Bilateral mandibular cyst: lateral radicular cyst, paradental cyst, or mandibular infected buccal cyst? Report of a case.
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Adolescent↗
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[Bacteriologic study of the contents of radicular cysts].
INTRODUCTION: Radicular cysts are, most often, oral tissue cysts. The basis for their development are the remains of Hertwig's epithelial sheath, which is stimulated to proliferate by infectious agents, mostly periapical granuloma or pulp necrosis. The cyst contents can be liquid, either clear or milky-white, or thick and yellowish-caseous pus. Bacteriological and histopathological researches have shown that development of radicular cysts from periapical lesions is a consequence of penetration of normal bacterial flora of the oral cavity. MATERIAL AND METHODS: The study has bacteriologically examined contents of 50 radicular cysts. They were operated between 1993 and 1995 at the Department of Oral Surgery of the Outpatient Health Care Centre Banja Luka. Pathological substrate of the cyst was punctured by a sterile needle and bacteriologically examined at the Microbiological Laboratory of the Clinical Centre in Banja Luka. DISCUSSION AND CONCLUSION: Radicular cysts contents most often consisted of: alpha-hemolytic streptococcus, Streptococcus pneumoniae, Staphyilococcus epidermidis, Streptococcus group B and alpha-hemolytic Streptococcus. It is concluded that normal oral cavity flora is present in the cysts contents, the infection penetrated through the root canal to periapex, where, due to the course of time, radicular cyst develops from periapical granuloma.
Bacteria↗
Paradental cyst mimicking a radicular cyst on the adjacent tooth: case report and review of terminology.
A distinctive form of paradental cyst can occur on the buccal and apical aspects of erupted mandibular molars. This cyst has peculiar clinical and radiographic features, although the microscopic findings are the same as those of odontogenic inflammatory cysts. Diagnostic and therapeutic problems can occur when this lesion is misinterpreted as a radicular cyst. The purpose of this paper is to present an additional case of a paradental cyst in the buccal and mesial aspects of a mandibular second molar involving the apical area of a mandibular first molar. The difficulty of diagnosis, treatment, and controversies regarding terminology are also discussed.
Adolescent↗
[Pathosis of radicular cyst. II. A case of multiple radicular cysts (author's transl)].
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Dentistry↗
Residual and inflammatory radicular cysts. Clinical and pathological aspects of 2 cases.
Inflammatory odontogenic cysts include radicular cysts and its etiological variance, residual cysts. Among these lesions, the radicular cyst is the most frequent. It is caused by the growth of remnants of Malassez cells involved in the development of the dental organ. Clinically, radicular cysts are difficult to diagnose. Histologic diagnosis is of primary importance in order to definitely discriminate the different kinds of periapical lesions. In this paper, the clinical, radiographic, etio-physio-pathological and microscopic features of these pathological formations are described. A case of a large radicular cyst and a case of residual cyst are reported and the surgical treatment and histologic differential diagnosis are presented.
Adult↗
Localization of mRNA for inflammatory cytokines in radicular cyst tissue by in situ hybridization, and induction of inflammatory cytokines by human gingival fibroblasts in response to radicular cyst contents.
The expression of mRNA encoding the inflammatory cytokines interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor alpha(TNF-alpha) have been examined in radicular cysts by in situ hybridization. Furthermore, the biological activity of the contents of radicular cysts (RCC) has been assayed by adding extracts of RCC to cultured human gingival fibroblasts (HGFs) and analyzing the culture medium for the release of inflammatory cytokines. In the epithelial layer, keratinocytes expressed all cytokine mRNAs examined at various levels. Basal layer cells expressed mRNA for each cytokine. In the subepithelial granulation tissue of the cysts, fibroblasts and macrophages expressed mRNA for IL-6, IL-8, IL-1beta and TNF-alpha mRNA at varying levels; especially clear expression of TNF-alpha and IL-1beta mRNA was detected on macrophages. The infiltrating lymphoid cells, largely composed of T cells and plasma cells, expressed these cytokine mRNAs, especially those encoding IL-6 and IL-8, at various levels. In vitro analysis indicated dose-dependent release of both IL-6 and IL-8 by HGFs in response to RCC. After heating to 100 degrees C for 10 min, RCC almost completely failed to stimulate IL-6 release from HGFs. Furthermore, anti-IL-1beta antibody (neutralization test) did not prevent the stimulation of IL-6 release by RCC. Significant amounts of IL-6 and IL-8 were detected in RCC in two cases, and a trace amount of IL-1beta was detected in one case. This study demonstrated the wide expression of mRNA encoding inflammatory cytokines in radicular cyst tissues, and RCC itself was capable of stimulating IL-6 and IL-8 production from HGFs.
