 Hello everyone welcome back to another session on dentistry and mode So in oral pathology so far we finished Important syndromes and important tumors now we are moving on to important sis so we have radical assist our endosyphonic keratocyst and Dentistry assist and these three are the most important ones for university exam So let's get into the details of radical assist So cyst is a pathological fluid filled cavity lined by an epithelium So cyst is always a well circumscribed lesion which has a clear boundaries That is a epithelial lining will be there So it has three components basically lumen wall and epithelial lining. This is the lumen innermost Which is innermost cavity which is having fluid And immediate to that lumen there will be lining and the outermost covering is capsule It's also known as wall. So these are the three components of cyst Now we are moving on to the classification We have basically two types one is Orendogenic and non-ordendogenic from the name itself we get the idea This is truth related. This is not truth related tissues are the origin cause of origin So orendogenic we have again two types developmental and inflammatory Okay, inflammatory is a cause of inflammation is resulting in cyst and developmental is default developmental problems or developmental process or resulting in a cyst formation So in developmental cyst we have orendogenic keratocyst, dentistry or follicular cyst Eruption cyst, lateral periodontal cyst, gingival cyst of infants. These are the developmental cysts in oral cavity In inflammatory cyst the most common one is radical cyst Which is having three types apical lateral and residual And another inflammatory cyst is paradental cyst in non-ordendogenic We have naso palatine dexist and naso label cyst. It's not particularly truth related So radical cyst is Is orendogenic cyst which is derived from cell rest of molasses Which proliferates in response to inflammation. So radical cyst is seen at the root tip So when keris occurs it is not treated it goes to the tip of root And it causes inflammation and it is becoming a cyst. That is the idea of radical cyst So it is In response to inflammation. So which is also known as apical paradontal cyst peri apical cyst or root end cyst So we have three basic types of radical cyst apical lateral and residual Apical and lateral is based on the relative position Of cyst with respect to the root. This is at the tip I was just circumscribing the tip exactly lateral cyst is not circumscribing the tip or apical foramen Which is uh more of a lateral side of it root Residual cyst actually there is no tooth which is uh originating from a residues of No remnants of a tooth And the most common location of radical cyst is maxillary anterior region then maxillary posterior Then mandibular posterior and mandibular anterior most common is maxillary anterior and least common is mandibular anterior So that is a radical cyst basic cyst classification and location about radical cyst So moving on to the epidemiology of radical cyst it is uh One of the most common cysts of a jaw that is 60 to 70 percentage of cysts are radical or peri apical cyst And it is most commonly seen between 20 to 60 years and it's very rare less than 10 years maxilla is more affected as because Porosity of maxillary bone is more favorable for cystic formation Compared to the mandibular one three is two one ratio that is three times more lesions are found in maxilla And it is a male predilection cyst with three is to two ratio compared to the females In clinical features, it is asymptomatic and slowly progressive But if infection enters the swelling becomes painful and rapidly expanding Otherwise, it is asymptomatic and a slowly progressive one The initial swelling is round and hard But later what happens is the part of wall is resolved leaving a soft flexure and swelling And blue is in color So initial it is very round and a hard structure But as the lesion expands the part of wall is resolved leaving a soft flexure and swelling So when bone has been reduced to egg shell cracking A crackling sensation may be felt on pressure So it will be reduced to egg shell cracking. There will be a crackling sensation When applying pressure So this is a important sequence of events how the radicular or peri apical cyst is formed So it starts with the cause that is either carries trauma, pulpal necrosis or periodontalysis And it leads to peri apical inflammation So once the inflammation starts it slowly develops and becoming peri apical granuloma That is granulation, tissue, scar or inflammatory cells will be there Which provide rich vascular area to rest of molasses And rest of molasses proliferate Which is forming a large mass of cell Then what happens? Then the inner cells of this mass deprived of nourishment So the inner cell will be deprived of nourishment Which undergo liquefaction necrosis Formation of a cavity in the center of granuloma And ultimately result with a proper epithelial line cavity Which is radicular or peri apical cyst Cyst wall separates from bone due to the pulpal irritation So how it starts? It starts with carries trauma, necrosis or periodontalysis That is the cause