What Is an Odontogenic Cyst?

Tooth-containing cysts are derived from normal tooth follicles during tooth development. Due to the cyst-like degeneration of the reticular layer of the enamel, the fluid around the tooth follicles penetrates between the crown and the epithelium, which is more common in young patients. The mandible is more frequent than the maxilla.

Dental cyst

Includes periodontal cysts and peridental cysts and dental cysts. This disease is more common in older patients. After root infection and injury, apical granulomas occur from cystoids, and lateral incisors are most common. The cyst is covered with squamous epithelial tissue, and the root apex of the diseased tooth protrudes into the cyst cavity.

Dental cyst introduction

Periodontal cysts and tooth-containing cysts grow slowly, but can continue to grow and compress the maxillary sinus bone to make it thin and displaced, or directly into the maxillary sinus. Giant cysts can damage the walls of the maxillary sinus and cause bulges on the cheeks, oral vestibules, hard palate, and alveolar processes. Due to the effect of tension, the eyeballs are shifted upwards and outwards, or swollen to the nasal cavity. When there is no infection, there is often no typical pain.

Clinical diagnosis can be based on the results of dental examination, maxillary sinus puncture, X-ray film (sinus radiograph-plain film or contrast agent injected into the capsule cavity) and other results. If percussion is performed when the cheek or oral vestibule is swollen, it can be understood that there is a smooth and elastic surface underneath, such as the feeling of pressing a ping pong ball or a broken egg shell.

Periodontal cysts are more susceptible to older people. The number of cysts can be single or multiple, and it is more common at the root of lateral incisors. The contents of the capsule are thin and transparent, and some are ginger or sauce-colored liquid, which contains cholesterol.

Dental cysts are younger and most common. Occurs in the incisors and the third molar above, and may also be extra teeth. Its contents are clear, dark brown or brown liquid, containing cholesterol. The shadow of the periodontal cyst on the X-ray film showed that the root of the diseased tooth protruded into the cavity of the capsule. The tooth-containing cysts showed that there were single or several intact teeth or crowns in the cyst. The position was not fixed, and the crowns protruded into the cavity.

Dental cyst symptoms and signs

Cysts are more common in adolescents. No conscious symptoms at first. If it continues to grow and the bone gradually expands to the surrounding area, facial deformities will form, and corresponding local symptoms may appear according to different parts.

Causes of dental cyst disease

Tooth-containing cysts, also known as filtering vesicle cysts, occur after the formation of the crown or root of the tooth, and a fluid leaks out between the remnant enamel epithelium and the crown surface to form a tooth-containing cyst. It can come from one tooth germ (including one tooth), or from multiple tooth germs (including multiple teeth). Tooth-containing cysts are one of the most common odontogenic jaw cysts, accounting for 18%, second only to apical cysts.

Diagnosis of dental cyst

Can be based on medical history and clinical manifestations. X-ray examination is very helpful for diagnosis. The cyst is shown as a clear round or oval transparent shadow on the X-ray film, and the edges are neat. A clear white bone reflection line is often present around the cyst, but sometimes the edges of the keratinized cyst must be irregular.

Dental cyst treatment options

Once diagnosed, surgical treatment should be performed in time to avoid causing continued displacement of adjacent teeth and occlusal disturbances. Surgery is usually performed from the mouth. If there is infection, antibiotics or other antibacterial drugs must be used to control inflammation before surgery. X-rays should be taken before surgery to clarify the scope of the cyst and the relationship between adjacent tissues.

Preparation of dental cysts before laser surgery

Laser cyst removal has minimal damage to surrounding tissues, and the patients have no typical discomfort during the operation. The author adopted different surgical approaches in the clinic according to the size and location of the cyst. A typical case had not entered the maxillary sinus, but the maxillary sinus floor and the anterior wall had been squeezed and displaced. The maxillary sinus radical surgery was used to remove the cyst and open a hole in the bottom of the surgical cavity (Nd: YAG Very convenient to open the hole) drainage through the lower nasal passage. Surgery can be performed on an outpatient basis.

1. The instrument is prepared with CO2 laser, Nd: YAG laser (the former power is 20W, and the latter power is 15W adjustable), and the Nd: YAG quartz fiber is cut by 2mm from the outer protective layer. Prepare auxiliary equipment and items as usual.

Before surgery, patients can be required to undergo routine physical examinations according to the size and location of the cysts, especially for large cysts, and elderly patients should be checked for heart, liver, spleen, lung, and kidneys to understand whether there are comorbidities to facilitate the operation Monitor and direct treatment.

Two hours before surgery, intramuscular injection of Lumila sodium 0.2-0.3mg, atropine sulfate 0.5mg intramuscularly (reduced dosage for children).

2. Local anesthesia (1% to 2% lidocaine solution) is routinely used for anesthesia for small cysts. General anesthesia can also be considered when choosing local anesthesia for complicated cysts.

Dental cyst laser surgery

The surgical approach is selected according to the location and size of the cyst. For smaller cysts, an incision can be made in the gingival sulcus (direct incision with CO2 laser focusing according to surgical requirements). Large cysts, those who squeeze and displace the maxillary sinus, are treated by radical maxillary sinus surgery (facial skin is opened by conventional surgery). CO2 laser or Nd: YAG laser was used to cut the bone wall to protect the bone wall as much as possible. If there is a pus-like change after draining the cystic fluid, rinse the sinus cavity with an antibiotic solution (use of penicillin for no more than 3 days, or Kanda solution and metronidazole solution). After cleaning the capsule cavity, use CO2 laser or Nd: YAG laser to cut the inner wall of the capsule. Note that when cutting the inner wall of the capsule, a low-power laser should be used instead of the original beam power, otherwise the submucosal tissue will be damaged during cutting. Commonly used power CO2 laser 5-10W, Nd: YAG laser 8W-10W. The inner wall of the cutting capsule should not only achieve postoperative mucosal secretion suppression, but also no damage to the submucosal tissue. During periodontal cyst surgery, the diseased teeth must be treated at the same time. During dental cyst surgery, the teeth in the cyst must be carefully found (the location and number can be judged in the X-ray film taken before surgery) and removed.

The cyst cavity was rinsed with antibiotic solution after the operation. Maxillary sinus radical surgery should be performed when the cyst is removed and a window is opened in the surgical cavity to open the lower nasal passage to facilitate drainage, especially for those with infection. Small cysts do not need to have holes. The larger cysts are sutured in layers according to the anatomical level.

Postoperative management of dental cysts

Postoperative patients are supplemented with antibacterial and anti-inflammatory treatment, and supportive treatment should be given for larger cysts after surgery. Patients with other concomitant diseases should adjust the treatment plan according to specific conditions after surgery.

After the operation, the patient had a slight edema reaction on the face, but the pain was mild. Analgesics did not need to be given. For those who couldn't tolerate the severe reaction, give Qutong tablets 0.5 to 1 g once. The symptoms could be improved. He-Ne laser 30mW for facial incision after surgery, once a day localized irradiation (careful protection of patients' eyes during irradiation), 15-20 minutes at a time, can help reduce edema, pain, etc., and has anti-inflammatory function, for surgical wounds Recovery is very beneficial.

Patients can keep their mouth clean after operation. They can rinse with borax solution and Yashi mouthwash several times a day. For the poor body and maxillary sinus surgery, nutritional intake should be strengthened at the same time as postoperative adjuvant drug treatment to facilitate an early recovery of the body. Patients with maxillary sinus radical surgery for nasal opening drainage should be rinsed aseptically if infection occurs, and the drainage port should be blocked.