Year : 2006 | Volume
: 24 | Issue : 3 | Page : 158--160
Radicular cyst associated with a deciduous molar: A case report with unusual clinical presentation
Y Ramakrishna1, D Verma2,
1 Dept. of Pedodontics and Preventive Dentistry, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India
2 Dept. of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India
Dept. of Pedodontics and Preventive Dentistry, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha - 442 004, Maharashtra
This article presents case report of a patient with radicular cyst associated with a primary molar with an unusual clinical presentation. The management comprised of enucleation of the cystic sac under general anesthesia.
|How to cite this article:|
Ramakrishna Y, Verma D. Radicular cyst associated with a deciduous molar: A case report with unusual clinical presentation.J Indian Soc Pedod Prev Dent 2006;24:158-160
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Ramakrishna Y, Verma D. Radicular cyst associated with a deciduous molar: A case report with unusual clinical presentation. J Indian Soc Pedod Prev Dent [serial online] 2006 [cited 2020 Jul 10 ];24:158-160
Available from: http://www.jisppd.com/text.asp?2006/24/3/158/27899
Radicular and residual cysts are by far the most common cystic lesions in the jaws. Radicular cysts are considered to be rare in the primary dentition, comprising only 0.5-3.3% of the total number of radicular cysts in both the primary and permanent dentition., Assuming that the developmental mechanisms of radicular cysts are identical in the primary and permanent dentition, the low frequency in the former is yet to be clarified. Most radicular cysts seen in the primary dentition are associated with mandibular molars.
A 7-year-old female patient reported to the Department of Pedodontics with a complaint of painless swelling in the lower right back region of the jaw since 3 months. Patient gave a history of surgery for ectopic thyroid tissue 2 months back. Past dental history revealed that she had undergone incomplete endodontic treatment in the same region 10 days ago.
On extraoral examination, a diffuse, nontender, hard bony swelling was noticed on the right side of the body of the mandible. Intraoral examination revealed a grossly decayed 85 and there was considerable expansion of buccal cortical plate from 84 to 46. Orthopantomogram revealed a single well-defined periapical radiolucency of about 3 ´ 2 cm in size extending from 44 to 46 anteroposteriorly and from interdental area to the lower border of the mandible [Figure 1]. There was considerable displacement of 44 and 45 tooth bud when compared with its counterpart on the other side. Occlusal radiograph confirmed the expansion of both the cortical plates [Figure 2]. The contents of the lesion were aspirated and they were found to be sterile.
Based on history, clinical and radiographic examination, a provisional diagnosis of radicular cyst associated with 85 was made. The case was posted for surgical enucleation of the lesion under G.A. Incision was made from 41 to 46 along the gingival margin and the cystic site was exposed [Figure 3]. There was considerable thinning of the buccal cortical plate, which was removed leaving the lingual plate intact. The cystic lining was enucleated and sent for histopathological examination [Figure 4]. Based on the surgeon's point of view, it was decided to extract 46 because of its involvement with the cystic lining and hampered root development when compared to 36. The surgical defect was packed with ribbon gauze soaked in betadine ointment, with one end left intraorally. A primary closure was attempted following hemostasis. Postsurgical period was uneventful and histopathological features were consistent with the clinical diagnosis of radicular cyst [Figure 5]. The cystic cavity was lined by nonkeratinized stratified squamous epithelium, with mixed inflammatory infiltration present in the wall as well as in the epithelium. The cystic wall composed of regularly arranged collagen fibers, fibroblasts and blood vessels.
A radicular cyst is one which arises from the epithelial residues in the periodontal ligament as a result of inflammation. The inflammation usually follows the death of the dental pulp and cysts arising in this way are found most commonly at the apices of the involved teeth. Many radicular cysts are symptomless and are discovered when periapical radiographs are taken of teeth with nonvital pulps.
