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Friday, January 27, 2017

A residual cyst, as the name implies, is a radicular, lateral periodotal, dentigerous or any other cyst that has persisted after it's associated tooth has been lost. Residual cysts show more predilection in males and they commonly affect the maxillary region

Below see 2 examples :

Friday, August 5, 2016

Impacted Canine resorbing root of central incisor. removal, Graft, PRF

Tuesday, July 12, 2016

Central Giant-Cell Granuloma

Central Giant-Cell Granuloma
Giant cell lesions of the jaws are more frequent in first two decade of life and are more prevalent in female patients 2:1  

Although other lesions containing giant cells do occur in other bones of the body, they are much less frequent and are generally felt to be variants of other tumors, most often a low-grade osteosarcoma.

Diagnosis of central giant cell granuloma is made histologically from an incisional biopsy.

Similar histological appearances are seen in the following lesions, which must often be differentiated:
  1. The brown tumor of hyperparathyroidism.

  2. The aneurysmal bone cyst.

  3. Cherubism.
Conventional management is surgical and consists of:
1. Enucleation and curettage. Despite this, a recurrence rate of 15-20% is often quoted, and in these cases treatment may need to be more aggressive and may need to consist of an “en bloc” resection.

2. Intralesional steroid injections protocol is a 50/50 mixture of 2% lidocaine with 1:100,000 epinephrine with triamcinolone (Kenalog®)

Experience with this technique is limited. In the hands of those who use this technique on a regular basis, it appears that it is successful in around 50% of cases
3. Calcitonin injections
In the United States only salmon calcitonin is available, and although it is more potent than human calcitonin, antibody formation can limit its effectiveness. Results from the use of calcitonin have shown fairly high success rates.
Treatment with alpha interferon
Based on the assumption that this lesion may be vascular in origin, subcutaneous alpha interferon has been used in the treatment of this lesion. It is given for its anti-angiogenic effects, though there is little evidence that the lesion is vascular in origin. The treatment has shown some success, but its use is limited by its side effects.
Below see a case treated with both Intralesional steroid injections and Calcitonin on a 12 year old with a 5 year follow up with no recurrence.
At presentation 

6 months post treatment
1 year post treatment

4 year post treatment

5 year post treatment

Friday, June 17, 2016


A mesiodent is an extra tooth in the maxillary anterior incisor region. Mesiodentes are the most common supernumerary teeth, occurring in 0.15% to 1.9% of the population. The etiology of mesiodens is unclear, but is twice prevalent in males (possibly an autosomal recessive gene), and there is a familial trait. Proliferation of the dental lamina and genetic factors have been implicated. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors, which can further alter occlusion and appearance.

Mesiodens sometimes interfere with eruption of permanent teeth and cause other alignment problems with the existing teeth. Only a small portion of supernumerary teeth eventually erupts.

To prevent additional damage such as misalignment and delayed eruption of the permanent central incisors early intervention is suggested. Usually it is preferred to wait until the root of the central and the lateral teeth are completely formed before mesiodents are removed.

Mesiodens have been found in certain syndromes such as cleft lip and palate, cleidocranial dysostosis, and Gardner's syndrome. Supernumerary teeth in general have associations with Ehler-Danlos syndrome, Apert syndrome, and Down's syndrome as well.

The concerns associated with mesiodens are listed below and removal is often needed

1. Delayed eruption of permanent teeth

2. Cyst formation

3. Crowding

4. Diastemas

5. Resorption of the roots of adjacent teeth
6. Eruption of mesiodens  in to the nasal cavity..
Below see two cases that show the mesiodents erupting in to the nasal cavity.



Friday, June 10, 2016

Glubomaxillary cyst or Periapical cyst?

Globulomaxillary cyst has been considered to be a developmental cyst that arises from entrapped nonodontogenic epithelium in the globulomaxillary suture. In recent years existence and histogenesis of this lesion has been disputed. It had been argued that the anterior maxilla was formed by merging of growth centers rather than fusion of facial processes and therefore,  ectodermal entrapment was ruled out. Recent embryologic studies have demonstrated that Fusion of facial processes does occur, and epithelium is entrapped in areas that later will lie between the maxillary lateral incisors and canines. At the present Globumaxillary cyst has been removed from WHO classification of non odontogenic cyst and some argue that it needs to be reinstated as a developmental non odontogenic cyst.

 Below see a case which could potentially be argued both ways. 40 year old male presented with swelling of the space between maxillary left canine and lateral incisor. Patient had been treated with a root canal treatment years go on teeth #8, 9, and 10 and does not recall why. He denies history of trauma to the anterior maxilla.   Panoramic x ray disclosed  potentially an endodontic lesion in apex of #10 and cystic lesion that has resulted in root divergence in the area of tooth #10 and 11. Tooth #11 has tested vital and has been ruled out as a potential source of the lesion.   Pathology was consistent with both periapical lesion arising from tooth#10 and a non odontogenic cyst.