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Periapical cyst

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closure to reduce chances of cyst regeneration. This type of treatment is more ideal for small cysts. A cystostomy is recommended for larger cysts that compromise important adjacent anatomy. The cyst is tamponaded to allow for the cyst contents to escape the bone. Over time, the cyst decreases in size and bone regenerates in the cavity space.
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could also be performed, which involves suturing the edges of the gingiva surrounding the cyst to remain open. The cyst then drains its contents and heal without being prematurely closed. The end result is the same as the cystostomy, bone regeneration. For both a cystostomy and marsupialization, root
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Initial stage: Epithelial cells from the rests of Malassez at the apex of the roots of a non-vital tooth (one where the nerve and blood supply in the tooth have degenerated and no longer exist) become stimulated due to the body's inflammatory response to bacterial endotoxins infecting the pulp or as
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Surgical options for previously treated teeth that would not benefit from root canal therapy include cystectomy and cystostomy. This route of treatment is recommended upon discovery of the cyst after inadequate root canal treatment. A cystectomy is the removal of a cyst followed by mucosa and wound
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The infected tissue of the periapical cyst must be entirely removed, including the epithelium of the cyst wall; otherwise, a relapse is likely to occur. Root canal treatment should be performed on the tooth if it is determined that previous therapy was unsuccessful. Removal of the necrotic pulp and
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Epithelial cells have an inherent quality to reproduce and cover any connective tissue that is not already lined with epithelia. Formation of an abscess must precede the epithelial proliferation in order for the cells to carry out this tendency. This theory explains why cysts are lined in epithelia
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Epithelial cells will form a mass inside the cavity and the innermost cells become deprived of nutrients because they are far from the source of nutrients (the blood vessels). The innermost cells die and form an aggregate of dead tissue. The inner cells undergo ischemic liquefactive necrosis which
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noises during examination, indicating extensive bone damage. Bulging of the buccal or lingual cortical plates may be present. Age of occurrence in the patient, the location of the cyst, the edges of cystic contours, and the impact that the cyst has on adjacent structures must all be considered for
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causes proliferation of epithelial rests of Malassez which release toxins at the apex of the tooth. The body's inflammatory response will attack the source of the toxins, leading to periapical inflammation. The many cells and proteins that rush to an area of infection create osmotic tension in the
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Periapical cysts begin as asymptomatic and progress slowly. Subsequent infection of the cyst causes swelling and pain. Initially, the cyst swells to a round hard protrusion, but later on the body resorbs some of the cyst wall, leaving a softer accumulation of fluid underneath the mucous membrane.
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shape on radiographs. There is also a severe border of cortication between the cyst and surrounding bone. Pseudocysts, on the other hand, have a fluid filled cavity but are not lined by epithelium, therefore they have a less severe and more blurred border between the fluid and bony surroundings.
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Several lesions can appear similarly in radiographic appearance. Intraoral X-rays or a 3-D cone beam scan of the affected area can be used to obtain radiological images and confirm diagnosis of cysts in the periapical area. Circular or ovoid radiolucency surrounding the root tip of approximately
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Expansion of the cyst causes erosion of the floor of the maxillary sinus. As soon as it enters the maxillary antrum, the expansion rate increases due to available space for expansion. Performing a percussion test by tapping the affected teeth will cause shooting pain. This is often clinically
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from a cyst. If the lesion is large it is more likely to be a cyst. Radiographically, both granulomas and cysts appear radiolucent. Many lesions of the mandible in particular appear cystlike in appearance. It is often necessary to obtain a biopsy and evaluate the tissue under a microscope to
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Larger cysts may cause bone expansion or displace roots. Discoloration of the affected tooth may also occur. Patient will present negative results to electric and ice test of the affected tooth but will be sensitive to percussion. Surrounding gingival tissue may experience
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Periapical cysts comprise approximately 75% of the types of cysts found in the oral region. The ratio of individuals diagnosed with periapical cysts is 3:2 male to female, as well as individuals between 20 and 60 years old. Periapical cysts occur worldwide.
