Dental cyst surgery: when is it necessary and how long does it take?

A dental cyst is a sac-like formation or closed cavity filled with fluid that develops within the jawbone or in the soft tissues surrounding the teeth.

Most jawbone cysts share similar characteristics, namely slow, asymptomatic, expansive growth, which will eventually lead to bone deformation. For this reason, they need to be removed surgically.

Dr. Marina Băjinaru, a specialist in dento-alveolar surgery, explains in this article the causes of dental cysts, the different types of dental cysts, and the recommended treatment.
 

A dental cyst is a pathological fluid-filled formation of bacterial origin that develops at the root of a tooth, usually as a result of an untreated infection.  

Causes of dental cysts:

• chronic bacterial infections caused by untreated tooth decay;
• pulp necrosis (dead nerve);
• incorrect root canal treatments;
• dental trauma.

Types of dental cysts

Depending on the cause of the cyst and its location, dental cysts can be either inflammatory or developmental.

Inflammatory cysts:

• Periapical cyst – develops at the tip of the root of a devitalised (nerve-free) tooth, as a result of inflammation caused by dental caries or trauma. These are the most common types of odontogenic cysts.
• Residual cyst – occurs when a periapical cyst is not completely removed during tooth extraction. Microscopically, residual cysts are identical to periapical cysts.
• Paradental cyst – also known as a buccal bifurcation cyst, this type of cyst occurs at the crown or root of a partially or fully erupted tooth.

Developmental cysts:

• Dentigerous cyst – occurs when fluid accumulates between the crown of the tooth and the enamel epithelium, leading to dilation of the dental follicle. It can occur in a wisdom tooth that remains impacted within the bone.
• Eruption cyst – occurs when the dental follicle does not separate properly from the erupting tooth.
• Gingival cyst – occurs in the gum, usually near the teeth. In most cases, it is benign and does not cause pain.
• Lateral periodontal cyst – is a growth that forms near the root of the tooth, from small remnants of tissue left over from the period when the teeth were developing.
• Keratocyst – is also caused by tissue remnants left over from the period when the teeth were developing. Although it is asymptomatic, like other types of cyst, when it grows to a large size, it may be accompanied by pain.

Detecting a dental cyst is difficult, not only in its early stages but even when it has grown to a large size, as it is asymptomatic.  

“Often, a dental cyst is discovered by chance during routine check-ups, through an investigation such as a cone-beam computed tomography (CBCT) scan. Clinical examination and the interpretation of radiological investigations are essential in assessing a cyst. Testing the vitality of the tooth is equally important. This is necessary to establish a correct differential diagnosis and to select the appropriate treatment plan,” explains Dr Marina Băjinaru, a specialist in dento-alveolar surgery.

Dental cyst X-ray  

Taking a dental X-ray is, in most cases, the only way to detect an inflammatory dental cyst.  

The affected tooth is devitalised, usually as a result of extensive dental caries and/or trauma, so there is no pain at the root.

Radiographically, the periapical cyst appears as a unilocular radiolucent area at the apex of the tooth root, with well-defined margins, which may sometimes be bordered by a dense bony contour.

Dental cysts do not go away on their own and, if left untreated, they grow in size.

In most cases, the main treatment option is endodontic treatment (root canal treatment).

“In the case of periapical granulomas, which are the early stage of cysts, endodontic treatment may be attempted as the first-line approach. If the lesion persists, conservative surgical treatment of the affected tooth will be carried out, involving apical resection – a much less invasive procedure than a cystectomy, whilst preserving the tooth.” – Dr Marina Băjinaru.

Cystectomy, the procedure by which a dental cyst is removed, is necessary when the infection can no longer be treated using endodontic methods, that is, when the cyst has grown to a large size.  

There are two surgical methods for removing a dental cyst:

• Apical resection, which involves removing the tip of the root of the affected tooth, together with the cyst, if it is still very small.
• Cystectomy is carried out under local anaesthetic and involves making an incision in the gum to expose the cyst and remove it.

Tooth extraction is recommended in cases where the affected tooth is irreparably damaged and the cyst is large. 

The duration of a dental cyst operation (dental cystectomy) varies depending on the size and location of the cyst, as well as the complexity of the procedure.  

A dental cystectomy can take anywhere from 30 minutes to several hours. 

The cost of a dental cystectomy at DENT ESTET depends on the location of the cyst, its size and the type of anaesthesia used.

See the DENT ESTET price list. 

Recovery following a dental cystectomy usually takes 7–14 days, involving mild discomfort and oedema (swelling) during the first 48–72 hours.

These symptoms can be alleviated by applying ice packs and taking medication. It is also important to avoid physical exertion, smoking and alcohol to prevent complications. 

A large dental cyst poses a risk to the surrounding bone structures and neighbouring teeth.  

Treatment, whether surgical or non-surgical, is recommended to remove the cystic sac, clean the infected area and prevent serious complications, such as an exacerbation of the condition, a dental abscess, tooth loss or a fracture of the jaw.