Dr H Ravikumar

Dr Ravishankar

Dr Reeta Jain

Dr Shashikaran

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IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 
e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 13, Issue 5 Ver. I. (May. 2014), PP 77-79 
www.iosrjournals.org 
www.iosrjournals.org                                                             77 | Page 
  
Odontogenic cysts- A clinicopathological study of 120 cases 
 
1
Dr H RaviKumar, 
2
Dr Ravishankar M N, 
3
Dr Shashikaran H C, 
4
Dr Reeta Jain 
1
Professor and Head, Department of Oral Surgery Triveni Institute of Dental Sciences & hospital Bilaspur, 
Chattisgarh 
2
Principal and Head, Department of oral surgery Purvanchal Institute of dental sciences GIDA, Gorakhpur 
(U.P) 
3
Reader, Department of Periodontics RKDF Dental College & Hospital Bhopal 
4
Principal and Head, Department of Prosthodntics Eklavya  Dental College & Hospital Kotputli, Jaipur, 
Rajasthan 
 
Abstract:  Odontgenic cysts are pathological lesions originating from tooth forming structures and they 
deserve critical attention due to the complications they cause. We report a study of 120 cases of dontogenic 
cysts with the features recorded as age, sex, site, etiology, incidence, radiological features and histological 
features for confirmative diagnosis. 
Key words:  Odontogenic cysts, developmental cysts, inflammatory cysts. 
 
I. Introduction 
A cyst is a pathological cavity lined by epithelium filled with fluid, semi-fluid and gaseous material 
which in turn is lined by capsule of connective tissue. Odontogenic cysts are pathologies originating from the 
tooth forming apparatus. They grow slowly and do not cause significant clinical symptoms. Since they grow 
within the bones they cause tooth or bone resorption, bone expansion, fracture or tooth displacement
1
. It is 
considered that cystic proliferation and degeneration of epithelium lead to the development of odontogenic 
cysts. These cysts are divided into two main categories: developmental and inflammatory. Developmental cysts 
are of unknown origin, and do not appear from inflammatory process, while inflammatory cysts are associated 
with inflammation
2
. Apart from this World Health Organization (WHO) has classified epithelial cysts as 
odontogenic cysts (inflammatory and developmental) and non-odontogenic cysts (nasopalatine and 
nasoalveolar). Cysts without epithelial lining (pseudocysts) are non-neoplastic bone lesions which includes 
solitary bone cyst and aneurismal bone cyst
3
. We present a study performed on 120 cases that were diagnosed 
with different types of odontogenic cysts. 
 
II. Study design 
The study was conducted in the department of Oral Surgery at Bapuji Dental College, Davangere, 
Karnataka. A total number of 120 cases were examined, diagnosed, treated and followed up over a period of 3 
years (2009-2012). The features recorded were age, sex, site, etiology, incidence, radiological features and 
histopathological features for the confirmed diagnosis. 
Out of 120 cases, 80 were male and 40 were female. An attempt was made to categorize the etiological 
factors like trauma, attrition, abrasion and caries. Each jaw was divided into 4 zones namely incisor-canine, 
premolar, premolar-molar and molar region. Ramus and angle area were included for mandibular molar region. 
Radiographical analysis was done by performing periapical, occlusal, paranasal sinus and panoramic 
radiographs. A fine needle aspiration biopsy was performed in cases with definite clinical and radiological 
features. 
The treatment plan for small cysts consisted of enucleation followed by primary closure, while for 
larger cysts marsupialization was done to facilitate decompression followed by enucleation. All the tissues were 
sent for histopathological diagnosis in department of oral pathology for confirmation. The follow-up was done 
with clinical and radiological investigations. An clinical examination was done to evaluate symptoms like pain, 
swelling, discoloration and loosening of teeth. Pathological findings like infection related to surgery and 
recurrence of cysts were assessed objectively. Healing of bony defect was assessed by post operative 
radiographs. 
 
III. Results 
The present study consisted of 120 cases with 80 males and 40 females. The age of the patients varied 
from 10-57 years with 48 cases in the age group of 21-30 years. Among 120 cases, the site of involvement of 
cyst was maxilla in 76 cases (63.3%) and mandible in 44 cases (36.7%). The incisor-canine area was the major 
site of involvement in maxilla (50%) followed by premolar region in 2 cases (6.7%) and one each in premolar-
Odontogenic cysts- A clinicopathological study of 120 cases 
www.iosrjournals.org                                                             78 | Page 
molar and molar region. In mandible molar-angle-ramus area was affected in 16 cases (13.4%), incisor canine 
and premolar area were equally affected in 12 cases each and in 4 cases premolar-molar area was involved. 
The type of cysts observed in the study were radicular cyst found in 60 cases (40 males and 20 females) 
followed by dentigerous cyst in 40 cases (28 males and 12 females), residual and keratocyst in 8 cases each and 
4 cases of golin’s cyst with equal gender distribution. The incidence of radicular cyst was 50% followed by 
dentigerous cyst which was 33.3%, while the incidence of residual and keratocyst was 6.7% and of gorlin’s cyst 
was 3.3%. Among these cases 44 cases of radicular cyst occurred in the maxilla and 16 occurred in the 
mandible. Dentigerous cyst was equal in both jaws while residual and gorlin’s cyst were seen in maxilla and 
keratocyst were seen in mandible. 
The method of treatment was enucleation with primary closure in 76 cases, enucleation with open 
packing in 32 cases while 12 cases were treated with marsupialization followed by enucleation with open 
packing. Hundred cases were done under local anaesthesia and 20 cases were done under general anaesthesia. 
 