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creates the cavity space surrounded by growing epithelial cells. This theory is unlikely in the absence of malignant transformation of epithelial cells as it does not follow the existing relationship between connective tissue and epithelium.
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Cyst development stage: Epithelial cells form strands and are attracted to the area which contains exposed connective tissue and foreign substances. Several strands from each rest converge and surround the abscess or foreign
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then allow bacteria to reach the level of the pulp, causing infection. The bacteria gains access to the periapical region of the tooth through deeper infection of the pulp, traveling through the roots. The resulting pulpal
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Cyst growth stage: Fluid flows into the cavity where the forming cyst is growing due to the increased osmolality of the cavity in relation to surrounding serum in capillaries. Pressure and size increase.
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a direct response to necrotic pulp tissue, therefore re-entering the growth phase. Bacterial byproducts then are able to seep into the periapical region through the infected pulp.
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Scholl, Robert J.; Kellett, Helen M.; Neumann, David P.; Lurie, Alan G. (1999-09-01). "Cysts and Cystic Lesions of the Mandible: Clinical and Radiologic-Histopathologic Review".
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Periapical true cysts - cysts containing cavities entirely surrounded in epithelial lining. Resolution of this type of cyst requires surgical treatment such as a cystectomy.
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Periapical pocket cysts - epithelium lined cavities that have an opening to the root canal of the affected tooth. Resolution may occur after traditional root canal therapy.
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Dunfee, Brian L.; Sakai, Osamu; Pistey, Robert; Gohel, Anita (2006-11-01). "Radiologic and Pathologic Characteristics of Benign and Malignant Lesions of the Mandible".
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Pressure and concentration differences between the cystic cavity and the growth surroundings influence fluid movement into the cyst, causing size increase.
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1-1.5 cm in diameter is indicative of the presence of a periapical cyst. The border of the cyst is seen as a narrow opaque margin contiguous with the
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the inflamed tissue as well as proper sealing of the canals and an appropriately fitting crown will allow the tooth to heal under uninfected conditions.
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The surrounding intraoral anatomical structures should be palpated to identify the presence of bone expansion or displacement of tooth roots as well as
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Menditti, Dardo; Laino, Luigi; Di Domenico, Marina; Troiano, Giuseppe; Guglielmotti, Mario; Sava, Sara; Mezzogiorno, Antonio; Baldi, Alfonso (2018).
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which proliferate to form the cyst. Such cysts are very common. Although initially asymptomatic, they are clinically significant because secondary
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Leandro Bezerra Borges; Francisco Vagnaldo Fechine; Mário Rogério Lima Mota; Fabrício Bitu Sousa; Ana Paula Negreiros Nunes Alves (2012).
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b. Bone resorption caused by metabolism of acidic substances produced by cysts contributes to cyst growth. Such substances include
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A non-vital tooth is necessary for the diagnosis of a periapical cyst, meaning the nerve has been removed by root canal therapy.
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Histopathology of a periapical cyst, with metaplastic changes of mucus-secreting cells (B), and ciliated cells (C).
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A fibrous capsule of varying thickness, with chronic inflammatory cells, wherein a plasma cells may be abundant
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Visual image of the face of the person shown on the CT scan above. Swelling can be observed in the right cheek.
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and growth factors, contribute to the mobilization and proliferation of epithelial cells in the area.
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Torabinejad, M. (February 1983). "The role of immunological reactions in apical cyst formation".
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where there is respiratory epithelium (pseudostratified ciliated columnar epithelium).
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The definitive mechanism by which cysts grow is under debate; several theories exist.
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Secondary symptoms of periapical cysts include inflammation and infection of the
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These lesions can grow large because they apply pressure over the bone, causing
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Most frequently located in the maxillary anterior region, the cyst is caused by
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resectioning may also be required in cases where root resorption has occurred.
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Relative incidence of odontogenic cysts. Periapical cysts are labeled at left.
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periapex which is the source of internal pressure increase at the cyst site.
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Webteam, University of Pittsburgh University Marketing Communications.