Most cysts associated with primary molars are located in the inter-radicular area and around the roots, whereas cysts related to permanent molars are usually located adjacent to the apex. This may be explained by the short and sometimes partially resorbed roots and the existence of accessory canals in the roots of primary molars. Thus the term periradicular cyst in primary molars is more appropriate than periapical or radicular cyst.
Radicular cysts originating from primary teeth are considered rare. Radicular radiolucencies related to deciduous teeth tend to be neglected and probably resolve after removal of the offending teeth. The frequency is low because pulpal and periapical infections in deciduous teeth tend to drain more readily than those of permanent teeth and antigenic stimuli which evoke the changes leading to formation of radicular cysts may be different.
There are several differences between radicular cysts originating from primary teeth and those originating from permanent teeth. The mandibular primary teeth are affected more frequently than maxillary teeth, in contrast to maxillary predominance in the permanent dentition. The difference in site distribution of radicular cysts in primary and permanent dentitions may be explained by different etiologic factors. In the primary dentition, caries and endodontically treated primary molars with materials containing formocresol are the most frequent etiological factors and the mandibular molars are the most frequently affected teeth. In the permanent maxillary incisors, the high frequency of radicular cysts results from trauma, caries and old silicate restorations.
Grundy, Adkins and Savage reported a series of cases of radicular cysts associated with deciduous teeth that had been treated endodontically with materials containing formocresol, which, in combination with tissue proteins, is antigenic and has shown to elicit a humoral and cell-mediated response.
The most common clinical and radiographic features of a radicular cyst in primary molars are
Mandibular buccal cortical plate expansionWell-defined unilocular radiolucencyThin reactive cortexDisplacement of succedaneous teethMisleading preoperative diagnosis
In the present case, a preoperative diagnosis of radicular cyst was made as it had fulfilled all the clinical and radiographic requirements that were explained above. But radicular cysts arising from deciduous teeth may mimic dentigerous cysts radiologically., That possibility was ruled out in the present case because of the unusual presentation and extension of the lesion involving 84,85,16,44,45 and the lesion being associated with a grossly decayed primary molar. During surgical enucleation, the same was noticed and a definitive diagnosis was made on the basis of gross specimen and histological picture.
According to Mass et al , the prevalence rate of radicular cysts associated with primary molars is probably higher compared with that in reported literature. It is possible that unlike cysts of permanent dentition, primary teeth are extracted but not submitted for pathological examination, a fact that may account for the low estimation of the real frequency of cysts associated with primary teeth.
In children, healing of the postsurgical osseous defects is always good as they have high propensity for bone regeneration. In our case, we could not notice this because the child was from a distant place and the parents expressed their inability to visit the hospital for regular follow-ups.
|1||Shear M. Radicular and residual cysts. In : Cysts of the oral region, 3rd ed. Wright: 1992. p. 136-62.|
|2||Bhaskar SN. Periapical lesion: Types, incidence and clinical features. Oral Surg Oral Med Oral Pathol 1966;21:65-72.|
|3||Mass E, Kalpan F, Hishberg K. A clinical and histopathological study of radicular cysts associated with primary molars. J Oral Pathol Med 1995;24:458-61.|
|4||Grundy RM, Adkins KF, Savage NW. Cysts associated with deciduous molars following pulp therapy. Aust Dent J 1984;29:249-56.|
|5||Block RM, Lewis RD, Sheats JB, Burke SH, Fawley J. Antibody formation and cell mediated immunity to dog pulpal tissue altered by formocresol within the root canal. AADR Abst 658. J Dent Res 1997;56:B241.|
|6||Savage NW, Adkins KF, Weir AV, Grundy GE. A histological study of cystic lesions following pulp therapy in deciduous molars. J Oral Pathol Med 1986;15:209-12.|
|7||Lustmann J, Shear M. Radicular cysts arising from deciduous teeth. Int J Oral Surg 1985;14:153-61.|
|8||Wood RE, Nortje, Radayihee A, Grolepass F. J Dent Child 1988;50:288-90.|
|9||Takeda Y. J Oral Pathol 1985;14:248-69.|