Multiple calcifying hyperplastic dental follicles: A case report

Abstract

This report describes a 31-year-old female patient with six impacted teeth. The crowns of the impacted teeth were surrounded with cyst-like lesions with a mixed internal structure and well-defined cortical borders. Microscopic examination of the specimen obtained from the follicle of the left mandibular third molar tooth revealed loose to moderately dense collagenous connective tissue with abundant calcified material and sparse epithelial islands. A diagnosis of multiple calcifying hyperplastic dental follicles was made.

Multiple calcifying hyperplastic dental follicles: a major diagnostic consideration in multiple pericoronal lesions - report of two cases

“…Moreover, the adjacent soft tissue of third molars could also have calcified material and odontogenic epithelium [16,17]. We believe, however, that there are several parameters which support considering the third molars to be teeth affected by MCHDF: 1) their affectedness is in the context of multiple involvement, 2) the most affected region are the posterior quadrants, 3) they exhibit enlarged pericoronal radiolucencies, 4) adult patient cases display third molar involvement [11][12][13], 5) and as in our case, these teeth have bilateral symmetric involvement. With respect to the last point, there is a case report covering histological features of calcifying hyperplastic dental follicles, but only two teeth are affected, and it has a unilateral presentation; interestingly, the lesions are in proximity [8].…”

“…To date, there have been few cases of MCHDF reported, in this discussion we have considered those that cover the following parameters: three or more teeth involved and with no association with dental or syndromic abnormalities [5][6][7][8][9][10][11][12][13][14]. A graphic summary of the information obtained from the 16 cases under consideration, can be seen in Fig.…”

“…MCHDF can affect the deciduous [13] and supernumerary teeth [10] and can be associated with dental agenesis [9] or the presence of paramolar teeth [6]. They can cause cortical expansion in both the maxilla and mandible [6,11,13]. MCHDF can also be associated with congenital phenotypic changes, not necessarily a syndromic established pattern [6,7] or systemic alterations (epilepsy, mental retardation, hematuria/hypercalciuria or hypothyroidism) [6,11], without knowing if there is a direct relationship.…”

“…They can cause cortical expansion in both the maxilla and mandible [6,11,13]. MCHDF can also be associated with congenital phenotypic changes, not necessarily a syndromic established pattern [6,7] or systemic alterations (epilepsy, mental retardation, hematuria/hypercalciuria or hypothyroidism) [6,11], without knowing if there is a direct relationship. So far, whether there is a vertical family component has not been established, but two brothers affected by MCDHF have been reported [6].…”

“…In this sense, although the common trait of MCHDF is calcification, this is not radiographically evident in the early stages and is therefore insubstantial, but has been demonstrated to be very premature [6,9]. In patients with a long (∼33.2 year old, range 22-40 year old) [8,[11][12][13] or progressive evolution [9,11], it is possible to observe radiopacities or increase them within their pericoronal radiolucencies, and the use of periapical radiographs is recommended to demonstrate this fact [11]. Several authors have reported sclerotic borders as a substantial radiographical finding [9][10][11][12]14].…”