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This illustrated notes covered all the important highyield points related to dentigerous cyst

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
Cyst clinical features
Epidemiology & Clinical features

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.
Dentigerous Cyst Radiological features
Dentigerous Cyst Radiological features

Pathogenesis of Dentigerous Cyst

Cyst Pathogenesis
Pathogenesis
Pathogenesis 2
Pathogenesis 2

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.
Histopathology
Histopathology

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.
Treatment
Treatment

Last minute revision

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Medinaz Dental Books

Medinaz Dental Cyst Book
Medinaz Dental Cyst Book

“High Yield Visual Book of Dental Cyst” is now available on “Medinaz” App. The App is available on Appstore & Playstore. Visit our website www.medinaz.com for other available books.

Book overview:
– All the necessary High-Yield Points
– 230+ Frequently tested facts
– 200+ hand drawn Images
– Mnemonics to remember
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– FREE UPDATES up to 1 year from the date of publish
– (Time span to be counted from the day it was published)
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