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![WHO CLASSIFICATION OF CYSTS [1992]:-
• Dentigerous cyst
• Eruption cyst
• Odontogenic keratocyst
• Gingival Cyst of newborn
• Gingival Cyst of adult
• Lateral periodontal cyst
• Calcifying odontogenic cyst
• Glandular odontogenic cyst
Developmental cysts
• Radicular cyst
• Residual cyst
• Paradental cyst
Inflammatory cysts
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ODONTOGENIC CYSTS.pptx
- 1. Dr Kiran KumarK R Professor Dept of Oral Medicine & Radiology • Navodaya Dental College 1
- 2.
- 3. Definition of theCYST A Pathologic cavity having fluid ,semi fluid, or gaseous contents and which is not created by accumulation of pus.(KRAMER 1974.) 3
- 4. Classification of Cysts 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 4
- 5. Classification of Cystsof the Jaws I. Cysts of the Jaws I(A). Epithelial lined II(B). Not epithelial lined 5
- 6. I(A). Epithelial –linedcysts (a). Developmental origin (b). Inflammatory origin (i).Odontogenic (ii).Non- Odontogenic 6
- 7. I(A)(a) DEVELOPMENTAL ORIGIN:- •I(A)(a)(i) ODONTOGENIC- i. Gingival cyst of infants ii. Odontogenic keratocyst iii. Dentigerous cyst iv. Eruption cyst v. Gingival cyst of adults vi. Developmental lateral periodontal cyst vii. Botryoid odontogenic cyst viii. Gandular odontogenic cyst ix. Calcifying odontogenic cyst 7
- 8. I(A)(a)(ii) NON –ODONTOGENIC:- • Mid palatal raphe cyst of infants • Nasopalatine duct cyst • Nasolabial cyst • II ( B)NON-EPITHELIAL –LINED CYSTS • Solitary bone cyst • Aneurysmal bone cyst 8
- 9. CYSTS ASSOCIATED WITHTHE MAXILLARY ANTRUM:- i. Mucocele ii. Retention cyst iii. Pseudo cyst iv. Postoperative maxillary cyst 9
- 10. • CYSTS OFTHE SOFT TISSUES OF THE MOUTH ,FACE AND NECK:- 1. Dermoid and epidermoid cysts 9. Cyst of the 2. Lymphoepithelial (Branchial cyst) salivary glands 3. Thyroglossal duct cyst 10. Parasitic cysts 4. Anterior median lingual cyst 5. Oral alimentary tract cyst 6. Cystic hygroma 7. Nasopharyngeal cyst 8. Thymic cyst 10
- 11. WHO CLASSIFICATION OFCYSTS [1992]:- • Dentigerous cyst • Eruption cyst • Odontogenic keratocyst • Gingival Cyst of newborn • Gingival Cyst of adult • Lateral periodontal cyst • Calcifying odontogenic cyst • Glandular odontogenic cyst Developmental cysts • Radicular cyst • Residual cyst • Paradental cyst Inflammatory cysts 11
- 12.
- 13.
- 14. RADICULAR CYST Radicular cystsare the most common inflammatory cysts and arise from the epithelial residues in the periodontal ligament. 14
- 15.
- 16. • RADIOGRAPHIC FEATURES:- 1.LOCATION:- o Epicenter - Apex of non-vital tooth. o Location - 60% maxilla - incisors & canines. o Non-vital deciduous tooth.( Buccal to developing bicuspid) 16
- 17.
