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Radicular cyst

Well-defined radiolucent lesion at the apex of the maxillary lateral incisor.


The circumscribed radiopaque (sclerotic) border signifies that the lesion is
self-contained, enlarges by expansion, and is slow-growing. There is no
change in the surrounding bone.
The large, welldefined radiolucency with a radiopaque (sclerotic) border
is suggestive (on a speculative basis) of a radicular cyst (periapical cyst).
Radicular cysts are the second most frequently occurring of the three
pulpo-periapical lesions. The involved tooth is nonvital.

The radicular cyst is the most common cyst and is frequently classified as
an inflammatory cyst. It has its origin from the cell rests of Malassez which
are present in periodontal and periapical ligament, and in periapical
granulomas.
Causes

- Infection from the crown of a carious tooth producing an inflammatory


reaction at the tooth apex and forming a granuloma.
-The liquefaction of the apical granuloma produces a radicular cyst.
-The pulp of the involved tooth is degenerated and the tooth is nonvital.

Initially, the patient may have had pain from the pulpitis and this is
followed by a period without symptoms when the cyst is formed. Therefore,
when radicular cysts are found they are usually painless but may sometimes
exhibit mild pain or sensitivity to percussion.
Follicular Cyst

Synonym: Dentigerous cyst

Definition
Cyst which encloses crown and is attached to neck of unerupted tooth. It
develops by accumulation of fluid between reduced enamel epithelium and
crown, or between layers of reduced enamel epithelium
(WHO).

Clinical Features
▬ Odontogenic
▬ Developmental
▬ Around tooth crown
▬ Mandibular third molar, maxillary canine and third molar, mandibular
second premolar
▬ Males more frequent than females
▬ All ages, particularly second to fourth decades
▬ Eruption cyst surrounds crown of an erupting tooth

-A dentigerous or follicular cyst is formed from the accumulation of fluid


between the reduced enamel epithelium and the completely formed tooth
crown or in the layers of the reduced enamel epithelium. The crown
projects into the cystic space.

- The tooth remains unerupted because of the overlying cyst.

-A dentigerous cyst almost exclusively occurs in the permanent dentition,


especially in association with impacted mandibular third molars and with
impacted maxillary canines. Sometimes the cyst may be situated on only
one surface of the crown.

- Radiographically, the well-defined radiolucency has a radiopaque


border and surrounds the crown of an impacted or unerupted tooth.
The dentigerous cyst is found in children and adolescents; the highest
incidence is in the second and third decades.

-Whenever a radiographic diagnosis of a dentigerous cyst is made, the


possibility of it being a mural ameloblastoma (that is, a neoplastic
transformation of the epithelial lining of a dentigerous cyst) should also be
considered.

- Other pericoronal radiolucencies that radiographically resemble


dentigerous cysts are stated below in the differential diagnosis for
consideration. It is, therefore, imperative that the clinician send the
enucleated specimen for microscopic examination.
-The differential diagnosis of a pericoronal radiolucency includes
dentigerous cyst, mural ameloblastoma, odontogenic adenomatoid tumor,
odontogenic keratocyst, ameloblastic fibroma, ameloblastoma, and
calcifying odontogenic cyst.
Canine Impaction
Multiple dentigerous cyst
Multiple supernumerary teeth in all four quadrants in a
developmental disturbance of cleido-cranial dysostosis.

Cleido cranial dysostosis or CCD mostly affects bones and teeth. The
clavicles ( collar bones) are either poorly developed or absent. The
shoulders can be brought together- hypermobility of the shoulder joints.
Distodens or distomolar is a supernumerary tooth that is distal to the
third molar. The distodens is impacted superiorly in the ramus.
Eruption cyst
Pre-op

Post -op
Eruption cyst

-The eruption cyst is a form of soft tissue benign cyst accompanying with
an erupting primary or permanent teeth and appears shortly before
appearance of these teeth in the oral cavity.

- It is a soft tissue analogue of the dentigerous cyst, but recognized as a


separate clinical entity.

-Dentigerous cyst develops around the crown of an unerupted tooth


lying in the bone, the eruption cyst occurs when a tooth is impeded in its
eruption within the soft tissues overlying the bone.

-The exact etiology of occurrence of eruption cyst is not clear. Aguilo et


al. in their retrospective clinical study of 36 cases, found early caries,
trauma, infection and the deficient space for eruption as possible
causative factors.

-Although there are a number of theories about their origin, both seem to
arise from the separation of the epithelium from the enamel of the crown
of the tooth due to an accumulation of fluid or blood in a dilated follicular
space.
GARRÉS OSTEOMYELITIS (Periostitis ossificans, Osteomyelitis
with proliferative periostitis)

Garrés osteomyelitis or proliferative periostitis is a type of chronic


osteomyelitis which is nonsuppurative. It occurs almost exclusively in
children and young adults who present symptoms related to a carious
tooth.

