Marsupialization of a large dentigerous cyst in the mandible with orthodontic extrusion of three impacted teeth. A case report

Abstract

The dentigerous cyst (DC) is the most common type of developmental odontogenic cyst. It is usually asymptomatic and associated with the crown of an unerupted or impacted tooth. However, after a long duration, it is likely to cause significant bone resorption, cortical expansion, and tooth displacement. This report presents a large infected DC in the mandible of a 12-year-old female patient. The DC was located inferior to badly decayed primary molars and surrounded three impacted permanent teeth: canine, first premolar, which had a dilacerated root, and second premolar. The DC was treated successfully by marsupialization and extrusion of the impacted teeth. In conclusion, the combination of marsupialization with orthodontic extrusion is a conservative, efficient protocol that stimulates bone healing and promotes the eruption of cyst-associated teeth even if they are deeply impacted, crowded, or have a dilacerated root. Key words:Dentigerous cyst, marsupialization, impacted teeth, orthodontic extrusion, dilacerated root.

Five Years Follow-up of a Spontaneous Eruption of an Impacted Mandibular Premolar Associated with a Dentigerous Cyst Treated by Marsupialization

“…The treatment of choice of DC is the enucleation and the removal of the affected tooth; in the case of large cysts, an initial phase of marsupialization followed by the total enucleation is recommended. If DC is connected with a canine or a premolar with a positive eruptive position, marsupialization is preferred [2][3][10][11]12,14].…”

“…Treatment modalities of DC are enucleation and decompression/marsupialization; however, despite the favorable prognosis of DC whatever the surgical technique is, some important factors must be considered for the treatment plan, such as DC size and proximity to anatomic structures, the patient's age, and the possibility of saving the involved tooth [2,6,[10][11][12]. Therefore, marsupialization in pediatric dentistry was preferred based on the higher tooth eruption potential in children with teeth open apices [12][13].…”

Spontaneous Eruption of a Deeply Impacted Premolar After Conservative Treatment of an Associated Dentigerous Cyst: A Case Report

“…Abu-Mostafa and Abbasi used a similar approach of marsupialization, but they applied fusidic acid cream to the gauze and intervened orthodontically [16]. A different approach through compression was followed by Bozdogan et al and Qian et al, where they utilized a lateral window, which can result in either a larger bone defect, ectopic eruption, or malocclusion of the developing permanent teeth [17][18].…”

Enucleação de Cisto Dentígero Associado a Terceiro Molar Inferior: Relato de caso

“…Entre os cistos odontogênicos não inflamatórios, o cisto dentígero é considerado o mais da raiz distal do terceiro molar mandibular, com maior prevalência em pacientes masculinos, de origem caucasiana e na segunda ou terceira décadas de vida [4][5][6][7][8][9][10] . Apesar da etiopatogenia dessa condição ser por muitos, descrito como incerta, acredita-se que a patogênese de tal lesão ocorra devido ao acúmulo de fluidos entre a coroa e o epitélio reduzido do esmalte, podendo ser consequência da pressão exercida por um folículo dentário no processo eruptivo [6][7][8]10 .…”

“…Clinicamente, o cisto dentígero apresenta-se de forma assintomática podendo, no entanto, apresentar sintomatologia quando associada a processos inflamatórios, bem como ocasionar expansão lenta da cortical óssea e consequentemente assimetria facial 6,8,10,11 . Através dos exames de imagens, observa-se uma imagem radiotransparente, unilocular de limites bem definidos e com margens escleróticas fina, em torno da coroa de um dente incluso [8][9][10] .…”