Print this page Email this page | Users Online: 445
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 6  |  Issue : 1  |  Page : 65-68

Normal eruption of impacted teeth associated with a dentigerous cyst managed by simple extraction and decompression


1 Department of Pedodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India
2 Department of Oral Diagnosis and Radiology, VSPM Dental College and Research Center, Nagpur, Maharashtra, India

Date of Web Publication19-Jan-2015

Correspondence Address:
Ritesh Rambharos Kalaskar
Department of Pedodontics, Government Dental College and Hospital, Nagpur, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-433X.149598

Rights and Permissions
  Abstract 

Dentigerous cyst is an epithelial-lined cavity that encloses the crown of an unerupted tooth at the cementoenamel junction, can be either developmental or inflammatory in origin. The purpose of this paper was to report of an asymptomatic dentigerous cyst of inflammatory origin in a 7.5-year-old child who was managed by conservative means of a simple extraction, followed by decompression under local anesthesia. After 16 months of follow-up, the cyst was completely ossified, and the displaced premolars were normally erupted in the oral cavity. Similarly, we also noticed rapid root maturation of the cyst involved premolars than the contralateral premolars.

Keywords: Decompression, dentigerous cyst, extraction, impacted tooth, inflammatory mandibular premolar


How to cite this article:
Kalaskar RR, Kalaskar AR. Normal eruption of impacted teeth associated with a dentigerous cyst managed by simple extraction and decompression. SRM J Res Dent Sci 2015;6:65-8

How to cite this URL:
Kalaskar RR, Kalaskar AR. Normal eruption of impacted teeth associated with a dentigerous cyst managed by simple extraction and decompression. SRM J Res Dent Sci [serial online] 2015 [cited 2023 Feb 8];6:65-8. Available from: https://www.srmjrds.in/text.asp?2015/6/1/65/149598


  Introduction Top


Inflammatory dentigerous cyst (IDC) is a relatively uncommon type of odontogenic cyst usually associated with the carious or traumatic nonvital primary teeth. [1] This cyst is mostly asymptomatic in nature and is discovered on routine radiographic examination. Radiographically, the cysts appear as a well-defined round or ovoid unilocular radiolucency with sclerotic border surrounding the crown of an involved unerupted permanent tooth. [2] This cyst gradually increases in size and may cause bone destruction, displacement, and resorption of the adjacent teeth as well as the obliteration of the maxillary antrum and nasal cavity. Due to the multipotentional nature of the cystic epithelium, several entities may also be associated with the wall of a dentigerous cyst such as odontogenic keratocyst, ameloblastoma, cystic ameloblastoma, and mucoepidermoid carcinoma. Therefore, these entities should be considered in the differential diagnosis. [3] Pathogenesis of a dentigerous cyst is still controversial; either developmental of inflammatory in origin. [4]

Inflammatory dentigerous cyst can be treated either by enucleation or marsupialization. The latter approach is preferred for larger cysts in pediatric patients because it facilitates eruption of the unerupted involved permanent teeth. [5],[6] The paper describes the management of an IDC that was treated by marsupialization that allowed complete normal eruption of the involved unerupted permanent tooth.


  Case report Top


A 7.5-year-old girl with noncontributory medical history reported to the Department of Pediatric Dentistry with a complaint of pain and swelling in relation to the mandibular left posterior region since 1 week. On extraoral examination, a buccal bulge was present in the mandibular left posterior region which was tender and hard on palpation. Intraoral examination revealed the presence of grossly carious mandibular primary left and right second molar [Figure 1]. A panoramic radiograph was advised which revealed a well-defined radiolucency of 3 cm × 3 cm in diameter in relation to the roots of mandibular primary first and second molar. The radiolucency also involved unerupted mandibular left premolars. Mandibular left second premolar was displaced towards the lower border of mandible [Figure 2]. Mandibular left first and second premolars were in the 6 th stage of Nolla's tooth development, which was coinciding with dental and chronological age of the patient [Figure 2]. Based on clinical and radiological findings, a provisional diagnosis of IDC was made. Marsupilization of the lesion was planned to save the unerupted premolars. Routine blood examinations were advised before marsupilization which were within normal limits.
Figure 1: Intraoral photograph showing carious 85

Click here to view
Figure 2: Panoramic radiograph showing well-defined osteolytic lesion surrounding the crown of 35

