This illustrated notes covered all the important highyield points related to dentigerous cyst
Table of Contents
General features
- Dentigerous cyst encloses crown of an unerrupted tooth
- It is attached to CEJ
- Forms by expansion of Dental Follicle
- It was also called Follicular cyst previously
- Brown & Smithe – preferred the term Dentigerous cyst over follicular cyst.
- Dentigerous = Tooth containing
- Follicular = Implies derivation from dental follicle, which is a mesodermal tissue
Epidemiology
- Most common in mandibular 3rd molar followed by maxillary canine > Maxillary 3rd molar > mandibular 2nd premolar
- Peak Occurrence – 3rd decade
- More common in males (1.8:1)
- White > Black (1.6:1)
Clinical features
- Most are incidental finding on a radiograph taken for missing or impacted tooth (failed to erupt)
- Slow enlarging swelling
- Greater tendency than other cysts to cause root resorption
Radiological features of Dentigerous Cyst
- Unilocular radiolucency associated with crown of unerrupted tooth
- Well defined sclerotic margins
- Occasionally Multilocular due to presence of trabeculae
Three radiological variants include:
Central:
Crown is enveloped symmetrically – Tooth often moves in apical direction due to pressure from cystic content. – Mandibular 3rd molar may be pushed towards lower border or into the ramus.
Lateral:
Usually seen in partially erupted teeth. – Dilation of follicle is seen on one side.
Circumferential:
Whole tooth appears to be entrapped by the cyst.
- Radicular cyst from primary tooth may mimic dentigerous cyst associated with succedaneous tooth
- Though it is not common
Distinguishing Dentigerous cyst from dental follicle
- Peri-coronal width (size of cyst) should be at- least 5cm to call it a cyst.
- Less than 5cm should be considered dental follicle.
- Proliferative markers like Bcl-2 & Ki-67 are seen more in dentigerous cyst.
- Apoptotic markers like Fas & ssDNA are more in dental follicle.
Pathogenesis of Dentigerous Cyst
Histopathology
Epithelial lining of dentigerous cyst
- Non-keratinized epithelium
- Epithelial lining is REE
- Consists of 2-4 cell layers of flat or cuboidal cells
- Discontinuity or proliferation of lining epithelium is seen in presence of inflammation in adjacent capsule
- Sometimes, the superficial layer is low columnar (ameloblast like) and is adherent to enamel
- Mucous producing cells may be found in 36% mandibular & 53% maxillary cysts
- Rarely ciliated cells may be seen; Ciliated & mucous cell result from metaplasia
- Hyaline bodies are also seen sometimes
- Sometimes budding of basal cells into capsule may be seen
- Nests, Islands & Strands of Odontogenic epithelium are often seen in the capsule.
Cyst Wall (Connective tissue capsule)
- Thin, fibrous, derived from dental follicle
- Consists of young fibroblasts, widely separated by stroma & ground substance
- Groung substance is rich in acid mucopolysaccharide.
Treatment
- Emphasis is given on conservative surgical treatment with orthodontics to retain the involved tooth & ensure its eruption into normal occlusion.
- Marsupialization may also be employed
- Teeth with incomplete root formation have better chance to erupt, as eruption is closely related to root development.
Last minute revision
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