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Developmental Developmental
Odontogenic Cysts Odontogenic Cysts
Dentigerous Cyst Dentigerous Cyst
(Follicular Cyst) (Follicular Cyst)
The most common The most common
developmental developmental
odontogenic cyst odontogenic cyst
accounts for 25% of all jaw accounts for 25% of all jaw
cysts cysts
Associated with unerupted Associated with unerupted
teeth teeth
Attached to Attached to
cementoenamel junction cementoenamel junction
Central type Central type
Lateral type Lateral type
Color Atlas oI Clinical Oral pathology
Neville, Damm and White, 2nd edition
Dentigerous Cyst
(Follicular Cyst)
Dentigerous cyst Dentigerous cyst Dentigerous cyst Dentigerous cyst
Origin: reduced enamel Origin: reduced enamel
epithelium between the follicle epithelium between the follicle
and the tooth crown and the tooth crown
enlarges by accumulation of fluid enlarges by accumulation of fluid
between proliferating, reduced between proliferating, reduced
enamel epithelium and crown enamel epithelium and crown
Dentigerous Cyst Dentigerous Cyst
(Follicular Cyst) (Follicular Cyst)
Pathogenesis Pathogenesis
1. Proliferation of reduced enamel epithelium 1. Proliferation of reduced enamel epithelium
and cyst formation and cyst formation
OR OR
2. Compression of the follicle fluid exudate 2. Compression of the follicle fluid exudate
separation of the reduced enamel epithelium from the separation of the reduced enamel epithelium from the
crown crown
3. May arise due to accumulation of inflammatory exudate 3. May arise due to accumulation of inflammatory exudate
from primary tooth/ mainly mandibular premolars from primary tooth/ mainly mandibular premolars
Dentigerous Cyst Dentigerous Cyst
(Follicular Cyst) (Follicular Cyst)
Clinical features Clinical features
Most common with 3 Most common with 3
rd rd
molars, maxillary canines molars, maxillary canines
and mandibular premolars and mandibular premolars
supernumerary teeth supernumerary teeth
Odontomes Odontomes
Asymptomatic unless Asymptomatic unless
Large...bone expansion Large...bone expansion
nfected..pain nfected..pain
Dentigerous cyst Dentigerous cyst Dentigerous cyst Dentigerous cyst
Radiographic Radiographic
Features Features
well well
circumscribed, circumscribed,
corticated border corticated border
usually unilocular usually unilocular
NOT NOT
DAGNOSTC DAGNOSTC
Odontogenic Odontogenic
keratocyst keratocyst
Unicystic Unicystic
ameloblastoma ameloblastoma
Dentigerous cyst Dentigerous cyst Dentigerous cyst Dentigerous cyst
Microscopic Features Microscopic Features
- - nonkeratinized stratified nonkeratinized stratified
squamous squamous
epithelial lining epithelial lining
- - may have occasional may have occasional
sebaceous or mucous sebaceous or mucous
cell metaplasia cell metaplasia
- - thick fibrous connective thick fibrous connective
tissue wall tissue wall
- - epithelial rests epithelial rests
- - inflammation +/ inflammation +/- -
Dentigerous Cyst Dentigerous Cyst
(Follicular Cyst) (Follicular Cyst)
Microscopic features Microscopic features
Dentigerous Cyst Dentigerous Cyst
Treatment and Prognosis Treatment and Prognosis
Enucleation and removal of the affected Enucleation and removal of the affected
tooth tooth
Little tendency to recur when completely Little tendency to recur when completely
removed removed
hy should the dentigerous cyst be hy should the dentigerous cyst be
removed? removed?
Can cause extensive bone destruction Can cause extensive bone destruction
Resorption of adjacent roots Resorption of adjacent roots
Displacement of teeth Displacement of teeth
Neoplastic transformation: Neoplastic transformation:
Ameloblastoma Ameloblastoma
Squamous cell carcinoma Squamous cell carcinoma
Central mucoepidermoid carcinoma Central mucoepidermoid carcinoma
Neoplastic transformation in Neoplastic transformation in
dentigerous cyst dentigerous cyst
Neoplastic transformation in Neoplastic transformation in
dentigerous cyst dentigerous cyst
Eruption Cyst Eruption Cyst
Soft tissue analogue of the dentigerous Soft tissue analogue of the dentigerous
cyst cyst
Soft, translucent swelling in the mucosa Soft, translucent swelling in the mucosa
Relatively common in children Relatively common in children
No treatment is necessary No treatment is necessary
ruption Cyst
Color Atlas oI Clinical Oral pathology
Neville, Damm and White, 2nd edition
Color Atlas oI Clinical Oral pathology
Neville, Damm and White, 2nd edition
ruption Cyst
"uestions? "uestions?