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Periapical cysts develop due to an inflammatory stimulus in 3 stages:
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Journal of Indian Society of Pedodontics and Preventive Dentistry
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Dental cysts are usually caused due to root infection involving
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Kirtaniya, BC; Sachdev, V; Singla, A; Sharma, AK (2010-07-01).
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Periapical cysts exist in two structurally distinct classes:
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There are two schools of thought regarding cyst expansion.
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Topic Completed: 1 March 2014. Revised: 13 December 2019
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Periapical is defined as "the tissues surrounding the
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causing dental caries. This infection is what causes
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Periodontitis as a manifestation of systemic disease
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of variable thickness, except when originating in a
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Chemical reaction with Interleukin and Prostaglandin
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CT scan through head showing a right periapical cyst
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Cholesterol clefts of a periapical cyst of the jaw.
62: 40: 35: 2029:Diseases of oral cavity, salivary glands and jaws 453:, it is virtually impossible to differentiate 1619: 1095: 8: 906: 904: 412:They sometimes have the following features: 327:but not why the initial cysts itself forms. 309:which are both produced by the cyst itself. 1626: 1612: 1604: 1392: 1182: 1102: 1088: 1080: 995: 73: 49: 32: 946: 866:"Difference between True and Pseudo Cyst" 781: 549: 100:, as a consequence of untreated chronic 1435:Combined periodontic-endodontic lesions 1244:Combined periodontic-endodontic lesions 516: 600:10.1148/radiographics.19.5.g99se021107 425:Cholesterol clefts in the cyst lining. 246:Complementary response to inflammation 1953:Autosomal recessive polycystic kidney 860: 858: 856: 7: 1948:Autosomal dominant polycystic kidney 1415:Generalized aggressive periodontitis 888:Annie S. Morrison; Kelly Magliocca. 750:"Apical Cyst Theory: a Missing Link" 675: 673: 671: 627: 625: 581: 579: 577: 575: 573: 571: 569: 682:Shafer's textbook of oral pathology 119:is "a pathological cavity lined by 1410:Localized aggressive periodontitis 748:Huang, George T.-J. (2010-10-05). 25: 143:epithelial cell rests of Malassez 141:. Its lining is derived from the 96:. It may develop rapidly from a 44:Radicular cyst, inflammatory cyst 27:Sac growth at the root of a tooth 1425:Necrotizing periodontal diseases 458:accurately identify the lesion. 210:diagnostic of pulpal infection. 