Etiology • Preceded by periapical granuloma; arises as follows:
• Secondary to necrosis of dental pulpal tissue • Stimulation of epithelial network (Malassez’s rest) at tooth
root apex results in cystification • Cyst growth continues secondary to effects of osmotic gradient
across epithelial lining layers, mediators of inflammation, and epithelial proliferation
Clinical Presentation • Asymptomatic unless there is an acute exacerbation • Usually a limited process at root apex or lateral to root surface • Radiograph shows a round and well-defined lucency, usually
• Secondary to necrosis of dental pulpal tissue • Stimulation of epithelial network (Malassez’s rest) at tooth
root apex results in cystification • Cyst growth continues secondary to effects of osmotic gradient
across epithelial lining layers, mediators of inflammation, and epithelial proliferation
Clinical Presentation • Asymptomatic unless there is an acute exacerbation • Usually a limited process at root apex or lateral to root surface • Radiograph shows a round and well-defined lucency, usually
with a sclerotic margin. • Generally 1 cm or less across, but can be significant in size • Root resorption uncommon
Microscopic Findings • Stratified squamous epithelial lining • Lumen filled with cell debris, fluid, cholesterol • Connective tissue wall with mixed inflammatory infiltrate
Diagnosis • Documentation of nonvital tooth • Radiograph shows alteration of apical bone
Differential Diagnosis • Periapical granuloma • Central giant cell granuloma • Odontogenic and nonodontogenic tumors • Metastatic tumor
Treatment • Endodontic therapy or • Periapical surgery and biopsy or • Tooth extraction and biopsy
Prognosis • Excellent • Occasional recurrences