- 18. • PERIPHERY ANDSHAPE:- • Shape :Round to oval shape. • Periphery: Well defined corticated border. • If cyst is secondarily infected –border will be lost. INTERNAL STRUCTURE:- • Mostly radiolucent. • Occasionally dystrophic calcification (in long standing cysts). 18
- 19. o EFFECTS ONSORROUNDING STRUCTURES:- o Adjacent teeth - Displacement & resorption of the roots o Nonvital tooth -resorption of the root rare. o Expansion of outer cortical plates - maxilla / mandible o Mandibular canal -displaced inferiorly 19
- 20. • DIFFERENTIAL DIAGNOSIS:- •Periapical granuloma • Odontogenic keratocyst • Lateral periodontal cyst • Peripical cemental dysplasia 20
- 21. RADICULAR CYST PERIAPICALGRANULOMA Size is ≥ 1cm. Size is ≤ 1cm. Shape- Round Border -Corticated Oval Sclerotic 21
- 22. RADICULAR CYST ODONTOGENIC KERATOCYST Tooth- Non vital Vital Maxillary anterior teeth . Cortical Expansion Mandibular ramus area No B-L Cortical Expansion 22
- 23. Dentigerous Cyst • Definition:- A dentigerous cyst is one that encloses the crown of an unerupted tooth by expansion of its follicle and is attached to the neck. • Browne & Smith - DENTIGEROUS CYST. • Dentigerous = tooth bearing. • Pathogenesis; Disintegration of Stellate Reticulum epithelial cells Accumulation of fluid in follicular space 23
- 24. • Clinical Features:- •Second most common cyst. • Peak - 2nd & 3rd decade. • M:F::2:1. • Site: Mandibular 3rd molar Maxillary canine & Mandibular Premolars. • May be associated with supernumerary tooth. 24
- 25. • Radiological features:- •LOCATION:- • Epicenter- Just above crown of the involved tooth. • Imp- Cyst is attached at the CEJ • 3 variants- i. Central variety- Covering crown 25
- 26. i. Circumferential variety- Coversthe entire crown without occlusal surface 26
- 27. iii. Lateral variety- Alonglateral surface of root with partially covering the crown. 27
- 28. • Inflammatory DC – –Spread of periapical infection non-vital deciduous tooth. • Multiple DC - Maroteaux- Lamy Syndrome 28
- 29.
- 30. PERIPHERI & SHAPE:- •Well defined - Circular or curved outline. • Secondary infected – loss of corticated border. INTERNAL STRUCTURE :- • Completely radiolucent. • Crown of involved tooth. 30
- 31. • Effects onsurrounding structures:- • Displaces & resorbs - adjacent teeth • Tooth Displacement –apically. • Slow growing cyst-expands cortices. • If cyst involving • maxillary 3rd molar- Floor of maxillary antrum displaced superiorly • mandibular 3rd molar- inferior alvoelar nerve canal- inferiorly 31
- 32. DENTIGEROUS CYST HYPERPLASTICFOLLICLE Follicular space > 5mm Normal Follicular space- 2-3mm 32
- 33. DENTIGEROUS CYST OKC Expansionof cortical plates Less expansion Adjacent tooth root resorption Less likely resorption Lesion is attached to CEJ of affected tooth Lesion is more apically 33
- 34. DENTIGEROUS CYST AMELOBLASTICFIBROMA Associated with unerupted tooth Not associated with unerupted tooth Molar region Premolar –molar region 34
- 35. Rx • Small-Enucleation • Large-Marsupialization Complications – SCC – Mucoepidermoid carcinoma – Ameloblastoma 35
- 36. ODONTOGENIC KERATOCYST • Synonym:-Primordial Cyst • The term Odontogenic Keratocyst - Philipsen in 1956. Pathogenesis: 36
- 37. Clinical features:- • Bimodalage . • 2 & 5th decade . • Male predominence. • Asymptomatic ,until secondarily infected . • Less/no cortical expansion. • On Aspiration – a thick, yellow, cheesey material of keratin. 37
- 38. • RADIOGRAPHIC FEATURES:- LOCATION:-Posterior body of the mandible -90% Ramus > 50% EPICENTER:- Superior to inferior alveolar canal. SHAPE :Smooth round or oval shape. PERIPHERY :- Corticated border unless secondarily infected. Scalloped outline ( contiguous arcs). 38
- 39.
