GINGIVAL CYST LOCATION: Lingual surface of mandibularcanine and premolars. COLOR: Bluish gray. APPEARANCE: Nodular and resembles mucocele CONTOUR Localized enlargement. PAINLESS ATTACHED or MARGINALGINGIVA
ORIGIN Develop from odontogenic epithelium orfrom surface or sulcular epithelium
RADIOGRAPHIC FINDINGS No radiographic findings because the usuallyinvolve the soft tissues
HISTOLOGY Gingival cyst cavity is lined by a thin , flattenedepithelium with or without localized areas ofthickening. Types of epithelium Non keratinized stratified squamous epithelium Keratinized stratified squamous epithelium Parakeratinized epithelium with palisading basal cells
PERIODONTAL CYST(Lateral Periodontal Cyst) Uncommon lesion. Localized destruction of periodontal tissues. Lateral root surface. LOCATIONMandibular canine-premolar area.ORIGIN Derived from rests of Malassez.CONTOUR Localized enlargementASYMPTOMATICPAINFUL
RADIOGRAPHIC FINDINGS Interproximal periodontal cyst appears on theside of the root as a radiolucent area borderedby a radiopaque line. Periodontal abscess is difficult to differentiatefrom periodontal cyst, radiographically
`Cyst Abscess Filled with fluid <1.5cm Gingiva appearsbluish gray Filled with puss 2-10cm Gingiva appears red
HISTOLOGY Cystic lining may be a loosely arranged , thin,nonkeratinized epithelium, sometimes withthicker proliferating areas.
TREATMENT Treatment is surgical excision and histopathologicexamination for a conclusive diagnosis. ENUCLEATION MARSUPIALIZATION COMBINATION ENUCLEATION WITH CURETTAGE
ENUCLEATION Enucleation means shelling out the entire cystic lesionwithout rupture.INDICATION: Small cyst, which can be done when the vital structures arenot involved.
Local AnesthesiaFlap design ismadeIncision madeaccording to thedesignTooth extractionBur andforcepIntraosseouswindowIrrigation toclean the cavityClosure bysuture (6-12months)
MARSUPIALIZATION Marsupialization refers to creating a surgical window inthe wall of the cyst, excavating the contents of the cystand maintaining continuity between the cyst wall and theoral cavity. This process decreases the pressure inside the cyst, andpromotes shrinkage of the cyst as well as bone fill.INDICATIONS: If surgical access is difficult Unerupted tooth involved Small cyst
COMBINATION Combined approach morbidity and completehealing of the defect. In this technique marsupialization is done firstand the enucleation is done at a later date. The advantage is that as marsupialization isdone first, it spares the vital structures. The sizeof the cystic cavity also becomes small and afterhealing the cystic lining becomes thick, makingenucleation easier at this stage.
ENUCLEATION WITHCURETTAGE After enucleation is done, a curette or bur is used toremove 1 to 2 millimeter of bone around the entireperiphery of cystic cavity.INDICATIONS For cysts reported to have high recurrence rate, forexample odontogenic keratocystAdvantages If enucleation leaves any remnants, curettage may removethem thereby decreasing the likelihood of recurrence.Disadvantage Curettage is more destructive to adjacent bone, blood