1960:Medullary cystic kidney disease 1721:Proliferating trichilemmal cyst 843:"the definition of cortication" 2024:Oral and maxillofacial surgery 825:"the definition of unilocular" 399:Stratified squamous epithelium 1: 1689:Proliferating epidermoid cyst 1651:Langerhans cell histiocytosis 1430:Abscesses of the periodontium 976:Revista GaĂşcha de Odontologia 727:10.1016/s0300-9785(83)80075-1 313:Nutritional deficiency theory 1814:Human musculoskeletal system 1239:Chronic apical periodontitis 1972:Congenital cystic dysplasia 1879:Congenital hepatic fibrosis 1725:Malignant trichilemmal cyst 1354:Calcifying odontogenic cyst 766:10.5436/j.dehy.2010.1.00013 498:Types of Periapical cysts: 2045: 1925:Cystic leukoencephalopathy 1359:Glandular odontogenic cyst 1234:Acute apical periodontitis 1993:Von Hippel–Lindau disease 1943:Polycystic kidney disease 1787:Keratin implantation cyst 1769:Pseudocyst of the auricle 1699:Eruptive vellus hair cyst 394:, periapical cysts show: 57: 48: 1874:Polycystic liver disease 1799:Adenoid cystic carcinoma 1754:nonstratified squamous: 1656:Lymphangioleiomyomatosis 1554:Linear gingival erythema 1452:A. actinomycetemcomitans 422:Scattered ciliated cells 102:periapical periodontitis 1782:Cutaneous columnar cyst 1756:Cutaneous ciliated cyst 1737:Steatocystoma multiplex 1680:follicular infundibulum 948:10.4103/0970-4388.73795 1866:Nasopalatine duct cyst 1861:Odontogenic keratocyst 1832:Human digestive system 1549:Horizontal bony defect 1375:Cracked tooth syndrome 1264:Vertical root fracture 680:R., Rajendran (2010). 491: 417:Rushton hyaline bodies 387: 379: 170: 1780:other and ungrouped: 1741:Steatocystoma simplex 1678:stratified squamous: 1661:Cystic bronchiectasis 1405:Chronic periodontitis 1325:Chronic periodontitis 1218:Pink tooth of Mummery 1203:Irreversible pulpitis 542:10.21873/invivo.11340 489: 385: 377: 168: 1935:Genitourinary system 1589:Vertical bony defect 1534:Gingival enlargement 1126:Caries (tooth decay) 646:10.1148/rg.266055189 286:Biochemical theories 278:Biomechanical theory 183:necrosis of the pulp 98:periapical granuloma 84:Commonly known as a 1907:Bile duct hamartoma 1569:Periodontal disease 1331:Periodontal disease 1303:Gingiva/periodontal 1208:Reversible pulpitis 1198:Internal resorption 1193:External resorption 1161:Internal resorption 1157:External resorption 684:. : Reed Elsevier. 222:. Untreated dental 92:is the most common 1998:Tuberous sclerosis 1892:Biliary hamartomas 1643:Respiratory system 1564:Periodontal pocket 1459:Capnocytophaga sp. 1290:Periapical abscess 1254:Periapical abscess 1054:External resources 894:Pathology Outlines 492: 388: 380: 348:proper diagnosis. 171: 161:Signs and symptoms 2006: 2005: 1902:Choledochal cysts 1841:Cysts of the jaws 1713:Trichilemmal cyst 1707:outer root sheath 1601: 1600: 1597: 1596: 1298: 1297: 1175:Pulp/periapical ( 1077: 1076: 754:Dental Hypotheses 111:of the root of a 82: 81: 30:Medical condition 16:(Redirected from 2036: 1981:Other conditions 1965:Nephronophthisis 1884:Peliosis hepatis 1856:Dentigerous cyst 1846:Odontogenic cyst 1628: 1621: 1614: 1605: 1529:Furcation defect 1393: 1349:Dentigerous cyst 1183: 1152:tooth resorption 1104: 1097: 1090: 1081: 996: 984: 983: 967: 961: 960: 950: 926: 920: 919: 908: 899: 897: 885: 876: 875: 873: 872: 862: 851: 850: 839: 833: 832: 821: 815: 814: 802: 796: 795: 785: 745: 739: 738: 710: 704: 703: 677: 666: 665: 640:(6): 1751–1768. 