Management of the malposition tooth that was caused by dentigerous cyst associated with impacted supernumerary tooth by using an obturator

Abstract

This report presents a case of eruption guidance for an upper right central incisor with a dentigerous cyst associated with an impacted supernumerary tooth in a 5-year-9-month-old boy. A swelling was seen in the region of an upper right central incisor. Radiographic examinations showed that a well-defined cystic lesion, containing an impacted supernumerary tooth crown in it, was located between the root of the primary upper right central incisor and a permanent upper central incisor germ. Under general anesthesia, the dentigerous cyst was removed at extraction of the upper impacted supernumerary tooth. And then, a socket was kept open wound. A histopathological examination confirmed the diagnosis of a dentigerous cyst associated with a supernumerary tooth. By using an obturator, we guided eruption of an upper right central incisor with malposition that was caused by the dentigerous cyst, and observed the way of the tooth eruption for two years and seven months. The obturator was inserted in the socket directly for three months until it was closed. After that, the obturator was used as only a removable space maintainer. Eight months after the operation, the obturator was removed because the upper left central incisor began to erupt. Two years and seven months after the operation, both upper central and lateral incisors had erupted completely. In this case, the obturator was used for expectation of natural eruption of permanent incisors, space maintenance and aesthetic recovery. The permanent incisors had been able to be guided to almost correct position without traction. some difficulties to do those treatments in pediatric dentistry, because some patients are uncooperative for earlier age, or some patients in mixed dentition period needing eruption guidance. Nevertheless it is necessary to treat correctly with those cases in order to develop the normal permanent dentition. In this case, we treated a 5-year-9-month-old boy with a dentigerous cyst caused by an impacted supernumerary tooth. The dentigerous cyst was removed at extraction of the upper impacted supernumerary tooth, and the socket was kept open wound. By using the obturator, we guided eruption of the upper right central incisor with malposition caused by dentigerous cyst. And then we observed for two years and seven months.

Quiste dentígero en un paciente pediátrico

“…Heredia la arcada dental 1,4 . En este sentido, Shigeoka et al 5 describe el uso de aparatos removibles con dispositivos obturadores como una alternativa para el manejo de las malposiciones dentales causadas por QD. El presente reporte describe la evolución imagenológica de un caso de QD con énfasis en el manejo quirúrgico conservador y la erupción del diente permanente en un paciente pediátrico después de tres años de seguimiento.…”

“…Clásicamente, el QD es tratado mediante enucleación y extracción del diente involucrado; sin embargo, en pacientes infantiles con compromiso de dientes en desarrollo la tendencia de tratamiento es distinto [1][2][3][4][5] . El esfuerzo se concentra en la preservación y erupción del diente permanente haciendo uso de la marzupialización/ descomprensión cómo técnica quirúrgica 3,4,5 .…”

“…En el caso descrito el tratamiento fue orientado a preservar el diente permanente involucrado, coincidiendo con la conducta conservadora de De Araujo et al 4 logrando la erupción natural del mismo y la incorporación adecuada a la arcada dental sin la necesidad del uso de aparatos removibles contrario a lo descrito por Shigeoka et al 5 . Luego de tres años de seguimiento, la serie de radiografías panorámicas revelaron la reducción de la extensión inicial de la lesión posterior a la descompresión hasta la ausencia radiográfica total de la lesión, la preservación del crecimiento radicular de la UD 45 y la evolución del proceso de erupción del diente no erupcionado hasta lograr la correcta ubicación funcional en la arcada sin hallazgos radiográficos evidentes de lesiones recidivantes.…”