3 - odontogenic cysts

Question 1

odontogenic cysts

inflammatory cysts - 3

all other developmental

Answer 1

periapical (radicular) cyst

residual periapical (radicular cyst)

buccal bifurcation cyst

developmental - dentigerious, eruption, primordial, OKC(NBCCS, Gorlin syndrome), gingival (alverolar) cyst of the new, pof the adult, lateral periodontal cyst, calcifying odontogenic cyst (gorlin cyst)

Question 2

inflammatory cyst

most common cyst of the jaws overall

Answer 2

periapical cyst

aka radicular cust or apical periodontal cyst

Question 3

originates due to inflammatory stimulation of the epithelial rest of Malassez (PDL; clusters of residual cells of HERS)

Answer 3

periapical cyst
aka radicular cust or apical periodontal cyst
most common cyst of the jaws

Question 4

periapical cyst
aka radicular cst or apical periodontal cyst

symp/asymp
tooth test vital/nontial

Answer 4

asymptomatic; if 2nd infected or large size may get swelling and pain
non-vital tooth

Question 5

radiographic features

round to ovoid radioluceny at apex
loss of lamina dura
may develo on lateral aspect of the root, presumably due to the presence of a lateral canal in the area “lateral radicular cyst)

Answer 5

periapical cyst

aka radicular cyst or apical periodontal cyst

Question 6

plain radiographs cannot differentiate btw a periapical cyst and _

Answer 6

and periapical granuloma

cyst has stratified squamous epithelial lining

granuloma - no cyst lining; inflamed granulation tissue surrounded by fibrous tissue

Question 7

periapical cyst uni or multilocular

Answer 7

unilocular

Question 8

histopathologic features

inflamed granulation tissue or fibrous CT lined by non-keratinized stratified squamous epi

Answer 8

periapical cyst
aka radicular cust or apical periodontal cyst

if no cyst lining is seen it is a “periapical granuloma”

Question 9

periapical cyst tx

Answer 9

endo
apicoectomy
extraction with curettage
radiographic follow up to confirm healing

some believe large cystic lesions cannot be resolved with conventional endodontics - experienced clinicians have successfully used nonsurgical root canal therapy
if the radiolucency fails to resolve - the lesion often can be managed successfully by nonsurgical endo retreat!!

larger lesions - endo, marsupialization, decompression, or fenestration - maybe biopsy

Question 10

periapical cyst
aka radicular cyst or apical periodontal cyst

Px

Answer 10

excellent, but if cyst is not removed it may persist as a residual cyst
once the source of the inflammation is removed the infection resolves and the bone heals - if comes back or stays = residual cyst

Question 11

inflammatory cyst
most often represent a periapical cyst which had not been removed with the extraction or resolved with endo
well defined radiolucency in the site of a previous extraction or endo tx tooth

Answer 11

residual cyst

Question 12

tx for residual cyst

px

Answer 12

tx - enucleation, excellent prognosis

Question 13

inflammatory cyst, usually children
mandibular molars
localized swelling buccal aspect of alveolar process +- pain
possible foul taste
Flat V-shaped extension of enamel into the bifurcation of a molar

Answer 13

buccal bifurcation cys

Question 14

radiographic features

may be difficult to detect
may have well-defined radiolucency in the furcation. SUPERIMPOSED over the roots

Answer 14

buccal bifurcation cyst

apicies typically tipped to lingual cortex (occlusal radiograph)

may see proliferative periostitis - single or multiple subperiosteal layers of bone formation

Question 15

inflamed granulation tissue or fibrous CT lined by non-keratinized startified squamous epi - like periapical cyst
need the radiograph

apicies typically tipped to lingual cortex (occlusal radiograph)

may see proliferative periostitis - single or multiple subperiosteal layers of bone formation

Answer 15

buccal bifurcation cyst

Question 16

tx for inflammatory buccal bifurcation cyst

px

Answer 16

enucleation
tooth does not require extraction
may heal spontaneously

good - bone fills in and normal periodontal probe depths in ~ 1 year
may need recontouring of furcation or surgery
involved tooth may be lost due to bone destruction

Question 17

most common developmental odontogenic cyst

aorund 3rd molars, 2nd most common cyst overal after periapical cyst

Answer 17

dentigerous cyst

Question 18

develops due to accumulation of fluid btw the crown ad the reduced enamel epithelium, which is eventually forms the epithelial ling of the cyst

between crown of tooth and follicle - late teens or 20’s

Answer 18

dentigerous cyst

2-3 decade
usually asymptomatic
can cause root resorption adjacent tooth

Question 19

radiographic features

assocaited with the crown of an unerupted tooth
radioluceny greater than 5mm probably a cyst

radioluceny small than 5mm probably a hyperplastic dental follicle

the two are histologically indistinguishable

Answer 19

dentigerous cyst

has to be associated with crown of tooth

small than 5mm probably just hyperplastic follicle

Question 20

dentigerious cyst
unilocular
attached to cervical area of tooth, well-defined, often corticated border, but if cyst is infected, borders may appear ill-defined

any unerupted tooth may have one what are 3 most common

Answer 20

dentigerous cyst

mandi 3rd molar
maxillary canine
maxillary 3rd molar

Question 21

histopathological features

uninflamed fibrous CT wall lined by thin, non-keratinized squamous epithelium
may see scattered mucous cells in lining - crown develops first then roots

Answer 21

dentigerous cyst

Question 22

dentigerous cyst tx and px

Answer 22

tx - removal of tooth and cyst

px - excellent - microscopic examination to rule out other cyst/tumor - mucous cells in lining may exaplkn central (intraosseoous) mucoepidermoid carcinoma

Question 23

developmental cyst
children
essentially dentigerous cyst that forms in the soft tissue overlying the crown of an erupting tooth
BLUEish swelling this the term “eruption hematoma”

Answer 23

eruption cyst

Question 24

developmental cyst
rare lesion that is thought to be histogenetically derived from degenerating tooth bud epithelium
develops in place of a tooth, before any mineralized material is deposited
concept and meaning of the term controversial

Answer 24

primordial cyst

never really a tooth - takes its place before any calcification starts
no history or extraction or surgery in area

Question 25

any tooth, including supernumerary teeth

no history of extraction or surgery in the area is mandatory for this dx

Answer 25

primordial cyst

never really a tooth - takes its place before any calcification

Question 26

radiographic features

unilocular radiolucency in area of missing tooth with no history or extraction or surgery

Answer 26

primordial cyst

Question 27

histopathological features
some controversy exists, but microscopic features of odontogenic
keratocyst OKC
Eurpoeans, britist insist that this and OKC are the same lesion

Answer 27

primordial

Question 28

Histopathological features

corrugated surface
cyst lined by PARAkeratotic stratified squamous epithelium
hyperchromatic and palisaded basal cells

Answer 28

primordial cyst

OKC?

Question 29

tx and px for primordial cyst

Answer 29

tx - enucleation

px - good - if histology is that of an OKC, lesion will have the increased recurrence rate of OKC