Dentigerous Cyst of Mandible: Literature Review and Case Report

Moitra PN and Kamble R

Published on: 2025-06-07

Abstract

A dentigerous cyst of the mandible is a rare entity in routine clinical practice. A dentigerous or follicular cyst is formed from the accumulation of fluid between the reduced enamel epithelium and the completely formed tooth crown or in the layers of the reduced enamel epithelium. Pulp necrosis is a commonly observed sequel in traumatised primary teeth and is one of the possible etiologic factors for the development of dentigerous teeth. These cysts are discovered unexpectedly on routine radiographic examination since DCs are asymptomatic unless after an infection. Decompression by simple marsupialization and extended follow-up are important roles in bone deposition and reduction of the cyst. Furthermore, surgical extraction can be performed non-traumatically for the cyst-associated tooth. One such case has been described in this report in which the treatment of choice was marsupialization along with extraction of the involved tooth.

Keywords

Dentigerous cyst; Marsupialization; Enucleation

Introduction

Dentigerous cysts (DC) are the second most common odontogenic cysts after radicular cysts, accounting for 37.9% - 84.5% of all odontogenic cysts. The crown, or a portion of the crown, of an unerupted or impacted tooth is surrounded by a dentigerous cyst [1]. The incidence of DCs is highest in the second and third decades of life. This cyst is usually rare in the first decade. For this reason, when it comes to diagnosis in young patients, it is usually difficult to state a definitive diagnosis without a pathological and radiographic diagnosis. DC is caused by an alteration of the reduced enamel epithelium (after completion of amelogenesis) that results in fluid accumulation between it and the enamel of the crown [2]. Dentigerous cysts, because they are usually asymptomatic, are sometimes recognised after they have expanded into the alveolar bone and have led to destruction [3]. On radiographic examination, a dentigerous cyst usually appears as a well-demarcated unilocular radiolucency, surrounding the crown of an unerupted tooth [2]. The cyst lining has non-keratinised stratified squamous epithelium. Enucleation or Marsupialization can be used to treat dentigerous cysts [4]. It is important to choose a safe treatment in young individuals and avoid surgical approaches that lead to aesthetic, functional, and psychological problems if facial defects occur. The decompression of large cysts was outweighed when the cyst is large to avoid the previously mentioned drawbacks of enucleation. Whenever these cysts are detected in a late stage, they are usually treated by enucleation followed by the extraction of the involved tooth [1].

Case Report

A 7-year-old male patient reported to the Department of Oral Medicine and Radiology, MCDRC, Chhattisgarh, INDIA, with his parents with a chief complaint of pain and swelling in his left lower back region of the jaw for one month. Swelling was insidious in onset, small in size. Swelling was accompanied with pain after 1 week. Pain was dull and throbbing in nature, causing an inability to chew from the left side and relieved on taking analgesics. Medical history was unremarkable. In the extraoral examination, slight facial asymmetry was observed, with submandibular lymph node swelling on the left side. Intraoral examination revealed deep occlusal caries w.r.t. 75 with a sinus opening on the buccal aspect with no active pus drainage. Obliteration of the buccal vestibule along with the bucco-lingual cortical plate expansion was appreciated. On the basis of the patient’s complaint and clinical examination, the provisional diagnosis was arrived at as an infected dentigerous cyst. Differential diagnosis included odontogenic keratocyst, ameloblastoma and radicular cyst. The panoramic radiograph revealed a large unilocular radiolucency (osteolytic lesion) associated with the crown of an unerupted permanent mandibular second premolar. There was resorption of the mesial root of the primary mandibular second molar. The lesion’s clinical appearance was compatible with a dentigerous cyst. No resorption of the lingual cortical plate was appreciated on the axial section of the CBCT. Biopsy analysis confirmed a typical dentigerous cyst lined by non-keratinised squamous epithelium with mild inflammatory cellular infiltration in the connective tissue with no dysplastic changes. On the basis of clinical, radiographic and histopathological examination, a final diagnosis of dentigerous cyst was made. The choice of treatment in this case was marsupialization of the cyst along with the extraction of 74 and 75. After the haematological examinations revealed normal values, the surgical procedure was carried out. The patient was prescribed antibiotics, analgesics, mouthwash and topical ointment for a period of 5 days. The patient was recalled periodically for the assessment of recurrence of the swelling, and even after 6 months of follow-up, there was no such recurrence. Six months after treatment, a panoramic radiograph revealed that the cystic lesion had disappeared and there was new bone growth.

Figure 1: Pre-Operative Extraoral Photo of the Patient (Frontal View).

Figure 2: Pre-Operative Intraoral Photo of the Patient Showing the Deciduous Carious Tooth, I.E. 75.

Figure 3: Pre-Operative Orthopantomogram of Patient.

Figure 4: Post-Operative Extraoral Photo of the Patient (Frontal View).

Figure 5: Post-Operative Intraoral Photo of the Patient.

Figure 6: Post-Operative Orthopantomogram of Patient.

Discussion

Dentigerous cysts were divided into developmental and inflammatory kinds by Benn and Altini in 1996. The majority of mandibular third molars are affected by developmental dentigerous cysts, which are caused by impacted mature teeth. The inflammatory type, on the other hand, affects a developing permanent tooth and is caused by an infected necrotic primary tooth stimulating the immature germ follicle of the permanent tooth [5].

According to Bloch, the overlying necrotic deciduous tooth is the source of the dentigerous cyst. The periapical infection that results will spread to an unerupted permanent successor follicle, resulting in inflammatory exudates and the creation of a dentigerous cyst [6].

When it comes to making a definitive diagnosis, a histologic examination is always the gold standard. Several treatment options for removing dentigerous cysts are suggested, with the goal of complete pathology elimination and dentition preservation with minimal surgical intervention [7].

Marsupialization, also known as decompression, is a procedure for relieving intracystic pressure by creating an auxiliary cavity. Hyomoto et al. (2003) discovered that marsupialization assisted the natural eruption of the concerned tooth in dentigerous cysts in 72.4 percent of cases, implying that it should be considered as a first line of treatment in paediatric patients. Because the dental follicle surrounding an unerupted tooth's crown is normally bordered by a thin layer of decreased enamel epithelium, microscopic characteristics alone may make it difficult to distinguish a small dentigerous cyst from a normal or larger dental follicle [8].

Dentigerous cysts, as opposed to radicular cysts or odontogenic keratocyst, appear to be more likely to cause root resorption of adjacent teeth. Cysts that form in a growing adolescent will grow considerably faster than in an adult. Treatment for a dentigerous cyst is determined by its size, location, and deformity; it frequently necessitates varied bone removal to guarantee entire cyst removal, especially in the case of big cysts. If the cyst is small, it can be enucleated, but a larger cyst may require marsupialization to be completely removed. Whenever a young patient's teeth are most important to them and the lesion is isolated, marsupialization is the choice of treatment [9].

In such situations, proper decision-making in selecting the appropriate treatment modality plays a crucial role in the prognosis of the overall therapy. For the present case, we considered all possible modalities by taking into account factors such as age, gender, location, and size, as well as the patient’s socioeconomic status. When treating a dentigerous cyst, because it is difficult to maintain patency in a bony lesion [10].

Conclusion

This case report shows the necessity for early diagnosis and treatment of a dentigerous cyst associated with an impacted tooth. Marsupialization is an effective surgical technique, even for an infected cyst. The patient must understand the importance of good oral hygiene in such cases for a satisfactory treatment.

Funding: No source of funding

Competing Interests: Not applicable

References