DENTIGEROUS CYST- an odontogenic cyst that surrounds the crown of impacted tooth , develops by fluid accumulation between REE(reduced enamel epithelium) and the enamel surface , resulting in a cyst which the crown located within the lumen.

1. ODONTOGENI
C CYST

2. TOPICS
CYST
❖ DENTIGEROUS CYST
⮚ INTRODUCTION
⮚ ETIOLOGY
⮚ CLINICAL FEATURES
⮚ RADIOGRAPHIC FEATURES
⮚ HISTOPATHALOGY
⮚ TREATMENT AND PROBNOSIS
❖ CALCIFYING ODONTOGENIC CYST
⮚ INTRODUCTION
⮚ ETIOLOGY
⮚ CLINICAL FEATURES
⮚ RADIOGRAPHIC FEATURES
⮚ HISTOPATHALOGY
⮚ TREATMENT AND PROBNOSIS

3. CYST
� It is Defined as a pathological cavity , may or may
not be lined by epithelium and containing fluid ,
semisolid or gaseous material.
� It is more common in orafacial region and it is most
common cause for chronic jaw swellings.

4. CYST
� Epithelium of the cysts of oral and paraoral
region usually derived from odontogenic
apparatus , their remnants or the epithelium
get entrapped at line of fusion of various
facial processes during development.
� Wall/capsule of cyst consist of collagenous
fiberous connective tissue which produce
various bone resorption factor for its growth
and expansion.

5. CLASSIFICATION OF CYST
� Based on aetiology and tissue of origin

6. HISTOGENIC CLASSIFICATION OF
ODONTOGENIC CYST
� CYST DERIVED FROM THE REDUCED ENAMEL EPTHELIUM
-DENTIGEROUS CYSTS
� CYSTS DERIVED FROM THE DENTAL LAMINA
-ODONTOGENIC KERATOCYST
-LATERAL PERIODONTAL CYST
-GLANDULAR ODONTOGENIC CYST
� CYST DERIVED FROM THE RESTS OF MALASSEZ
-RADICULAR CYST
-RESIDUAL CYST
� UNCLASSIFIED ODONTOGENIC CYSTS
-PARADENTAL CYST

7. DENTIGEROUS
CYST
• INTRODUCTION
• ETIOLOGY
• CLINICAL FEATURES
• RADIOGRAPHIC FEATURES
• HISTOPATHALOGY
• TREATMENT AND PROBNOSIS

8. DENTIGEROUS CYST(FOLLICULAR
CYST)
It defined as odontogenic
cyst that surrounds the
crown of impacted tooth ,
develops by fluid
accumulation between
REE(reduced enamel
epithelium) and the enamel
surface , resulting in a cyst
which the crown located
within the lumen.

9. DENTIGEROUS CYST
� Most common
developmental odontogenic
cyst (about 20% of all jaw
cysts).
� Population estimation :-1.44
cyst for every 100 unerupted
teeth.
� 10% of impacted teeth
formed a dentigerous cyst.
� It mainly involves the crown
of permanent tooth
(deciduous tooth is rarely
involved).

10. DENTIGEROUS CYST
� Mostly developmental in origin
but some example appear
inflammatory pathogenesis-when
dentigerous cyst develop around
crown of unerupted permanent
tooth due to periapical
inflammation from overlying
primary tooth.
� Misdiagnosed :- KERATOCYST OF
ENVELOPMENTAL
VARIENTY,FOLLICULAR
KERATOCYST,UNILOCULAR
AMELOBLASTOMA,- radiologically-
so diagnosis-based upon
defination

11. PATHOGENESIS
INTRAFOLLICULAR
� Occurs due to
accumulation of fluid
between the layers of
reduced enamel
epithelium i.e inner
enamel and outer
enamel epithelium
after formation of
crown.
EXTRAFOLLICULAR
�Cyst forms by
accumulation of
fluid between
the unerupted
tooth and
reduced enamel
epithelium.
Two origins

12. PATHOGENESIS
INTRAFOLLICULAR
� Occurs within
enamel organ- by
degeneration of
stellate reticulum at
an early stage of
tooth development-
resulting in cyst
formation
associated with
enamel hypoplasia.
EXTRAFOLLICULAR
� Crown of
permanent tooth
may impinge into
the already existing
radicular cyst
around the
deciduous teeth but
this is rare because
radicular cyst rarely
associated with
deciduous teeth.

