ORAL RADIOLOGY SEMINAR

Cyst of the Jaw

SHAHIBUL AFZAN WAHAB

O711498
 ** just to recall….

What is a cyst ?
A- connective tissue wall that forms the cyst

B- epithelium that can line a cyst developing

within the oral regions. 

A pathologic cavity, lined by epithelium,

containing fluid or semisolid material.
 Classification of Cysts

True cysts Pseudo cysts

Odontogenic Traumatic bone
cysts cyst

Non-
odontogenic Aneurysmal bone
cysts cyst

Static bone cyst

**p.s:
True cysts: possess an epithelial lining.
Pseudo cysts: possess NO epithelial lining.
• Paradental cysts Unclassified
• Odontogenic keratocysts (OKC)
• Lateral periodontal cysts
• Gingival cysts of the adult
• Dental lamina cysts of the
Dental lamina
newborn
• Glandular odontogenic cyts
• Dentigerous cysts
Epithelium
• Eruption cysts
Reduced Enamel
• Periapical / Radicular cysts
Malassez
• Residual cysts
Rests of
Classification of odontogenic cysts
**do you remember??
Classification of non- odontogenic
cysts (developmental cysts)

Non-
odontogenic
cysts

Nasopalatine Nasolabial
duct cysts cysts
TRANSITIONAL
 …let’s concentrate on our topic today…

CYSTS AND THEIR

RADIOLOGICAL APPEARANCE…

do not sleep…

…and don’t play-play … =)

 True cyst> odontogenic cyst>
Periapical / Radicular / Apical periodontal
cysts
An odontogenic cyst derived from rests of Malassez that
proliferate in response to inflammation.

Age: 20-50 year-old

Frequency: Most common of all jaw cysts

(70%)
Site: Apex of any non-vital tooth.

Size: 1.5-3 cm in diameter (if smaller the

radiographic distinction between cyst and granuloma
cannot usually be made)

Shape: - round
- unilocular

Outline: - smooth
- well defined
- well corticated if long standing and
continuous with the lamina dura of the associated
tooth.

Radiodensity: Uniformly radiolucent

Effects: - adjacent teeth: displaced, rarely

absorbed

- buccal expansion
- displacement of the antrum
CASE REPORT
• This lateral incisor clinically shows a cavity previously
occupied by a mesial composite restoration, which
was done 4 years ago, and recently fell off.
• The patient relates a history of occasional pain in
that tooth as well as tenderness in the periapical
area.
• She also states that about 2 years ago she had an
episode of marked swelling and intense pain in
that area which was treated elsewhere with
antibiotics.
• Further treatment at the time, as indicated by the
attending dentist, was not performed because the
patient failed to maintain the appointment.
• Note the caries on the distal of this tooth and the
large periapical radiolucency.
• The lateral incisor was treated endodontically and
with a retrofill and on the basis of the biopsy the
periapical lesion was diagnosed histologically as a
radicular cyst.
From our clinic…
 True cyst> odontogenic cyst>
Residual cysts
A cyst that remains at the site of a previously extracted
tooth

Age: Adults, over 20 years old.

Site: Apical regions of the tooth-
bearing portion of the jaws.

Size: Variable, usually around 2-3cm

in diameter

Shape: - Round
- Unilocular

Outline: - Smooth
- Well-defined
-Usually well corticated

Radiodensity: Uniformly
radiolucent

Effects: - Adjacent teeth displaced,

rarely resorbed

- Buccal expansion

- Displacement of the antrum

 This large residual cyst has been present
for many years in the mandible of a 67
year-old man. Arrow A points to the
mandibular canal. Arrow B points to the
expansion of the labial cortical plate
produced by the cyst. Arrow C points to a
radicular rest.

This cyst was a consequence

to caries in the first maxillary
molar. That molar was
extracted and portions of the
cystic wall were left within
bone. Those rests gave rise
to a so-called residual cyst.
Therefore, any cyst must be
carefully removed in order to
avoid recurrences.
From our clinic…
 True cyst> odontogenic cyst>
Dentigerous cyst
An odontogenic cyst that surrounds the crown of an impacted
tooth; it is caused by fluid accumulation between the reduced
enamel epithelium and the enamel surface, resulting in a cyst in
which the crown is located within the lumen and root or root
outside.