IV. Discussion 
The radicular cyst is a chronic inflammatory lesion with a cavity lined by a non-keratinized stratified 
squamous epithelium. It is the most frequent cyst found in the jaw ranging from 38%-68%
4
 which is consistent 
with our study as the frequency of radicular cyst in our study was 60%. It is said to arise from the epithelial 
remnants in the periodontal ligament as a result of inflammation. Usually it is asymptomatic and is discovered 
during radiological analysis as a round or pear shaped unilocular radiolucent lesion surrounded by thin 
radiopaque mrgin extending from lamina dura of the involved tooth and may displace adjacent teeth or cause 
mild root resorption
5,6
. Although the source of epithelium is usually a cell rest of Malassez but other sources like 
crevicular epithelium, sinus lining or epithelium lining of fistulous tracts have also been considered
7
. Recently 
the role of VEGF (Vascular Endothelial Growth Factor) and MMP-9 have been suggested in the angiogenesis of 
radicular cyst
8
. It occurs commonly in males involving maxillary region in the 3
rd
 to 5
th
 decade of life which is 
same in our study as the incidence of radicular cyst have found to be 44 cases in the maxilla and 16 in the 
mandible. 
Dentigerous cysts are odontgenic developmental cysts which generally occurs solitary or unilaterally 
commonly associated with mandibular 3
rd
 molars,, maxillary canine, mandibular 2
nd
 premolar and maxillary 3
rd
 
molars
9
. They occur commonly in adolescents and young adults and often involve mandibular molars; which is 
consistent with our study as the age of the patients varied from 21-30 years. The exact etiopathogenesis of 
dentigerous cyst is unknown but it has been proposed that the crown of a permanent tooth may erupt into a 
radicular cyst of a primary predecessor resulting in the formation f an extra follicular dentigerous cyst. This 
theory was rarely accepted because radicular cyst involving primary dentition is extremely rare
10
. There are no 
characteristic histopathological features which can be used reliably to distinguish the dentigerous cyst from 
other types of odontogenic cysts. It is usually composed of thin connective tissue wall with a thin layer of 
stratified squamous epithelium lining the lumen
11
. 
Odontogenic keratocyst (OKC) is a benign intraosseus odontogenic tumor occurring from first to ninth 
decade of life with males commonly affected than females. The mandible is involved more than the maxilla
12
 
which is same in our study also. It involves approximately 10% of all jaw cyst with predominance in molar-
angle-ramus area
13
 which is consistent with the area involved in our study also. On clinical examination OKC 
presents itself as swelling, pain, discharge, aggressive growth, invasion of adjacent structures, recurrence and 
localized asymptomatic swelling which is the most common symptom
14
. In our study the patients were found 
only with the clinical symptom of swelling and pain. Radiographically OKC shows unilocular or multilocular 
radiolucency with scalloped and well defined margins which is same as the radiographic details in our study 
also. 
The calcifying cystic odontogenic tumor or Gorlin’s cyst was first described by Gorlin in 1962 and it 
was recognized as a distinct pathologic entity by WHO in 1971. It is a benign cystic neoplasia constituting 2% 
of benign odontogenic lesions and representing 1% of odontogenic cysts
15
 which is consistent with our cases 
also (4 Cases). It is divided into 3 subgroups based on location (intraosseous and extraosseous) and histologic 
features
16
. It shows ameloblastoma like ghost cells that may calcify and has been shown to have diversity in its 
clinical and histologic features. Clinically, it presents as a painless slow growing tumor, equally affecting 
maxilla and mandible involving most commonly the incisor-canine area. It occurs in third to fourth decade of 
life with no gender predilection
17
 which correlates with our study also. The characteristic features of Gorlin’s 
cyst is the presence of ghost cells which are also found in other tumors like Malherbe calcificant epithelioma of 
skin, ameloblastic fibro-odontoma, complex and compound odontoma, craniofaringioma, meloblastoma and 
carcinoma which should be excluded while reporting Gorlin’s cyst. Since the nature of the ghost cells is 
unknown, the accepted theory states that there would be a squamous metaplasia of the epithelium with the 
subsequent queratinization which could be normal or aberrant. 
Odontogenic cysts- A clinicopathological study of 120 cases 
www.iosrjournals.org                                                             79 | Page 
It is concluded that association of different types of odontogenic cysts with the age, sex, site, etiology, incidence 
and histopathological features reveals that demographic knowledge can be helpful in early diagnosis and their 
prompt treatment.  
 
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Odontogenic cysts-A clinicopathological study of 120 cases

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Odontogenic cysts-A clinicopathological study of 120 cases

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