1. File #40 means:
a. 0.40 is the diameter at d1 ***
b. 0.40 is from d1 to d16
2. Cause of radicular cyst:
a. Non vital tooth ***
b. Vital tooth
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RADICULAR CYCLE:
Symptom:
asymptomatic It can be large enough to cause inflammation or cause tooth movement.
Diagnosis:
there is no response to thermal or electrical tests, nor to percussion or palpation. The radiograph shows a radiolucent area with loss of continuity of the hard lamina usually delineated by a rounded radiopaque line, which can be larger than a granuloma and include more than one tooth.
Neither the size nor the shape of a radiolucent area is a definitive indication of the presence of a cyst.
These root cysts grow slowly, and they acquire large dimensions with expansion of the external cortices. In principle, the cyst is asymptomatic, it can only be seen by radiographic procedures. The differential diagnosis between cyst and granuloma is difficult, although the size factor is not decisive in establishing this diagnosis; It is accepted that from 2 cm (evolution of 10 years), the lesion is considered cystic and capable of giving symptoms. Depending on its location, different topographic forms are distinguished, the highest frequency is in the maxilla, in the anterior region; in this case, the evolution takes place towards the vestibule, nostril, palatine region, maxillary sinuses and more rarely, the tuberosity.
In the jaw the evolution is towards the vestibular, along the body of the jaw, sometimes reaching the ascending limb.
The cyst can be infected secondarily and manifests itself as acute cellulitis, it can also fistulize and suppurate to neighboring regions (mouth and skin), it can also cause paraesthesia, deviation of neighboring teeth and even cause mandibular fractures. The diagnosis is established by radiological signs and by the clinic that reveal only advanced stages of these.
Radiographic characteristics:
a widening of the periodontal space, a rounded or oval radiolucent area with periquistic condensation bone line is observed.
Treatment:
The need to distinguish granuloma from the cyst in terms of treatment is debatable, since the treatment for both is the same. And even if it is a point of controversy, it would seem that the result of the treatment is also the same.
Surgical enucleation of root cysts is not always necessary in all cases. Cysts are present in approximately 42% of the areas of rarefaction at the apex of the teeth. Its favorable resolution of these areas of rarefaction after duct treatment occurs in 80 to 98% of cases, so a percentage of these scars may have been cysts. Studies of successes and failures give ample evidence of some cysts healed after endodontic treatment.
The resolution mechanism is not fully explained. Several hypotheses have been raised for explanation.
The treatment of choice for a root cyst is conventional endodontic therapy followed by careful monitoring periodically. If the lesion does not resolve or if symptoms appear, then surgical treatment will be indicated.
If there is certainty, by biopsy, of the presence of a cyst, conventional duct treatment plus surgical removal will be well indicated.
When a cyst is large, removal by curettage can damage the vitality of neighboring teeth due to interruption of blood circulation during curettage.
Prognosis: depends on the tooth involved, extent of bone destruction, accessibility for treatment, etc.
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RADICULAR CYCLE:
Symptom:
asymptomatic It can be large enough to cause inflammation or cause tooth movement.
Diagnosis:
there is no response to thermal or electrical tests, nor to percussion or palpation. The radiograph shows a radiolucent area with loss of continuity of the hard lamina usually delineated by a rounded radiopaque line, which can be larger than a granuloma and include more than one tooth.
Neither the size nor the shape of a radiolucent area is a definitive indication of the presence of a cyst.
These root cysts grow slowly, and they acquire large dimensions with expansion of the external cortices. In principle, the cyst is asymptomatic, it can only be seen by radiographic procedures. The differential diagnosis between cyst and granuloma is difficult, although the size factor is not decisive in establishing this diagnosis; It is accepted that from 2 cm (evolution of 10 years), the lesion is considered cystic and capable of giving symptoms. Depending on its location, different topographic forms are distinguished, the highest frequency is in the maxilla, in the anterior region; in this case, the evolution takes place towards the vestibule, nostril, palatine region, maxillary sinuses and more rarely, the tuberosity.
In the jaw the evolution is towards the vestibular, along the body of the jaw, sometimes reaching the ascending limb.
The cyst can be infected secondarily and manifests itself as acute cellulitis, it can also fistulize and suppurate to neighboring regions (mouth and skin), it can also cause paraesthesia, deviation of neighboring teeth and even cause mandibular fractures. The diagnosis is established by radiological signs and by the clinic that reveal only advanced stages of these.
Radiographic characteristics:
a widening of the periodontal space, a rounded or oval radiolucent area with periquistic condensation bone line is observed.
Treatment:
The need to distinguish granuloma from the cyst in terms of treatment is debatable, since the treatment for both is the same. And even if it is a point of controversy, it would seem that the result of the treatment is also the same.
Surgical enucleation of root cysts is not always necessary in all cases. Cysts are present in approximately 42% of the areas of rarefaction at the apex of the teeth. Its favorable resolution of these areas of rarefaction after duct treatment occurs in 80 to 98% of cases, so a percentage of these scars may have been cysts. Studies of successes and failures give ample evidence of some cysts healed after endodontic treatment.
The resolution mechanism is not fully explained. Several hypotheses have been raised for explanation.
The treatment of choice for a root cyst is conventional endodontic therapy followed by careful monitoring periodically. If the lesion does not resolve or if symptoms appear, then surgical treatment will be indicated.
If there is certainty, by biopsy, of the presence of a cyst, conventional duct treatment plus surgical removal will be well indicated.
When a cyst is large, removal by curettage can damage the vitality of neighboring teeth due to interruption of blood circulation during curettage.
Prognosis: depends on the tooth involved, extent of bone destruction, accessibility for treatment, etc.