Age: Usually adolescents/ 20-40 year-

olds, occasionally the elderly.

Frequency: About 20% of all cysts

Site: Usually with the crown of an erupted
and displaced tooth, typically teeth where
eruption is impeded, e.g. upper 3s and lower 8s.

Size: Very variable

Shape:- Round/ oval, typically enveloping the

crown symmetrically
- Unilocular

Outline: -smooth
-well defined
-often well corticated

Radiodensity: Uniformly radiolucent

Effects: - associated tooth unerupted and

displaced.

-adjacent teeth: displaced, resorbed in

about 50%, enveloped by large cysts.

-buccal/medial expansion  facial

asymmetry and displacement of the antrum
 YOUR TOPIC GOES HERE
Radiographical appearance:
 YOUR SUBTOPIC GOES HERE

Jaw Xray showing a very large dentigerous cyst (yellow dots)

(tooth:red dots) on the patient’s lower right jaw.
Varieties of dentigerous cyst
(depending on the cyst/crown relationship)

Central type

Lateral type

Circumferential type
 True cyst> odontogenic cyst>
Eruption cyst
An odontogenic cyst with the histologic features of a
dentigerous cyst that surrounds a tooth’s crown that has
erupted through bone but not soft tissue and is clinically
visible a s a soft fluctuant mass on the alveolar ridges.

Radiographical appearance:

Enlarged follicular space.

Eruption cyst
 True cyst> odontogenic cyst>

Odontogenic keratocyst
A cyst derived from the remnants of the dental
lamina, with a biologic behaviour similar to benign
neoplasm, with a distinctive lining of six to ten cells
in thickness, and that exhibits a basal cell layer of
palisaded cells and a surface of corrugated
parakeratin.
Site: Post. body /angle of mandible
extending into the ramus.

Size: Variable, but often large in the

mandible.

Shape:
- oval, extending along the body of
mandible with little mediolateral
expansion.
- pseudolocular/ multilocular

Outline:
-smooth and scalloped
-well defined and corticated

Radiodensity: Uniformly radiolucent.

Odontogenic keratocyst prior to treatment
2 years after treatment
4 years after treatment – recurrence of cyst
 True cyst> odontogenic cyst>

Lateral periodontal cyst

A slow-growing, non-expansile developmental
odontogenic cyst derived from one or more rests
of the dental lamina, exhibiting a lining of 1 to 3
cuboidal cells and distinctive focal thickenings
(plaque).

Age: Adults over 30 years old

Frequency: Rare
Site: Lateral surface of the roots of vital
teeth in the lower canine/ premolar region
or upper lateral incisor region.

Size: Small (< 1cm in diameter)

Shape:- Unilocular (very occasionally

multilocular)
- Round

Outline:- Smooth
- Well-defined and corticated

Radiodensity: Uniformly radiolucent

Effects : -Adjacent teeth-displaced if cyst

become large, rarely absorbed
- Buccal expansion if large
 True cyst> odontogenic cyst>
Gingival cyst of the adult
A small development odontogenic cyst of the gingival soft
tissue derived from the rests of the dental lamina, exhibiting a
lining of squamous to cuboidal epithelium with occasional
distinctive focal thickenings similar to those seen in the lateral
periodontal cyst.

Clinical distribution, clinical size , age of

occurrence and histologic features =
lateral periodontal cyst

.: lateral periodontal cyst= intraosseous

gingival cyst= extraosseous
 Radiographical appearance
• Because they are confined to the gingival soft tissues 
not apparent on radiograph

• Occasionally  they will cause a pressure-induced

depression (saucerization) in the underlying alveolar bone
 apparent on radiograph.
 True cyst> odontogenic cyst>

Dental lamina cyst

of the newborn
Small, sometimes multiple, raised cystic nodules
that occur on the alveolar ridges of infants; they
are derived from rests of the dental lamina and
consists of a keratin-filled cystic cavity.
Dental lamina cyst of
newborn
 True cyst> odontogenic cyst>

Glandular odontogenic cyst

(sialo-odontogenic cyst)
A unilocular or multilocular odontogenic cyst
derived from the rests of dental lamina and
characterized by a lining with variable numbers of
small intraepithelial glandular structures lined by
cuboidal or columnar cells, often including mucus
cells.
Clinically,
occurs mainly in middle-
aged adults,common in
mandibular anterior region
of the jaw,painless.

