A COMPOUND ODONTOMA ASSOCIATED WITH RADICULAR CYST - A RARE CASE REPORT

Radicular cysts and Chin implants; An unexpected complication prompting explantation – Case report

BackgroundRadicular cysts are the most frequent odontogenic cysts of the jaws. Radicular cysts arising from the primary teeth are very rare and comprise 0.5% to 3.3% of radicular cysts in both primary and permanent dentitions.Case PresentationIn this paper, we report the clinical, radiographical, and histological characteristics of a radicular cyst associated with a maxillary deciduous first molar. The treatment plan included extraction and enucleation of the cyst under local anesthesia after the elevation of a mucoperiosteal flap, which led to satisfactory and uneventful healing.ConclusionEarly diagnosis of radicular cysts associated with the primary dentition allows for a less aggressive treatment plan and prevents adverse effects on the permanent successor.

Radicular cyst is a most common type of odontogenic cyst that develops mostly as sequel of untreated dental caries. It is classified as inflammatory type originated mostly from cell rests of Malassez. Radicular cyst arising from deciduous teeth is rare, accounting for just 0.3% to 5% of the total number. Residual kind of radicular cyst in deciduous teeth are still very sparse in literature. Most of the residual cysts are asymptomatic and are found only on routine radiographic examination. We are presenting an interesting and rare case of symptomatic residual radicular cyst of left primary first molar extraction socket with secondary infection in a 5-year-old child. Our aim is to emphasize on investigations, recognition, and treatment of such inflammatory residual radicular lesions associated with deciduous teeth, which has been an unreported clinical entity.

To characterize plasma cell subsets in chronic periapical lesions affecting permanent and primary teeth. Only chronic periapical lesions without root canal treatment were selected. Twenty-one radicular cysts and 7 periapical granulomas affecting permanent teeth and 19 radicular cysts and 4 periapical granulomas affecting primary teeth were assessed for immunoglobulin (Ig) light chain (kappa and lambda), Ig heavy chain (IgG, IgG4, IgA, IgM and IgD) and plasma cell immunohistochemical markers (MUM1/IRF4, EMA and CD138). The data acquired were analysed by Student's t test, Mann-Whitney U, Friedman test followed by Dunn's multiple comparison test and Spearman's rank correlation. All cases were polyclonal (having similar kappa/lambda light chain ratios). IgG was most abundant compared to other Ig heavy chains (all, P<0.001); like Ig light chains, but unlike IgA, there was greater expression of IgG in the primary compared to the permanent dentition, for both radicular cysts (P<0.001) and periapical granulomas (P=0.53). Notably, IgG4 expression was greater in the permanent than the primary dentition, for both radicular cyst (P<0.05) and periapical granuloma (P=0.65). IgM and IgD expression was scarce and variable, whereas plasma cell populations were detected efficiently through EMA, CD138 and MUM1/IRF4 markers, the latter being more sensitive in both dentitions. There were slight variations in the Ig light and heavy chain profiles in chronic periapical lesions when comparing the permanent and primary dentitions. The ability of IgG4+ plasma cell infiltration to modulate inflammatory responses in chronic periapical lesions arising from permanent as opposed to primary teeth should be considered in future studies.

This study aimed to evaluate tryptase and E-cadherin protein expression in odontogenic keratocysts (OKCs) and radicular cysts (RCs) and their relationship with lesion size. Thirty OKC and 30 RC cases were analyzed by immunohistochemistry. Tryptase expression was quantitatively assessed using the quantification of mast cells, and expression of E-cadherin was semi-quantitatively analyzed estimating the proportion of positive cells: 1 = less than 25% of immunopositive cells; 2 = 26 to 50% of immunopositive cells; 3 = 51 to 75% of immunopositive cells; 4 = more than 75% of immunopositive cells. Data on cystic lesion sizes were obtained from patients' clinical files, based on previous radiographic exams, and the lesions were categorized into three groups: group 1 (< 2 to 2cm); group 2 (> 2 to 4cm), and group 3 (> 4cm). Higher mast cell means were found for RCs, with the predominance of degranulated mast cells in both OKCs and RCs (p = 0.082). Concerning the epithelial component, a higher concentration of degranulated mast cells was detected in RCs (p = 0.000). Regarding connective tissue, degranulated mast cells were more evident in OKCs (p = 0.762). A negative correlation was observed between E-cadherin expression and total number of mast cells (p = 0.011), degranulated mast cells (p = 0.040), and degranulated mast cells in both superficial (p = 0.035) and deep connective tissues (p = 0.009). Concerning lesion size, a negative correlation with total number of mast cells (p = 0.016) and number of degranulated mast cells (p = 0.049) was observed, both in the epithelial components. Herein, the larger the lesion size, the lower the number of degranulated mast cells in the epithelium (r = - 0.271; p = 0.49), suggesting that these cells play a role in the initial cystic expansion phase. The higher expression of tryptase in degranulated mast cells was linked to a lower expression of E-cadherin, which may be related to a change in the epithelial permeability in these lesions, contributing to increased cystic content and lesion growth. Evidence of the relationship between mast cells and E-cadherin in the growth of odontogenic cysts was studied.

