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Oral Disease for FINALS > Management of cysts > Flashcards

Management of cysts Flashcards

1
Q

General approach to managing a cyst (4)

A

Enucleation
-removal in entirety without cutting
Currettage (if it falls to bits)
-removal of tissue by scraping or scooping (in portions)
Resection
-removal of part of an organ
-takes pathology and margin of normal tissue
Marsupialisation
-creation of a pouch by suturing cyst lining to external surface

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2
Q

Which cysts are important with regards to undergrad exams? (5)

A 
Potentially manageable in dental practice
-radicular
-dentigerous
Recurrence
-odontogenic keratocyst
Common MOS
-mucocele
-sebaceous (epidermoid) cyst)
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3
Q

Management of radicular cysts (5)

A
  1. RCT?
  2. Extract causative tooth (cyst likely to come with it or resolve if small)
  3. Extract causative tooth then enucleate cyst (if large or retained)
  4. Rarely, marsupialise +/- further therapy (if exceedingly large)
  5. Apicect
    - anterior tooth (mainly)
    - acceptable orthograde RCT
    - patient accepts risks (e.g. recession)
    - consider implant first
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4
Q

Indications for apicectomy (2)

A
  1. Persistent symptoms/pathology in a non-vital
    tooth
  2. (re)RCT is an unfeasible solution
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5
Q

Persistent symptoms/ pathology *(5)

A 
Apical cyst
Swelling
Discharge
Mobility
-grade I II or II
Pain
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6
Q

When is (re)RCT unfeasible? (9)

A 
Cyst
Adequate re-RCT has failed
Sclerotic canal, cannot instrument
Canal morphology: curvature, accessory canals
Post crown, cannot be removed
Complex crown/ bridge, likely perforation rather than instrumentation
Irretrievable snapped instrument
Root perforation
Fractured root
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7
Q

Relative contra-indications to (re)RCT (lots)

A 
Previous apicectomy
Molars
Poor OH
Active caries
Sinus disease (recurrent sinusitis)
Implant
Unwilling to have LA
High mobility index
Advanced perio
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8
Q

Absolute contra-indications to (re)RCT (4)

A

Severe bleeding disorder
Endocarditis risk
Unrestorable
Post-crown retrievable

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9
Q

3 flap designs (3)

A

Mucoperisteal
Semilunar
Leubke-Oschenbein

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10
Q

Enucleation rules (4)

A
  • Apical 3mm of root removed (apical delta)
  • No need to remove to base of bone cavity
  • 90o to long axis of tooth
  • IRM Vs MTA as retrograde RCT
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11
Q

Why is semilunar flap design no longer used? (2)

A
  1. Scarring

2. Potential to leave margin of incision overlying cystic cavity – void

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12
Q

Leubke-Oschenbein flap design rules (6)

A
  1. 4mm below gingival margin, but in attached mucosa(!)
  2. As with semilunar, scarring
  3. Where is the gingival sulcus?
  4. Where is the crestal bone on a tooth that is non-vital and infected?
  5. Where are you going to stitch this flap?
  6. What do you think of the blood supply to the marginal gingivae?
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13
Q

Mucoperiosteal fap design - why is it good? (3)

A
  1. Best access
  2. Minimal scarring
  3. Gingival recession
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14
Q

Component phases in MTA (6)

A 
Tricalcium silicate
Dicalcium silicate
Tricalcium aluminate
Tetracalcium aluminoferrite
Gypsum
Bismuth oxide
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15
Q

Component phases in portland cement (5)

A 
Tricalcium silicate
Dicalcium silicate
Tricalcium aluminate
Tetracalcium aluminoferrite
Gypsum
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16
Q

What is the difference between MTA and portland cement (2)

A
  1. Bismuth Oxide added for radiopacity

2. 1mg = £50 10kg = £3.50

17
Q

3 main things to know about keratocysts (3)

A
  1. Histopathology and how links to recurrence
  2. Associated syndromes
  3. Treatment
18
Q

Features of Gorlin-Goltz syndrome (5)

A 
Multiple Keratocysts
- Multiple Basal Cell Carcinomas, not limited to
 sun exposed areas
- Cervical Rib/ skeletal deformities
- Frontal Bossing, Hypertelorism
- Calcified Falx Cerebri
19
Q

Gorlin-Goltz syndrome (3)

A

Autosomal Dominant, Chromosome 9q, Prevalence 1:60,000

20
Q

Dentigerous cysts (2)

A

• Enucleate along with removing unerupted
tooth
• Eruption cyst requires no treatment

21
Q

Mucous extravasation cyst removal (4)

A 
• Blunt dissection / excision
• Difficulty with removing;
1. Housed in soft tissue
2. Scarring/ fibrosis
3. Not epithelially lined
22
Q

Sebacious (epidermoid) cysts (4)

A
  • Contain Keratin
  • Punctum
  • Traumatic implantation of skin
  • Acquired

Oral Disease for FINALS (34 decks)

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