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INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010:2(1):28-32

CASE REPORT

Bilateral Maxillary Dentigerous Cysts A Case Report

Kannan.N1, Patil Rajendra2, Sreenivasulu.P3

Abstract: A dentigerous cyst is the second most common Odontogenic cyst, after radicular cyst. It encloses the crown of an unerupted tooth at the cementoenamel junction; the mandibular third molars are the most commonly affected &maxillary canines are next commonly affected. This cyst accounts for approximately 24% of all true cysts of the jaws, and their frequency in the general population has been estimated at 1.44 cysts for every 100 unerupted teeth. This paper reports the presentation of a bilateral maxillary dentigerous cyst and its incidence present in the literature.

Key Words: Dentigerous Cyst, Maxilla, Odontogenic cyst etc.

Received on: 5th December 2009 Accepted on: 22 February 2010

Introduction: A dentigerous cyst is the second most common odontogenic cyst, after radicular cyst(1). It encloses the crown of an unerupted tooth at the syndromes, bilateral dentigerous cysts associated with the mandibular third molars are rare. This cyst accounts for approximately 24% of all true cysts of the jaws, and their frequency in the general population has been estimated at 1.44 cysts for every 100 unerupted teeth. There is usually no pain or discomfort associated with the cyst unless it becomes secondarily infected(6, 7).

cementoenamel junction; the mandibular third molars are the most commonly affected &maxillary canines are next commonly affected (1-3). They usually present in the 2 or 3 decades of life and rarely seen during childhood(2, 4). Most of the dentigerous cysts are single and solitary(2, 4). Bilateral and multiple cysts are usually found in association with a number of syndromes including Cleidocranial Dysplasia and MaroteauxLamy syndrome(2-5). In the absence of these Cite This Article: Kannan.N, Patil Rajendra, Sreenivasulu.P. Bilateral Maxillary Dentigerous Cysts A Case Report. Int J Dent Clinics [Internet]. 2010 Jan-March [cited Date of Citation]; Vol 2(1):28-32.
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Case report:

A 32 years-old male patient presented to the Department of Oral Medicine & Radiology of Narayana Dental College & Hospital, Nellore with a complaint of pain and pus discharge from upper left back region of the jaw since 6months. The swelling subsided after taking some medication and

subsequently pus discharge started.

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On extra-oral examination diffuse swelling was seen in the left cheek region which measured 1x1cm. On palpation swelling was soft in consistency & non tender. Right & Left submandibular

Dentigerous Cysts in relation to 13 & 23. The patient was prescribed a combination of amoxicillin250mg and cloxacillin250mg thrice daily for control of the infection and diclofenac sodium 50mg twice daily for the control of the pain.

lymphnodes were palpable, mobile & non tender. On intra-oral examination there was an over-retained 53 and missing 23. Intra-orally there was partial obliteration of upper left buccal vestibular sulcus region extending from 24 to 26 region which was tender on palpation. Sinus opening with pus discharge on digital pressure was seen from left buccal vestibular sulcus region adjacent to 26. On aspiration with fine needle pus and blood were observed. Maxillary cross sectional Occlusal and Panoramic Radiograph revealed bilaterally impacted permanent maxillary right and left canines with well defined radiolucencies around the both canines with & sclerotic border extending mesial aspect of 15 crossing the midline and upto mesial aspect of 26. On careful examination there was a thin sclerotic line demarcating the lesions into two individual

Figure 1

radiolucent areas. Based on clinical findings and radiographic features we reached provisionally diagnosis of Bilateral Dentigerous cysts. Surgical Enucleation of the cysts along with extraction of the impacted canines was done under local anesthesia and specimen sent for Figure 2

histopathological examination. Microscopic examination revealed patchy cystic lining made up of a thin nonkeratinized stratified squamous epithelium with focal areas exhibiting arcading, proliferating epithelium. Chronic inflammatory changes & increased vascularity were noted in the sub-epithelial fibro-cellular connective tissue. The histopathological findings were Figure 3

confirmative of the diagnosis of Bilateral Infected

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Intra Oral Photograph showing partial obliteration of vestibular sulcus with intra oral sinus opening

Figure 4 Panoramic Radiograph showing radiolucencies surrounding the impacted maxillary canines

and enclosing the crown of an unerupted tooth at the cementoenamel junction(2, 8). Dentigerous cysts are the second most common odontogenic cysts(2). They account for approximately 24% of all true cysts in the jaws(4-6, 9). Cysts involve impacted, unerupted permanent teeth, supernumerary teeth, odontomas, and rarely they may involve deciduous teeth. They were usually seen in the second and third decades. Cysts are located in the posterior mandible in 75% of the cases. Most frequently involved teeth are the mandibular third molars and maxillary canines(4, 6, 8, 9). It develops by accumulation of fluid between the reduced enamel epithelium and the tooth crown. Figure 5 Maxillary cross sectional Occlusal view showing radiolucencies around the impacted canines Most dentigerous cysts are developmental in origin, with a slight male predilection M:F= 1.57:1.00.(10) There is usually no pain or discomfort associated Discussion: A dentigerous cyst is defined as an epithelium lined pathological cavity arising from the enamel organ due to an alteration in the reduced enamel epithelium with the cyst, unless it becomes secondarily infected. A dentigerous cyst can be suspected when the follicular space is more than 5 mm (11, 12).

