No abstract

The second most frequently found cyst in the jaws is dentigerous cyst comprising of 14-20% cysts in the jaw. Mostly found in the mandible with male predilection. [1-4] This cyst is attached to the cervical margin of the tooth which is impacted. Reduced enamel epithelium proliferates after the enamel formation is complete which leads to the development of dentigerous cyst. These cysts enlarge as a result of accumulation of fluid between the crown of an impacted tooth and the reduced enamel epithelium. [5] When radiographs are taken to determine the reason for failure of a tooth to erupt, dentigerous cysts are usually discovered. They are usually unilocular, always radiolucent and large lesions occasionally show a scalloping multilocular pattern. [3,4,6,7] The frequency of impaction is roughly the same as that of cyst formation for mandibular third molars. Maxillary third molars have higher frequency of impaction than cyst involvement, which suggest that this tooth has a much lower relative risk of developing a dentigerous cyst than its mandibular counterpart. [8] Similarly, the risk of formation of cyst around the crowns of impacted mandibular first premolars, maxillary incisors, or mandibular second molars is very high, although the frequency of failure of eruption of these teeth is extremely low. [9] Dentigerous cysts are mostly painless but may attain large size with root resorption of teeth till it manifests clinically or radiographically. Treatment of cyst remains cystic enucleation and removal of suspected impacted tooth. Prognosis is good and recurrence is rare if removed completely. Dentigerous cysts are seen most commonly in association with impacted maxillary and mandibular third molars and maxillary canines. Supernumerary teeth accounts only 5% of dentigerous cysts, of which mesiodens is the most common type. Initially such cysts remains completely painless unless infected, and discovered on routine radiographs. This paper presents a case of 35-year-old male patient with a dentigerous cyst associated with impacted right mandibular premolars and supernumerary teeth that caused painful swelling in the right lower buccal vestibule. The patient was treated surgically by enucleation of a dentigerous cyst in toto with surgical extraction of premolars and supernumerary teeth under local anaesthesia followed by primary wound closure.