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CASE REPORT
Year : 2008  |  Volume : 26  |  Issue : 4  |  Page : 168-170
 

Dentigerous cyst in primary dentition: A case report


1 Department of Pedodontics, Dr. HSJ Institute of Dental Sciences, Punjab University, Chandigarh., India
2 Department of Oral Surgery, Dr. HSJ Institute of Dental Sciences, Punjab University, Chandigarh, India

Correspondence Address:
S Passi
Dr. HSJ Institute of Dental Sciences, Punjab University, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.44035

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   Abstract 

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between the reduced enamel epithelium and the tooth crown of an unerupted tooth. There is usually no pain or discomfort associated with the cyst unless there is acute inflammatory exacerbation. Management of dentigerous cyst in primary dentition needs special consideration regarding the preservation of the developing permanent tooth buds. Here, we report a case of dentigerous cyst in primary dentition in a 10-year-old male patient and its management.


Keywords: Dentigerous cyst, marsupilization, primary dentition


How to cite this article:
Passi S, Gauba K, Agnihotri A, Sharma R. Dentigerous cyst in primary dentition: A case report. J Indian Soc Pedod Prev Dent 2008;26:168-70

How to cite this URL:
Passi S, Gauba K, Agnihotri A, Sharma R. Dentigerous cyst in primary dentition: A case report. J Indian Soc Pedod Prev Dent [serial online] 2008 [cited 2019 Nov 12];26:168-70. Available from: http://www.jisppd.com/text.asp?2008/26/4/168/44035



   Introduction Top


Cysts of the jaw present as swelling of jaws and midface. Of the different varieties, odontogenic cysts are the ones that develop from epithelial remnants of the tooth-forming organ. A dentigerous cyst is an epithelial-lined developmental cavity that encloses the crown of an unerupted tooth at the cementoenamel junction. Dentigerous cysts are the second most common odontogenic cyst after the radicular cyst accounting for 24% of all the true cysts of the jaw. [1] Dentigerous cysts are generally discovered when radiographs are taken to investigate a failure of tooth eruption, missing tooth, or malalignment. There is usually no pain or discomfort associated with the cyst unless there is acute inflammatory exacerbation. Radiographs show a unilocular, radiolucent lesion characterized by a well-defined sclerotic margins and associated with crown of the unerupted tooth. While the normal follicular space is 3-4 mm, a dentigerous cyst can be suspected when the space is more than 5 mm. [2]

Various treatment options have been proposed for the management of dentigerous cyst. Two most common treatment modalities used are: (1) total enucleation for small lesions, and (2) marsupilization for decompression of large of large volume cysts, or a combination of both. [3],[4],[5]


   Case Report Top


A 10-year-old boy presented to the Department of Pedodontics, Dr. H.S. Judge Institute of Dental Sciences, Chandigarh, with the chief complaint of pain and swelling in the lower right side of the jaw. Clinical history revealed that the swelling started as a small painless nodule which increased to the present size over a period 10 months. Extraoral examination revealed hard firm swelling present near the lower border of the mandible [Figure 1]. Intraoral examination revealed swelling of firm consistency causing bulging of the cortical bone with pain and mobility of the teeth in the same region [Figure 2]. The swelling was tender and egg-shell crackling was elicited with 84 and 85 that were found to be cariously involved. Radiographic examination showed unilocular, radiolucent area extending from mesial root of deciduous mandibular right first molar to the distal aspect of the root of the left deciduous canine enclosing the tooth buds of premolars causing displacement of the same [Figure 3]. Histopathologic examination of the aspiration biopsy showed a cystic lesion, and presumptive diagnosis of the dentigerous cyst was made. To spare the unerupted permanent tooth buds marsupilization was chosen as a treatment of choice. Surgical intervention was performed under local anesthesia. Treatment procedure comprised of extraction of 83, 84, and 85 which created a large window. The flap was reflected along with the thinned-out bone. The contents of the cyst were evacuated and the cyst was irrigated to remove any residual fragments and debris [Figure 4]. The cavity was packed with iodoform glycerin guaze. The dressing was placed in such a manner so as to stabilize displaced premolars in their minimally developed sockets and to guide their eruption. The removed surgical specimen was histopathologically examined confirming the diagnosis of dentigerous cyst. The patient was recalled after 10 days for the change of dressing to allow decompression and eruption of the teeth [Figure 5]. After one month both the premolars erupted into the dental arch.