13. PATHOGENESIS
INTRAFOLLICULAR
� The fluid pressure incites
a proliferation of OEE
which remains attached
to tooth at CEJ and the
IEE is then pressed onto
the crown surface.
EXTRAFOLLICULAR
� but an inflammatory
follicular cyst - may
develop due to
inflammation at apex of
decidous tooth.

14. CYST EXPANSION
1.ERUPTING TOOTH
PRESSURE ON IMPACTED FOLLICLE
VENOUS STASIS
TRANSUDATION OF SERUM
INCREASE IN HYDROSTATIC PRESSURE
CYST EXPANSION

15. CYST EXPANSION
2.INFLAMMATORY CELLS
CELL WALL (phospholipids)
ARCHIDONIC ACID
LIPOXYGENASE CYLO-OXYGENASE
LEUKOTREINS PROSTAGLANDINS
(collagenase collagen destruction)
C4 , D4 E2 , E3
OSTEOCLASTIC ACTIVITY
BONE RESORBTION

16. CYST EXPANSION
3.Release of GAG from the walls &
their diffusion into cyst fluids - play
an important role in expansile cyst
growth by increasing osmolality of
cyst fluid,hence raising internal
hydrostatic pressure of cyst.
4.Passage of Desquamated
Epithelial cells & Inflammatory cells
into cyst cavity contribute to
increase in intracystic osmotic
tension further expansion of cyst.

17. Clinical features
� 2nd and 3rd decade -most of lesion
� Male:Female ratio - 3:2
� Always associated with impacted,
embedded or unerupted tooth.
� Common Sites :- Mandibular and
Maxillary third molar and Maxillary
cuspid area (commonly impacted
teeth).
� mostly dentigerous cyst are solitary
,bilateral dentigerous cysts are rare if
present due to associated with
numerous syndrome (cleidocranial
dysplasia and Maroteaux-lamy
syndrome).
Cleidocranial dysplasia:-rare ,
genetic condition that affects
teeth and bones.
Maroteaux-lamy syndrome:-
inherited disease caused by
deficiency in the enzyme
ASRB(arylsulfatase B)
responsible for breakdown of
large sugar molecules.

18. Clinical Features
• Potent to become
aggressive lesion.
• Expastion of bone with
1. Subsequent facial
asymmetry
2. Extreme displacement of
teeth
3. Severe root resorption of
adjacent teeth
4. Pain are brought by
continued enlargement of
the cyst or secondary
infection.

19. Clinical Features
� Unerupted 3rd
molar -result in
“hallowing out” -
entire ramus
,extending upto
coronoid process
and condyle or
cortical plates are
also involved due
pressure exerted by
lesion.

20. RADIOGRAPHIC FEATURES
� Unerupted tooth crown lined by symmetrically by
radiolucency area.
� distinction between small dentigerous cyst and
enlarged dental follicle by follicular space (normal
3-4mm,D.cyst- more than 5mm).

21. RADIOGRAPHIC FEATURES
• Three Radiological
variation of
dentigerous cyst are:-
1. Central dentigerous
cyst
2. Lateral dentigerous
cyst
3. Circumferential
dentigerous cyst

22. RADIOGRAPHIC FEATURE :-
• Radiolucent area surrounded by
thin sclerotic line represent bony
reaction.
• Cyst is smooth, unilocular lesion but
sometime multilocular appearance
may occur
1. CENTRAL DENTIGEROUS CYST
• Crown enveloped symmertically
• Pressure applied to crown push
tooth away from direction of
eruption.
• mandibular 3rd molar pushed to
lower border of mandible.
• maxillary canine pushed into
maxillary sinus.

