Factors influencing an eruption of teeth associated with a dentigerous cyst: a systematic review and meta-analysis

Abstract

Background A dentigerous cyst (DC) is a pathology embracing the crown of an unerupted tooth at risk of malignant transformation. The causal tooth is usually removed together with the cyst. However, if there are orthodontic contraindications for extraction, two questions arise. (1) Which factors favor spontaneous eruption? (2) Which factors imply the necessity of applying orthodontic traction? This systematic review aimed to identify factors conducive/inconducive to the spontaneous eruption of teeth after dentigerous cyst marsupialization. Methods In accordance with the PRISMA guidelines, the main research question was defined in the PICO format (P: patients with dentigerous cysts; I: spontaneous tooth eruption after surgical DC treatment; C: lack of a spontaneous tooth eruption after surgical DC treatment; O: determining factors potentially influencing spontaneous tooth eruption). The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for keywords combining dentigerous/odontogenic/follicular cysts with teeth and/or orthodontics, as well as human teeth and eruption patterns/intervals/periods/durations. The following data were extracted from the qualified articles (4 out of 3005 found initially): the rate of tooth eruption after surgical treatment of the cyst, the age and sex of the patients, the perpendicular projection distance between the top of the tooth cusp and the edge of the alveolar process, tooth angulation, the root formation stage, the cyst area, and the eruption space. The articles were subjected to risk of bias and quality analyses with the ROBINS-I protocol and the modified Newcastle–Ottawa QAS, respectively. Meta-analyses were performed with both fixed and random effects models. The GRADE approach was used to evaluate the quality of the evidence. The systematic review was registered in PROSPERO under ID CRD42020189044. Results Nearly 62% of DC-associated premolars erupted spontaneously after cyst marsupialization/decompression. Young age (mean = 10 years) and root formation not exceeding 1/2 of its fully developed length were the factors likely to favor spontaneous eruption. Conclusion The small number of published studies, as well as their heterogeneity and the critical risk of bias, did not allow the creation of evidence-based protocols for managing teeth with DC after marsupialization. More high-quality research is needed to draw more reliable conclusions.

Dentigerous Cysts with Diverse Radiological Presentation Highlighting Diagnostic Challenges

“…The center of the cyst may be located above or below the crown, except when the tooth is not in an upright position or when the cyst orients laterally during its development. Other radiological signs, less specific to DC, are the boundaries of the lesion: generally, well-defined, rounded, a thin sclerotic margin [ 4 , 8 , 11 ], and the radiolucent homogeneous, unilocular internal appearance of the lesion [ 4 , 5 , 6 , 7 , 8 , 9 ]. On the other hand, the effects on the surrounding anatomical structures (adjacent teeth, bone cortex, IAC, nasal cavity, and maxillary sinus floor) can be variable and include discharge, displacement, and expansion or resorption [ 8 , 9 , 12 ].…”

“…A dentigerous cyst (DC), also known as a follicular cyst, is a cyst of non-inflammatory odontogenic origin that develops from the pericoronal tissue (dental sac or dental follicle) of an impacted tooth, either permanent or deciduous or supernumerary [ 1 , 2 , 3 , 4 , 5 , 6 ]. Several factors have been investigated and are known to play an important role in tooth eruption [ 7 ]. DCs represent more than 24% of the cysts of the maxilla [ 8 , 9 , 10 ].…”

Marsupialization of Dentigerous Cysts Followed by Enucleation and Extraction of Deeply Impacted Third Molars: Two Case Reports

“…The studies that evaluated the indicators for a spontaneous eruption and a cyst-associated tooth were systematically reviewed by Nahajowski et al [ 10 ] who concluded that the most critical factors are the patient's age younger than 10 years, less than half root formation. Other factors are tooth depth, inclination, and appropriate space [ 11 ].…”

Evaluation of the Relationship between the BMI and the Sequence and Chronology of Eruption in Permanent Dentition in Spanish Population

“…Recently, mutations in the PTHR1 gene have been associated with primary eruption failure (arrest of supraosseous eruption), and mutations in GNAS with other dental eruption defects [ 6 , 7 ]. Other factors, such as dentigerous cysts, and craniofacial deformities, such as cleft palate, have been described in association with abnormalities in dental eruption [ 8 , 9 , 10 ].…”