ODONTOGENIC CYSTS

ORAL AND MAXILLOFACIAL SURGERY

1. SEMINAR ODONTOGENIC CYSTS CLINICAL FEATURES RADIOGRAPHIC FEATURES DIFFERENTIAL DIAGNOSIS Yasmin Moidin 2008 Batch Al Azhar Dental College Thodupuzha

2. Introduction Classification Types of odontogenic cysts Conclusion Reference CONTENTS

3. Cyst is defined as a pathological cavity filled with fluid which is solid semisolid or gaseous form which may or may not be lined by epithelium Cyst can occur within bone or soft tissues They may be asymptomatic or associated with swelling and pain INTRODUCTION

4. Cysts are generally slow growing, expansile lesions They grow by hydraulic expansion Radiographically , they often appear radiolucency surrounded by thin radioopaque border

5. CLASSIFICATION BY ETIOLOGY DEVELOPMENTAL : Unknown origin but are not the result of an inflammatory reaction Dentigerous cyst Eruption cyst Odontogenic keratocyst Gingival cyst of newborn CLASSIFICATION

6. Gingival cyst of adult Lateral periodontal cyst Calcifying odontogenic cyst Glandular odontogenic cyst INFLAMMATORY : result of inflammation periapical cyst Residual cyst Paradental cyst

7. CLASSIFICATION BY TISSUE OF ORIGIN DERIVED FROM RESTS OF MALASSEZ Periapical cyst Residual cyst DERIVED FROM DENTAL LAMINA (RESTS OF SERRES) Odontogenic kertocyst Gingival cyst of newborn Gingival cyst of adult

8. Lateral periodontal cyst Glandular odontogenic cyst UNCLASSIFIED Paradental cyst Calcifying odontogenic cyst

9. A dentigerous cyst results because of the enlargement of the follicular space of the whole or part of the crown of an impacted or unerupted tooth and is attached to the neck of the tooth DENTIGEROUS CYST

10. CLINICAL FEATURES The cyst is always associated initially with the crown of an impacted, embedded or unerupted tooth Sites: mandibular and maxillary third molar and maxillary cuspid areas Most dentigerous cysts are solitary Expansion of bone with subsequent facial asymmetry, extreme displacement of teeth, sever root resorption of adjacent teeth and pain

11. RADIOGRAPHIC FEATURES Reveal a radiolucent area associated with an unerupted tooth crown The radiolucent area is surrounded by a thin sclerotic line representing bony reaction

12. Three radiological variations:- Central variety, crown is enveloped symmetrically Lateral type, results from dilatation of the follicle on one aspect of the crown Circumferential type, follicle expands and entire tooth is enveloped by cyst DIFFERENTIAL DIAGNOSIS Ameloblastoma and ameloblastic fibroma Adenomatoid odontogenic tumour Calcifying odontogenic cyst

13. Developmental primordial and follicular primordial cyst Odontogenic keratocyst Cystic ameloblastoma Radicular cyst Hyperplastic follicle

14. Eruption cyst is defined as an odontogenic cyst that surrounds a tooth crown that has erupted through bone but not soft tissue and is clinically visible as a soft fluctuant mass on the alveolar ridges ERUPTION CYST

15. CLINICAL FEATURES Found in children and occcasionally in adults Common site – anterior to first molar Lesion appear as circumscribed, fluctuant, translucent swelling of the alveolar ridge over the site of the erupting tooth When the circumcoronal cystic cavity contains blood, swelling appears purple or deep blue; hence the term ERUPTION HAEMATOMA

16. RADIOGRAPHIC FEATURES It may show soft tissue shadow since the cyst is confined within it and there is usually no bone involvement DIFFERENTIAL DIAGNOSIS Dentigerous cyst

17. A cyst derived from the remnants of the dental lamina, with a distinctive lining of six to ten cells in thickness and exhibits a basal cell layer of palisaded cells and a surface of corrugated parakeratin ODONTOGENIC KERATOCYST

18. CLINICAL FEATURES The cyst may occur at any age Peak incidence is in 2 nd and 3 rd decades of life Predilection for occurrence in males Common site:- third molar area Other features: pain, soft-tissue swelling and expansion of bone and neurological manifestations – parasthesia of lips

19. RADIOGRAPHIC FEATURES They are unilocular , presenting a well-defined peripheral rim Scalloping of the border represents variations in the growth pattern of cyst

20. DIFFERENTIAL DIAGNOSIS Dentigerous cyst Ameloblastoma Primordial cyst Residual cyst Traumatic cyst Benign odontogenic tumor Giant cell granuloma Odontogenic myxoma

21. These are multiple , occasionally solitary, superficial raised nodules on edentulous alveolar ridges of infants that resolve without treatment, derived from rests of the dental lamina and consisting of keratin-producing epithelial lining GINGIVAL CYST OF NEWBORN

22. CLINICAL FEATURES Small discrete white swellings of the alveolar ridge Lesion appear to be asymptomatic and donot produce discomfort in infants