Click here to view


Under local anesthesia (Dentocaine 2% Pharma Health Care Product, Mumbai), extraction of mandibular primary left first and second molar was done which led to opening of the cystic cavity and draining of thick brown-colored fluid. During this process, enough soft tissue was removed from the superior portion of the cyst for histopathological analysis. Cortical plates were compressed, and a sterile iodoform gauge was placed in the cystic cavity for continuous drainage. The iodoform gauge was changed after every 2 days for a period of one. After 1 week, the edges of the extraction wounds had epithelialized. Histopathological examination showed dentigerous cyst lined by stratified squamous epithelium having features of inflammation including numerous proliferating blood vessels and mixed inflammatory cells [Figure 3]. The patient was recalled after every 3 months for follow-up examinations. Nine-month follow-up clinical and radiographic examinations showed erupted premolars and almost complete bone healing [Figure 4] and [Figure 5]. After 13 months of follow-up, the radiolucent lesion was completely resolved, and the premolars had erupted completely. The apex of the involved second premolar was almost closed [Figure 6]. Whereas, the mandible right premolars showed only 1/3 of root formation [Figure 6].
Figure 3: Histopathological image of the lesion showing more colonized fibrous wall with chronic inflammatory cells and thicker epithelial lining

Click here to view
Figure 4: Clinical picture after 12 months of decompression

Click here to view
Figure 5: A 12-month follow-up panoramic radiograph showed reduced size of the osteolytic lesion

Click here to view
Figure 6: An 18-month follow-up panoramic radiograph showing complete ossification of the lesion and premolars in occlusion

Click here to view



  Discussion Top


Dentigerous cyst can be either developmental or inflammatory in origin. Developmental type mostly affects impacted mature tooth, usually the mandible's third molar. [7] IDC develops as a result of intrafollicular spread of periapical inflammation from an overlying nonvital primary tooth. This cyst usually involves the unerupted immature premolars, because the follicle of the premolars is more closely associated with the roots of primary mandible's molars, facilitating easy spread of inflammation. [8] They are mostly observed in the first and early part of the second decade. [9] It is known that almost every child had one or more decayed primary molars, but only a few proportions of them progress to develop into an IDC. This could be attributed to the fact that:

  1. Either the cyst is under-reported or under-recognized,
  2. Might resolve after removal or exfoliation of the involved primary tooth,
  3. Resolve after pathologic resorption of the entire root, 4. Primary molar roots are not closely associated with its successors.


These cysts have also been reported to occur even after pulp treatment. Asiαn-Gonzαlez et al.[10] reported with an IDC in a formocresol pulpotomized primary molar. It seems that even early endodontic treatment cannot prevent the development of these cysts.

Odontogenic keratocyst, unicystic ameloblastoma, radicular cyst are considered in the differential diagnosis of IDC. IDC is usually observed in the first decade of life, whereas all the above-mentioned lesions are observed in the second and third decade. Second, leaking out of cystic fluid during an extraction of a primary tooth confirms the clinical impression of the cyst. Radiograph alone cannot differentiate the above-mentioned lesions so a histopathological examination should be performed wherever possible. In the present case, content of the cystic cavity and histopathological examination confirmed the diagnosis of IDC.

Inflammatory dentigerous cyst can be either treated with marsupialization or enucleation. Marsupialization is preferred by many authors due to many advantages such as : C0 onservative technique, prevent loss and facilitate eruption of permanent teeth, stimulate rapid bone formation, and prevent damage to anatomic structures such as maxillary sinus and inferior alveolar nerve. Study conducted by Qian et al. suggested that IDC associated mandibular premolars can erupt spontaneously after marsupialization. [11] A recent case report in a 10-year-old child in which permanent teeth in relation to IDC were saved by marsupialization. [12] However, marsupialization leaves the pathologic tissue in situ that increases the risk of recurrence and a possibility of an aggressive lesion in the residual tissue. [11]

It is a well-known fact that there is a close relationship between the eruption and level of root formation. [12] A permanent tooth breaks through the alveolar bone when approximately two-third of the root formation has taken place and continues to erupt within the oral cavity till a stage of wide open apex. [12],[13] But this might not be true for the tooth associated with an IDC. Such teeth on the contrary show rapid eruption and rapid root maturation. In the present case, eruption of the cyst associated premolar was faster than the noncyst associated contralateral premolars. It is suggested that marsupialization decreases the intracystic pressure that speed up the eruption rate and rapid bone formation. [14]

In the case of mature root, the tooth may not erupt to the normal position because the tooth has lost the ability to erupt and may be hopelessly displaced. [7],[8],[15] Such cases usually required orthodontic traction to facilitate eruption. There are no data available with respect to the optimum timing to initiate orthodontic traction of the cyst associated premolars. However, we suggest that a complete resolution of the radiolucent lesion is the optimum timing to initiate orthodontic traction if required.