Inflammation, peri apical granuloma Then cell rest of molasses It proliferates It becoming a large mass Then inner mass deprived of nourishment It undergo liquefaction necrosis And formation of a cavity So that is the pathogenesis of radicular cyst So how do we diagnose radicular cyst? We can use a combination of radiographs And vitality test We can do a vitality test mostly It will be a non vital tooth And radiographic appearances are most conclusive evidence We will easily understand a periapical cyst from a radiograph So in clinical findings, the signs and symptoms The smaller cysts do not usually become acutely infected But the larger cysts, there will be expansion of bone Displacement of tooth root And crepitus on palpation of alveolar bone And negative responses will be there on pulp testing And the regional lymph nodes will be affected Moving on to the radiographic features That is most commonly identical to periapical granuloma There will be a radio opaque line around the periphery of Radiolucent area So this cyst will be a radiolucent area But that will be Covered or surrounded by a radio opaque line So mostly it will be a avoid or round radiolucency With a radio opaque line at the borders Mostly it will be less than 1.5 centimeter diameter And it will be a well circumscribed lesion So the differential diagnosis can be periapical granuloma Or endogenic tumors and giant solutions So treatment options are most commonly we should do Root canal filling Then extraction is also needed in few cases Extraction of non-vital tooth and curatage of the apical zone If it is very much infected Root canal filling with episectomy And if it is not properly done there is chance for residual cyst So severe condition we need to go for Enucleation or marsupialization So that's all about radical assist It is the most common cyst One of the common cysts And cyst and tumors are different So this is the first cyst in our segment The next one is dentiture assist And odendogenic keratocyst also coming up So I'll come up with dentiture assist in my next session Thank you Hello everyone, welcome back to a new session on dentistry and more Today's topic is dentiture assist So last class we have seen radical assist or periapical cyst The second most common cyst after the radical assist is dentiture assist So let's see the details of dentiture assist Dentiture assist, the name itself gives an idea about its origin That is denti gerus Gerus means a germinal So dental tooth forming cells associated with assist Is known as dentiture assist Exactly the enamel epithelium We know reduced enamel epithelium Which is the outermost covering when the tooth irreps into the oral cavity So some malformation or some improper reaction happening With the reduced enamel epithelium creating assist Which is known as dentiture assist Which is the second most common cyst after radical or periapical cyst That is the ordendogenic cyst It is also known as follicular assist Because it creates a follicle above the tooth crown So it is also known as a follicular assist So usually these type of patients comes to the clinic With a swelling and an unerupted tooth So there is a swelling associated with unerupted tooth So you might keep a differential diagnosis of dentiture assist So that is a common symptom associated with this So we will begin with There is an enclosure of part or all of the unerupted tooth in dentiture assist So a part or hole of the tooth just like this This is a hole of the tooth or part of the tooth is enclosed by the cyst So there is fluid accumulation between the reduced enamel epithelium And the enamel surface of unerupted or impacted tooth So tooth is there So as the tooth erupts into the oral cavity This reduced enamel epithelium supposed to move away But what happens is there is some reaction happening Fluid is getting accumulated between this tooth crown that is enamel And the reduced enamel epithelium And creating assist that is a fluid accumulation So it is basically from dental follicle Moving on to the clinical features It is most commonly seen between first, second and third decade There is no gender predilection It is commonly seen equally distributed Males and females are equally affected But it is most commonly mantibular areas are affected Compared to maxilla 70 percentage cases are reported in mantibule Compared to the maxilla where it is 30 percentage So the mantibule it is most commonly the ankle of mantibule Then canine regions So maxillary and mantibular canine regions are affected After that maxillary third molar area So the most common site is ankle of mantibule And least common site is maxillary third molar area It is usually a painless condition or a painless cyst But it become painful when there is a secondary infection And it is an aggressive solution It grows in an aggressive nature There will be bone expansion and facial asymmetry Because it is affecting mostly the mantibular posterior region Tooth remain uninterrupted That is the thing because it is the cyst is over the tooth crown Connecting the cemento enamel junctions are a part of tooth So tooth will be most of the time uninterrupted So how this happening pathogenesis So first there