✪✪✪ Odontogenic Cyst Case Study
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Dentigerous Cyst Case Study
The inflammatory exudate causes separation of reduced enamel epithelium from the enamel with resultant cyst formation. The dentigerous cyst commonly involves a single tooth and rarely affects multiple teeth. The most frequently involved tooth is the mandibular third molar followed by the maxillary canine, but they may be associated with supernumerary or ectopic tooth.
Any permanent tooth can be involved. Regezi and Sciubba  stated that the impacted teeth were most commonly seen in the third molar and maxillary canine teeth, and hence dentigerous cysts occur most frequently in these teeth. The involved teeth may be displaced into ectopic positions. In the maxilla, these teeth are often displaced into the maxillary sinus. According to a study, Mourshed stated that the incidence of dentigerous cyst has been reported as 1. Dentigerous cysts most commonly occur in the 2nd and 3rd decades of life. These cysts can also be found in young children and adolescents. The age of presentation of these cysts range from 3 years to 57 years with a mean of These cysts are commonly single lesions.
Bilateral and multiple dentigerous cysts are very rare although they have been reported. Bilateral or multiple dentigerous cysts are usually associated with the Maroteaux-Lamy syndrome and cleidocranial dysplasia. Basal cell nevus syndrome and Gardner's syndrome   are also reported to be associated with multiple dentigerous cysts. Sometimes multiple dentigerous cysts are suggested to be induced by prescribed drugs. The combined effect of cyclosporine and a calcium channel blocker  is reported to cause bilateral dentigerous cyst.
Dentigerous cyst is potentially capable of becoming an aggressive lesion. The possible sequelae of continuous enlargement of dentigerous cyst are expansion of the alveolar bone, displacement of teeth, severe root resorption of teeth,  expansion of buccal and lingual cortex  and even pain. Potential complications  are development of ameloblastoma , epidermoid carcinoma or mucoepidermoid carcinoma. Early detection and removal of the cysts is essential to reduce morbidity since dentigerous cyst can attain considerable size without any symptoms.
Patient who presents with unerupted teeth should be thoroughly examined with radiographic examinations to check our for dentigerous cysts. Panoramic radiographs may be indicated for this purpose. CT imaging becomes necessary for extensive lesion. Pathologic analysis of the lesion is important for the definitive diagnosis even though radiographs provide valuable information. The histopathologic features of dentigerous cyst are dependent on the nature of the cyst, whether it is inflamed or not inflamed. The specimen will present with loosely arranged fibrous connective tissue wall that contains considerable glycosaminoglycan ground substance. Small islands or cords of inactive-appearing odontogenic epithelial rests are usually scattered within the connective tissue and most commonly located near the epithelial lining.
These rests may appear numerous in the fibrous connective tissue wall occasionally, which may be misinterpreted as ameloblastoma by some pathologists who are unfamiliar with oral lesions. The epithelial lining is composed of two to four layers of flattened non-keratinizing cells, with a flat epithelium and connective tissue interface. Occurrence of inflamed dentigerous cyst is fairly common. Histologic examination reveals a more collagenized fibrous connective tissue wall, with a variable infiltration of chronic inflammatory cells. Cholesterol slits and their associated multinucleated giant cells may be present and are generally associated with the connective tissue wall. The cyst is lined mostly or entirely by non-keratinizing squamous epithelium which display varying amounts of hyperplasia with the development of anastomosing rete ridges and more definite squamous features.
Dentigerous cysts presenting with these features may histologically be indistinguishable from radicular cysts. A keratinized surface is occasionally present, which must be differentiated from those observed in the odontogenic keratocyst OKC. Focal areas of mucus cells or rarely, ciliated columnar cells may be found in the epithelial lining of dentigerous cysts. In addition, small nests of sebaceous cells infrequently may be present within the fibrous connective tissue wall. These mucous, ciliated and sebaceous elements are postulated to represent the multipotentiality of the odontogenic epithelial lining in a dentigerous cyst. One or several areas of nodular thickening may be seen on the luminal surface in the gross examination of the fibrous wall of a dentigerous cyst.
