Odontogenic Cysts
In this article, we will write about the different types of odontogenic cysts, its special features, diagnosis and proper management and treatment. To read about the other Type of cysts of the Jaw:
Radicular cyst
Other Names
Periapical cyst, apical periodontal cyst, or dental cyst.
Features
- Most common.
- Inflammatory cyst because in the majority of cases it is a consequence to pulpal necrosis with an associated periapical inflammatory response. ( Rests of Malassez )
- Related to the apex of non vital tooth or related to lateral canal.
- cyst formation occurs as a result of epithelial proliferation, which helps to separate the inflammatory stimulus ( necrotic pulp ) from surrounding bone.
Clinical features
- Asymptomatic, unless associated with infection or intra-cystic pressure.
- Swelling of the jaw is the chief complaint.
- Soft fluctuant swelling, bluish in color beneath the mucosa.
- Cause bone resorption.
- On palpation may feel bony and hard unless if bone resorption occurs thus it feels soft and rubbery.
- Slight Male Prevalence.
- Occurring in 3rd to 6th decade.
- 60% in Maxilla Canine or incisors.
Radiographically
- Location apex of a non-vital tooth, but occasionally on the mesial or distal of the teeth.
- Cannot be differentiated from periapical granuloma.
- Radiolucency ( round or ovoid ) with narrow, opaque margin that is continuous with the lamina Dura.
- well defined cortical border.
- Root Resorption of offending tooth and occasionally the adjacent tooth.
Differential Diagnosis
- Odontogenic keratocyst.
- Stafne’s developmental salivary gland defect.
Treatment
- Extraction of the associated non-vital tooth and curettage of the apical zone.
- RCT may be performed with an apicoectomy ( direct curettage of the lesion ).
- The most often used is only RCT, since most periapical lesions are granulomas and resolve after removal of the inflammatory stimulus ( necrotic pulp ).
- Surgery ( apicoectomy and curettage ) is done for persist lesions, presence of a cyst or inadequate RCT. Residual cyst may occur if the cyst lining incompletely removed.
Residual cyst
Features
- It arises either due to improper surgical elimination of a radicular cyst or extraction of the related tooth without removal of the cyst
Clinical Features
- Asymptomatic and often is discovered on radiographic examination of an edentulous area.
- Its clinical and histological characteristics are identical to those of a radicular cyst
- Radiographically it will seen as a radiolucency of variable size at the site of a previous tooth extraction.
Radiographically
- Often in the mandible and always above the inferior alveolar nerve canal.
- Periphery and shape. cortical margin shape is oval or circular.
Differential Diagnosis
- Odontogenic keratocyst.
- Stafne’s developmental salivary gland defect.
Treatment
- complete removal of the cystic lesion ( enucleation ).
- In large cyst; Marsupialization is achieved by creating a window to evacuate the cyst and to decrease the intracystic pressure. Refer to Article to explain the Difference between.
Lateral periodontal cyst
Features
- Unkeratinized developmental cyst.
Lateral Periodontal Cyst In The Mandibular Region - Usually related to a vital tooth.
- Proliferation of rests of dental lamina.
- It is rare, mostly seen in males over 50 years of age.
- Gingival cysts in adult are histogenetically and pathologically similar.
Clinical Features
- Asymptomatic.
- Mandibular premolars and bicuspid region and occasionally in the incisors areas.
- Maxillary lateral incisors region.
- 4th and 5th decades of life most effected.
Radiographically
- Well-delineated, round or teardrop-shaped.
- Unilocular radiolucency with opaque margin along the lateral surface of a vital tooth root.
Diffrentail Diagnosis
- A small odontogenic Keratocyst.
- Small mental foramen.
- small neurofibroma
- a radicular cyst at the foramen of a lateral (accessory) pulp canal.
Treatment
- Local excision is generally curative.
- In case of multilocular ( botryoid ) cyst seems to have recurrence potential, follow up, therefore suggested for treated multilocular odontogenic cyst.
Gingival cyst ( Newly Born)
Features
- It is a cyst that arises from the rest cells of the dental lamina
- Solitary nodules on the crest of the alveolar ridge of the new born or very young infants. it appears as a multiple, small, firm, white or grayish-white nodules on the alveolar ridge .
- Epstein´s pearls are cystic nodules found on the hard palate or at the junction of hard and soft palate.
Treatment
- No treatment is necessary, because spontaneous rupture usually occur early.
Gingival cyst ( Adults)
Features
- A small developmental cyst of the gingival tissues derived from the remnants of dental lamina. It appears as a small circumscribed painless swelling, same color as the color of the gingiva.
Treatment
- Local excision.
Epstein’s pearls
Bohn’s nodules
Dental lamina
Dentigerous or follicular cyst
Definitions
Dentigerous Cyst is one which encloses part or all of an unerupted crown of a tooth. It is attached to the junction where the tooth enamel meets the root (amelocemental junction) and arises in the follicular tissues covering the fully formed crown of the unerupted tooth.