Retrospective investigations of odontomas in Japanese children and one recurrent case were carried out. Thirty-nine cases of odontoma in 38 children were treated in the Paediatric Dentistry Clinic of Niigata University Dental Hospital between September 1979 and December 2002. The patients consisted of 23 males and 15 females and their ages ranged from 1 year 2 months to 14 years old. The chief complaints were delayed tooth eruption in 19 cases (five: primary teeth, 14: permanent teeth), retention of primary teeth in 11, incidentally found on the radiographic examination in eight cases, and swelling of the jaw in one case. Thirty-four cases (87%) were associated with tooth eruption disturbances. The most frequently affected region was the maxillary anterior region. Treatment consisted of surgical removal of odontomas in all cases, after which if the impacted teeth did not erupt, exposure of the crown and/or orthodontic traction was performed. Pathological diagnoses were compound odontoma in 30 cases, complex odontoma (n = 7), and compound and complex odontoma (n = 2). A retrospective study of the radiographs revealed the developing process of odontomas in four cases and odontoma disturbed tooth eruption since the early uncalcified developing stage. A recurrent case was a boy aged 6 years 5 months in whom the first surgical removal of odontoma was performed at the age of 1 year 8 months. Recurrence of an odontoma is very rare, but in very young children odontomas are in the early developing stages, containing uncalcified portions, so it is important to perform periodical observations until the succedaneous teeth erupt.

Langerhans cells (LCs) play important roles in cell-mediated immune reactions, as well as in the pathogenesis of periapical lesions. The aim of this study is to evaluate the role of LCs in the proliferative epithelium of radicular cysts (RCs) and the release of the proinflammatory cytokine tumor necrosis factor α (TNF-α) associated with epithelial thickness. Thirty cases of RCs and 30 cases of residual RCs were randomly selected. Morphologic analysis was performed to evaluate the association between the inflammatory infiltrate, cystic epithelial thickness and lesion size, in addition to immunohistochemical assessment of CD1a, CD68, and TNF-α. The highest macrophage percentages and TNF-α scores were found in RCs (P=0.038 and 0.017, respectively). The largest number of LCs was observed in RCs (P=0.021), especially those exhibiting atrophic epithelium (P=0.05). In addition, LCs were positively correlated with the number of macrophages in both RCs and residual RCs (P=0.033 and 0.002, respectively). In contrast to LCs, the largest number of macrophages was detected in cases with an intense inflammatory infiltrate (P=0.022). In addition, the highest TNF-α scores were associated with an intense inflammatory infiltrate (P=0.024) when analyzed in the capsule of RCs (P=0.017). In conclusion, LCs participate in defense mechanisms and were present in all cases evaluated. Along with macrophages, these cells release proinflammatory cytokines such as TNF-α, which is responsible for inducing the continued proliferation of cystic epithelium.

Apical infection spreading to adjacent teeth: a case report

Discrepancy in diagnosis and characteristics of odontogenic cystic lesions in mixed dentition period; a retrospective study

Objectives: The aim of this case report is to describe radiographically the specific features of periapical cysts to differentiate them from dentigerous cyst lesions despite their similar clinical appearance. Case Report: A 21-year-old female patient came to Dental Hospital in Bandung with a referral for a cone-beam computed tomography (CBCT) examination with a clinical diagnosis of suspected right mandibular dentigerous cyst and left mandibular periapical cyst. The patient said that during the past month, swelling had appeared on both sides of the jaw, which was getting bigger, the pain was intermittent, and it was disturbing when eating. Intraoral examination showed gingival enlargement, muccobucal fold disappeared. Extraoral examination, facial asymmetry was found due to unilateral swelling. Radiographic examinations showed both lesions were oval, unilocular, radiolucent internal structures with an average density of 4.7-32 HU resembling soft tissue density, corticated or radiopaque borders, caused expansion of the mandibular corpus buccally and lingually and to mesial and distal, cortical thinning and displacement of the inferior mandibular canal. Conclusion: Lesions on the jaws have almost the same clinical appearance, but through CBCT examination the type of lesion can be well determined. Periapical cyst lesion with large size has a clinical appearance like dentigerous lesions, but radiographically will show a different specific picture.