Antibodies↗
[Postoperative radicular cyst--correlation between radical operation of the frontal sinus and formation of radicular cyst].
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Frontal Sinus↗
[Pathosis of radicular cyst. I. A result of clinico-biochemical examination in a typical case of radicular cyst (author's transl)].
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Dentistry↗
Measurement of interleukin 1 alpha and 1 beta (IL-1 alpha and IL-1 beta) in human cystic lesions of the jaw. Implications for the pathogenesis of radicular cysts.
Human radicular cystic tissue of jaws was found to contain between 0.823 pg/mg to 18.026 pg/mg interleukin 1 beta and from 0.34 pg/mg to 0.708 pg/mg interleukin 1 alpha. No IL-1 beta and alpha could be found in specimens from healthy patients. A finding which may be extremely relevant in cystic growth and episodes of alveolar bone resorption around the cystic lesion.
Antibodies, Monoclonal↗
Runx2 expression is associated with pathologic new bone formation around radicular cysts: an immunohistochemical demonstration.
BACKGROUND: Radicular cysts are the most common cysts in human jaw bones. These lesions induce bone remodeling of the surrounding alveolar bones, which was termed 'condensing osteitis', and was suggested to be related to cells of the osteoblastic lineage. The Runx2 (core-binding protein [cbfa]1/polyoma enhancer-binding protein [pebp]2alphaA) was shown to be a DNA-binding transcriptional molecule expressed in osteoprogenitor cells. METHODS: We confirmed the specificity of anti-Runx2 antiserum, using Western blotting analysis. We investigated the expression and localization of Runx2 in 32 radicular cyst cases with bone tissue fragments, immunohistochemically. RESULTS: Signals for Runx2 were seen in 18 cases (56.3%) of radicular cysts with bone formation. These signals were immunolocalized in the nuclei of the spindle-shaped osteoprogenitor cells in the cyst walls, whereas only a few signals were seen in the cuboidal osteoblastic cells near the fibrous bones. Signals for type I collagen were immunolocalized in the dense collagen fibers in the cyst walls and in the matrix of the fibrous bone around the radicular cysts, whereas no signals were seen on the inner portions with inflammatory cell infiltration of the cyst walls. Very weak signals for transforming growth factor (TGF)-beta1 were infrequently seen in the osteoblasts of the fibrous bone, whereas signals for TGF-beta2 were observed in young osteocytes in the fibrous bones, in B-cell lymphocytes infiltrating into the inner portions, and on the cellular membranes of the lining epithelium. CONCLUSIONS: The nuclear expression of Runx2 in spindle-shaped cells in the outer portions may play an essential role in the induction of fibrous bone tissue around radicular cysts. TGF-beta2 may play a role in the production of type I collagen, which acts as a template for pathologic new bone formation, in radicular cysts.
Activin Receptors, Type I↗
A clinical and histopathological study of radicular cysts associated with primary molars.
Radicular cysts originating from primary teeth are considered rare. The study analyzed 49 primary molars with radiolucent lesions ranging from 4-15 mm in diameter. 73.5% of the lesions were diagnosed as radicular cysts, and 26.5% as granulomas. The lesions were more frequent in the mandible. All lesions were associated with severely decayed teeth and only 4 had previous pulp therapy. The present study and the survey of the literature suggest that radicular cysts associated with primary teeth are not rare.
