This document defines and classifies odontogenic cysts, which are epithelium-lined sacs that arise from odontogenic epithelium. It discusses the most common types, including periapical (radicular) cysts, dentigerous cysts, odontogenic keratocysts, glandular odontogenic cysts, and calcifying odontogenic cysts. For each cyst type, it describes characteristics such as prevalence, location, radiographic appearance, histopathology, treatment involving enucleation or marsupialization, and prognosis. It also discusses the basal cell nevus syndrome that can be associated with odontogenic keratocysts.

1. ODONTOGENIC CYSTS
DR. MOHAMED EL SAYED
OMFS CONSULTANT
KFMC ,TAIF, KSA
2018

2. DEFINITION
• An epithelium-lined sac filled with fluid or soft material.
• Cysts of the jaws may be divided into two types: (1) those arising from Odontogenic epithelium
(i.e., odontogenic cysts) and (2) those from oral epithelium that is trapped between fusing
processes during embryogenesis (i.e., fissural cysts ).
• Enlargement of cysts is sed by-gradual expansion, and most are discovered on routine dental
radiographs. Cysts are usually Asymptomatic unless they are secondarily infected. overlying
mucosa is normal in color and consistency , and no sensory deficits from encroachment nerves are
found. Cysts do not usually cause resorption of the roots of teeth;
• The radiographic appearance of cysts is characteristic and exhibits a distinct, dense periphery of
reactive bone (i.e., condensing osteitis) with a radiolucent center

3. CLASSIFICATION OF ODONTOGENIC CYSTS
1) Developmental. 2) Inflammatory
1. Dentigerous cyst 1. Periapical ( radicular) cyst
2. Eruption cyst. 2. Buccal bifurcation cyst
3. Odontogenic keratocyst. 3. Residual cyst
4. Gingival (alveolar cyst of the newborn)
5. Gingival cyst of the adult
6. Lateral periodontal cyst
7. Calcifying odontogenic cyst
8. Glandular odontogenic cyst

5. PERIAPICAL (I.E., RADICULAR) CYST
• The most common of all cystic lesions of the jaws and results from inflammation or necrosis of the dental pulp.
• Because it is impossible to determine whether a periapical radiolucency is a cyst or a granuloma, removal at the
time of the tooth extraction is recommended. If, the tooth is restorable, endodontic treatment followed by periodic
radiographic follow-up will allow assessment of the amount of bone fill. If none occurs or the lesion expands in
size, the lesion probably represents a cyst and should be removed by periapical surgery.
• When extracting teeth with periapical radiolucencies, enucleation via the tooth socket can be readily
accomplished using curettes when the cyst is small
• In large cysts or cysts proximal to neurovascular structures, nerves and vessels are usually found pushed to one
side of the cavity by the slowly expanding cyst and should be avoided or handled as atraumatically and as
little as possible.

7. DENTIGEROUS CYST
• Occurs in association with an unerupted tooth, most commonly mandibular
third molars. Other common associations are with maxillary third molars,
maxillary canines, and mandibular second premolars. They may also occur
around supernumerary teeth and in association with odontomas
• Most commonly seen in 10- to 30-year olds.
• There is a slight male predilection, and their prevalence appears to be
higher in Whites than in Blacks.
• Radiographically, the dentigerous cyst presents as a well-defined unilocular
radiolucency, often with a sclerotic border, this radiolucency typically and
preferentially surrounds the crown of the tooth

8. TYPES OF DENTIGEROUS CYST RADIOGRAPHICALLY
• Central :
in which the radiolucency surrounds just the crown of the tooth, with the
crown projecting into the cyst lumen.
• Lateral :
the cyst develops laterally along the tooth root and partially surrounds the
crown.
• Circumferential :
exists when the cyst surrounds the crown but also extends down along the
root surface, as if the entire tooth were located within the cyst.

9. DISTINGUISHING BETWEEN A DENTIGEROUS CYST
AND AN ENLARGED DENTAL FOLLICLE.
• Any pericoronal radiolucency that is > 4 or 5 mm is considered suggestive of cyst formation and should be
submitted for microscopic examination.