23. 2. LATERAL DENTIGEROUS CYST
• Dilatation of follicle -in one
aspect of crown.
• Commonly seen in
impacted mandibular 3rd
molar which is partially
erupted-as its superior
aspect is exposed.
3. CIRCUMFERENTIAL
DENTIGEROUS CYST
• Follicle expands in such
manner in which the entire
tooth appearsto be
enveloped by cyst.

24. HISTOLOGIC FEATURES
� No characteristic microscopic features
can reliably distinguish dentigerous
cyst from other type of odontogentic
cysts.
� Composed of thin connective tissue
wall with thin layer of stratified
squamous epithelium lining the lumen.
� Rete pegs formation is generally
absent except in secondary infection.
� consist loose fibrous connective tissue
or sparsely collagenized myxomatous
tissue which can be mistakenly
diagnosed as either odontogenic
fibroma or odontogenic myxoma.

25. HISTOLOGIC FEATURES
� Presence of varying number of
islands of odontogenic epithelium
� Cyst exhibit inflammation have
Rushton bodies within the lining
epithelium.
� Cyst lumen thin,watery yellow fluid,
occasionally blood tinged.
� Pluripotentialities of epithelium
emphasized by Gorlin who
described -mucus secreting cells in
-lining stratified squamous
epithelium, -respiratory epithelium
lining,-sebaceous cell in C.T wall ,-
lymphoid follicles with germinal
centres

26. TREATMENT
� Treatment usually dictated
by size of lesion:-
� small lesions can removed
entirely by surgically with
little difficulty.
� large cyst lead to serious
loss of bone often treated
by surgical drain or
marsupializaton.
� In complete surgical
removal may potentially
danger of fracturing the
jaw.
� recurrence is relatively
uncommon.

27. POTENTIAL COMPLICATIONS
� Development of an ameloblastoma either from the
lining epithelium or from rests of odontogenic
epithelium in the wall of the cyst.
� Development of epidermoid carcinoma from the
same two sources of epithelium.
� Development of a mucoepidermoid carcinoma.
� Vickers and Godin have stressed that
hyperchromatism of basal cell nuclei, palisading
with polarization of basal cells and cytoplasmic
vacuolization with intercellular spacing of the lining
epithelium, when observed together, are
manifestations of impending neoplasia .

28. CALCIFYING
ODONTOGENIC
CYST
• INTRODUCTION
• ETIOLOGY
• CLINICAL FEATURES
• RADIOGRAPHIC FEATURES
• HISTOPATHALOGY
• TREATMENT AND PROBNOSIS

29. CALCIFYING ODONTOGENIC
CYST
▪ ALSO KNOWN AS:-
• Keratinizing and/or calcifying
epithelial odontogenic cyst
• Gorlin cyst
• Cystic keratinizing tumor
It first described by
Gorlin(1962):-
A distinct clinicopathologic
entity and a possible oral
analogue of pilomatrixoma of
skin,showing to the presence of
ghost cell keratinization.

30. TERMS
� GOLD(1963)-termed as namely
“Keratinizing and COC”
� KURT THOMA and HENRY GOLDMAN:-
consider these lesion to odontogenic
tumors of ectodermal and
mesodermal origin.
� Striking histological feature:- “ghost
cell” keratinization of odontogenic
epithelium.
� Lesion share more histologic feature
with rare , intracranial neoplasm K/a
'Craniopharyngioma'

31. CALCIFYING ODONTOGENIC
CYST
� According to the dualistic concept. COC
contains two entities- a cyst and a
neoplasm.
� Some regarded COC as a tumor with a
tendency for cyst formation.
� WHO(2004) based on this monistic concept
classified all COCS as neoplasms.
� The cystic lesion is termed as “calcifying
cystic odontogenic tumor”.
� The neoplastic variant as ''Dentinogenic

32. CALCIFYING ODONTOGENIC
CYST
� WHO latest classification (2017), they are moved back
to cyst category they clinically behave like “Non-
Neoplastic lesion”.
� COC represents a heterogeneous group of lesions
that exhibit a variety of clinicopathologic and
behavioral features.
� Because of this diversity, there is confusion and
disagreement on the terminology and classification of
these lesions.
� This lesion present either as cyst or neoplasm (Solid).

