Radicular cyst

RADICULAR CYST

1. RADICULAR CYST Presented by Dr.D.Venkatesh kumar 1 st yr PG

2. contents INTRODUCTION DEFINTION CLASSIFICATION PERIAPICAL CYST RESIDUAL CYST PATHOGENISIS CLINICAL FEATURES HISTOPATHOLOGICAL FEATURES TREATMENT CONCLUSION REFERENCES

3. INTRODUCTION Def: A pathological cavity having fluid, semi fluid or gaseous content and which is not created by accumulation of pus, it is frequently but not always lined by epithelium. Dr . KRAMER 1974 COMPONENT OF CYST: 1. Lumen (cavity) 2. Wall (capsule) 3. Epithelial lining

4. I.CYSTS OF JAWS EPITHELIAL NON -EPITHELIAL EPITHELIAL DEVELOP - MENTAL INFLAMMA- TORY DEVELOPMENTAL ODONTOGENIC NON ODONTOGENIC WHO CLASSIFICATION ( kramer,pindborg,shear 1992)

5. EPITHELIAL LINED CYST DEVELOPMENTAL INFLAMMATORY ODONTOGENIC NON ODONTOGENIC Lateral periodontal cyst Gingival cyst of the adults. Gingival cysts of newborn. Odontogenic keratocyst Dentigerous cyst Eruption cyst. Botryoid odontogenic cysts Glandular odontogenic cyst Calcifying odontogenic cyst Naso -Palatine duct cyst Naso -Labial cyst Midpalatine raphae cyst of infants Median palatine, median alveolar & median mandibular cysts Globulomaxillary cyst Radicular cyst Residual cyst Paradental cyst Inflammatory collateral cyst

6. RADICULAR CYST Radicular cyst ae the most common inflammatory cysts & arise from the epithelial residues in the PDL as a result of periapical periodontitis following death & necrosis of pulp. Also known as : Apical Periodontal Cyst Periapical Cyst Root End Cyst

7. TYPES OF RADICULAR CYST 1 . Apical 70% 2 . Lateral 20% 3 . Residual 10%

8. CLINICAL FEATURES Usually asymptomatic Slowly progressive Infected-painful & rapidly expands Initially swelling - round & hard. Later, wall is resorbed-fluctuant swelling, bluish in color, beneath the mucous membrane.

9. B one resorbed - egg shell thickness a crackling sensation ( crepitant )-pressure.

10. Phase of enlargement Phase of cyst formation Phase of initiation PATHOGENESIS

11. PATHOGENESIS CARIES , TRAUMA, PERIODONTAL DISEASE , PULPAL NECROSIS Necrotic Debris is Inflammatory Stimulus PERIAPICAL INFLAMMATION PERIAPICAL GRANULOMA Composed of granulation tissue, scar & inflammatory cells PROVIDE RICH VASCULAR AREA TO RESTS OF MALASSEZ RESTS OF MALASSEZ PROLIFERATE INITIATION

12. FORM LARGE MASS OF CELLS INNER CELLS OF MASS DEPRIVED OF NOURISHMENT UNDERGO LIQUEFACTION NECROSIS FORMATION OF A CAVITY IN THE CENTRE OF GRANULOMA RADICULAR CYST / PERIAPICAL CYST Cyst formation

13. M ain factors in the pathogenesis of cyst formation are: Proliferation of epithelial lining & fibrous capsule Hydrostatic pressure of cystic fluid Resorption of surrounding bone Infection-pulp chamber-inflammation & proliferation of ERM Internal pressure-important for growth of cyst PATHOGENESIS OF CYST

14. Hydrostatic pressure - cysts- 70cm of water Net effect-pressure is created-osmotic tension within the cyst cavity.

15. Residual cyst Retained periapical cysts-teeth extracted. L ining is a nondescript stratified squamous epithelium. Theoretically , it could develop-dental granuloma - left after-extraction.

16. Residual cyst Clinically-find in routine radiographic examination. Symptomatic-secondarily infected . Usually , residual cysts do not expand bone

17. DIAGNOSIS Diagnosis is done by the combination of : Radiographic appearances. A non vital tooth. Appropriate histopathological appearances.

18. RADIOGRAPHIC FEATURES Identical to periapical granuloma. L esion-chronic progressive-developing- pre-existing granuloma G reater size than granuloma Occasionally-exhibits-radiopaque line-periphery of radiolucent area. Radiolucency-round to ovoid.

19. RADIOGRAPHIC FEATURES Majority cysts <1.5 cm in diameter. Periapical cyst is well circumscribed. May be associated-resorption of apices of teeth, displacement of teeth or both.

20. Cystic fluid: Cyst fluid (watery & opalescent)-sometimes viscid and yellowish Usually brownish-breakdown of blood Gold or straw colour – cholesterol crystals HISTOPATHOLOGY

21. EPITHELIAL LINING: Non-keratinized stratified squamous epithelium 2%-Keratinization Early cyst-arcading pattern-later-Fair regularly arranged. Lacks a well-defined basal cell layer HISTOPATHOLOGY

22. EPITHELIAL LINING: Polymorphonuclear leucocytes- long standing cyst Hyaline bodies (Rushton bodies) may be found Mucous cells – as a result of metaplasia

23. Histopathology Wall/Capsule Composed of collagenous fibrous connective tissue Capsule is vascular & infiltrated-chronic inflammatory cells Cholesterol crystals-disintegrating RBC that readily crystallises-tissues-shear1963

24. Cholesterol from this source & serum accumulates -lack-normal lymphatic drainage . Arwill & heyden 1973-conformed-origin RBC-crystals form in congested capillaries-inflamed areas. ß-lipoproteins-plasma-thin capillaries-split-cholesterol & phospholipids – skaug1976

25. Wall/Capsule: Cholesterol crystals-surrounded-giant cells Plasma cells-prominent Russel bodies- Pulse or Seed granulomas - cyst wall

26. Differential Diagnosis Periapical granuloma Periapical scar Traumatic bone cyst Odontogenic tumors Giant cell tumors Primary occeous tumors

27. TREATMENT Root canal treatment Extraction-non-vital tooth & curettage-apical zone . RCT with apicoectomy Persistant lesions-Surgery

28. Cyst-incompletely removed  residual cyst. Continued growth-cyst- significant bone resorption- weakening - maxilla & mandible. Enucleation Marsupialization

29. conclusion Radicular cyst is a most common cyst occurs in oral cavity. However , it usually goes unnoticed and rarely exceeds the palpable dimension . P athologist need through knowledge for the exact diagnosis of the lesion which helps in proper treatment and preventing the recurrence.

30. REFERENCES Cysts of the oral and maxillofacial regions , Mervyn Shear , 4 th edition. Textbook of oral pathology, Shafer’s ,6 th edition. Textbook of oral medicine, Burkitts Textbook of oral pathology, Neville ,1 st south asia edition . Clinical pathological correlation , Regezi , 4 th edition Oral pathology, Somes & Southam , 4 th edition . Indian Journal of Pathology and Microbiology - 5 3 ( 4 ), October - December 2010