Odontogenic Keratocyst (OKC) Odontogenic Keratocyst (OKC)
Keratinizing cystic odontogenic tumor Keratinizing cystic odontogenic tumor
More growth potential than most other More growth potential than most other
odontogenic cysts odontogenic cysts
Tendency to recur Tendency to recur
Specific histopathologic features Specific histopathologic features
Arises from cell rests of dental lamina Arises from cell rests of dental lamina
Make up 3 Make up 3- -11% of all odontogenic cysts 11% of all odontogenic cysts
Odontogenic Keratocyst Odontogenic Keratocyst
Clinical Features Clinical Features
70 70- -80% in body and 80% in body and
ramus of the ramus of the
mandible mandible
50% in third molar 50% in third molar
area area
n mandible and n mandible and
maxilla: posterior to maxilla: posterior to
premolars premolars
Odontogenic Keratocyst Odontogenic Keratocyst
Clinical Features Clinical Features
Few symptoms Few symptoms
unless secondarily unless secondarily
inflamed inflamed
Grow in Grow in
anterioposterior anterioposterior
direction direction
Reach large sizes Reach large sizes
without gross without gross
expansion expansion
Odontogenic Keratocyst Odontogenic Keratocyst
Microscopic Features Microscopic Features
Thin, folded keratinized Thin, folded keratinized
st sq ep st sq ep
6 6- -10 cells, uniform 10 cells, uniform
thickness thickness
Corrugated surface Corrugated surface
Polarization and Polarization and
palisading of basal cell palisading of basal cell
nuclei nuclei
High mitotic activity High mitotic activity
nflammation may alter nflammation may alter
these features these features
Odontogenic Keratocyst Odontogenic Keratocyst
Microscopic Features Microscopic Features
Fibrous waII: Fibrous waII:
Thin, low tensile strength Thin, low tensile strength
contains "daughter cysts contains "daughter cysts
More in nevoid BCC syndrome More in nevoid BCC syndrome
High rec. rate High rec. rate
Lumen: Lumen:
hite cheesy material: keratin hite cheesy material: keratin
debries debries
Little free fluid Little free fluid
Low soluble protein level<4gm/dl Low soluble protein level<4gm/dl
Odontogenic keratocyst Odontogenic keratocyst
Odontogenic keratocyst must not be used Odontogenic keratocyst must not be used
to describe any cyst producing keratin to describe any cyst producing keratin
such as radicular and dentigerous such as radicular and dentigerous
%umors and Cysts oI the jaws
AFIP 29
Odontogenic Keratocyst
Odontogenic Keratocyst Odontogenic Keratocyst
Radiographic Features Radiographic Features
Associated with unerupted tooth in 25% Associated with unerupted tooth in 25%- -
40% of cases 40% of cases
Can present like lateral periodontal cyst Can present like lateral periodontal cyst
ell defined radiolucent area ell defined radiolucent area
Smooth corticated margin Smooth corticated margin
Uni or multilocular Uni or multilocular
Can displace teeth, roots, and perforate Can displace teeth, roots, and perforate
cortical plate cortical plate
Color Atlas oI Clinical Oral Pathology
Neville, Damm and White, 2nd edition
OKC
Color Atlas oI Clinical Oral Pathology
Neville, Damm and White, 2nd edition
OKC
Color Atlas oI Clinical Oral Pathology
Neville, Damm and White, 2nd edition
OKC OKC
Odontogenic Keratocyst Odontogenic Keratocyst
Growth of the OKC Growth of the OKC
Predominantly anterio posterior direction Predominantly anterio posterior direction
Not due to osmotic pressure Not due to osmotic pressure
Factors invoIved: Factors invoIved:
Active epithelial growth: Active epithelial growth:
High mitotic rate, not uniform, in clusters High mitotic rate, not uniform, in clusters
Multicentric growth pattern Multicentric growth pattern
Folding in cancellous spaces Folding in cancellous spaces
Abnormal cell cycle controlling proteins similar Abnormal cell cycle controlling proteins similar
to that seen in neoplasia to that seen in neoplasia
Higher in nevoid BCC syndrome Higher in nevoid BCC syndrome
Odontogenic Keratocyst Odontogenic Keratocyst
Growth Growth
Cellular activity in the connective tissue capsule Cellular activity in the connective tissue capsule
Active growth according to proliferating epithelium Active growth according to proliferating epithelium
Osteoclasts located at the tip of proliferating lining Osteoclasts located at the tip of proliferating lining
Production of bone resorbing factors Production of bone resorbing factors
PG, L1, L6, collagenase PG, L1, L6, collagenase
Focal production of these factors Focal production of these factors
More L1 compared to radicular and dentigerous cysts More L1 compared to radicular and dentigerous cysts
ntracystic pressure? ntracystic pressure?
Odontogenic Keratocyst Odontogenic Keratocyst
Management and Prognosis Management and Prognosis
Surgical excision Surgical excision
Peripheral ostectomy, Carnoy solution, intracystic Peripheral ostectomy, Carnoy solution, intracystic
Carnoy solution injection, decompression first Carnoy solution injection, decompression first
Recurrence rate of 30% (3 Recurrence rate of 30% (3- -60%) 60%)
Most recur within 5 years, may not occur till Most recur within 5 years, may not occur till
10 years or more 10 years or more long term clinical and long term clinical and
radiographic follow up radiographic follow up
Occasionally, local resection and bone Occasionally, local resection and bone
grafting grafting
Odontogenic Keratocyst Odontogenic Keratocyst
hy does OKC show high recurrence rate? hy does OKC show high recurrence rate?