Child↗
Obturator after marsupialization of a recurrence of a radicular cyst of the mandible.
The radicular cyst is the most common odontogenic cyst. We present the case of a 51-year-old man with an extended recurrence of a radicular cyst of the mandible that was treated with marsupialization. Subsequently, an obturator was fitted, and in 10 months a resolution (clinically and radiographically) of the cystic cavity was noticed without any signs of recurrence. The marsupialization is a well-established, nonaggressive treatment of large odontogenic cysts and shows advantages in preserving vital structures, with reduced risk of pathological mandibular fractures. The patient, however, must be compliant and accept the prolonged treatment of marsupialization.
Humans↗
Quantitative analysis of the epithelial lining architecture in radicular cysts and odontogenic keratocysts.
BACKGROUND: This paper describes a quantitative analysis of the cyst lining architecture in radicular cysts (of inflammatory aetiology) and odontogenic keratocysts (thought to be developmental or neoplastic) including its 2 counterparts: solitary and associated with the Basal Cell Naevus Syndrome (BCNS). METHODS: Epithelial linings from 150 images (from 9 radicular cysts, 13 solitary keratocysts and 8 BCNS keratocysts) were segmented into theoretical cells using a semi-automated partition based on the intensity of the haematoxylin stain which defined exclusive areas relative to each detected nucleus. Various morphometrical parameters were extracted from these "cells" and epithelial layer membership was computed using a systematic clustering routine. RESULTS: Statistically significant differences were observed across the 3 cyst types both at the morphological and architectural levels of the lining. Case-wise discrimination between radicular cysts and keratocyst was highly accurate (with an error of just 3.3%). However, the odontogenic keratocyst subtypes could not be reliably separated into the original classes, achieving discrimination rates slightly above random allocations (60%). CONCLUSION: The methodology presented is able to provide new measures of epithelial architecture and may help to characterise and compare tissue spatial organisation as well as provide useful procedures for automating certain aspects of histopathological diagnosis.
Journal Article↗
High IL-6 synthesis in cultured fibroblasts isolated from radicular cysts.
OBJECTIVE: Inflammatory cytokines have been reported to be related with inflammation and expansion of jaw cysts. In this study, to examine the relationship between radicular cysts and inflammatory cytokines, it was found that there was notable unique evidence on cytokine synthesis from fibroblasts isolated from radicular cysts. METHODS: The expression of such cytokines, namely, interleukin-1beta, IL-1beta, IL-6, IL-8, IL-10, tumour necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), transforming growth factor-beta1 (TGF-beta1), and granulocyte-macrophage colony-stimulating (GM-CSF) mRNA, in nine radicular cysts was examined and compared with that detected in six specimens of healthy gingival mucosa. Furthermore, separating all fibroblasts from their respective radicular cysts, healthy gingival mucosa, and healthy periodontal ligaments, these fibroblast groups were cultured without stimulators and a supernatant for each was obtained to analyse IL-1beta, IL-6, IL-8, TNF-alpha, and IFN-gamma by ELISA. RESULTS: Differences between radicular cysts and healthy gingival mucosa were not clearly shown by the expression of cytokine mRNA. Analysing inflammatory cytokine synthesis in fibroblast groups from these three kinds of tissues, surprisingly, the levels of IL-6 mRNA and protein were recognised to be higher in fibroblasts of radicular cysts than in those of control tissues by ELISA and a real-time RT-PCR. Significant differences in the cultured supernatants of these fibroblast groups were not recognised in the release of IL-1beta, IL-8, TNF-alpha, and IFN-gamma by ELISA. CONCLUSIONS: From these results, it was suggested that fibroblasts inducing IL-6 production might play important roles in the expansion of radicular cysts. It is considered that fibroblasts around radicular cysts may lead to high IL-6 synthesis over time in chronic inflammation.
Adult↗
Immunolocalization of interstitial collagenase (MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in radicular cysts.
