Radicular cyst

1. RADICULAR CYST
Maryam Arbab
House Officer
SBDC

2. INTRODUCTION
• Cyst is pathological fluid-filled cavity lined by
epithelium.
COMPONENT OF CYST:
1. Lumen (cavity)
2. Wall (capsule)
3. Epithelial lining
CYST

3. NON - ODONTOGENIC
DEVELOPMENTAL INFLAMMATORY
 Nasopalatine duct
(incisive canal) cyst
 Nasolabial
(nasoalveolar) cyst
CLASSIFICATION
TYPES OF CYSTS
ODONTOGENIC NON - ODONTOGENIC
Odontogenic keratocyst
 Dentigerous
(follicular) cyst
Eruption cyst
 Lateral periodontal cyst
 Gingival cyst of infants
(Epstein pearls)
 Gingival cyst of adults
 Glandular odontogenic
cyst
Orthokeratinized
odontogenic cyst
 Radicular cyst
Apical
Lateral
Residual
Paradental cyst

4. RADICULAR CYST
• An odontogenic cyst derived from Cell Rests of
Malassez that proliferate in response to
inflammation.
Also known as :
• Apical Periodontal Cyst
• Periapical Cyst
• Root End Cyst

5. TYPES OF RADICULAR CYST
• 1. Apical 70%
• 2. Lateral 20%
• 3. Residual
Most common location:
• Maxillary anterior region
• Maxillary posterior region
• Mandibular posterior region
• Mandibular anterior region

7. EPIDEMIOLOGY
• Common – Constitutes approx one half to three fourth of
all cysts in the jaws
• Relative frequency: 60-70%
• Frequent in ages between 20-60 years (rarely in <10years
age) (Peaks in third through sixth decades)
• Maxilla is 3 times more affected than mandible
• M/F ratio: 3:2

8. CLINICAL FEATURES
• Usually asymptomatic
• Slowly progressive If infection enters, the swelling
becomes painful & rapidly expands (partly due to
inflammatory edema)
• Initially swelling is round & hard.
• Later, part of wall is resorbed leaving a soft fluctuant
swelling, bluish in color, beneath the mucous
membrane.

9. • When bone has been reduced to egg shell thickness,
a crackling sensation may be felt on pressure.

10. PATHOGENESIS
CARIES, TRAUMA, PERIODONTAL DISEASE,
PULPAL NECROSIS ( Death of Dental Pulp )
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

11. 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 wall separates from bone due to pulpal irritation

12. DIAGNOSIS
Diagnosis is done by the combination of :
• Radiographic appearances.
• A non vital tooth.
• Appropriate histopathological appearances.
• By definition, a non vital tooth is necessary for the
diagnosis of a periapical cyst.

13. Clinical Findings
Signs And Symptoms:
• Small radicular cysts do not usually become acutely infected, are
frequently asymptomatic, and can be identified on routine dental x-
rays.
• Larger cysts may produce expansion of the bone, displacement of
tooth roots, and crepitus on palpating the expanded alveolar plate.
• The discoloration of non vital teeth along with a negative response
of the affected tooth to electric pulp testing or ice are the presenting
signs.
In addition, infected radicular cysts are painful, the involved tooth is
sensitive to percussion, and there may be swelling of the overlying
soft tissues and lymphadenopathy.

14. RADIOGRAPHIC FEATURES
• Identical to periapical granuloma.
• Since the lesion is a chronic progressive one
developing in a pre-existing granuloma
• cyst may be of greater size than
granuloma
• due to longer duration
• Occasionally, exhibits thin, radiopaque line
around the periphery of radiolucent area.
• Radiolucency associated is generally round to
ovoid.
• Indicates reaction of bone to slowly
expanding mass.

15. • Majority cysts <1.5 cm in diameter.
• Long standing cysts: May cause resorption of
offending tooth and occasionally of adjacent teeth.
• Periapical cyst is well circumscribed.
• Distinct line of cortication seperating it from the
surrounding teeth.
• May be associated with the resorption of apices of
teeth, displacement of teeth or both.

16. Differential Diagnosis
• Periapical granuloma
• Previously treated apical pathology, surgical defect or
periapical scar
• Periapical cemento-osseous dysplasia (early
dysplasia)
• Traumatic bone cyst
• Odontogenic tumors
• Giant cell lesions
• Metastatic diseases
• Primary osseous tumors

18. TREATMENT
• Root canal filling ( removal of necrotic pulp; the
inflammatory stimuli ).
• Extraction of the involved non-vital tooth & curettage
of apical zone.
• Root canal filling in association with apicoectomy
(direct curettage of the lesion).
• Surgery ( apicoectomy and curretage ) is performed for
lesions that are persistent, indicating the presence of a
cyst or inadequate root canal treatment.

19. • If the cyst is incompletely removed  residual cyst.
• Continued growth of the cyst can cause significant bone
resorption along with weakening of the maxilla and mandible.
• Enucleation
• Marsupialization

20. Residual Periapical Cyst

22. Lateral Periapical Cyst

23. Lateral Periapical Cyst