629: 620: 619: 594:(5): 1107–1124. 583: 564: 563: 553: 521: 475:Marsupialization 451:Radiographically 392:light microscopy 339:Oral examination 94:odontogenic cyst 78: 77: 53: 33: 21: 2044: 2043: 2039: 2038: 2037: 2035: 2034: 2033: 2019:Gross pathology 2009: 2008: 2007: 2002: 1976: 1929: 1911: 1851:Periapical cyst 1826: 1808: 1767:no epithelium: 1685:Epidermoid cyst 1665: 1637: 1635:Cystic diseases 1632: 1602: 1593: 1559:Occlusal trauma 1539:Gingival pocket 1499: 1439: 1385: 1379: 1363: 1335: 1304: 1294: 1268: 1259:Phoenix abscess 1222: 1170: 1165:Root resorption 1146:Hypercementosis 1114: 1108: 1078: 1073: 1072: 1049: 1048: 1007: 993: 988: 987: 969: 968: 964: 928: 927: 923: 910: 909: 902: 887: 886: 879: 870: 868: 864: 863: 854: 841: 840: 836: 823: 822: 818: 811:dental.pitt.edu 804: 803: 799: 747: 746: 742: 715:Int J Oral Surg 712: 711: 707: 692: 679: 678: 669: 631: 630: 623: 585: 584: 567: 536:(5): 999–1007. 523: 522: 518: 513: 484: 464: 448: 446:Differentiation 432: 403:maxillary sinus 372: 354: 341: 333: 324: 315: 303:Prostaglandin-2 288: 280: 256: 216: 207: 201:when palpated. 191:lymphadenopathy 163: 153:and damage. 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1291: 1288: 1286: 1283: 1281: 1278: 1277: 1275: 1271: 1265: 1262: 1260: 1257: 1255: 1252: 1250: 1247: 1245: 1242: 1240: 1237: 1235: 1232: 1231: 1229: 1225: 1219: 1216: 1214: 1213:Pulp necrosis 1211: 1209: 1206: 1204: 1201: 1199: 1196: 1194: 1191: 1190: 1188: 1184: 1181: 1178: 1173: 1166: 1162: 1158: 1154: 1153: 1149: 1147: 1144: 1142: 1139: 1137: 1134: 1132: 1129: 1127: 1124: 1123: 1121: 1117: 1113: 1112:tooth disease 1105: 1100: 1098: 1093: 1091: 1086: 1085: 1082: 1069: 1065: 1064: 1060: 1059: 1056: 1052: 1045: 1041: 1040: 1036: 1034: 1030: 1029: 1025: 1023: 1019: 1018: 1014: 1010: 1009: 1006: 1001: 997: 990: 981: 977: 973: 966: 963: 958: 954: 949: 944: 940: 936: 932: 925: 922: 917: 916:www.medeco.de 913: 907: 905: 901: 895: 891: 884: 882: 878: 867: 861: 859: 857: 853: 848: 844: 838: 835: 830: 826: 820: 817: 812: 808: 801: 798: 793: 789: 784: 779: 775: 771: 767: 763: 759: 755: 751: 744: 741: 736: 732: 728: 724: 720: 716: 709: 706: 701: 697: 693: 691:9788131215708 687: 683: 676: 674: 672: 668: 663: 659: 655: 651: 647: 643: 639: 635: 634:RadioGraphics 628: 626: 622: 617: 613: 609: 605: 601: 597: 593: 589: 588:RadioGraphics 582: 580: 578: 576: 574: 572: 570: 566: 561: 557: 552: 547: 543: 539: 535: 531: 527: 520: 517: 510: 508: 505: 504:Lateral: 20% 502: 499: 496: 488: 481: 479: 476: 472: 468: 461: 459: 456: 452: 445: 440: 437: 436: 435: 429: 424: 421: 418: 415: 414: 413: 407: 404: 400: 397: 396: 395: 393: 384: 376: 369: 367: 364: 360: 351: 349: 346: 338: 336: 330: 328: 321: 319: 312: 310: 308: 307:Interleukin-1 304: 299: 297: 293: 285: 283: 277: 275: 269: 265: 261: 260: 259: 253: 248: 245: 244: 243: 240: 238: 233: 230: 225: 221: 213: 211: 205:Complications 204: 202: 200: 196: 192: 186: 184: 180: 175: 167: 160: 158: 156: 152: 148: 144: 140: 136: 135:dental caries 133:secondary to 132: 129: 124: 122: 118: 114: 110: 105: 103: 99: 95: 91: 87: 76: 70: 67: 65: 61: 56: 52: 47: 43: 39: 34: 19: 1988:Hydatid cyst 1850: 1761:Hidrocystoma 1731: 1705: 1679: 1494:T. denticola 1492: 1487:T. forsythia 1485: 1478: 1471: 1466:F. nucleatum 1464: 1457: 1450: 1444:Pathogenesis 1150: 1119:Hard tissues 1061: 1037: 1026: 1011: 979: 975: 965: 941:(3): 203–8. 