The process arises secondary to a low-grade chronic infection, usually from


the apex of a carious mandibular first molar.
The infection spreads towards the surface of the bone, resulting in
inflammation of the periosteum and deposition of new bone underneath
the periosteum.
This peripheral formation of reactive bone results in localized periosteal
thickening.
The inferior border of the mandible below the carious first molar is the
most frequent site for the hard nontender expansion of cortical bone. On an
occlusal view radiograph, the deposition of new bone produces an "onion-
skin" appearance.
Garrés osteomyelitis
demonstrating an expansion of the inferior border of the mandible (onion-
skin appearance) caused by the periapical infection of the mandibular first
molar.
Histiocytosis X has caused complete destruction of the interdental
alveolar bone in the molar region. Described as floating teeth.
Idiopathic internal root resorption of pulpmcanal of right central
incisor.

The localized increase in size of the pulp may result in spontaneous root
fracture. When a similar resorption occurs in the pulp chamber, the tooth is
called a "pink tooth" because of its clinical appearance.
The replanted left central incisor tooth has undergone complete root
resorption. The silver point of the root canal filling is holding the crown in
place. Replantation produces rough and irregular root resorption.
“Idiopathic root resorption” (IRR)

There was no sign of caries or any other abnormal finding except root
resorption in both of the second mandibular molars. OPG showed
extensive root resorption of the left second mandibular molar and mild
external root resorption of the right second mandibular mo
Resorption

-Tooth resorption is a common sequela following injuries to or irritation of


the periodontal ligament and/or tooth pulp.

- The course of tooth resorption involves an elaborate interaction among


inflammatory cells, resorbing cells, and hard tissue structures.

- The key cells involved in resorption are of the classic type, which include
osteoblasts and odontoclasts.

Definition

Resorption of dental hard tissues is shown to be associated with


osteoclastic cell activity , an unwelcomed condition defined as the
continuous loss of dentine and cementum owing to clastic cellular
function

Types of tooth resorption


-internal resorption
-external resorption.

Internal resorption

Two types
- root canal (internal) replacement resorption
- internal inflammatory resorption.

External resorption

-external surface resorption,


-external inflammatory root resorption,
-replacement resorption
-ankylosis.

External inflammatory root resorption can be further categorized into


cervical resorption with or without a vital pulp (invasive cervical root
resorption) and external apical root resorption. Other variations of
resorption include combined internal and external resorption and transient
apical breakdown.

External inflammatory root resorption (EIRR) is defined as a


dynamic process which provokes the loss of different dental tissues,
involving periodontal ligaments (PDL), dental hard tissues, and even the
dental pulp in advanced stages.

Most often, the phenomenon initially reveals itself with small-sized lesions
of cementum within PDL and, if not treated, may progress towards the
involvement of the dental pulp.

Primary crowding is caused by a tooth size incompatibility between


primary and permanent teeth, and is generally of genetic origin.

Secondary crowding occurs in the posterior area due to premature


extractions of primary molars, with consequent loss of the arch length.

Physiological root resorption in primary teeth leads to the


exfoliation of the teeth and allows the permanent teeth to erupt.
-The dental pulp plays an important role in the resorption process.
-Resorption starts between 1 and 3 years after the apical closure, followed
by exfoliation after three years.

Asymmetrical root resorption may be due to several factors such as


-age,
- presence of caries/restorations,
- presence of pulpotomy,
- discrepancy in the size between the premolar and its predecessor and the
position of the developing tooth in relation to the primary root

Cross-bites and other malocclusions can potentially develop if there is over


retention of primary molars. Other complications include space loss,
impaction of succedaneous teeth, tipping of adjacent teeth, supraeruption
of opposing teeth and vertical bone loss. It can also lead to difficult
extractions. The findings of this study are like Peretz et al. in which over
one-half (55%) of the root resorption in the primary first molar was in the
distal root. Another study done by Moorrees et al. had somewhat different
results in which mesial roots resorbed earlier than the distal root. This
difference could be due to different study populations or different methods
of study.

Infraocclusion (Submergence or Ankylosis)

It is a condition where teeth are found with their occlusal surface below the
adjacent teeth, long after they should have reached occlusion.

The frequency of infraocclusion of primary molars of mandible is 10-fold


higher in contrast to those of the maxilla. Some studies showed that the
first mandibular primary molars are most often affected.

The principal etiology of infraocclusion is ankylosis between the roots of the


infraoccluded tooth and the surrounding bone. As a result, the tooth
involved remains in a state of static retention, whereas in the adjacent
areas, eruption and alveolar growth continue.

Classification

 Slight – occlusal surface located approximately 1 mm below the expected


occlusal plane in the tooth.
 Moderate – occlusal surface approximately level with the contact point of
one or both adjacent tooth surfaces.
 Severe – occlusal surfaces level with or below the interproximal gingival
tissue of one or both adjacent tooth surfaces
Mesiodens

Supernumerary teeth are extra teeth in comparison to normal dentition. It


is more common in the central region of the upper or lower jaw; however,
its occurrence in the mandible is rare.

The most common type of supernumerary tooth as indicated by Alberti et


al is mesiodens.

Mesiodens may occur as single, multiple, unilateral or bilateral. The


presence of multiple supernumerary teeth is called ‘mesiodentes’

The occurrence of mesiodens in primary dentition is quite rare despite


the fact that in permanent dentition it has even been considered as the
most common dental abnormality .

It has been reported that in 82% of the cases it occurs in the maxilla,
specifically in the premaxillary region.

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