Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2005  |  Volume : 23  |  Issue : 1  |  Page : 49--50

Dentigerous cyst associated with permanent central incisor: A rare entity


RS Desai, SS Vanaki, RS Puranik, AS Tegginamani 
 Department of Oral and Maxillofacial Pathology, P.M.N.M. Dental College and Hospital, Bagalkot, India

Correspondence Address:

Abstract

Dentigerous cyst is one of the most prevalent types of odontogenic cyst and is associated with crown of an unerupted or developing tooth. Dentigerous cyst is more commonly seen with mandibular third molar and maxillary canine and rarely other teeth are involved. Here we report a case of dentigerous cyst involving permanent maxillary central incisor.



How to cite this article:
Desai R S, Vanaki S S, Puranik R S, Tegginamani A S. Dentigerous cyst associated with permanent central incisor: A rare entity.J Indian Soc Pedod Prev Dent 2005;23:49-50


How to cite this URL:
Desai R S, Vanaki S S, Puranik R S, Tegginamani A S. Dentigerous cyst associated with permanent central incisor: A rare entity. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2019 Dec 6 ];23:49-50
Available from: http://www.jisppd.com/text.asp?2005/23/1/49/16030


Full Text

Dentigerous simply means containing teeth[1] Dentigerous cyst is most common intra bony lesion of jaws in children. It is one of the most prevalent types of odontogenic cysts and is associated with crown of an unerupted or developing tooth, particularly the mandibular third molar, maxillary canine followed by mandibular premolars, supernumerary teeth and rarely the central incisor. Males are more commonly affected than females. It may occur at any age but the greatest incidence is in second and third decade of life.[2]

 Case Report



A 8-year-old boy presented with painless swelling in left maxillary anterior region of six months duration.

On general examination the patient was apparently healthy with normal growth and development for his age. Intra oral examination revealed a bony hard swelling in maxillary left anterior region extending from the maxillary left deciduous central incisor to deciduous second molar with well defined border measuring about 2.5 x 3 cm. No bruit or pulsation was observed. There were no signs of acute or chronic infection.

The occlusal radiological examination showed large circular well defined and unilocular radiolucent area surrounding unerupted permanent maxillary central incisor [Figure 1]. After clinical and radiological examination a provisional diagnosis of dentigerous cyst was made, however adenomatoid odontogenic tumor and ameloblastic fibroma were also considered in differential diagnosis. After routine investigations the cyst was enucleated under general anesthesia and the specimen was submitted for histopathological examination.

The excised specimen showed the cyst lining attached around cemento-enamel junction of the left permanent central incisor measuring about 3x3 cm [Figure 2]. Histopathological examination of Hematoxylin and Eosin stained section revealed cystic lumen having a thin fibrous cystic wall lined by 2-3 layers of flat epithelial cells resembling reduced enamel epithelium. The underlying connective tissue was devoid of inflammatory cell infiltration. After correlating the clinical, radiological and histopathological features a final diagnosis of dentigerous cyst was made [Figure 3].

 Discussion



Dentigerous cyst can be defined as one which encloses the crown of an unerupted tooth and is attached at the cemento-enamel junction.[3] According to a revised definition it is a cyst arising by separation of follicle from around the anatomical crown of an unerupted tooth within the jaws.[2]

Dentigerous cyst accounts for more than 24% of jaw cysts and it is the most common developmental cyst of oral region. The dentigerous cyst occurs most commonly in second[2] and third decade.[4] Investigators in their study found 1.5% incidence of central incisor involved as compared to 45.7% of mandibular third molar involving in 184 cases.[2] A very substantial majority involve mandibular third molar, the maxillary permanent canine in next order of frequency of involvement, followed by mandibular premolars and maxillary third molars in decreasing order.

A study reported by Mourshed state that 1.44 per cent of impacted teeth may undergo dentigerous cyst transformation.[5] So the dentigerous cyst involving permanent central incisors is rare. The involvement of central incisor is unusual studies by Daley and Wysocki[4] reported 0.1-0.6% and 1.5% by Shear[2]. The dentigerous cyst develops around an unerupted tooth by accumulation of fluid between the reduced enamel epithelium and the enamel. It has been suggested that the pressure exerted by a potentially erupting tooth on an impacted follicle obstructs the venous outflow and there by induces rapid transudation of serum capillary walls. The increased hydrostatic pressure of this pooling fluid separates the follicle from the crown with or without reduced enamel epithelium[2]

Unlike other odontogenic cysts, the epithelial cells that line the lumen of dentigerous cyst are reduced enamel epithelium origin and possess an unusual ability to undergo metaplastic transition into other epithelial cell types because of this unusual ability, the epithelial lining often contains focal areas of orthokeratinization or a mixture of mucin-secreting and ciliated cells. On occasion some untreated dentigerous cysts rarely but have potential to develop odontogenic tumor like ameloblastoma and malignancy like oral squamous cell carcinoma and mucoepidermoid carcinoma.[6]

Dentigerous cyst associated with anterior teeth will result in failure of eruption and leads to esthetic and orthodontic problems. Absence of central incisor can have an impact of social stigma affecting the psychology of child.

References

1Regazi, Sciubba. Oral pathology Clinical-Pathological correlations, WB Saunders Co. 1989.
2Shear M. Dentigerous (follicular) cyst. In: Cysts of the oral region, 2nd Ed. Bristol: Wright PSG; 1983. p. 56-75.
3Azaz B, Shteyer A. Dentigerous cysts associated with second mandibular bicuspids in children: Report of five cases. J Dent Child 1973;40:29-31.
4Daley TD, Wysocki GP. The small dentigerous cyst: The diagnostic dilemma Oral Pathol Oral Surg Oral Med Endod 1995;79:77-81.
5Mourshed F. A Roentenographic study of dentigerous cyst: Incidence in a population sample. Oral Surg 1964;18:54-61.
6Slootweg PJ. Carcinoma arising from reduced enamel epithelium. J Oral Pathol 1987;16:479-82.