10. TREATMENT AND PROGNOSIS
• Enucleation of the cyst and removal of the associated tooth, often without a preceding incisional biopsy
• Curettage of the cyst cavity
• Large dentigerous cysts may be treated with marsupialization when enucleation and curettage might otherwise
result in neurosensory dysfunction or predispose the patient to an increased chance of pathologic fracture.
Some patients who are not candidates for general anesthesia may also be treated with a marsupialization
procedure in an office setting under local anesthesia.
• The prognosis for most histopathologically diagnosed dentigerous cysts is excellent, with recurrence being a rare
findings

11. ODONTOGENIC KERATOCYST
• Aggressive clinical behavior.
• Two variants of this cyst are well known; the sporadic cyst and the cyst associated
with the nevoid basal cell carcinoma syndrome.
• keratocyst is important for three reasons: (1) this cyst is recognized as being more
aggressive than other odontogenic cysts,(2) the odontogenic keratocyst has a
higher rate of recurrence than other odontogenic cysts,and (3) the association
with nevoid basal cell carcinoma syndrome requires that the clinician examine a
patient with multiple cysts of the jaws for physical findings that might diagnose this
syndrome.

13. OKC
• 60% of cases are seen in people between 10 and 40 years old.
• A slight male predilection is usually seen, and 60 to 80% of cases involve the mandible, particularly in the
posterior body and ascending ramus.
• When multiple multilocular radiolucencies are noted on a panoramic radiograph, the clinician must perform an
incisional biopsy and investigate the possibility of nevoid basal cell carcinoma syndrome
• The wall is usually thin and friable, which can pose problems for removal in one piece intraoperatively. Epithelial
budding and the presence of daughter cysts may be noted in the connective tissue wall. It is generally advisable
to ask the pathologist to examine the sections carefully for these two features as they generally impart a more
aggressive character to the cyst.

14. CLINICAL FEATURES OF THE BASAL CELL
NEVUS SYNDROME
• ≥ 50% frequency: Multiple basal cell carcinomas Odontogenic keratocysts, Epidermal cysts of the skin,
Palmar/plantar pits ,Calcified falx cerebri, Enlarged head circumference ,Rib anomalies (splayed, fused, partially
missing, bifid), Mild ocular hypertelorism ,Spina bifida, occulta of cervical or thoracic vertebrae
• 15–49% frequency: Calcified ovarian fibromas, Short fourth metacarpals, Kyphoscoliosis or other vertebral
anomalies, Pectus excavatum or carinatum, Strabismus (exotropia)
• < 15% frequency: (but not random) Medulloblastoma, Meningioma, Lymphomesenteric cysts, Cardiac fibroma,
Fetal rhabdomyoma, Marfanoid build ,Cleft lip and/or palate, Hypogonadism in males, Mental retardation

16. GLANDULAR ODONTOGENIC CYST
(SIALOODONTOGENIC CYST)
• Rare and recently described cyst of the jaws that is capable of aggressive behavior and
recurrence.
• Glandular odontogenic cysts occur most commonly in middle-aged adults, with a mean
age of 49 years.
• Eighty percent of cases occur in the mandible and a strong predilection for the anterior
region of the jaws with many mandibular lesions crossing the midline
• These cysts may appear either unilocular or multilocular radiographically
• There is a histologic similarity between the glandular odontogenic cyst and the
predominantly cystic intraosseous mucoepidermoid carcinoma.
• Recurrence rate approximately 30% and therefore resection is recommend

18. CALCIFYING ODONTOGENIC CYST (COC)
GORLIN’S CYST
• The COC may be associated with other recognized odontogenic tumors, most commonly the odontoma. Adenomatoid odontogenic
tumors and ameloblastomas
• Ghost cell keratinization, the characteristic microscopic feature of this cyst, is also a defining feature of the cutaneous lesion known as
the calcifying epithelioma of Malherbe or pilomatrixoma
• The World Health Organization’s classification groups the COC with all its variants as an odontogenic tumor
• The COC is predominantly an intraosseous lesion, although 13 to 30% occur as peripheral lesions.
• Both the peripheral and central lesions occur with about equal frequency in the maxilla and mandible.
• There appears to be a predilection for the incisor and canine areas.
• Mean age of occurrence of about 30 years.
• COCs that are associated with odontomas tend to occur in younger patients, with a mean age of 17 years.
• COCs appear radiographically as unilocular well-defined lesions with radiopaque structures within the lesions

20. SURGICAL MANAGEMENT OF CYSTS
• Cysts of the jaws are treated in one of the following four basic
methods:
• (1) enucleation,
• (2) marsupialization,
• (3) a staged combination of the two procedures,
• (4) enucleation with curettage.

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