To investigate the mechanisms involved in expansion of radicular cysts, monoclonal antibodies against interstitial collagenase (MMP-1) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were used to localize the sites of MMP-1 and TIMP-1 expression in 30 radicular cysts. Positive MMP-1 staining was detected in the lining epithelium and subepithelial fibroblasts, macrophages, endothelial cells and osteoblasts/osteocytes in all specimens. Positive TIMP-1 staining was identified in osteoblasts/osteocytes and endothelial cells of all specimens, and in the lining epithelium and subepithelial fibrous connective tissue wall of five radicular cysts with an intense inflammatory cell infiltrate. The number and distribution of positive cells for MMP-1 or TIMP-1 varied widely among individual specimens, but strong immunostaining was constantly detected at sites with prominent subepithelial inflammation. Results here support the hypothesis that MMP-1 may play an important role in the expansion of radicular cysts. The absence of TIMP-1 expression in lining epithelium and subepithelial fibroblasts and macrophages in most cases studied indicated that an imbalance between MMP-1 and TIMP-1 production may lead to radicular cyst expansion.
Antibodies, Monoclonal↗
Pathways of inflammatory cellular exudate through radicular cyst epithelium: a light and scanning electron microscope study.
A feature of radicular cyst histology is the observation that polymorphonuclear leucocytes infiltrate the epithelium whereas chronic inflammatory cells do not and accumulate in the subepithelial connective tissue. Material for the study of this phenomenon consisted of radicular cysts fixed in formol saline. Observation under the SEM indicated that the lumenal surface of the radicular cyst is characterized by numerous interepithelial spaces through which polymorphonuclear cells reach the cyst cavity. The cells on the lumenal surface are associated with interepithelial spaces. Observations of the cut surface indicate that channels occur between epithelial cells through which the polymorphonuclear leucocytes migrate. The channels may also be a pathway for exudates from capillaries to reach the cyst cavity and provide a means for radicular cyst enlargement. Erosions of epithelial cells and features of necrosis of superficial cells were observed. Thus it appears that polymorphonuclear leucocytes migrate through definite channels between epithelial cells in the radicular cyst lining, the chemotactic stimulus being degeneration and breakdown of the superficial epithelial cells.
Epithelium↗
Age changes in residual radicular cysts.
Histological and radiographic study of 33 uninfected residual radicular cysts has shown that there is a slow increase in mineralised deposits within the cyst lumen with time. This becomes prominent histochemically in those cysts more than 8 years old and radiographically 6 years later. It would appear that mineralisation in these elderly cysts is due to dystrophic calcification of degenerate cellular material within the cyst lumen. Inflammation in all cysts, apart from mild granulomatous reactions related to cholesterol within cyst walls, was minimal. Overall reduction of cyst size with increasing epithelial atrophy and loss of hyaline bodies and mucous cells, has been shown to occur with increasing cyst age. It is suggested that the majority of radicular cysts heal spontaneously following extraction of the associated tooth. Furthermore, lesions that persist as residual radicular cysts will also undergo slow resolution if inflammation is not a prominent feature.
Calcinosis↗
Immunohistochemical localization of cyclooxygenase-2 in radicular cysts.
AIM: The purpose of this study was to investigate the expression of cyclooxygenase-2 (COX-2) in radicular cysts. METHODOLOGY: Thirty biopsy specimens of radicular cysts were examined using immunohistochemistry. A peroxidase-labelled streptavidin-biotin technique was used for identification of the COX-2. Fisher's exact test (two-tail) was used for statistical analysis of the results. RESULTS: The result demonstrated that COX-2 expression was significantly higher in radicular cysts with higher levels of inflammatory infiltrates. COX-2 stain was detected in the lining epithelium, subepithelial fibroblasts, macrophages and endothelial cells in all specimens. CONCLUSIONS: COX-2 expression is significantly higher in radicular cysts. COX-2 may play an important role in the pathogenesis of radicular cysts.
Capillaries↗