Dentigerous cyst

Dentigerous cyst
Dr.Krishnamohan

1. DENTIGEROUS CYST WITH EMPHASIS ON ITS COMPLICATIONS DR.KRISHNA MOHAN POST GRADUATE STUDENT DEPT. OF ORAL PATHOLOGY SRM DENTAL COLLEGE

2. SYNOPSIS CYST - 1) DEFINITION 2) CLASSIFICATION 3) PATHOGENESIS DENTIGEROUS CYST - DEFINITION TERMINOLOGY EPIDEMIOLOGY CLASSIFICATION CLINICAL FEATURES RADIOLOGICAL FEATURES HISTOLOGICAL FEATURES INVESTIGATION TREATMENT COMPLICATIONS

3. STAGES OF TOOTH DEVELOPMENT Bud stage Cap stage Bell stage –Early bell stage -Late (or)advanced bell stage

4. CYST A cyst is pathologic cavity having fluid, semifluid, or gaseous contents that are not created by the accumulation of pus; frequently, but not always, is lined by epithelium . KRAMER’S(1974)

5. TYPES OF CYST TRUE CYSTS : Cysts which are lined by epithelium, E.g. Dentigerous Cyst, Radicular Cyst, etc. PSEUDO CYSTS : Cysts which are not lined by epithelium, E.g. Solitary Bone Cyst, Aneurysmal Bone Cyst,Traumatic bone cyst etc.

6. CLASSIFICATION (WHO 1992 )

7. WHO 2005

8. WHO 2017

9. SHEAR CLASSIFICATION According to Shear cysts are classified under three main headings: I ) Cysts of the jaws II) Cysts associated with the maxillary antrum III Cysts of the soft tissues of the mouth, face, neck and salivary glands.

10. CYSTS OF THE JAWS EPITHELIAL-LINED CYST NON-EPITHELIAL-LINED CYSTS ODONTOGENIC NON ODONTOGENIC Gingival cyst of infants Odontogenic keratocyst Dentigerous cyst Eruption cyst Gingival cyst of adults llateral periodontal cyst Botryoid odontogenic cyst Glandular odontogenic cyst Calcifying odontogenic cyst Midpalatal raphe cyst of infants Nasopalatine duct cyst Nasolabial cyst Inflammatory origin Radicular cyst, apical and lateral Residual cyst Paradental cyst and juvenile paradental cyst Inflammatory collateral cyst Solitary bone cyst Aneurysmal bone cyst 

11. CYSTS ASSOCIATED WITH THE MAXILLARY ANTRUM Mucocele Retention cyst Pseudocyst Postoperative maxillary cyst CYSTS OF THE SOFT TISSUES OF THE MOUTH, FACE AND NECK Dermoid and epidermoid cysts Lymphoepithelial cyst Thyroglossal duct cyst Nasopharyngeal cyst Thymic cyst

12. SHAFERS CLASSIFICATION DEVELOPMENTAL CLASSIFICATION BASED ON ETIOLOGY CLASSIFICATION BY TISSUE OF ORIGIN Dentigerous cyst Eruption cyst Odontogenic keratocyst Gingival (alveolar) cyst of newborn Gingival cyst of adult Lateral Periodontal cyst Calcifying odontogenic cyst Glandular odontogenic cyst . INFLAMMATORY   Periapical Residual periapical (radicular) cyst Paradental cyst DERIVED FROM RESTS OF MALASSE DERIVED FROM DENTAL LAMINA ( REST OF SERRES) Periapical cyst Residual cyst Derived from reduced enamel epithelial Dentigerous cyst Eruption cyst Odontogenic keratocyst Gingival (alveolar) cyst of newborn Gingival cyst of adult Lateral Periodontal cyst Calcifying odontogenic cyst Glandular odontogenic cyst.

13. PATHOGENESIS OF CYST INITIATION CYST FORMATION ENLARGEMENT

14. INITIATION Initiation results in the proliferation of the developing odontogenic epithelial cells and the formation of small cavity Cell Rests of Malassez Reduced Enamel Epithelium Cell Rests of Serres (Dental Lamina)

15. CYST ENLARGEMENT Harris (1974) Postulated the theories Mural growth - Peripheral cell division 2) Hydrostatic –Accumulated contents 3) Bone resorbing factor

16. DENTIGEROUS CYST Latin word Denti -Tooth Gerous - Bearing or Producing Also called follicular cyst or pericoronal cyst Developmental odontogenic cyst of epithelial origin. Occurs in association with an unerupted tooth

17. DEFINITION An odontogenic cyst that surround the crown of impacted tooth,caused by fluid accumulation between the reduced enamel epithelium and enamel surface ,resulting in a cyst in which the crown is located within the lumen.

18. PATHOGENESIS THEORY :TOLLERS ET AL INTRAFOLLICULAR EXTRAFOLLICULAR INTRAFOLLICULAR : It may develop by the accumulation of fluid either between the reduced enamel epithelium and the enamel or within enamel organ itself.

19. According to Atkinson(1976)

20. ACCORDING TO AL-TALABANI AND SMITH(1980)

21. CLINICAL FEATURE AGE: first to third decades SEX: equal in both sex SITE: maxilla-33%, mandible-67% most frequently located in angle of mandible, canine region of maxilla & mandible maxillary 3rd molar area , rarely at anterior segment Usually painless , pain arise when secondary infection occurs If untreated-swelling became large

22. Expansion of bone with subsequent facial asymmerty Pus may discharge in case of secondary infection

23. RADIOLOGICAL FEATURE Well defined radiolucent area unilocular or multilocular radiolucency encircle the crown of unerupted tooth

24. Central variety Lateral variety Circumferential variety CENTRAL CIRCUMFERENTIAL LATERAL

25. EXPANSION

26. ASSOCIATED DISEASE Bilateral cysts are found in association with Basal cell nevus syndrome, Cleidocranial dysplasia and a rare form of amelogenesis imperfecta .

27. HISTOLOGICAL FEATURE

28. CYST LINED BY THIN KERATINISED EPITHELIUM

29. CYST LINED BY NON KERATINISED EPITHELIUM

30. CYST LINED BY CILIATED COLUMNAR EPITHELIUM

31. MUCOUS CELLS SEEN WIHIN THE EPITHELIAL LINING

32. EPITHELIAL LINING CONTAINING RUSHTON BODIES

33. INFLAMMED DENTIGEROUS CYST

34. DENTIGROUS CYST IN PRIMARY DENTITION Frequently in children is low 10 years of age. Periapical inflammation from a non-vital primary tooth The spread of periapical inflammation may affect the germ of permanent tooth and may induce the formation of a cyst.

35. INVESTIGATION FNAC BIOPSY OPG CT BLOOD TEST

36. TREATMENT Enucleation Marsupialisation Removal of associated tooth

37. POTENTIAL COMPLICATION OF DENTIGEROUS CYST Ameloblastoma Mucoepidermoid carcinoma Squamous cell carcinoma

38. THANK YOU