Benn A, Altini M
Department of Conservative Dentistry, University of the Witwatersrand, Johannesburg, South Africa.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Feb;81(2):203-9. doi: 10.1016/s1079-2104(96)80416-1.
The exact histogenesis of dentigerous cysts remains unknown, but most authors favor a developmental origin from the tooth follicle. The aim of this article is to report a series of 15 dentigerous cysts that we believe to be of inflammatory origin. These inflammatory dentigerous cysts occurred in the first and early part of the second decades of life. Males were affected more frequently, and there did not appear to be any racial predilection. All of the cases involved permanent teeth: premolars in nine cases, canines in four cases, and second molars in two cases. The mandible was affected twice as frequently as the maxilla. In 13 cases, nonvital grossly carious or heavily restored deciduous teeth were associated with the cysts. Some of these teeth had been extracted before the cysts were diagnosed. In the remaining two cases, both of which involved the second permanent molars, there were no nonvital deciduous teeth, however both had concomitant proliferative periostitis. All of the cysts were moderately or intensely inflamed and were lined predominantly or entirely by nonkeratinized stratified squamous epithelium that in some cases was markedly hyperplastic and exhibited anastomosing rete ridges mimicking radicular cysts. In the majority of cases, parts of the cysts were lined with a 2 to 3 cell layer thick cuboidal epithelium that we believe was derived from reduced enamel epithelium. Rests of odontogenic epithelium frequently were evident in the cyst walls. We suggest that these cysts arose as a result of periapical inflammation from any source but usually from a nonvital deciduous tooth and spreading to involve the follicles of the unerupted permanent successors. The inflammatory exudate causes separation of the reduced enamel epithelium from the enamel with resultant cyst formation. This study proposes the existence of two types of dentigerous cysts: one developmental and the other inflammatory in nature.
含牙囊肿的确切组织发生尚不清楚，但大多数作者倾向于认为其起源于牙囊的发育过程。本文旨在报告一系列我们认为起源于炎症的15例含牙囊肿。这些炎性含牙囊肿发生在生命的第二个十年的第一个十年及早期。男性受影响更为频繁，且似乎不存在任何种族偏好。所有病例均累及恒牙：9例为前磨牙，4例为尖牙，2例为第二磨牙。下颌骨受累的频率是上颌骨的两倍。在13例病例中，肉眼可见的无活力的严重龋坏或修复过度的乳牙与囊肿相关。其中一些牙齿在囊肿被诊断之前就已拔除。在其余2例病例中，均累及第二恒磨牙，没有无活力的乳牙，但两者均伴有增生性骨膜炎。所有囊肿均有中度或重度炎症，主要或完全由非角化复层鳞状上皮衬里，在某些情况下，该上皮明显增生并呈现出类似根囊肿的吻合性 rete 嵴。在大多数病例中，囊肿的部分区域衬有2至3层细胞厚的立方上皮，我们认为其来源于釉质上皮的缩余。牙源性上皮残余在囊肿壁中常常可见。我们认为这些囊肿是由任何来源的根尖周炎症引起的，但通常来自无活力的乳牙，并扩散至累及未萌出恒牙的牙囊。炎性渗出物导致釉质上皮与釉质分离，从而形成囊肿。本研究提出存在两种类型的含牙囊肿：一种是发育性的，另一种本质上是炎性的。
