Odontogenic cysts

KCOC Primordial cysts Dentigerous Periodontal cysts

cysts

Keratinizing and Odontogenic central, lateral, ) Inflammatory:

calcifying .keratocyst (circumferential a)apical
odontogenic
cyst, Gorlin's b)lateral
.cyst c)residual

Cysts of :Developmental
.eruption
a)lateral
developmental
cyst

b) gingival cyst
of adults

c)gingival cyst of
newborn "
"bohn's nodules
 Odontogenic cysts
Periodontal cysts
Developmental Inflammatory
Gingival cyst of new born Gingival cyst of .Lateral dev Residual Lateral Apical P.O.C
adults

they are multiple white - Non inflammatory - Non - Inflammatory hyperplasia of epithelial rests- Etiology and
nodules of not more than developmental cyst inflammatory .of malassez .def
a few mm in diameter in occurring adjacent cyst occurs
the alveolar ridge of new to a vital tooth at adjacent to or Develop from pre-existing periapical-
.born .the gingival laterals to the .granuloma
root of a vital As proliferation occurs the central cells are-
They originate from - It's considered to - .tooth
remnants of the dental be the soft tissue separated from their source of nuitrition so
lamina which proliferate counterpart of the proliferation of- they become necrotic and liquefy. " akl akl
.to form small cysts .lateral dev. Cyst rests " akl :D
odontogenic
gingival cyst - epithelium at
arises from the lateral side
remenants of .of roots
dental lamina in
the soft tissue "
epithelial rests of
" serre's

.Asymptomatic - Any age. From 40 - any age. From- the- They form Age : adult life- Clinical
.to 60 .40 to 60 pulpless along the features
tooth from lateral Sex: men>-
males= females - male to - which a aspect of women
female 2:1 periapical the root as
small, well- Site: anterior-
circumscribed In the - cyst has a result of region of maxilla
painless swelling of mandibular arisen may opening of
the gingival, less premolar and be a lateral assymptomatic,-
.than 1cm canine region. extracted root canal discovered during
In the maxilla and the and routine
may involve free - lateral incisor cyst may irritation radiographic
or attached .region persist and of examination,
gingival and may cause periodonta painless and
involve the gingival asymptomatic- swelling of .l tissue slowly progressing
.papilla itself bla bla bla :D the .unless infected
edentulous
The lesion has the - .jaw hard at first then -
same color as the a crackling
surrounding normal they - sensation is felt
mucosa but interfere on pressure then
sometimes larger with the at last it becomes
lesions erode fitness of soft fluctuant
underlying bone dentures swelling bluish in
and give bluish and may color beneath the
.discoloration cause .mucosa
fracture of
..the jaws the related tooth -
.is non-vital

ve because it's in- - radiolucent- round or oval- Radiographic

..a soft tissue .area well defined ally
radiolucency
small seldom - surrounded by a
.over 1 cm narrow
may or may - radioopaque
not be .margin
surrounded by The cyst ranges -
an radioopaque from 5mm to
.margin several cms in
.diameter

The tooth often -

has a large
carious cavity or
.filling

Root resorption -
of the tooth or the
adjacent one may
.occur

Very large cyst -

Odontogenic cysts
Odontogenic cysts
 Odontogenic cysts
Dentigerous cysts
P.O.C (central, lateral, circumferential ) Eruption cyst

Etiology and it orginates through cystic change of the reduced-
.def enamel epithelium after complete formation of
enamel of the tooth with accumulation of fluid
between reduced enamel epithelium and the tooth
.crown
the attachment of the cyst lining at the -
.amelocemental junction suggests this origin
uncommon superficial dentigerous cyst occurring in the soft-
tissue of the gum or alveolar mucosa over a tooth about to
.erupt
It is a dilatation of the normal follicular space above the -
crown of an erupting tooth caused by accumulation of tissue
.fluid or blood

cysts appear to form between the layers reduced -

enamel epithelium the layer which remains
.attached to the enamel usually degenerates