   Discussion Top


Dentigerous cysts are common developmental cysts. Since cysts can attain considerable size with minimal or no symptoms, early detection and removal of the cysts is important to reduce morbidity. Although evidence in the literature suggests that dentiger­ous cysts occur more frequently during the second decade of life, [6],[7] these lesions can also be found in children and adolescents. The incidence of dentigerous cysts is twice as high in male patients [8],[9] compared to female counterparts.

Marsupilization, decompression, and the Partsch operation all refer to creating a surgical window in the wall of the cyst, evacuating the contents of the cyst, and maintaining continuity between the cyst and the oral cavity, maxillary sinus, or nasal cavity. It is a technique that attempts to relieve intracystic pressure through the creation of an accessory cavity. This technique was selected since it is a more conservative intervention for the treatment of large cysts, especially in pediatric dentistry, considering the frequent proximity of these lesions to the developing permanent teeth buds, as is evident in the case under discussion [Figure 3]. Marsupilization can be used either as a sole therapy for a cyst or as a preliminary step in management, with enucleation deferred until later. In most instances enucleation is done after marsupilization. In the case of a dentigerous cyst involving unerupted permanent teeth, there may not be any residual cyst to remove once the teeth erupt into the dental arch as seen in the present case wherein the unerupted permanent teeth erupted into the dental arch [Figure 5].

 
   References Top

1.D0 aley TD, Pringle GA. Relative incidence of odontogenic tumours and oral and jaw cysts in a Canadian population. Oral Sur Oral Med Oral Pathol 1994;77:276-80.  Back to cited text no. 1    
2.Goaz PW, Stuart CW. Cysts of the jaws. In: Oral radiology, principles and interpretation. 3 rd . St. Louis: Mosby; 1994. p. 400.  Back to cited text no. 2    
3.Delbem AC, Cunha RF, Vieira AE, Pugliesi DM. Conservative treatment of radicular cyst in a 5- yr, Old child: A case report. Ibt J Paediatr Dent 2003;13:447-50.  Back to cited text no. 3    
4.Perez DM, Molare MV. Conservative treatment of dentigerous cyst in children: A Report of 4 cases. J Indian Soc Pedod Prev Dent 1996;14:49-51.  Back to cited text no. 4    
5.Fortin T, Couder JL, Francois B, Huer A, Niogrer F, Jourlin M, et al. Marsupilization of dentigerous cyst associated associated with foreign body using 3 D CT images: A case report. J Clin Pediatr Dent 199;22:29-33.  Back to cited text no. 5    
6.Arotiba JT, Lawoyin JO, Obiechina AE. Pattern of occurrence of odontogenic cysts in Nigerians. East Afr Med J 1998;75:664-6.  Back to cited text no. 6  [PUBMED]  
7.Ziccardi VB, Eggleston Tl, Scheinder RE. Using fenestration technique to treat a large dentigerous cyst. J Am Dent Assoc 1997;128:201-5.  Back to cited text no. 7    
8.Benn A, Altini M. Dentigerous cysts of inflammatory origin: A clinicopathologic study. Oral Surg Oral Radiol Endod 1996;81:203-9.  Back to cited text no. 8    
9.Ustuner E, Fitoz S, Atasoy C, Erden I, Akyar S. Bilateral maxillary dentigerous cysts: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:632-5.  Back to cited text no. 9    


    Figures

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


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    Abstract
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