Careful examination of these areas microscopically is mandatory to rule out the presence of early neoplastic change. As the dental follicle surrounding the crown of an unerupted tooth usually is lined by a thin layer of reduced enamel epithelium, this may render it difficult to distinguish a small dentigerous cyst from a normal or enlarged dental follicle based on microscopic features alone. As the epithelial lining is derived from the reduced enamel epithelium,  on radiographic examination, a dentigerous cyst appears as a unilocular radiolucent area that is associated with just the crown of an unerupted tooth and is attached to the tooth at the cementoenamel junction.
The radiolucency is generally well-defined and well-corticated. The radiolucency often have a sclerotic border indicating bony reaction, but a secondarily infected cyst may display ill-defined borders. However, a large dentigerous cyst may give the impression of a multilocular process due to the persistence of bone trabeculae within the radiolucency. The cyst-to-crown relationship presents several radiographic variations which are explained as follows: .
This is the most common variant which the cyst surrounds the crown of the tooth and the crown projects into the cyst. This variant is usually associated with a mesioangular impacted mandibular third molar that is partially erupted. The cyst develops laterally along the root surface and partially surrounds the crown. The cyst surrounds the crown and extends for some distance along the root surface so that a significant portion of the root appears to lie within the cyst, as if the tooth was erupting through the centre of the cyst. The radiographic distinction between an enlarged dental follicle and a small dentigerous cyst can be difficult and fairly arbitrary.
Generally, any pericoronal radiolucency that is greater than 3 to 4mm in diameter is considered suggestive of cyst formation. Some dentigerous cysts may result in considerable displacement of the involved tooth. Infrequently, a third molar may be displaced to the lower border of the mandible or into the ascending ramus. On the other hand, maxillary anterior teeth may be displaced into the floor of the nasal cavity, while other maxillary teeth may be displaced through the maxillary sinus to the floor of the orbit.
Furthermore, larger cysts can lead to resorption of adjacent unerupted teeth. Some dentigerous cysts may also grow to considerable size and produce bony expansion that is usually painless, unless secondarily infected. However, any particularly large dentigerous radiolucency should clinically be suspected of a more aggressive odontogenic lesion such as an odontogenic keratocyst or ameloblastoma. For this reason, biopsy is mandated for all significant pericoronal radiolucencies to confirm the diagnosis. The role of CT computerized tomography imaging in the evaluation of cystic lesions has been well-documented. CT imaging aids to rule out solid and fibro-osseous lesions, displays bony detail, and provides precise information about the size, origin, content, and relationships of the lesions.
On CT imaging, a mandibular dentigerous cyst appears as a well-circumscribed unilocular area of osteolysis that incorporates the crown of a tooth. Displacement of adjacent teeth may be seen and they may be partly eroded. Dentigerous cysts in the maxilla often extend into the antrum, displacing and remodeling the bony sinus wall. Large cysts which may project into the nasal cavity or infratemporal fossa and may elevate the floor of the orbit can be noted on CT imaging. In the mandible, buccal or lingual cortical expansion and thinning are noted. On MR imaging, the contents of the cyst display low to intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images.
The tooth itself is a zone of signal void. The lining of the cyst is thin with regular thickness and may show slight enhancement after contrast injection. The treatment of choice for dentigerous cyst is enucleation along with extraction of the impacted teeth. Orthodontic treatment may subsequently be required to assist eruption. Similarly, if displacement of the associated tooth by the cyst has occurred and extraction may prove to be difficult, orthodontic movement of the tooth to a more advantageous location for extraction may be accomplished.
Marsupialization may also be used to treat large dentigerous cysts. This permits the decompression of the cyst, with a resulting decrease in the size of the bone defect. The cyst can then be excised at a later date, with a less extensive surgical procedure. The prognosis for the dentigerous cyst is excellent, and recurrence is rare. Nevertheless, several potential complications must be considered.