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Radiographically dentigerous cyst shows a unilocular area that is associated with the crown of an unerupted tooth. The radiolucency has well-defined sclerotic borders, with bucco-lingual expansion of cortical plates. A large dentigerous cyst may give the impression of being multilocular, because of the persistence of bone trabeculae within radiolucency. There are several cyst-to-crown radiographic

common; the cyst surrounds the crown of the tooth crown projects into the cyst. The lateral variety is usually associated with mesio-angular impacted mandibular third molars that are partially erupted. In the circumferential variant, cyst surrounds the crown and extends for some distance along the root; significant portion of the root appear to lie within the cyst(10).

variations are present. The central variety is

Table 1.Depicting age & gender wise reported cases of bilateral and multiple dentigerous cysts along with treatment done(1)
Author Myers Henefer Stamback Callaghan Burton and Scheffer Swerdloff and Cols Crinzi McDonnell Eidinger ONeil, Mosby, and Lowe Banderas and Cols Sands and Tocchio Ko, Dover, and Jordan De Biase and Cols Shah, Thuau, and Beale Ustuner and Cols Batra and Cols Freitas and Cols Cury and Cols Year 1943 1964 1970 1973 1980 1980 1982 1988 1989 1989 1996 1998 1999 2001 2002 2003 2004 2006 2008 Gender Female Female Male Male Female Female Female Male Male Male Male Female Male Male Male Male Female Male Male Age (yrs) 19 52 09 38 57 07 15 15 15 05 38 03 42 08 39 06 15 14 05 Location Permanent mandibular right & left third molars Permanent maxillary right & left canines Permanent mandibular right & left third molars Permanent mandibular right & left third molars Permanent mandibular right & left third molars Permanent mandibular right & left third molars Permanent mandibular right & left third molars Permanent mandibular 2nd premolar / 2nd molar (side not informed) Permanent mandibular right & left third molars Permanent mandibular right & left third molars Permanent mandibular right & left third molars Primary mandibular right &left central incisors/ Permanent mandibular right & left first molars Permanent mandibular right & left third molars Permanent mandibular right & left third molars Permanent mandibular right & left third molars Permanent maxillary right & left canines Permanent mandibular right and left third molars/second premolar (side not informed) Permanent mandibular right & left 2nd & 3rd molars Permanent mandibular right & left third molars Treatment Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation Enucleation No treatment Enucleation Enucleation Enucleation Enucleation

Conclusion Our patient presented with a painless left facial swelling. Over a period of several weeks, the expanding lesion in the left cheek, with additional imaging and histologic examination, revealed itself to be a dentigerous or follicular cyst associated with impacted canines. Although dentigerous cysts are more often found in the mandible, they may occur, as in our patient, in the maxilla. Histologic examination of the cyst lining is essential to differentiate this relatively benign lesion from a more aggressive lesion, such as an ameloblastoma or an odontogenic

keratocyst, both of which require aggressive resection to prevent recurrence. Most reports of dentigerous cysts are found in the surgical literature (dental, oral/facial, or otolaryngology) are in mandible, with few reports in the maxilla. Our patient is a reminder to general pediatricians to include the dentigerous cyst in the differential diagnosis of painless midfacial facial swelling. Authors Affiliations: 1. Dr. N. Kannan,
2. Dr. Rajendra Patil, Professor & Head,

Professor, 3. Dr. P. Sreenivasulu,

Postgraduate scholar, Department of Oral Medicine & Radiology, Narayana Dental College & Hospital, Nellore-524002, Andhra Pradesh, India. Chinthareddypalem,

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radiolucencies and the significance of early detection. Australian Dental Journal2002;47(3):262-5. Address of the Corresponding Author Prof. Dr. N. Kannan MDS Professor & Head, Department of Oral Medicine & Radiology Narayana Dental College & Hospital, Chinthareddypalem, Nellore-524002 Andhra Pradesh, India Tel: +919849282098 Fax: 0861-2305092 E mail: natarajankannan1@rediffmail.com

dentigerous cysts--report of an unusual case and review of the literature. Journal of the Canadian Dental Association1999;65(1):49-51. 6. Daley T, Wysocki G, Pringle G. Relative

incidence of odontogenic tumors and oral and jaw cysts in a Canadian population. Oral surgery, oral medicine, oral pathology1994;77(3):276-80. 7. Weber A. Imaging of cysts and odontogenic

tumors of the jaw. Definition and classification. Radiologic Clinics of North America1993;31(1):101.

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