Hindawi Publishing Corporation
Case Reports in Dentistry
Volume 2013, Article ID 123148, 3 pages
Conservative Approach in the Management of Radicular Cyst in
a Child: Case Report
Narendra Varma Penumatsa, Srinivas Nallanchakrava, Radhika Muppa,
Arthi Dandempally, and Priyanaka Panthula
Department of Pediatric Dentistry, Panineeya Mahavidyalaya Institute of Dental Sciences & Research Centre,
Dilsukhnagar, Hyderabad, Andhra Pradesh 500060, India
Correspondence should be addressed to Narendra Varma Penumatsa; firstname.lastname@example.org
Received 19 December 2012; Accepted 13 January 2013
Academic Editors: A. Kasaj and A. Markopoulos
Copyright © 2013 Narendra Varma Penumatsa et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
Radicular cyst is the most common odontogenic cystic lesion of inflammatory origin. It is also known as periapical cyst, apical
periodontal cyst, root end cyst, or dental cyst. It arises from epithelial residues in the periodontal ligament as a result of
cyst associated with a primary molar.
Radicular cyst is an inflammatory jaw cyst originating from
epithelial remnants of the periodontal ligament as a result
of inflammation that is generally a consequence of pulp
necrosis. The resulting cyst commonly involves the apex of
the affected tooth . They are the most common of all
jaw cysts and comprise about 52.3%  to 68%  of all
cysts affecting the mandible . Caries is the most frequent
aetiological factor of radicular cyst in the primary dentition
. They also result from the traumatic injuries to the
primary teeth .
Very few cases are seen in the first decade, after which
there is a fairly steep rise, with a peak frequency in the third
decade. Radicular cysts are rare in the primary dentition,
representing only 0.5–3.3% of the total number in both
primary and permanent dentitions . The male preponder-
ance occurs essentially in the fourth and fifth decades. The
lower frequency in females, which has also been reported
by other workers, may be because they are less likely to
neglect their teeth . These cysts are slow growing and
asymptomatic unless secondarily infected. Extraction or
endodontic treatment of the affected tooth is required when
clinical and radiographic characteristics indicate a periapical
inflammatory lesion. The normal treatments for radicular
cysts include total enucleation in the case of small lesions,
marsupialisation for decompression of larger cysts, or a
combination of the two techniques. Inflammatory cysts do
not recur after adequate treatment.
2. Case Report
An 8-year-old male patient reported to the department of
pedodontics and preventive dentistry, PMVIDS, Hyderabad,
with a chief complaint of extra oral swelling on the left lower
back region of the jaw since 2 months. Past dental history
7 days ago.
On extraoral examination, a well-defined, nontender,
hard bony swelling was noticed on the left side of the body
of the mandible measuring 2 × 3cm in size. Intraoral exam-
Orthopantomograph revealed a single well-defined periapi-
ination revealed grossly decayed left mandibular primary
second molar with buccal cortical plate expansion (Figure 1).
2 Case Reports in Dentistry
left primary second molar.
Figure 2: Orthopantomograph showing mandibular left primary
second molar associated with periapical radiolucency.
Figure 3: Histological view of radicular cyst.
completed) (Figure 2). Based on history, clinical and radio-
associated with second mandibular left primary molar was
Conservative treatment was planned to save premolar tooth
bud; treatment plan included extraction of left mandibular
first and second molars and followed by marsupialisation
under local anaesthesia. A tissue specimen was then sent
for the histological examination which confirmed our pro-
visional diagnosis of a radicular cyst. Findings of the his-
tological view showed stratified squamous epithelium with
pattern (Figure 3). Regular followup of the case was done.
Postextraction healing was uneventful.
Figure 4: Orthopantomograph showing erupted mandibular left
first and second premolars.
Figure 5: Postoperative picture after 8-month followup showing
erupted permanent mandibular left premolars.
After duration of 8 months, it was noted that underlying
permanent mandibular premolars (34, 35) erupted into their
normal position in the oral cavity, and a new bone formation
was found in cystic lesion space (Figures 4 and 5).
Radicular cysts originating from primary teeth are consid-
ered rare. The frequency is low because pulpal and periapical
infections in deciduous teeth tend to drain more readily than
those of permanent teeth and antigenic stimuli which evoke
the changes leading to formation of radicular cyst may be
According to Mass et al.  the prevalence rate of radic-
ular cysts associated with primary molars is probably higher
compared with that in the reported literature. It is possible
that, unlike cysts of permanent dentition, primary teeth are
extracted but not submitted for pathological examination,
a fact that may account for the low estimation of the real
frequency of cysts associated with primary teeth .
As these cysts are asymptomatic till secondarily infected,
they are usually diagnosed during routine radiographs. The
sequelae of an untreated or undiagnosed radicular cyst could
be harmful to the patient’s future dental development. A
patient with an untreated radicular cyst may present with the
and a bluish tinge caused by buccal expansion of the cortical
Case Reports in Dentistry3
plates. Furthermore, displacement of the successor tooth or,
even more unforgiving, the loss of its vitality may result
[4, 9, 10].
is marsupialization rather than enucleation is considered to
save the premolar tooth bud and monitoring the eruption of
 A. C. B. Delbem, R. F. Cunha, A. E. M. Vieira, and D. M. C.
Pugliesi, “Conservative treatment of a radicular cyst in a 5-
year-old child: a case report,” International Journal of Paediatric
Dentistry, vol. 13, no. 6, pp. 447–450, 2003.
 M. Shear, Cysts of the Oral Regions, Wright, Bristol, UK, 3rd
 H. C. Killey and L. W. Kay, Benign Cystic Lesions of the
Jaws, Their Diagnosis and Treatment, Churchill Livingstone,
Edinburgh, UK, 1977.
 S. Gandhi and D. L. Franklin, “Presentation of a radicular
cyst associated with a primary molar,” European Archives of
Paediatric Dentistry, vol. 9, no. 1, pp. 56–59, 2008.
Journal of Oral Pathology & Medicine, vol. 24, no. 10, pp. 458–
 J. Lustmann and M. Shear, “Radicular cysts arising from
International Journal of Oral Surgery, vol. 14, no. 2, pp. 153–161,
 Y. Ramakrishna and D. Verma, “Radicular cyst associated
with a deciduous molar: a case report with unusual clinical
presentation,” Journal of Indian Society of Pedodontics and
Preventive Dentistry, vol. 24, no. 3, pp. 158–160, 2006.
 P. N. R. Nair, “New perspectives on radicular cysts: do they
heal?” International Endodontic Journal, vol. 31, no. 3, pp. 155–
 R.E.Wood,C.J.Nortj´ e,A.Padayachee,andF.Grotepass,“Rad-
icular cysts of primary teeth mimicking premolar dentigerous
cysts: report of three cases,” ASDC Journal of Dentistry for
Children, vol. 55, no. 4, pp. 288–290, 1988.
 J. P. Lustig, D. Schwartz-Arad, and A. Shapira, “Odontogenic
cysts related to pulpotomized deciduous molars: clinical fea-
Pathology, Oral Radiology and Endodontology, vol. 87, no. 4, pp.