Odontogenic cysts (root cyst, gingival cyst, gingival cyst) develop slowly, asymptomatically, reach considerable size, destroy the surrounding tissues. How to recognize them early, before they can do significant damage to the body? What is their treatment of odontogenic cysts?
Odontogenic cystsis a wide group of lesions present in the craniofacial area, which develop slowly, asymptomatically, reach considerable size, destroy the surrounding tissues, and are detected mostly accidentally on radiographs . Histopathological examination is crucial in making the correct diagnosis. The further treatment procedure depends on the result of this examination, as well as the location and size of the cyst.
The Greek word kystis literally means a cavity or bladder that is closed on all sides. The Polish equivalent of the word used in medicine is a cyst. According to the medical definition proposed by Kramer, a cyst is a pathological cavity filled with content of varying consistency and cohesiveness (liquid, semi-fluid, or less often gas) that is not related to purulent discharge. Cysts are found both in soft tissues and bones, they are surrounded by a fibrous bag, which is sent from the inside with epithelial tissue (true cyst) or does not have such a sending, such a formation is called pseudocyst.
How do odontogenic cysts form?
The development of dentition is accompanied by many complex processes at the cellular and tissue level. After the end of their role, the tissues involved in tooth formation disappear and are gradually replaced by successive generations of cells that make up tooth buds. Sometimes, however, a small group of cells breaks out of the established pattern and remains in an inactive form immersed in mature tissues. As long as these cells remain inactive, there is nothing to fear. However, it sometimes happens that under the influence of various factors, e.g. inflammation, they are activated and the cyst develops slowly. Such activation may also occur spontaneously, then we are dealing with developmental cysts.
Division of the maxillofacial cyst
The basic division of cysts in this area segregates them according to the origin of the present epitheliuminside them: if the lining epithelium is connected with the tissues of the developing tooth, then such a cyst is called an odontogenic cyst, if there is no such connection, we are dealing with non-odontogenic cysts. The microscopic image visible on the histopathological examination is decisive. The odontogenic cysts include:
- Radicular cyst ( Cystis radicularis )- is the most common cyst in the jaw bones. These types of lesions account for approximately 60 percent of odontogenic cysts located in this area. Due to its triggering factors, it is also called an inflammatory cyst. It usually develops around the tooth's root tip with a dead, gangrenous pulp. More common in the maxilla than the mandible, especially in the front teeth. Radical cysts are found in patients of all ages, most often they affect people between 20 and 50 years of age. Characteristic for them is the amber color of the content, iridescent with cholesterol crystals. Properly performed root canal treatment may cause the atrophy of the root cyst, but it is not a rule. A special case of a root cyst is a residual cyst, formed from granulation tissue left in the socket after tooth extraction.
- Germ cyst- associated with the tooth developing in the bone. The radiological image of the cyst covering the crown of the impacted tooth is characteristic. The pathogenesis of the disease is not clear. Germinal cysts constitute 1/4 of the cysts located in the area of the maxillary bones. They most often develop in the mandible around wisdom tooth buds and second premolars, while in the maxilla it is most numerous along with third molars and canines. Its variant, developing in the gingival soft tissues, is an eruptive cyst ( Cystis eruptiva ).
- Gingival cyst ( Cystis gingivalis )- develops in the soft tissues of the oral cavity near the alveolar processes. It can be found at any age and is most often diagnosed in infants, often at birth. It appears as a white, white-yellow lump on toothless alveolar processes in babies. Infant gingival cysts do not require treatment and go away on their own.
Symptoms and diagnosis of odontogenic cysts
Cysts are benign changes that develop slowly, they are characterized by a relaxing growth. Initially, they do not show any symptoms, revealing their presence only after reaching a considerable size. Pain occurs when the cyst is infected with bacteria. Symptoms that appear in the courseCysts are facial asymmetry, distension or bone tumor, tooth displacement. The development of the cyst causes the loss of pressure on the adjacent tissues, and the large-sized bone cysts can cause pathological fractures and loosening of the teeth. If the developing cyst presses on the nerve trunks, sensory disturbances and paresthesia may appear. An important examination performed to diagnose cysts is an X-ray examination. Most of the bone cysts are accidentally detected on pantomographic pictures, the so-called overview. On the radiograph, the cyst is visible as an oval or round, sharply limited bone loss. In order to diagnose the type of cyst, a histopathological examination is necessary. The research also provides information on whether the cyst lining has cancerous transformation.
Odontogenic cysts: treatment
Surgical procedures involve the removal of the cyst with the fibrous bag surrounding it. Sometimes it is necessary to extract the tooth or the so-called tooth root resection associated with the root cyst. These procedures are usually performed under local anesthesia. They can take the form of a simple enucleation or curettage carried out in one visit. Another possible form of bone cyst treatment is a two-stage procedure.
Treatment of odontogenic cysts is surgical treatment, administration of antibiotics is only used in the case of infection of the cyst.
The first stage is to drain the contents of the cyst, which gradually reduces its size, the so-called decompression of the cyst. This phase usually takes about 6 months. during this time, the patient must wear an acrylic obturator and make regular check-ups. After this period, you can proceed to the second stage, i.e. removing the remains of the cyst. The above methods can be combined with mechanical, chemical or thermal cleaning of the bone cavity after the cyst.
In exceptional cases, a radical procedure is used, i.e. excision of a cyst with a bone fragment, the so-called bone resection. The prognosis after correct and complete removal of the cyst is good. Relapses of the disease may rarely occur.