  Conclusion Top


Inflammatory dentigerous cysts can be treated successfully by extraction of the nonvital and decompression of the cystic cavity. Although cyst associated premolar show rapid eruption, the chance of mesial and distal drifting of the adjacent tooth is also increased; hence, space maintainer should be planned. Due to multipotential nature of this cystic epithelium, the patient must be followed up until eruption of the involved permanent teeth and bony consolidation of the cyst.

 
  References Top

1.
Tilakraj TN, Kiran NK, Mukunda KS, Rao S. Non syndromic unilateral dentigerous cyst in a 4-year-old child: A rare case report. Contemp Clin Dent 2011;2:398-401.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Kumar R, Singh RK, Pandey RK, Mohammad S, Ram H. Inflammatory dentigerous cyst in a ten-year-old child. Natl J Maxillofac Surg 2012;3:80-3.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Farman GA, Nortjé CJ, Wood RE. Cysts of the jaws. In: Oral and Maxillofacial Diagnostic Imaging. 1 st ed. St. Louis, MO: Mosby Co.; 1993. p. 212-6.  Back to cited text no. 3
    
4.
Kusukawa J, Irie K, Morimatsu M, Koyanagi S, Kameyama T. Dentigerous cyst associated with a deciduous tooth. A case report. Oral Surg Oral Med Oral Pathol 1992;73:415-8.  Back to cited text no. 4
    
5.
Bodner L, Woldenberg Y, Bar-Ziv J. Radiographic features of large cystic lesions of the jaws in children. Pediatr Radiol 2003;33:3-6.  Back to cited text no. 5
    
6.
Berdén J, Koch G, Ullbro C. Case series: Treatment of large dentigerous cysts in children. Eur Arch Paediatr Dent 2010;11:140-5.  Back to cited text no. 6
    
7.
Benn A, Altini M. Dentigerous cysts of inflammatory origin. A clinicopathologic study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:203-9.  Back to cited text no. 7
    
8.
Mahajan S, Raj V, Boaz K, George T. Non-syndromic bilateral dentigerous cysts of mandibular premolars: A rare case and review of literature. Hong Kong Dent J 2006;3:129-33.  Back to cited text no. 8
    
9.
Mintz S, Allard M, Nour R. Extraoral removal of mandibular odontogenic dentigerous cysts: A report of 2 cases. J Oral Maxillofac Surg 2001;59:1094-6.  Back to cited text no. 9
    
10.
Asián-González E, Pereira-Maestre M, Conde-Fernández D, Vilchez I, Segura-Egea JJ, Gutiérrez-Pérez JL. Dentigerous cyst associated with a formocresol pulpotomized deciduous molar. J Endod 2007;33:488-92.  Back to cited text no. 10
    
11.
Qian WT, Ma ZG, Xie QY, Cai XY, Zhang Y, Yang C. Marsupialization facilitates eruption of dentigerous cyst-associated mandibular premolars in preadolescent patients. J Oral Maxillofac Surg 2013,71:1825-32.  Back to cited text no. 11
    
12.
Kumar R, Singh RK, Pandey RK, Mohammad S, Ram H. Inflammatory dentigerous cyst in a ten-year-old child. Natl J Maxillofac Surg 2012;3:80-3.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.
Bodner L. Cystic lesions of the jaws in children. Int J Pediatr Otorhinolaryngol 2002;62:25-9.  Back to cited text no. 13
    
14.
Miyawaki S, Hyomoto M, Tsubouchi J, Kirita T, Sugimura M. Eruption speed and rate of angulation change of a cyst-associated mandibular second premolar after marsupialization of a dentigerous cyst. Am J Orthod Dentofacial Orthop 1999;116:578-84.  Back to cited text no. 14
    
15.
Takagi S, Koyama S. Guided eruption of an impacted second premolar associated with a dentigerous cyst in the maxillary sinus of a 6-year-old child. J Oral Maxillofac Surg 1998;56:237-9.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed2366    
    Printed120    
    Emailed0    
    PDF Downloaded232    
    Comments [Add]    

Recommend this journal