Radiographically,
Well-defined,
Unilocular or more common
multilocular radiolucent
area.
The radiograph shows the typical
multilocular appearance of the glandular
odontogenic cyst.
True cyst> odontogenic cyst>
Paradental cyst
A cyst of odontogenic origin commonly located
subgingivally on the buccal aspect of an erupted
mandibular molar (bifurcation cyst) or the distal
surface of a partially erupted mandibular third
molar.
True cyst> non- odontogenic cyst>
Nasopalatine duct cyst
(incisive canal cyst)
An intraosseous developmental cyst of the midline
of the anterior palate, derived from the islands of
epithelium remaining after closure of the
embryonic nasopalatine duct.
Radiographical appearance:

• Well-circumscribed oval / heart-shaped radiolucency.

• Located in the midline of the anterior maxilla between the

roots of the central incisors.
True cyst> non- odontogenic cyst>
Nasolabial duct cyst
A developmental cyst of the soft tissue of the
anterior muccobuccal fold beneath the ala of the
nose, most likely derived from the remnants of the
inferior portion of the nasolacrimal duct.
 Radiographical
appearance

• It is not
readily apparent
radiographically unless contrast medium is
injected into the cystic lumen to facilitate visualization .

• Focal pressure-induced bone resorption (saucerization)

of the anterior maxilla can be occasionally
demonstrated on radiographs and is most readily seen
in the edentulous patient.
 Pseudo cyst>
Static bone cyst
An intraosseous pseudocyst, devoid of an epithelial
lining and either empty or filled with serous or
sanguinous fliud. The etiology is unknown.
Age: Children/ young adults

Frequency: Rare

Site: Mandible, particularly anteriorly and in the

premolar/molar region

Size: Variable, up to several centimetres in diameter.

Shape:
- -Unilocular
- -Irregular, but the upper border arches between the
roots of teeth.

Outline:
- -Smooth and undulating
- -moderately well-defined
- -moderately well or poorly corticated

Radiodensity: Uniformly radiolucent

Effects:
-- Adjacent teeth: minimal/no displacement
-- Minimal/ no expansion of the jaw
 Pseudo cyst>
Aneurysmal bone cyst
A pseudocyst that consists of blood-filled
spaces surrounded by multinucleated giant
cells and fibrous connective tissue.
•    Rare cyst of the jaws.
•    Arise as primary lesion or secondary to
bone disease
•    Occurs in people less than 20 yrs
•    post ramus region of the mandible
•    Firm expansile swelling causes facial
deformity

RADIOGRAPHICALLY : 
•    uni or multilocular with ballooned out
appearance due to cortical plate expansion
 Pseudo cyst>
Traumatic bone cyst
A pathologic cavity in bone that is not
lined with epithelium. The cause is
uncertain, although an association with
trauma has been suggested.

Radiographical appearance:

Well-defined unilocular/multilocular
radiolucent lesion that
characteristically shows scalloping
around the roots of teeth.
Traumatic bone cyst in the mandibular premolar
region. Note the intact lamina dura and the poor
definition inferiorly.
 REFERENCE
1.Essentials of Dental Radiography and Radiolgy
Fourth Edition, Eric Whaites (2007)
(borrowed from Rafiq)

2. Contemporary Oral and Maxillofacial Pathology,

J. Phillip Sapp (2004)

3. General and Oral Pathology for the Dental

Hygienist, Leslie DeLong (2008)

4. Oral Pathology for the Dental Hygienist , Ibsen

(2009)
 Wait!
Let’s watch a video
about cyst…