expansion of the dentigerous cyst is related to -

secondary increase in cystic fluid osmolarity as a
result of degeneration of desquamated epithelial
.cells into the cyst lumen

mitotic undex for dentigerous cyst is low in -

.comparison with primordial cyst

Clinical Age: 20 to 30 years .Age: Children deciduous teeth or permanent molars

features
Sex: more common in males .Site: Gum overlying the unerupted tooth

Site: more in mandibular third molar and maxillary Shape: soft rounde swelling. If blood is present in the cystic
canines and it may involve a supernumerary tooth space the swelling appears deep blue and hence the name
.""eruption hematoma
.or an odontome

no symptoms and discovered accidentally but-

.when infected it becomes painful and swelled

As the cyst grows bone resorption and expansion

.occurs with subsequent facial asymmetry

Radiographic Well defined, radiolucent area surrounded by a

.sclerotic line
features
Central: the most common where the cyst
surrounds the crown of the tooth and the crown
.projects into the cyst

Lateral: associated with the mesioangular impacted

mandibular third molars that are partially erupted.
The cyst grows laterally along the root surface and
.partially surrounds the crown

Circumferential: the cyst surrounds the crown and

extends for some distance along the root so that a
significant portion of the root appears to lie within
.the cyst

a third molar may be displaced to the lower border-

.of the mandible or higher up into the sky

Histopatholog thin regular non keratinized stratified squamous-

ical .epithelium

features the epithelial connective tissue junction is flat but -

when inflammation or infection occurs epithelial
.hyperplasia with rete pegs may be noted

in the maxilla ciliated epi. And hyaline bodies may -

.be seen and it may keratinized

the connective tissue wall is rich in glycoprotiens -

and mucopolysaccarides. Inflammatory cells are
.absent

cholesterol clefts and giant cells may be seen with -

.epithelial discontinuities

:Cyst contents
 Odontogenic cysts
P.O.C (Odontogenic keratocyst (primordial cyst
Etiology and definition it arises from enamel organ before tooth-
formation
cyst which arise in an area without any -
missing tooth develop from supernumerary
.tooth or rests of dental lamina
Clinical features Age: 20 to 30 years
Sex: kolo zay b3do
.Site: mandible posterior portion
Asymptomatic unless infected and may
produce parasethia of the lower lip, pain
.and swelling of the jaw
Radiographic features Unilocular or multilocular radiolucency
:Cyst contents
Keratocysts contaic keratin, seen during
operation s dirty white or yellowish
material which is similar to the pus but
.without the offensive smell
Histopathologic features Boso ana haktebo zay mal dr shara7eto
:7asah easier ml malzama
:types 2
:orthokeratinized-1
regular epithelial lining of stratified-
sqaumous epithelium 6-8 cells thick
.arises from a flat basement membrane
the nuclei of the basal cell is away -
from the basement membrane " zay el
"enamel organ
mitotic index is more than other -
.cysts
orthokeratinized is less aggressive -
.with much lower rate of recurrence
:parakeratinized -2
the epithelial lining is irregular with-
.rete pegs
the basal cell are coloumnar -
palisade with prominent polarized and
intensly stained nuclei, the cells of the
stratum spinosum show intercellular
.edema
the surface is corrugated with a -
KCOC
it is believed to be derived from-
odontogenic epithelial remnants within
the gingival or within the mandible or
.maxilla
.Age: before 40 years
.Sex: common in females
Site: more in the maxilla and thea
.anterior part of the mandible
of the cysts are intraosseous, 25% % 75-
are present in the soft tissue in the
.gingival or retromolar area
Appearance: painless swelling in the
gingival or the alveolar bone . as the
cyst enlarges it displaces roots of
adjacent teeth. If the cyst become
.infected the swelling becomes painful
Intraosseous KCOC present as unilocular
or multilocular radiolucency with well
demarked irregular margins. Within the
radiolucency, scattered calcifications of
variable densities giving appearance of
"salt and pepper " 2y kalam b2a :D
In some cases mineralization may
develop to such an extent that the
radiographic margins of the lesion are
difficult to determine. The size of the
.cyst varies from 1 to 8 cm in diameter
lumen lined by stratified squamous-
epithelium having coloumnar or cuboidal
layer of cells with their darkly stained
nuclei away from the basement
membrane. In more solid lesions
significant intraluminal epithelial
proliferation will fill the cyst lumen, the
epithelial layer is irregular and variable
thickness. Lining is very similar to an
.ameloblastic type of epithelium
above the basal layer are more loosely-
arranged epithelial cells that resemble
.the stellate reticulum of enamel organ
the epithelium may proliferate, the -
cells become swollen with hyaline
homogenous cytoplasm that stains
deeply eosinophylic. Nuclei undergo
karyolysis as keratinization progresses
such cells sre called ghost cells clusters
of ghost cells may undergo dystrophic
.calcification and become basophyilic
in other areas of the cyst lining and in-
 Odontogenic cysts
parakeratotic surface layer that can be
seen shedding individual or clusters
.squamous cells into the cyst lumen
the lumen may contain large -
.amount of keratin debris or clear
include budding of the basal layer -
.into the underlying connective tissue
daughter cysts may form within -
connective tissue wall of the cyst, small
or large islands of epithelial cells
exhibiting central keratinization or
.micro-cyst formation
it forms 85% to 95% of all -
odontogenic keratocysts
high index of mitotic division and -
high rate of reccurence 40%
the fibrous connective tissue wall, there
may be irregular eosinophyllic masses
that are considered by some as
dentinoid if the full thickness of the
epithelium is affected by the ghost cell
may be shed into the cavity of the cyst.
The ghost cells may be broken coming
into contact with connective tissue
.component f the cyst
:Differential diagnosis
Early lesions with no calcification show a
cystic radiolucency that must be
differentiated from ameloblastoma, later
when a mixed radiolucent radioopaque
appearance is present the lesion must
be differentiated from adenomatoid
.adontogenic tumor