33. DUALISTIC CLASSIFICATION OF COC (BY
TOIDA ET AL)
� CYST:
-Calcifying Ghost Cell Odontogenic Cyst (CGCOC)
� NEOPLASM:
A. Benign: Calcifying Ghost Cell Odontogenic Tumour
a. Cystic variant: Cystic CGCOT
b. Solid Variant: Solid CGCOT
B. Malignant: Malignant CGCOT
� COMBINED LESION : Each of the categories mentioned above ( CGCOC,
CGCOT and malignant CGCOT) associated with the following lesions.
� α Odontoma
� β Ameloblastoma
� γ Other odontogenic lesion

34. CALCIFYING ODONTOGENIC
CYST
� Neoplastic variant -
aggressive and behave as
malignant neoplasm, which is
termed as “Ghost cell
Odontogenic Carcinoma”.
� Cystic variant-more common
than the neoplastic or solid
variant.
� In the extraosseous variants-
two-thirds are cystic.

35. Etiology
� Pathogenesis - uncertain
� Believed to develop from dental lamina,
reduced enamel epithelium,
odontogenic epithelial remnants,
gingiva or bone.

36. CLINICAL FEATURE
� AGE:- Average (30 year old).
� No gender Predilecation.
� Site :- both in maxilla and
mandible, with increased
occurrence in incisor and
canine region.
� COC associated with other
odontogenic lesions such as:-
odontomas, adenomatoid
odontogenic tumors and
{ameloblastomas}.
� COC with Odontomas:-
younger patient [age-17 year
old(avg)], Painless Swelling ].

37. CLINICAL FEATURE
� Extraosseous lesions-
tender,painful swelling of
gingiva and they account 5%-
17% of all cases.
� Occur in 6th to 8th decades of
life
� Presence as fibroepithelial
polyp, pyogenic granuloma or
peripheral giant cell
granuloma.

38. RADIOGRAPHIC FEATURES
� Well defined unilocular radiolucent lesions and may have scalloped
borders.
� Resorption and Displacement of adjacent teeth are not un-common.
� Radio-opacities representing the calcifications or odontomes are seen in
1/2(half) of the cases.
� Extra osseous lesions may have saucer shaped radiolucencies.

39. HISTOPATHALOGIC FEATURES
� It is a Simple cyst with a fibrous
wall lined by ameloblastoma like
epithelium,with focal collections
of ghost cells which may -
calcify.
� The lining epithelium may be of 4
to 10 cells in thickness(fig A).
� The basal layer is made up of
cuboidal or palisaded tall
columnar cells (fig C).
� The epithelial cells above this
layer are many cells thick and

40. HISTOPATHALOGIC FEATURES
� Characteristic feature -
presence of ghost cells.
� Pale, eosinophilic enlarged,
ballooned, elongated
elliptoid or ovoid epithelial
cells,with indistinct outline
and appear as fused when
in groups.
� Nuclear membrane is faint
due to the degeneration of
the nuclear content.
� Cells represent an abnormal
keratinization process and
tend to calcify.

41. HISTOPATHALOGIC FEATURES
� Calcifications appear as
basophilic and are
believed to be of
dystrophic type.
� Juxtaepithelial dyplastic
dentin (dentinoid)
formation.
� Lining epithelium may
proliferate into the
lumen and the lumen
may be filled with
masses of ghost cells
and calcifications(fig D).

42. TREATMENT AND PROBNOSIS
� Enucleation is the treatment of
choice for calcifying cystic
odontogenic tumour.
� Few recurrences of the
intraosseous type have been
reported.
� Central (intraosseous)
dentinogenic ghost cell tumour
is treated by surgical excision.
� Removal of the tumour may
require block excision or
segmental resection,
depending on its size or
anatomic extent.

43. THANK
YOU