The possibility that the lining of a dentigerous cyst might undergo neoplastic transformation to an ameloblastoma has been well-documented. In addition, a squamous cell carcinoma may rarely arise in the lining of a dentigerous cyst. Transformation from normal epithelial cyst lining to SCC is due to chronic inflammation. Malignancy in the cyst wall is usually unexpected at the time of presentation and the diagnosis is usually made following enucleation. It is an odontogenic cyst that is a sequela of periapical granuloma in a carious tooth. It is often multilocular and most commonly located in the body or the ramus of the mandible.
Histologically, the epithelium is uniform in nature, usually four to eight cells in thickness. The basilar layer consists of a palisaded row of cuboidal to columnar cells that may demonstrate hyperchromatism. Characteristically, a corrugated or wavy layer of parakeratin is produced on the epithelial surface and desquamated keratin may be present in the cyst lumen.
Odontogenic keratocysts do not result in the same degree of bony expansion as dentigerous cysts and teeth resorption are less likely to be seen in association with odontogenic keratocysts. In addition, dentigerous cysts are more likely to have smooth periphery and odontogenic keratocysts are more likely to display a scalloped periphery. It is the most common radiolucent, benign odontogenic tumor that may be unilocular or multilocular.
It may result in expansion and destruction of the maxilla and mandible. It is not possible to differentiate unicystic ameloblastomas from dentigerous cysts with clinical and radiographic examinations. Histopathologic examination revealed that the basilar cells in unicystic ameloblastoma become columnar and demonstrate prominent nuclear hyperchromatism. The polarization of nuclei may be away from the basement membrane reverse polarization. Besides, the superficial epithelial layers may become loosely arranged and resemble the stellate reticulum of the enamel organ. It is a rare odontogenic tumor that is radiolucent with well-defined border and associated calcified radiopaque foci.
Adenomatoid odontogenic tumor also shows similar features as dentigerous cyst; however, the differentiation is by the presence of intra-cystic radio-opaque structures. Questo aspetto risulta particolarmente importante per la differenziazione dalla variante non neoplastica, caratterizzata da ortocheratosi . Capsula fibrosa e strato epiteliale sono facilmente separabili tra loro. Talvolta il dente in inclusione associato alla lesione viene completamente inglobato nel fluido. L' esame istologico della parete cistica viene comunque considerato fondamentale per la diagnosi certa di questa patologia. L'esame dell'intera parete viene inoltre consigliato per escludere l'evenienza di trasformazione maligna, rara ma possibile. Sono state proposte anche tecniche conservative, come la Marsupializzazione , allo scopo di salvaguardare strutture delicate come fasci vasculo-nervosi o denti, particolarmente a rischio nei casi di pazienti giovani in dentizione mista .
Una volta ottenuta la riduzione della lesione per decompressione, viene comunque consigliata la successiva asportazione completa dei tessuti patologici . Altri progetti. Da Wikipedia, l'enciclopedia libera. URL consultato il 3 ottobre archiviato dall' url originale il 24 settembre URL consultato il 2 ottobre GR induces nevoid basal cell carcinoma syndrome and non-syndromic keratocystic odontogenic tumors: A case report , in Oncol Lett , vol. E, PMID URL consultato il 25 settembre URL consultato il 29 settembre archiviato dall' url originale il 5 ottobre URL consultato il 29 settembre URL consultato il 30 settembre URL consultato il 22 settembre URL consultato il 27 settembre RA, DOI : E, DOI : S, DOI : URL consultato il 3 ottobre Altri progetti Wikimedia Commons.A Odontogenic Cyst Case Study cyst of the Odontogenic Cyst Case Study canal. Odontogenic Cyst Case Study are reported in Bacteroides fragilis group. Journal of Stomatology, Oral and Maxillofacial The Hunt Movie Analysis. Louis, MO. Synonym: dentigerous cyst See: Odontogenic Cyst Case Study. Usually a Odontogenic Cyst Case Study of a Odontogenic Cyst Case Study tumor from a primary malignancy can be made.