DEPARTMENT OF ORAL

MEDICINE AND RADIOLOGY

A CASE REPORT ON

INFECTED PERIAPICAL CYST

Submitted by

ANTONY SEBASTIAN
C.R.I.
 PERIAPICAL CYST

DEFINITION:
Epithelium at the apex of a non-vital tooth can be
presumably stimulated by inflammation to form a true
epithelial lined cyst or periapical cyst.
Periapical cyst represents a fibrous connective tissue
wall lined by epithelium with a lumen containing fluid and
cellular debris.
Prevalance:- 15% (approximately )
A similar cyst, best termed a lateral radicular cyst
may appear on the lateral aspect of the root.
Periapical inflammatory tissue that is not curreted at
the time of teeth removal may give rise to an inflammatory
PATHOGENESIS
CARIES
↓
PULPAL NECROSIS
↓
PERIAPICAL INFLAMMATION
↓
PERIAPICAL GRANULOMA
↓
PROVIDE RICH VASCULAR AREA TO RESTS OF MALASSEZ
↓
RESTS OF MALASSEZ PROLIFERATE
↓
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.
RADIOGRAPHIC FEATURES
 Loss of lamina dura along adjacent root.
 Rounded radiolucency encircles the affected tooth
apex.
 Root resorption is common.

HISTOPATHOLOGICAL FEATURES
 Squamous epithelium may show exocytosis,
spongiosis or hyperplasia.
 Lumen filled with fluid and cellular debris.
 Arch-shaped calcifications known as Rushton bodies
 Dystrophic calcification, cholesterol clefts
multinucleated giant cells,red blood cells.
 Areas of hemosiderin pigmentation
 Walls of inflammatory cyst will contain Hyaline
bodies.
TREATMENT
i) Extraction
ii) Conservative non-surgical endodontic therapy
combined with marsupialization, decompression or
fenestration.

DIFFERENTIAL DIAGNOSIS
 Periapical granuloma
 Periapical abcess
 Cementoma (Stage I )
 Traumatic bone cyst.
 CASE SHEET
IDENTIFYING DATA
Name : Mr. Revathi
Age : 23 yrs
Sex : Female
Occupation : Phone technician
Address : C-2, Gandhi Nagar,
Kichipalayam
Salem-15.
OP.No : 02832

CHIEF COMPLAINT
Patient complains of swelling in the lower part of the
chin region for the past 3 months and also complaint of
HISTORY OF PRESENT ILLNESS
Patient was apparently normal 3 months back, then
she noticed a small swelling in the lower part of the chin
region patient also complaint of apetite, fever patient was
under medication but the swelling has subside.

PAST MEDICAL HISTORY

Drug allergy – present allergy to unknown drug.

PAST DENTAL HISTORY

She has undergone extraction of 36 five years back

PERSONAL HABIT
Mixed diet
Brushes once daily with brush and paste.
FAMILY HISTORY
No relevant history

CLINICAL EXAMINATION: GENERAL EXAMINATION:-

Built - Moderately built and nourished
Gait
Skin Normal
Sclera
Conjunctiva
Pallor
Cyanosis Absent
Oedema
Clubbing
Vital Signs
Temperature: Afebrile.
Pulse rate : 74 beats/min

EXTRAORAL EXAMINATION
Face : Symmetrical
Swelling
Situation : Lower part of the chin
Size : 1 x 1 cm
Shape : Oval
Consistency : Soft
Tenderness : Absent
Surface of skin : Pinchable
Pus discharge : Present
Nose
Lips
Eyes No abnormality detected
Paranasal Sinuses
T.M.J
Salivary Gland
Lymphnode Examination - Not palpable

INTRAORAL EXAMINATION
SOFT TISSUE EXAMINATION:
Buccal mucosa
Labial mucosa
Tongue No Abnormalities detected
Floor of the mouth
Palate
Gingiva
Colour - Greyish pink
Contour - Scalloped
Consistency - Firm
Bleeding on probing - Absent
Surface texture - Stippling present.
Periodontal Pocket - Absent.
Tonsil / Pharynx - No abnormalities detected
Pain on palpation - In the vestibular sulcus region in
relation to 31,16.

HARD TISSUE EXAMINATION

Number of teeth Present - 31
Missing teeth - 36
Dental Caries - 26
Tenderness on percussion- Pain on percussion in relation to
31,16.
Wasting disorders
Attrition
Abrasion Nil
Erosion
Mobility - Nil
Occlusion - Class I
Deposits - Calculus (generalized)
present
Stains - Absent.
Fractured teeth - Nil
SUMMARY
Patient named, Revathi, 23 yrs, Female, complaints
of swelling in the lower part of chin region for the past 3
months the swelling was single, non tender and 1*1cm she
also complaint of fever , loss of apetite,
depression. patient is un known allergy to drugs pain on
percussion and palpation present in relation to31,16
generalised hard and soft deposit present lymph node was
not palpable dental caries in relation to26.

PROVISIONAL DIAGNOSIS:
Infected periapical cyst in relation to 31.
 
DIFFERENTIAL DIAGNOSIS :
Periapical granuloma
Periapical abcess.
INVESTIGATION :
IOPA in relation with 31

FINAL DIAGNOSIS :
Infected Periapical cyst in relation to 31.
 
TREATMENT PLAN :
RCT in relation to 31.
Surgically: Apicectomy in relation to 31.
FACIAL VIEW
INTRA ORAL VIEW
IOPA
BIOPSY
POST OPERATIVE VIEW