Though a clinical examination may reveal a deep fissure or pit on the surface of an anterior tooth, radiographic examination is a more accurate approach to diagnose an invagination. Dens invaginatus is one of the common dental deformities, but the defect involving the root and its association with radicular cyst is still very uncommon. The objective of this case presentation is to report a case of radicular dens in dente, which is a rare dental anomaly. This case report shows that dens invaginatus with an open apex and a radicular cyst can be treated successfully using currently available materials.

Radicular cysts are the most common odontogenic cystic lesions of inflammatory origin and are managed either by surgical enucleation or by marsupialization. We illustrate the possibility of complete healing of cystic periapical lesions in permanent and mixed dentition with conservation of vital structures. This article aims to report two clinical cases of radicular cysts of huge proportion treated with two different techniques in an effort to shed some light on the advantages and disadvantages as well as a brief discussion of the leading criterias that should be taken into consideration when assessing the treatment modalities.

Dentigerous cyst is caused by fluid accumulation between the epithelium and the crown of an unerupted tooth. It grows by expansion of the follicle and is attached to the neck of the tooth. The radicular cysts are inflammatory jaw cysts at the apices of teeth with infected and necrotic pulps. These arise from the epithelial residues in the periodontal ligament as a result of inflammation, usually following death of the pulp. We present a case of a cystic lesion creating dilemma between radicular and dentigerous cyst.

TNF-α is a pleiotropic cytokine that is considered as a primary modifier of inflammatory and immune reaction in response to various inflammatory diseases and tumour. We investigated levels of TNF-α in 43 radicular cysts and 15 odontogenic keratocysts, obtained from patients undergoing surgery, under local anaesthesia, and after aspiration of cystic fluid from non-ruptured cysts. TNF-α is elevated in both cysts' fluid, but higher values were found in radicular cysts in comparison to keratocysts. The significantly higher concentration of TNF-α was associated with smaller radicular cysts, higher protein concentration, higher presence of inflammatory cells in peri cystic tissues, and the degree of vascularisation and cysts wall thickness (Mann-Whitney U-test, p<0.05). No correlation was found based on these parameters in odontogenic keratocyst, but all cysts have detectable concentrations of TNF-α. We here for the first time present that a difference in the concentration of TNF-α exists between these two cystic types.

Background: Dental cysts, particularly dentigerous cysts (DCs), are a common pathological condition affecting the jawbone. The literature categorizes DCs based on histology and associates them with impacted teeth, often leading to complications. However, the occurrence of DCs in the elderly and their association with mandibular premolars is not well-documented, presenting a knowledge gap in dental pathology and management. Objective: This case report aims to present a rare clinical case of an impacted mandibular premolar associated with a dentigerous cyst and a periodontal lesion, detailing the clinical management, radiographic diagnosis, histopathologic analysis, and surgical intervention. Case presentation: A 65-year-old male patient presented with pain and mobility in tooth 36. Clinical examination, radiographic imaging, and histological analysis were conducted to diagnose and plan the treatment—the treatment involved enucleation of the DC and extraction of the impacted tooth. Histological examination was performed using hematoxylin and eosin staining to determine the nature of the cyst. Results: The patient’s postoperative recovery was uneventful, with complete remineralization of the site after one year. Histological findings indicated a significant inflammatory infiltrate, predominantly lymphocytes, suggesting a periodontal cyst. The impacted mandibular premolar association with a DC in an elderly patient is rare, with the literature reporting a higher frequency of such cysts in younger demographics. Conclusions: The case report contributes to the existing literature by highlighting the successful management of a rare case of an impacted mandibular premolar with a dentigerous cyst and periodontal lesion. It emphasizes the importance of accurate diagnosis and individualized treatment planning in managing complex dental cyst cases. It suggests a conservative approach to prevent surgical risks, especially near critical anatomical structures.