Don't forget the ‘watch and wait’ approach

As surgeons, the authors, like many readers, are keen to address any problem seen with a scalpel/drill/scaler, rather than adopting a more conservative approach. Here we present two cases when the ‘wait and watch approach’ was indeed the right option.

A 58-year-old male was referred to the local maxillofacial department by his general medical practitioner with temporomandibular joint pain. An incidental finding of an asymptomatic impacted LR3 with an apparent dentigerous cyst formation was seen on routine imaging (Figure 1). A CBCT confirmed the presence of a unilocular cystic lesion, benign in appearance, associated with the crown of the unerupted LR3, which had no intervening bone with the inferior alveolar canal (Figure 2). After discussing conservative versus surgical management, including the associated risks and benefits of each, particularly inferior dental nerve injury, the patient opted for a watch and wait approach. His subsequent review was delayed owing to the COVID-19 pandemic, and at 2 years he remained asymptomatic, and surprisingly, surveillance imaging revealed resolution of the cystic lesion (Figure 3). A further review 2 years later showed no evidence of recurrence (Figure 4), and he was subsequently discharged for continued surveillance in primary dental care.