1. 1. Epithelial budding and Epithelial budding and satellite cyst satellite cyst
formation formation
2. 2. Relatively Relatively thin fibrous capsule thin fibrous capsule
3. 3. Thin friable epithelium Thin friable epithelium
4. 4. Biologic quality Biologic quality of the cyst epithelium of the cyst epithelium
Odontogenic Keratocyst Odontogenic Keratocyst
Management and Prognosis Management and Prognosis
f multiple OKC are present, evaluate the f multiple OKC are present, evaluate the
patient for nevoid basal cell carcinoma patient for nevoid basal cell carcinoma
syndrome syndrome
AD AD
Mutation in tumor suppressor gene on Mutation in tumor suppressor gene on
chromosome 9q termed patched gene (PTCH) chromosome 9q termed patched gene (PTCH)
Nevoid basal cell carcinoma Nevoid basal cell carcinoma
syndrome syndrome
Oral: Multiple OKC, through out the life Oral: Multiple OKC, through out the life
Earlier than OKC Earlier than OKC
Skin: Skin:
Multiple basal cell carcinoma, any where, around puberty Multiple basal cell carcinoma, any where, around puberty
Hyperkeratosis of palms and soles Hyperkeratosis of palms and soles
Cysts and benign tumors of skin Cysts and benign tumors of skin
Skeletal: rib abnormalities, vertebral deformity, cleft lip and Skeletal: rib abnormalities, vertebral deformity, cleft lip and
palate palate
CNS: calcification of falx cerebri, brain tumors CNS: calcification of falx cerebri, brain tumors
Ophthalmologic Ophthalmologic
Hypertelorism Hypertelorism
Odontogenic keratocyst in Odontogenic keratocyst in
basal cell nevus syndrome basal cell nevus syndrome
Basal Cell Nevus Syndrome Basal Cell Nevus Syndrome
Treatment and Prognosis Treatment and Prognosis
Basal cell carcinomas treated by Moh's Basal cell carcinomas treated by Moh's
surgery surgery
Keratocysts surgically removed Keratocysts surgically removed
Usually have normal lifespan Usually have normal lifespan
Orthokeratinized Odontogenic Cyst Orthokeratinized Odontogenic Cyst
7 7- -17% of all keratinizing jaw cysts 17% of all keratinizing jaw cysts
Not a specific type of odontogenic cysts Not a specific type of odontogenic cysts
Previously considered as orthokeratinized Previously considered as orthokeratinized
variant of OKC variant of OKC
Orthokeratinized Odontogenic Cyst Orthokeratinized Odontogenic Cyst
Histopathologic features Histopathologic features
Stratified squamous Stratified squamous
epithelium epithelium
Orthokeratotic surface Orthokeratotic surface
No characteristic lining No characteristic lining
of OKC of OKC
Orthokeratinized Odontogenic Cyst Orthokeratinized Odontogenic Cyst
Treatment and Prognosis Treatment and Prognosis
Enucleation and curettage Enucleation and curettage
Recurrence is rare, 2% Recurrence is rare, 2%
No association with nevoid basal cell No association with nevoid basal cell
carcinoma syndrome carcinoma syndrome
":c.ion..
Lateral Periodontal Cyst Lateral Periodontal Cyst
<2% of all epithelium lined jaw cysts <2% of all epithelium lined jaw cysts
Lateral periodontal cyst Lateral periodontal cyst
Pathogenesis Pathogenesis
Derived from the Derived from the
post post- -functional functional
dental lamina dental lamina
(limited growth (limited growth
potential). potential).
Located on the Located on the
lateral surface of a lateral surface of a
tooth that is vital tooth that is vital
Lateral Periodontal Cyst Lateral Periodontal Cyst
Clinical Features Clinical Features
Asymptomatic Asymptomatic
75 75- -80% in premolar 80% in premolar- -canine canine- -lateral incisor area lateral incisor area
Mandible > maxilla Mandible > maxilla
Associated with vital or non Associated with vital or non- -vital tooth vital tooth
Radiographic Features Radiographic Features
A well defined radiolucency A well defined radiolucency
Relatively small: less than 1 cm Relatively small: less than 1 cm
Radiographic features are not diagnostic Radiographic features are not diagnostic
Lateral Periodontal Cyst Lateral Periodontal Cyst
Histopathologic features Histopathologic features
Plaque like thickening Plaque like thickening
Color Atlas oI Clinical Oral Pathology
Neville, Damm and White, 2nd edition
Lateral Periodontal
Cyst
Lateral Periodontal
Cyst
USC School of Dentistry
Lateral Periodontal Cyst Lateral Periodontal Cyst
Management and Prognosis Management and Prognosis
Could be multilocular, described as botryoid Could be multilocular, described as botryoid
Treatment Treatment - - Prognosis Prognosis
Surgical excision or Surgical excision or
curettage curettage
Preserve dentition Preserve dentition
Recurrence infrequent Recurrence infrequent
Botryoid is different Botryoid is different
LateraI periodontaI cyst LateraI periodontaI cyst
Cingival cyst of the adult
"uestions "uestions