International Journal of Oral & Maxillofacial Pathology. 2012;3(2):53-55 ISSN 2231 – 2250

Available online at http://www.journalgateway.com or www.ijomp.org

Case Report

Radicular Cyst Associated With an Endodontically Treated Deciduous Molar: A Case

Report with Emphasis for Regular Follow Up

Suchitra G, Bhagirathi DL, Kango Prasad Gopal

Abstract

This article presents a case report of a patient with a periapical cyst associated with an endodontically treated primary mandibular molar. It may be implicated that the intracanal medicaments used for pulp therapy may be the probable etiologic factor for the occurrence of these cysts as has been enumerated in the literature. This does not implicate that intracanal medicaments should not be used, but it is prudent to imply that pulpotomy treated primary molars should receive periodic postoperative radiographic examination and absence of clinical symptoms does not mean that a pulpotomy treated tooth is healthy emphasizing the role of regular follow up of such treated cases.

Key Words: Jaw Cysts;Radicular Cyst;Tooth;Deciduous;Endodontic;Pulpitis;Inflammation,

Suchitra G, Bhagirathi DL, Kango Prasad Gopal. Radicular Cyst Associated With an Endodontically Treated Deciduous Molar: A Case Report with Emphasis for Regular Follow Up. International Journal of Oral and Maxillofacial Pathology; 2012:3(2):53-55. ©International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.

Received on: 24/01/2012 Accepted on: 19/02/2012

Introduction

Periapical cysts are the most common cysts of the jaws constituting for approximately one half to three fourths of all cysts of the
jaws1. They arise from the epithelial residues in the periodontal ligament as a result of
periapical periodontitis following death and necrosis of the pulp. They are relatively rare in the first decade of life and in the primary dentition, even though caries and non-vital teeth are rather common in this age group.
In deciduous teeth they account for only 0.5-
3.3% of the total number of radicular cysts in both the primary and permanent dentition. Though the mechanism of development of these cysts is common for both primary and permanent dentition, their low frequency in
primary teeth is yet to be clarified2.

Case Report

An eleven year old female patient reported to the outpatient department of our college with a chief complaint of swelling in the lower left back teeth region of the jaw since two months. Her past dental history revealed that endodontic treatment was done in a private dental office in the same region one year back. Extra-oral examination revealed a diffuse non tender bony hard swelling on the left side of the body of the mandible. Left submandibular lymph nodes were palpable, soft and tender. Intra-oral examination (Figure 1a) revealed a stainless steel crown in relation to tooth #75 and grade II mobility in relation to tooth #74. There was expansion of the buccal cortical plate and
obliteration of the vestibule in relation to tooth #75.
Intra Oral Periapical radiograph (Figure 1b) showed a well-defined unilocular radiolucent lesion measuring around 1.0 x 1.5 cm in size at the periapical region of tooth #75. Occlusal radiograph (Figure 1c) confirmed the buccal expansion of the lesion. Based on clinical and radiographic findings a radicular cyst associated with tooth #75 was rendered and the lesion excised under local anesthesia. Surgical exploration revealed a cystic sac. On histopathologic examination the lesion showed a cystic lumen lined by stratified squamous non keratinized epithelium of varying thickness surrounded by fibrous connective tissue wall made of collagen fibers, fibroblasts and few chronic inflammatory cells confirming the clinical diagnosis (Figure 1d).

Discussion

Radicular cysts associated with deciduous teeth are considered exceptionally rare2. They account for less than 1% of all cases. The frequency of radicular cysts originating from primary teeth as reflected by the
number of reported cases is substantially
lower than those associated with permanent teeth3. Being asymptomatic, these cysts are left unnoticed until detected during routine periapical radiography. Most radicular cysts
seen in the primary dentition are associated with mandibular molars, teeth that are most frequently affected by dental caries4.

©2012 International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited . All Rights Reserved

ISSN 2231 – 2250 Radicular Cyst Associated With an Endodontically Treated..... 53

