Radicular cyst or periapical odontogenic cyst

It is an most commonly occuring inflammatory odontogenic cyst. Around 60% of all jaw cysts and 15% of all periapical lesions are due to radicular cyst

1. Radicular Cyst Sayyed Jani BDS

2. Introduction: Most common odontogenic cyst Around 60% of all jaw cysts and 15% of all periapical lesions are Radicular cyst. It is an inflammatory odontogenic cyst surrounding the periapical region of tooth.

3. Etiopathogenesis : It occurs as a result of (a) Bacterial infections (b) Necrosis of Dental pulp (c) Dental caries

4. Demographs : Gender prediction: Males > Females Age prediction: 20 to 60 years Site of occurance : Commonly maxillary anteriors followed by mandibular premolars and molars . Origin: odontogenic

5. Clinical features: Asymptomatic mostly painless slow growing swelling associated teeth shows sensitive to percussion Rarely causes expansion of cortical plates Long standing of cyst may undergo an acute exacerbation of inflammatory process and develop rapidly into abscess and then may proceed to cellulitis or form a draining fistula. On aspiration we can see straw coloured fluid with cholesterol crystals.

6. Radiographic features: Radiographic features are similar to Periapical Granuloma. We can’t differentiate between Radicular cyst and Periapical Granuloma. Unicystic radiolucent areas are seen which are surrounded by thin radiopaque line which indicates reaction of bone to the slowly expanding mass.

7. Histological features: Lining epithelium is Non keratinized stratified squamous epithelium. Epithelium shows spongiosis and inflammatory cell infiltration. Epithelium shows arcading pattern Epithelium shows Rushton bodies . Rushton bodies - arc shaped ; eosinophilic ; hyaline bodies. They are refractile ; amorphous in structure; Brittle in nature . There is no clinical significance and their origin is unknown. They are also seen in residual cyst . Connective tissue – delicate with dense inflammatory cell infiltration. Deeper portion of connective tissue is more fibrous. Cystic lumen contains straw coloured fluid with cholesterol crystals.

8. Treatment and prognosis: Root canal therapy of the involved teeth along with periapical surgery or extraction of involved tooth followed by periapical curettage . If the cyst is incompletly removed then the remnant cells may develop into Residual cyst.