 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 or endocyanic keratocyst and Dentistry resist 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 a lumen innermost Which is innermost cavity which is having a fluid And immediate to that lumen there will be lining and the outermost covering is capsule So 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-ordentogenic 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 assist formation So in developmental cyst we have orendogenic keratocyst, dentistry or follicle assist 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 assist Which is having three types apical lateral and residual And another inflammatory cyst is paradental cyst. In non-ordentogenic we have nasopalatine dexist and naso label cyst It's not particularly truth related So radical assist is Is orendogenic cyst which is derived from cell rest of molasses Which proliferates in response to inflammation. So radical assist 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 assist. That is the idea of radical assist So it is In response to inflammation. So which is also known as apical paradental cyst peri apical cyst or root end cyst So we have three basic types of radical assist 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 Which is circumscribing the tip exactly lateral cyst is not circumscribing the tip or apical foramen Which is uh more of an lateral side of it root Residual cyst actually there is no tooth which is uh originating from a residues of or remnants of a tooth And the most common location of radical assist is maxillary anterior region then maxillary posterior Then mantibular posterior and mantibular anterior most common is maxillary anterior and least common is mantibular anterior So that is radical assist basic cyst classification and location about radical assist So moving on to the epidemiology of radical assist it is uh One of the most common cysts of joe 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 mantibular one three is to 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 of 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 a 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 science 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 It 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 salitions 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 apacal 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 will come up with dentiture assist in my next session Thank you