938: 934: 924: 915: 912:"Cystostomy" 893: 869:. Retrieved 846: 837: 828: 819: 810: 800: 760:(2): 76–84. 757: 753: 743: 721:(1): 14–22. 718: 714: 708: 681: 637: 633: 591: 587: 533: 529: 519: 506: 503: 501:Apical: 70% 500: 497: 493: 482:Epidemiology 473: 469: 465: 449: 433: 416: 411: 389: 355: 342: 334: 325: 316: 300: 289: 281: 273: 257: 241: 234: 217: 208: 197:may exhibit 187: 176: 172: 125: 106: 89: 85: 83: 1890:bile duct: 1804:Breast cyst 1307:Periodontal 359:lamina dura 292:Collagenase 220:tooth decay 155:radiographs 86:dental cyst 41:Other names 2013:Categories 1748:Keratocyst 1717:Pilar cyst 1544:Gingivitis 1519:Edentulism 1505:Pathologic 1316:Gingivitis 1227:Periapical 1177:Endodontal 1039:DiseasesDB 871:2017-12-09 511:References 363:unilocular 254:Mechanisms 237:resorption 149:can cause 121:epithelium 1584:Recession 1397:Diagnoses 1341:Bone cyst 1273:Ungrouped 1131:Attrition 1110:Acquired 1063:eMedicine 774:2155-8213 700:682882649 654:0271-5333 608:0271-5333 462:Treatment 455:granuloma 352:Radiology 331:Diagnosis 296:cytokines 147:infection 69:Dentistry 64:Specialty 1774:Mucocele 1524:Fremitus 1514:Calculus 1507:entities 1280:Pulpitis 1136:Abrasion 957:21157055 792:25346864 662:17102048 616:10489168 560:30150421 345:crepitus 229:necrosis 199:crepitus 131:necrosis 115:" and a 1872:liver: 1249:Fistula 1141:Erosion 1068:ent/681 1033:D011842 783:4205966 735:6406374 551:6199599 530:In Vivo 1579:Plaque 1186:Pulpal 955:  790:  780:  772:  733:  698:  688:  660:  652:  614:  606:  558:  548:  224:caries 214:Causes 193:. The 139:trauma 128:pulpal 88:, the 71:  1694:Milia 1386:from 1368:Other 1044:31994 1022:K09.0 267:body. 113:tooth 1739:and 1723:and 1719:and 1715:and 1687:and 1671:Skin 1028:MeSH 982:(1). 953:PMID 788:PMID 770:ISSN 731:PMID 696:OCLC 686:ISBN 658:PMID 650:ISSN 612:PMID 604:ISSN 556:PMID 305:and 179:pulp 151:pain 117:cyst 109:apex 1013:ICD 943:doi 778:PMC 762:doi 723:doi 642:doi 596:doi 546:PMC 538:doi 390:In 290:a. 137:or 2015:: 1163:, 1159:, 1066:: 1042:: 1031:: 1020:: 1017:10 980:60 978:. 974:. 951:. 939:28 937:. 933:. 914:. 903:^ 892:. 880:^ 855:^ 845:. 827:. 809:. 786:. 776:. 768:. 756:. 752:. 729:. 719:12 717:. 694:. 670:^ 656:. 648:. 638:26 636:. 624:^ 610:. 602:. 592:19 590:. 568:^ 554:. 544:. 534:32 532:. 528:. 185:. 104:. 1627:e 1620:t 1613:v 1327:) 1323:( 1309:) 1305:( 1179:) 1167:) 1155:( 1103:e 1096:t 1089:v 1015:- 1005:D 959:. 945:: 918:. 896:. 874:. 849:. 831:. 813:. 794:. 764:: 758:1 737:. 725:: 702:. 664:. 644:: 618:. 598:: 562:. 540:: 20:)

Index

Radicular cyst

Specialty
Dentistry
Edit this on Wikidata
odontogenic cyst
periapical granuloma
periapical periodontitis
apex
tooth
cyst
epithelium
pulpal
necrosis
dental caries
trauma
epithelial cell rests of Malassez
infection
pain
radiographs

pulp
necrosis of the pulp
lymphadenopathy
alveolar plate
crepitus
tooth decay
caries
necrosis
resorption

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