e +antom* #ot +orma ag"omer*ri mixte• prezența celulelor fantomă permite diferențierea de
ameloblastom
TUMOR2 ODONTOGEN4
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 55/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4
E#ite"iuame"o7"a!ti% %u%e"u"e +antom*
Ce"u"e +antom*,i +ormare de
dentin*di!#"a'i%* )n
!troma 67roa!*adia%ent*
"e'iunii %(i!ti%e $%o"1 Jan
TUMOR2 ODONTOGEN4
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 56/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 57/66
TUMOR2 ODONTOGEN4C23CIFIC2NT4 CHISTIC4
• Tratamentu" %on!t* )n enu%"eerea"e'iunii
• Forme"e extrao!oa!e nu !e )n!o e!%de re%uren e
• Rare re%uren e )n %a'u" "e'iuni"orintrao!oa!e
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 58/66
TUMOR2 DENTINOGEN4CU CE3U3E F2NTOM4
TUMOR2 DENTINOGEN4 CU CE3U3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 59/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4 $TDCF&
• 3e'iune neo#"a'i%* agre!iv* "o%a" %u mor+o"ogie!imi"ar* ame"o7"a!tomu"ui %e a!o%ia'*#re'en a intrae#ite"ia"* ,i !troma"* a %e"u"e"or+antom* ,i +ormare de dentin* di!#"a'i%*
• )nt-"nit* din de%ada a < a #-n* )n %ea de a 8 a• +re%ven * u,or %re!%ut* "a 7*r7a i• TDCF extrao!oa!* #redi"e% ie #entru regiunea
anterioar* a maxi"are"or• TDCF intrao!oa!* #redi"e% ie #entru regiunea%u#rin!* )ntre %anin ,i #rimu" mo"ar
TUMOR2 DENTINOGEN4 CU CE3U3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 60/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4
Jarianta extrao!oa!*0• nodu" exo6ti% !e!i" "a nive"u" mu%oa!ei gingiva"e
!au a"veo"are•
#oate a#*rea )n arii edentate• ma@oritatea au diametru" :/ > %m $maxim %m&
• %re,te "ent/ a!im#tomati%*Radio"ogi%0• am#rentarea o!u"ui !u7ia%ent ,i di!"o%area
din i"or
TUMOR2 DENTINOGEN4 CU CE3U3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 61/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4
Jarianta intrao!oa!*0• diametru" %u#rin! )ntre > ,i Q>: %m• a!im#tomati%*• ex#an!iunea %orti%a"ei o!oa!e eventua" %u re!or7 ia
a%e!teia ,i exten!ie )n e!uturi"e moi• din ii adia%en i #ot 6 di!"o%a i ,i mo7i"iRadio"ogi%0• "e'iune uni"o%u"ar* radiotran!#arent* %u o#a%i6ere
varia7i"* )n +un% ie de gradu" de %a"%i6%are• margini 7ine de"imitate• +re%vent re!or7 ia din i"or adia%en i• uneori a!o%ia'* un dinte im#a%tat
TUMOR2 DENTINOGEN4 CU CE3U3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 62/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4
Zon* de radiotran!#aren * "o%a"i'at*mandi7u"ar
TUMOR2 DENTINOGEN4 CU CE3U3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 63/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4 a!#e%t mi%ro!%o#i%
• #"a@e ,i in!u"e rotunde de e#ite"iu odontogen di!#u!e )ntr o !trom* %on@un%tiv* matur*
• #ro"i+erarea in6"trea'* e!uturi"e )nve%inate• a!#e%tu" %om#onentei e#ite"ia"e !imi"ar %u a"
ame"o7"a!tomu"ui• tran!+ormarea %e"u"e"or e#ite"ia"e )n A%e"u"e +antom*A
#re'ente i'o"at !au )n gru#uri mari0 – %e"u"e anu%"eate %u %ito#"a!ma omogen eo'ino6"* – #re'en a a%e!tora )n !trom* rea% ie in amatorie de %or#
!tr*in – une"e !e #ot %a"%i6%a
• tumora +ormea'* adia%ent e#ite"iu"ui mi%i %antit* i dedentin* di!#"a'i%* %e #oate in%"u'iona %e"u"e"e +antom*
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 64/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4
21 Tran!+ormarea%om#onentei e#ite"ia"e
!imi"are reti%u"u"ui !te"at )n%e"u"e +antom*/ une"e
%a"%i6%ate
B1 Tran!+ormarea%om#onentei e#ite"ia"e
!imi"are reti%u"u"ui !te"at )n%e"u"e +antom* ,i #re'en a
adia%ent* a dentinei
di!#"a'i%e $ &
TUMOR2 DENTINOGEN4 CU CE3U3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 65/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4
dentin*di!#"a'i%*
%e"u"e+antom*
TUMOR2 DENTINOGEN4 CU CE3U3E
8/16/2019 Gig Eles Prodasta Cas
http://slidepdf.com/reader/full/gig-eles-prodasta-cas 66/66
TUMOR2 DENTINOGEN4 CU CE3U3EF2NTOM4
Diagno!ti% di+eren ia"- ame"o7"a!tomu" $a7!en a %e"u"e"or +antom* ,i
a dentinei&-
tumora odontogen* %a"%i6%ant* %(i!ti%*$"e'iune %(i!ti%* uni%*/ 7ine de"imitat*& Tratament
- TDCF intrao!oa!* e!te agre!iv* ,i !e
re%omand* ex%i'ia "arg* $uneori re%idivea'*&- TDCF extrao!oa!* enu%"eere/ nu re%idivea'*• Ri!% de ma"igni'are %ar%inom odontogeni% %u
%e"u"e +antom*