23. A small developmental odontogenic cyst of the gingival soft tissue derived from the rests of the dental lamina, containing a lining of embryonic epithelium of cuboidal cells and distinctive focal thickenings GINGIVAL CYST OF ADULT

24. CLINICAL FEATURES Lesion is small, well- cirumscribed , painless, swelling of the gingiva Lesion is of same color as the adjacent normal mucosa and 1cm in diameter It occurs in free or attachment gingiva and gingival papilla

25. RADIOGRAPHIC FEATURES It is a soft tissue lesion and if it enlarges to sufficient size, it causes superficial erosion of the cortical plate of bone DIFFERENTIAL DIAGNOSIS Lateral periodontal cyst

26. A slow growing, non expansile developmental odontogenic cyst derived from one or more rests of the dental lamina, containing an embryonic lining of one to three cuboidal cells and distinctive focal thickenings LATERAL PERIODONTAL CYST

27. CLINICAL FEATURES Predilection for occurrence in males Site: mandibular bicuspid/ cuspid /incisor area When the cyst is located on labial surface of the root, there is a slight mass

28. RADIOGRAPHIC FEATURES Radiolucent area in apposition to the lateral surface of a tooth root Lesion is small, border is definitive and surrounded by thin layer of sclerotic bone

29. DIFFERENTIAL DIAGNOSIS Gingival cyst of adult Botryoid cyst Lateral radicular cyst Lateral periodontal abscess Lateral dentigerous cyst Residual cyst Primordial cyst Globullomaxillary cyst Median mandibular cyst Small OKC Mental foramen Small neurofibroma Radicular cyst

30. A rare, well circumscribed, solid or cystic lesion derived from odontogenic epithelium that contains ghost cells and spherical calcifications CALCIFYING ODONTOGENIC CYST

31. CLINICAL FEATURES It is more common in females It occurs anterior to first molar It is a slow growing , painless, non-tender swelling which causes expansion and destruction of cortical plates The cystic mass may become palpable and discharging

32. RADIOGRAPHIC FEATURES The central lesion may appear as a cyst like radiolucency with variable margins which may be smooth well defined or irregular in shape with poorly defined borders Perforation of cortical plates can be seen

33. DIFFERENTIAL DIAGNOSIS Fibrous dysplasia Partially calcified odontoma Adenomatoid odontogenic tumor Ossifying fibroma Odontogenic fibroma Cementoblastoma Dentigerous cyst Ameloblastic fibroadenoma Calcifying epithelial odontogenic tumor

34. A large solitary or multilocular odontogenic cyst derived from rests of dental lamina, consisting of a stratified squamous epithelium containing numerous mucus-secreting cells GLANDULAR ODONTOGENIC CYST

35. CLINICAL FEATURES A slight male predilection Common site is anterior mandible Lesion shows slow progressive growth, painless and locally destructive

36. RADIOGRAPHIC FEATURES The lesions appear well defined with a multilocular pattern DIFFERENTIAL DIAGNOSIS Lateral periodontal cyst

37. Periapical cysts results when rests of malassez in the periodontal ligament are stimulated to proliferate and undergo cystic degeneration by inflammatory products which are associated with necrosis of the pulp PERIAPICAL CYST

38. CLINICAL FEATURES The tooth is painful and sensitive to percussion It represents a chronic inflammatory process and develops over a prolonged period of time This acute exacerbation leads to abscess, then proceed to a cellulitis and form a draining fistula

39. RADIOGRAPHIC FEATURES A peri or para apical round or oval radiolucency of variable size which is well-delineated and marked with a radioopaque rim

40. DIFFERENTIAL DIAGNOSIS Periapical granuloma Periapical scar Surgical defect Periapical cementoma Traumatic bone cyst Periapical abscess Mandibular infected buccal cyst Odontogenic keratocyst Benign tumor Ossifying fibroma

41. Residual cyst are retained periapical cysts from teeth that have been removed CLINICAL FEATURES Usually asymptomatic and found on routine radiographic examinations It is found in tooth bearing area RESIDUAL CYST

42. RADIOGRAPHIC FEATURES It may present well defined radiolucency that can vary in size from a few mm to several cm; with thin radioopaque margins DIFFERENTIAL DIAGNOSIS Primordial cyst Keratocyst Traumatic cyst Ameloblastoma

43. Paradental cyst is an inflammatory cyst which develops on the lateral surface of a tooth root PARADENTAL CYST

44. CLINICAL FEATURES It occurs in younger age group Seen in third decades of life Male predilection It is usually associated with third molar on buccal surface and covers the bifurcation The tooth is usually vital It may occur bilaterally

45. RADIOGRAPHIC FEATURES These are the non-widening of the periodontal ligamentspace and the lesion was superimposed on the buccal root surface When there was a distal as well as a buccal radiolucency , the distal element was separate from distinct distal follicular space

46. DIFFERENTIAL DIAGNOSIS Periodontal abscess Langerhan’s cell histiocytosis Dentigerous cyst

47. S M Balaji – textbook of oral and maxillofacial surgery Neelima Malik – textbook of oral and maxillofacial surgery Shafers – textbook of oral pathology Freny Karjodhkar – textbook of radiology REFERENCE