Features
- Second most common.
- Arise from reduced enamel epithelium of the dental follicle of an unerupted tooth.
- Developmental.
- Attached to the tooth cervix ( ECJ ).
- Enclose the crown of unerupted tooth.
Clinical Features
- Associated with 3rd molar and maxillary canine; mostly IMPACTED.
- More in Mandible.
- 2nd to 3rd decades.
- More in Males
Radiographically
- Well-defined, unilocular or occasionally multilocular Radiolucency.
- The unerupted tooth is often displaced.
- n the mandible the RL may extend to the ramus or to the body of mandible.
- In maxillary canine region the cyst may extend into the sinus or to the orbital floor.
- Resorption of adjacent tooth root maybe seen.
Treatment
- Extraction of the tooth and enucleation.
- Marsupilization of the cyst to allow for decompression and subsequent shrinkage of the lesion.
Eruption cyst
Definition
The eruption cyst is the soft tissue analogue of the follicular cyst.
Features
- Developmental.
- Result from fluid accumulation within the follicular space of an erupting tooth.
- The epithelium lining this space is simply reduced.
Clinical Features
- It appears as soft fluctuant blue to dark red mass on the alveolar ridge in place of any erupting tooth, particularly molar and canines.
Radiographically
- Negative as it is soft tissue cyst above the crown of unerupted tooth.
Treatment
- No treatment is needed, because the tooth erupts through the lesion, the cyst disappears spontaneously without complication.
Odontogenic Keratocyst (Primordial Cyst)
Features
- Arises from reduced enamel epithelium, dental lamina rests and malassez rests.
- May exhibit aggressive clinical behavior.
- Associated with nevoid basal cell carcinoma.
- It can be found any where in the jaw.
- Highly recurrence after initial surgical intervention.
- characterized by keratinizatoin and budding cyst lining.
- Has a wide age range but there is a peak incidence in the 2nd and 3rd decade with a smaller peak in the 5th decade.
- The cysts are more common in males and 70% occur in the wisdom tooth and ramus region of the lower jaw.
- Can Reach Large sizes without causing expansion, because it predominantly enlarges anterior-posterior direction.
Clinical Features
- Arises from reduced enamel epithelium, dental lamina rests and malassez rests.
Gorlin syndrome Manifestations - May exhibit aggressive clinical behavior.
- Associated with nevoid basal cell carcinoma. (Gorlin syndrome) it has many manifestations:
- Oral – multiple odontogenic keratocysts, cleft lip or palate.
- Skin – multiple nevoid basal cell carcinoma
- Skeletal – rib anomalies, vertebral deformities, polydactyly (Birth defect characterized by the presence of more than the normal number of fingers or toes)
- Central nervous system – calcified falx cerebri, brain tumors
- It can be found any where in the jaw.
- Highly recurrence after initial surgical intervention.
- Characterized by keratinizatoin and budding cyst lining.
Radiographically
- Well-circumscribed Radiolucency with smooth radiopaque margins.
- Multilocular most common in large lesions.
- It may cause buccal expansion.
- It may cause displacement of roots or IAC.
- Resorption of the root is common.
- May be associated with missing or unerupted tooth.
- It maybe difficult to distinguish from Dentigerous cyst.
Odontogenic Keratocyst
Differential Diagnosis
- Dentigerous cyst
- The cyst is likely to be an OKC if the cyst is connected to the tooth at a point apical to the cementoenameljunction or if no expansion of the cortical plates has occurred.
- Ameloblastoma.
- Odontogenic myxoma.
- A simple bone cyst.
Treatment
- Surgical excision with peripheral osseous curettage or osteoectomy is the preferred method of management.
- The use of chemical cauterization of the cyst in Highly recurrence cyst has been advocated.
- In Large cyst; Marsupilization, followed by enucleation, may be an attractive alternative.
Reasons for recurrences
- Thin and fragile cystic epithelium.
- Has satellite cysts (daughter cysts).
- Epithelial lining has intrinsic growth potential.
- Has increased mitotic activity.
- Patients with nevoid basal cell syndrome have particularly tendency for recurrence of keratocysts.
Glandular Odontogentic Cyst
Features
- Rare.
- Developmental odontogenic cyst.
- Most common site of occurrence is the front region of the lower jaw.
- They present as slow-growing, painless swellings.
- The cyst has a potentially aggressive, locally invasive nature.
- Recurrence tendency.
Paradental Cyst
Features
- Arises along partly erupted wisdom teeth that is involved by pericoronitis.
- Mostly in the lower jaw.
- Located at the cheeks side of the tooth
Sources
- Ibn Sina University Curriculum By Dr. M. Shanbari.
- INTELLIGENT DENTAL RADIOGRAPHIC APPEARANCE OF CYSTS PART 2 by Dr. MEIFONG.
- Wikipedia.
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