:reasons of recurrence *

thin epithelial lining may fragment -1

and may be partially retained as a weak
attachment between epithelium and
connective tissue leading to seading of
.viable epithelial cells into the tissues

satellite cysts may be left behind in-2

.the bone after the operation

.high mitotic index of the eoithelium-3

treatment .Simple enucleation

 Odontogenic cysts

:7agat kont albaha fo2 :D

:Mechanism of enlargement of inflammatory periodontal cyst

Remnants of cellular debris are found within the cyst lumen producing an increase in osmotic pressure of the cystic fluid
as a result of the breakdown of complex tissue proteins into a larger number molecules of more simple proteins. The result is
fluis transport across the epithelial lining and connective tssue that act as a semi permeable membrane, in an attempt to
.equalize the osmotic pressure and so enlargement occurs

The growth stimulates osteoclastic bone resorptin and enlarging the bone cavity and allowing further expansion of the cyst.
Osteoclastic bone resorption also stimulated by bone resorbing factors from inflammatory cells and cellular elements within
.perioheral portion of the lesion

:Microscopic variation in cyst walls of periodontal cyst

Pseusostartified ciliated coloumnar epithelium: this may be seen in periapical cyst of maxillary
.teeth which involve maxillary sinus

Dystrophic calcification: as hemotoxiphyilic calcified deposits may be found in the epithelium and
.connective tissue

(Keratinized lining( ortho or para

Hyaline bodies or rushton bodies: may be found within the epithelial lining ( thin linear curved
bodies amorphous in structure eosinophyilic in reaction). The origin of such bodies is controversial. Some
believe that they are hematogenous origin arising from thrombus formation in some capillaries being
formed chiefly from their red blood cells as a rouleaux phenomenon. Others believe that they have an
..odontogenic origin

Kda 5alasna el odontogenic cysts w rabena ma3ana b2a fel ba2y.. u may also read ml malzama
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