8. HISTOLOGY
Gingival cyst cavity is lined by a thin , flattened
epithelium with or without localized areas of
thickening.
Types of epithelium
Non keratinized stratified squamous epithelium
Keratinized stratified squamous epithelium
Parakeratinized epithelium with palisading basal cells
10. RADIOGRAPHIC FINDINGS
Interproximal periodontal cyst appears on the
side of the root as a radiolucent area bordered
by a radiopaque line.
Periodontal abscess is difficult to differentiate
from periodontal cyst, radiographically
11. `
Cyst Abscess
Filled with fluid
<1.5cm
Gingiva appears
bluish gray
Filled with puss
2-10cm
Gingiva appears red
12. HISTOLOGY
Cystic lining may be a loosely arranged , thin,
nonkeratinized epithelium, sometimes with
thicker proliferating areas.
14. TREATMENT
Treatment is surgical excision and histopathologic
examination for a conclusive diagnosis.
ENUCLEATION
MARSUPIALIZATION
COMBINATION
ENUCLEATION WITH CURETTAGE
15. ENUCLEATION
Enucleation means shelling out the entire cystic lesion
without rupture.
INDICATION:
Small cyst, which can be done when the vital structures are
not involved.
16. Local Anesthesia
Flap design is
made
Incision made
according to the
design
Tooth extraction
Bur and
forcep
Intraosseous
window
Irrigation to
clean the cavity
Closure by
suture (6-12
months)
17.
18. MARSUPIALIZATION
Marsupialization refers to creating a surgical window in
the wall of the cyst, excavating the contents of the cyst
and maintaining continuity between the cyst wall and the
oral cavity.
This process decreases the pressure inside the cyst, and
promotes shrinkage of the cyst as well as bone fill.
INDICATIONS:
If surgical access is difficult
Unerupted tooth involved
Small cyst
20. COMBINATION
Combined approach morbidity and complete
healing of the defect.
In this technique marsupialization is done first
and the enucleation is done at a later date.
The advantage is that as marsupialization is
done first, it spares the vital structures. The size
of the cystic cavity also becomes small and after
healing the cystic lining becomes thick, making
enucleation easier at this stage.
21. ENUCLEATION WITH
CURETTAGE
After enucleation is done, a curette or bur is used to
remove 1 to 2 millimeter of bone around the entire
periphery of cystic cavity.
INDICATIONS
For cysts reported to have high recurrence rate, for
example odontogenic keratocyst
Advantages
If enucleation leaves any remnants, curettage may remove
them thereby decreasing the likelihood of recurrence.
Disadvantage
Curettage is more destructive to adjacent bone, blood
a)Histologic slide showing stratified squamous epithelium with areas of focal thickening b) Higher magnification showing corrugated parakeratin surface and palisaded basal cell layer.
a) Intrabony osseous defect before cyst enucleation. b) Following debridement, decortication and allograft placement. C) Collagen membrane adaptation. D) Primary flap closure using 5.0 Dacron suture.
(a) Exposure of the cyst, (b) Enucleation and curettage, (c) Soaking of the saline pack placed in the cystic cavity within seconds, (d) Achieving optimal hemostasis for retrograde filling