Dental Cyst : Causes, Symptoms, And Treatment

Dental Cyst: Causes, Symptoms, And Treatment

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Answer. A dental cyst is also called a radicular cyst or periapical cyst.

It is the most common type of inflammatory cystic lesion, which occurs about the apex of a non-vital tooth.

In this case, if the involved tooth is extracted the remaining cystic cavity within the bone is known as residual cyst.

Read and learn More Cysts: Types, Causes, Symptoms, and Treatment

Dental cyst Pathogenesis

The radicular cyst develops due to the proliferation and subsequent cystic degeneration of the “epithelial cell rests of Malassez”, in the periapical region of a non-vital tooth.

“What Should I Do If My Dental Cyst Grows Larger”

The process of development of this cyst occurs in various stages:

• Phase of initiation.
• Phase of proliferation.
• Phase of cystifiation.
• Phase of enlargement.
• The phase of initiation: During this phase, the bacterial infection of the dental pulp or direct inflammatory effect of necrotic pulpal tissue, in a non-vital tooth causes stimulation of the “cell rest of Malassez” which are present within the bone near the root apex of teeth.
  The phase of proliferation: The stimulation to the cell rests of Malassez leads to excessive proliferation of these cells, which leads to the formation of a large mass or island of immature proliferating epithelial cells at the periapical region of the affected tooth.
• Phase of cystification: Once a large bulk of the cell rest of Malassez is produced, its peripheral cells get adequate nutritional supply but its centrally located cells are often deprived of proper nutritional supply.
  As a result, the central group of cells undergoes ischemic liquefactive necrosis while the peripheral group of cells survives.
  This eventually gives rise to the formation of a cavity that contains a hollow space or lumen inside the mass of the proliferating cell rest of Malassez and a peripheral lining of epithelial cells around it.
• Phase of enlargement: Once a small cyst is formed, it enlarges gradually by the following mechanisms:

• Higher osmotic tension of the cystic fluid causes progressive increase in the amount of fluid inside its lumen and this causes increased internal hydrostatic tension within the cyst.
  The process results in cyst expansion due to resorption of the surrounding bone.
• The epithelial cells of the cystic lining release some bone resorbing factors like prostaglandins and collagenase, etc. which destroy the bone and facilitate expansion of the cyst.

“Effective Ways To Manage Dental Cyst Recovery”

Dental cyst Clinical Features

• It is common in women around the third and fourth decades.
• Upper anterior teeth are more affected
• The involved tooth shows the presence of caries, fractures, or discoloration.
• Slow enlarging bony hard swelling of the jaw with expansion and distortion of cortical plates.
• Cysts remain asymptomatic if uninfected
• Severe bone destruction by the cystic lesion may produce springiness.
• If the cyst is secondarily infected, it leads to the formation of an abscess then it is called a cyst abscess.

“Understanding The Causes Of A Dental Cyst“

Dental cyst Radiological Features

• It appears as a rounded or pear-shaped radiolucency at the apex of nonsensitive tooth or with nonvital tooth.
• Radiolucency is more than 1.5 cm in diameter but usually less than 3 cm in diameter. It has got well-defied outline with thin hyperostotic borders.
• Margins: In uncomplicated cases margins are smooth, and the cortex is usually well-defied, well-etched, and continuous, except in some cases, there may be window formation.
  There is also a thin white line surrounding the margins of the bone cavity.
  This thin layer of cortical bone is almost always present unless suppuration supervenes in the cyst.
• The image of radiopaque borders is continuous with lamina dura around the associated tooth. Infection may cause the borders to become less distinct.
• Radicular cysts of long duration may cause resorption of roots.
• Adjacent teeth are usually displaced and rarely resorbed.
  There is also buccal expansion involving the maxillary area then displacement of the antrum occurs.

Dental Cyst Differential Diagnosis

• Periapical granuloma: If radiolucency which appear on the radiograph is smaller than 1.5 cm, it is considered to be periapical granuloma.
• Periapical scar: It is ruled out on the basis of history and location.
• Lateral periodontal cyst: Radicular cyst originates from the maxillary lateral incisor and is positioned in between the root of the lateral incisor and canine and is confused with the lateral periodontal cyst.
  In this case, tooth vitality should be checked, the tooth associated with a lateral periodontal cyst is vital and a radicular cyst is nonvital.
• Periapical cementoma: In the case of a radicular cyst tooth is nonvital while in the case of periapical cementoma tooth is vital.

“Best Practices For Dental Cyst Surgical Management”

Dental cyst Treatment

• Non vital teeth are associated with the cyst can either be extracted or they can be retained by endodontic treatment, i.e. apicoectomy.
• External sinus tracts should always be excised to prevent epithelial ingrowth.
• A commonly employed surgical procedure for radicular cysts is enucleation.
• Very small cysts can be removed through tooth socket.
• Large cysts that encroach upon the maxillary sinus or inferior alveolar neurovascular bundle may be treated by marsupialization.