Pediatrik Hastalarda Dentigeröz Kistler
Özet
Pediatrik hastalarda çenelerde oluşan kistik lezyonlar nadiren semptomatik olup, radiküler kistlerden sonra en sık görülen türü sürmemiş dişlerle ilişkili dentigeröz kistlerdir. Gelişimsel ve inflamatuar olmak üzere iki tipi bulunan bu kistler, genellikle asemptomatik seyrettikleri için teşhis edildiklerinde büyük boyutlara ulaşıp kortikal kemikte ekspansiyona, komşu dişlerde kök rezorpsiyonuna ve dişlerde yer değiştirmeye neden olabilirler. Ayırıcı tanıda periapikal kist, odontojenik keratokist ve ameloblastoma gibi lezyonlardan ayrılması için kesin teşhis, aspirasyon biyopsisi ve histopatolojik inceleme ile konur. Radyografik olarak sürmemiş dişin kuronu etrafında düzgün sklerotik sınırlı uniloküler radyolusent alanlar izlenir. Tedavide rutin yaklaşım total cerrahi enükleasyon ve ilişkili dişin çekilmesi olsa da çocuk hastalarda gelişmekte olan diş germini korumak, mental durumu ve oklüzyonu tehlikeye atmamak adına marsupiyalizasyon ve dekompresyon gibi konservatif yöntemler tercih edilir. Marsupiyalizasyon ile kist içi basınç azaltılarak kemik iyileşmesi tetiklenir ve belirli kriterlere sahip gömülü dişlerin ortodontik tedaviye gerek kalmadan kendiliğinden sürmesi sağlanabilir.
Although cystic lesions in the jaws of pediatric patients are rarely symptomatic, dentigerous cysts associated with unerupted teeth are the most common type after radicular cysts. These cysts, categorized into developmental and inflammatory types, are generally asymptomatic; hence, by the time they are diagnosed, they may reach large sizes, causing cortical bone expansion, root resorption of adjacent teeth, and tooth displacement. To differentiate them from lesions like periapical cysts, odontogenic keratocysts, and ameloblastomas, a definitive diagnosis is established through aspiration biopsy and histopathological examination. Radiographically, well-circumscribed unilocular radiolucent areas with smooth sclerotic borders are observed around the crown of an unerupted tooth. Although the routine treatment consists of total surgical enucleation and extraction of the involved tooth, conservative methods such as marsupialization and decompression are preferred in pediatric patients to protect the developing tooth germ and avoid compromising their mental status or occlusion. Marsupialization reduces intracystic pressure, triggers bone healing, and can enable embedded teeth meeting specific criteria to erupt spontaneously without requiring orthodontic treatment.
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