will be cystic changes in the remnants of enamel organ So it encloses the crown of an uninterrupted tooth Which is attached to cemento enamel junction So what happens there is expansion of follicle When fluid collects or the space is created between The reduced enamel epithelium surrounding a developing tooth Which degenerates So when erupting tooth compress the tooth follicle Which obstructs venous outflow Which induces serum to cross through the capillary walls That is the process which is happening So it is a very simple process Tooth irreps into the oral cavity So when tooth irreps this reduced enamel epithelium should move away And the tooth irreps But what happens here Here the tooth with reduced enamel epithelium is not moving away Collection of fluid is happening between this reduced enamel epithelium And the developing tooth So there will be expansion of this follicle And fluid will be collected between the space And later cystic changes happening And it becomes a proper cyst In radiographic features it will be Just like any cyst well defined radiolusin area It can be uni or multi-locular It covers entire crown of uninterrupted tooth And in radiographic way it expands Three direction one is It can be circumferential or lateral or coronal So these three types of growth can happen Or it can be seen in radiographic feature It is not easy to see these three ways of expansion in a clinical setup So we need to make this more clearer by using a radiograph In histologic features There is a cystic lining Which is composed of reduced enamel epithelium And there will be occasional caracanization By metaplesia And inflammatory cells Chronic inflammatory cells will be there If it is infected So that is about histologic features And we can do investigation Using OPG and CT scan IOPA can be taken And biopsy should be taken to get a clear picture about this Dentiture assist And treatment options we have Enucleation, masopilization Or a combination of enucleation and masopilization And also a curatage associated with enucleation Also can be performed Dentiture assist Treatment Modality So that is all about dentiture assist or follicular assist So let us see the OKC that is Orendogenic keratocyst in the next session Thank you Hello everyone Welcome back to a new session on dentistry and more Today we have Orendogenic keratocyst or OKC to learn So we covered radical assist and dentiture assist in our last session So the third one is Orendogenic keratocyst It is a benign Which is not very common one And which is a locally aggressive type of cyst Now let us get into the details of OKC As the name suggests it is a tooth related cyst And which has a keratin deposition That is why it has Orendogenic keratocyst It is originated from dental lamina Remnants in mantibul and maxilla Or it could be extension of basal cells of overlying epithelium So either dental lamina it forms from dental lamina Or from the basal cell of overlying epithelium Moving on to the histopathology The epithelium lining is uniform lithium May be 8 to 10 cell is The basal layer is palisaded Nuclear is polarized and intensely stained Luminous cells has parachartinized and corrugated profile And there will be micro cyst formation So uniform epithelium lining palisaded basal layer Polarized and highly stained nuclei Parachartinized and corrugated Luminous epithelial cells and micro cyst formation In clinical features It commonly seen in second to third decade Or it can affect to any age group especially adults people And mantibular molar area That is a posterior border is most commonly affected Well coming to the radiographic features It has smooth oval shape And the cortical border If a cortical border is well defined If not secondarily infected And this radiolucinations In some cases there will be multi-locular appearances Mostly it will be radiolucinations Some cases there will be the bone septa Will be giving a multi-locular appearances And there will be keratin presence in the cyst So that is why it is getting keratocyst name So what is the effect on surrounding structures? So when it grows along the internal aspect of joe With minimal expansion But sometimes upper ramus and coronoid process It shows expansion And it displaces and resorb teeth with But the degree of displacement and resorption is not as severe as dentistry cyst So dentistry cyst the displacement and resorption Of the adjacent is more compared to the okc Inferior alveolar canal may be displaced inferiorly Because of the compression or the pressure it applies And it occupies the maxillary andrum If it affects the maxillary If the cyst is in the maxillary region It occupies the maxillary andrum region Most commonly the differential diagnosis is Dentistry cyst amyloblastoma or odendogenic mixoma Treatment can be done using wide surgical accession to avoid recurrence Or masopilization also can be applied So odendogenic keratocyst is not very detailed one It is a benign rare cyst which is locally aggressive Seen in the posterior mantibular area most commonly And which has keratin deposits in the cyst So that's all about okc or odendogenic keratocyst I'll come up with a new topic in oral pathology Thank you