- 40. INTERNAL STRUCTURES:- • Multilocularradiolucency.- Radiolucent with curved internal septa Effects on surrounding structures:- • Grow along medullary cavity of jaws. • No/ Slight B-L expansion. • Less resorption & displacement of the tooth. 40
- 41. Differential Diagnosis:- • Dentigerouscyst • Ameloblastoma • Odontogenic myxoma • Simple bone cyst. 41
- 42. Odontogenic Keratocyst Dentigerouscyst Multilocular radiolucency Unilocular radiolucency Less cortical expansion More buccal cortical expansion Not often root resorption present Resorption & displacement 42
- 43. Odontogenic keratocyst Ameloblastoma Lesscortical expansion More cortical expansion 1st ,2nd or 3rd decades Older age Paresthesia absent Paresthesia may be present 43
- 44. Odontogenic Keratocyst OdontogenicMyxoma Radiolucent –multilocular ,soap bubble appearance Radiolucent-radiopaque, tennis racket or step ladder appearance Thin septa curved ,or cicular Thin etched septa is straight always 44
- 45. Odontogenic Keratocyst SimpleBone Cyst Scalloped borders mostly towards the inferior border of mandible Scalloping borders towards the crestal bone Resorption or displacement of tooth No resorption or displacement of tooth Loss of lamina dura No loss of lamina dura 45
- 46. BASAL CELL NEVUSSYNDROME or GORLIN-GOLTZ SYNDROME Syndrome comprises of variety of abnormalities:- 1. B= Multiple nevoid Basal Cell Carcinomas of the skin. 2. S= Skeletal abnormalities. 3. C= Central nervous system abnormalities 4. M= Multiple odontogenic keratocyst. 5. EN= Endocrine system abnormality. 46
- 47. • Clinical features:- •After 5 years of age & before 30 years. • Skin lesions- small ,flattened, flesh or brown color papules on face, trunk & neck. 47
- 48. • Basal cellcarcinoma of the skin 48
- 49. • Skeletal abnormalities–Bifid rib, Synostosis of ribs. 49
- 50. • Multiple OKCin multiple sites of jaws. 50
- 51. • Costal abnormalitiesas agenesis , deformity, kyphoscoliosis, vertebral fusion, polydactyly, shortening of metacarpals. 51
- 52. • Temporal &temperoparietal bossing. 52
- 53. • Minor hypertelorism. •Mild prognathism. • Calcification of falx cerebri & duramater in early life. 53
- 54.
- 55. • DIFFERENTIAL DIAGNOSIS:- •Multiple myeloma • Cherubism Basal Cell Nevus Syndrome Multiple Myeloma Multilocular radiolucencies Multiple punched out radiolucencies with corticated borders. 55
- 56.
- 57. Basal Cell NevusSyndrome Cherubism Multiple multilocular radiolucency No jaw expansion, Bilateral multilocular radioluceny. Significant jaw expansion No displacement of the teeth Pushes posterior teeth in anterior direction 57
- 58. CALCIFYING EPITHELIAL ODONTOGENICCYST o Synonym- Calcifying Odontogenic cyst o Gorlin cyst. o Clinical features:- o 1st peak is 10-19 years, 2nd peak is 7th decade. o Slow-growing, painless swelling of jaw. o Expansion destroy cortical plate. o Advanced lesion--- discharge 58
- 59. • On ASPIRATION:-viscous, granular, yellow fluid. • RADIOGRAPHIC INTERPRETATION:- • Location– 75% anterior to the 1st molar. Cuspid and premolar region. Sometimes manifests as pericoronal radiolucencies. • Peripheri & Shape– well defined corticated, Ill defined & irregular in cyst like lesions . 59
- 60. • Internal structure:-varies usually… completely radiolucent --- small evidence of foci of calcified material . • Effects on supporting structures:- 20%-50% commonly associated with cuspid & impedes its eruption. Displacement & resorption of roots Perforation of cortical plate. 60
- 61.
- 62. • Differential Diagnosis •Dentigerous cyst • Adenomatoid odontogenic tumour • Ameloblastic fibro-odontoma 62
- 63. CEOC DENTIGEROUS CYST Notevident always pericoronally Always pericoronal radiolucent Tiny fleks of calcification masses are evedent Uniform radiolucent 63