3 - odontogenic cysts Flashcards
odontogenic cysts
inflammatory cysts - 3
all other developmental
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)
inflammatory cyst
most common cyst of the jaws overall
periapical cyst
aka radicular cust or apical periodontal cyst
originates due to inflammatory stimulation of the epithelial rest of Malassez (PDL; clusters of residual cells of HERS)
periapical cyst
aka radicular cust or apical periodontal cyst
most common cyst of the jaws
periapical cyst
aka radicular cst or apical periodontal cyst
symp/asymp
tooth test vital/nontial
asymptomatic; if 2nd infected or large size may get swelling and pain
non-vital tooth
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)
periapical cyst
aka radicular cyst or apical periodontal cyst
plain radiographs cannot differentiate btw a periapical cyst and _
and periapical granuloma
cyst has stratified squamous epithelial lining
granuloma - no cyst lining; inflamed granulation tissue surrounded by fibrous tissue
periapical cyst uni or multilocular
unilocular
histopathologic features
inflamed granulation tissue or fibrous CT lined by non-keratinized stratified squamous epi
periapical cyst
aka radicular cust or apical periodontal cyst
if no cyst lining is seen it is a “periapical granuloma”
periapical cyst tx
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
periapical cyst
aka radicular cyst or apical periodontal cyst
Px
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
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
residual cyst
tx for residual cyst
px
tx - enucleation, excellent prognosis
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
buccal bifurcation cys
radiographic features
may be difficult to detect
may have well-defined radiolucency in the furcation. SUPERIMPOSED over the roots
buccal bifurcation cyst
apicies typically tipped to lingual cortex (occlusal radiograph)
may see proliferative periostitis - single or multiple subperiosteal layers of bone formation
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
buccal bifurcation cyst
tx for inflammatory buccal bifurcation cyst
px
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
most common developmental odontogenic cyst
aorund 3rd molars, 2nd most common cyst overal after periapical cyst
dentigerous cyst
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
dentigerous cyst
2-3 decade
usually asymptomatic
can cause root resorption adjacent tooth
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
dentigerous cyst
has to be associated with crown of tooth
small than 5mm probably just hyperplastic follicle
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
dentigerous cyst
mandi 3rd molar
maxillary canine
maxillary 3rd molar
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
dentigerous cyst
dentigerous cyst tx and px
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
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”
eruption cyst
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
primordial cyst
never really a tooth - takes its place before any calcification starts
no history or extraction or surgery in area
any tooth, including supernumerary teeth
no history of extraction or surgery in the area is mandatory for this dx
primordial cyst
never really a tooth - takes its place before any calcification
radiographic features
unilocular radiolucency in area of missing tooth with no history or extraction or surgery
primordial cyst
histopathological features
some controversy exists, but microscopic features of odontogenic
keratocyst OKC
Eurpoeans, britist insist that this and OKC are the same lesion
primordial
Histopathological features
corrugated surface
cyst lined by PARAkeratotic stratified squamous epithelium
hyperchromatic and palisaded basal cells
primordial cyst
OKC?
tx and px for primordial cyst
tx - enucleation
px - good - if histology is that of an OKC, lesion will have the increased recurrence rate of OKC