Figure 1: The Intraoral photograph (a) showing expansion of the buccal cortical plate. The intra oral periapical radiograph (b) and occlusal radiograph (c) showed a well-defined unilocular radiolucency. The photomicrograph shows cystic epithelium with underlying stroma (d).
In an extensive review from 1898-1985, Lustmann et al found only 28 cases and later they added 23 cases5. Until now a total of 123 cases have been published6. Turner presented a case of a 9-year-old boy with a cyst associated with a right lower first
deciduous molar and commented that the occurrence of dental cysts with temporary teeth was very unlikely5. Sprawson stated that although the origin of dental cysts from
deciduous teeth had not been described, he was of the opinion that they do form. He suggested furthermore that they may become separated from the roots of the deciduous tooth by the normal process of root resorption, go on growing and that they may eventually envelope developing unerupted permanent teeth. The result of this process he regarded as a typical
dentigerous cyst.5 Bloch-Jorgensen’s
conclusion was that these cysts originate from the necrotic primary teeth and, while developing, contact the corresponding permanent successor.5
Radicular radiolucencies related to deciduous teeth tend to be neglected and probably resolve after removal of the offending teeth. Various reasons have been speculated including the tendency of drainage being more in deciduous teeth due to presence of accessory canals, the type of antigenic stimulus that evokes the change and they being not frequently subjected to
histopathologic evaluation7. Pre-operatively they may also be mistaken for dentigerous cyst associated with permanent successors. For the diagnosis of a radicular cyst associated with a deciduous tooth the
criteria as suggested by Lustmann and
Shear 5 has been followed.
(i) The presence of a non-vital deciduous tooth in intimate relationship to the radiolucent lesion or a record that such a relationship had been present in the past.
(ii) The presence of a radicular cyst epithelial lining in the lesion.
(iii) No involvement of the crown of the permanent successor in the cystic cavity.

54 Suchitra G et al., ISSN 2231 - 2250

The most commonly implicated etiologic agent is dental caries followed by trauma. In the present case, since the tooth had undergone endodontic treatment one year back materials containing formocresol, along with tissue proteins could be the probable agent for eliciting antigenic stimulus and
humoral and cell-mediated response4. Irrespective of the causative factor the
pathogenic mechanism underlying the
formation and expansion of the cyst remains the same. But several differences have been observed between the radicular cysts of deciduous and permanent teeth. They are observed more frequently at the interradicular area, increased frequency in mandibular molars, histopathologically being similar to that of permanent teeth, except for
fewer cholesterol clefts8. The adverse effect associated with these lesions especially in the young individuals includes enamel
hypoplasia, cessation of root development,
displacement and damage of the permanent successor.

Conclusion

This case presented to us after one year of endodontic treatment of the deciduous tooth, thus exposing the potential danger of the above mentioned complications to the permanent successor. Hence, periodic follow up of the treated cases of deciduous teeth is of utmost importance especially until the eruption of the permanent successor.

Author Affiliations

1.Dr.Suchitra G, Assistant Professor,

2.Dr.Bhagirathi DL, Professor, 3.Dr.Kango Prasad Gopal, Assistant Professor, Rajiv Gandhi University of Health Sciences, Department of Oral

and Maxillofacial Pathology, Al-Ameen Dental

College and Hospital, Bijapur – 586108, Karnataka State, India.

Acknowledgement

We would like to thank the staff members of the oral pathology department for their support & cooperation.

References

1. Regezi, Sciubba, Jordan. Oral Pathology Clinical pathologic correlations, 5th ed. Saunders: Elsevier;
2009. p237.
2. Ramakrishna Y, Verma D. Radicular cyst associated with a deciduous molar: A case report with unusual clinical presentation. J Indian Soc Pedod Prev Dent 2006;24:158-60.
3. Mass E, Kaplan H, Mass E, Kaplan I, Hirshberg A. A clinical and histopathological study of radicular cysts associated with primary molars. J Oral Pathol Med 1995;24:458-61.
4 Bhat SS, Vidhya M, Sargod S. Radicular cyst associated with endodontically treated deciduous tooth: A case report. J Indian Soc Pedo Prev Dent
2003;21:139-41.
5 Lustman J, Shear M. Radicular cysts arising from deciduous teeth. Review of the literature and report of 23 cases. Int J Oral Surg 1985:14:153-61.
6 Shetty S, Angadi PV, Rekha K.
Radicular Cyst in Deciduous Maxillary
Molars: A Rarity. Head Neck Pathol
2010;4(1):27-30.
7 Mervyn Shear, Paul M. Speight. Cysts of the Oral and Maxillofacial regions. 4th Ed, Blackwell Munksgaard; 2007. 123p.
8 Elango I, Baweja DK, Noorani H, Shivaprakash PK. Radicular Cyst
Associated with Deciduous Molar following Pulp Therapy: A Case Report. Dent Res J 2008;5(2):95-8.

Corresponding Author Dr. Suchitra G, Assistant professor,

Department of Oral and Maxillofacial

Pathology, Al-Ameen Dental College, Bijapur-586108, Karnataka State, India.

Phone: 8147209114

E-mail:suchipra75@rediffmail.com

Source of Support: Nil, Conflict of Interest: None Declared.


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