5 year old golden presented with gingival swelling around the maxillary canine.

Image 1.

Image 2. Here are the films

Image 3. Here are some more films

Image 4. Last film

Here is some information on cysts.

A cyst is composed of three structures: a central cavity (lumen), an epithelial lining, and a outer wall (capsule). The cystic cavity usually contains fluid or semisolid material such as cellular debris, keratin, or mucus.

Odontogenic cysts occur from a disturbance of normal odontogenesis and are categorized by the stage of tooth growth where the cyst forms.

Periapical (radicular) cysts - also referred as apical periodontal cysts, develop at the root apex of an erupted tooth whose pulp has been devitalized. The etiology of periapical cysts usually begin with blunt trauma, causing pulpal necrosis, apical granuloma and cyst formation. Radiographically, a radiolucent area associated with the apex is noted. Treatment is extraction or root canal therapy. Dentigerous cyst-surrounds the crown of an impacted, unerupted, or impacted secondary tooth. The crown is inside the cyst, root outside. Dentigerous cysts may expand into adjacent bone, move adjacent teeth, and /or resorb roots in the area. Neoplastic transformation to ameloblastoma and epidermoid carcinoma is possible.

Eruption cyst-surrounds the crown of an erupted tooth. Treatment involves surgically incising the cyst from the crown.

Follicular cyst-dilation of the normal follicular space around the crown of a tooth that is unerupted or impacted. Radiographic findings show the crown of an unerupted tooth contained in the radiolucent area while the root(s) is anchored in alveolar bone. Clinically the enamel will be completely developed in a follicular cyst.

Treatment is surgical removal of the unerupted tooth and curettage to remove the cystic wall. The defect can then be filled with bone grafting material.

Another radiograph, I was concerned about the periapical lucency of the mesial second premolar root also

Image 5.

The diagnosis is a radicular cyst. Treatment extraction of the affected tooth or root canal therapy, exposure and removal of the cyst and fill defect.

Image 6.

I only extracted first premolar and filled defect with Consil.

Image 7.

Closure

Image 8.

Apex on the first premolar appeared abnormal on radiograph and clinically. Chose not to extract 206 because distal root periapical area looked normal, and owner agreed to bring back for follow up radiographs. Mesial periapical area around the second premolar looks suspicious.

Refer to associated Dentistry Board discussion