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The Seven-year Journey of an Ectopic Canine: Multidisciplinary Management of a Dentigerous Cyst in the Early Mixed Dentition Thibault Colloc Roderick Morrison Mark Burrell Colin Larmour Dental Update 2024 48:10, 707-709.
Authors
ThibaultColloc
DDS, MFDS RCPS(Glasg)
Post Dental Core Trainee Fellow, OMFS Department, Ninewells Hospital, Dundee
The Aberdeen Royal Infirmary oral and maxillofacial surgery department is involved in the joint planning of cases with the orthodontic and restorative departments of the Aberdeen Dental Hospital to agree an optimal treatment plan for patients, with input from all three specialties. A 7-year-old girl was referred to the orthodontic department by her GDP due to non-eruption of the upper left central incisor. This was related to an associated dentigerous cyst. This presentation illustrates the phases of treatment involving marsupialization of the dentigerous cyst; surgical extraction and orthodontic treatment in order to provide the patient with the optimal outcome for her dentition. A retrospective assessment of the case is presented through photographs and radiological imaging outlining the chronology of the treatment and the outcome of marsupialization of the dentigerous cyst. It highlights this more conservative surgical approach as giving the best chances of preserving unerupted teeth in a younger patient. Marsupialization of a dentigerous cyst associated with UL1 and conservative management of cystic pathology led to preservation and natural mesial eruption of UL3 into the position of UL1. The unerupted UL1 associated with cystic pathology was extracted due to its ectopic position and root dilaceration. Seven years after diagnosis of the dentigerous cyst associated with the unerupted UL1, surgical and orthodontic management has facilitated the for patients tooth to erupt into the UL1 position. Restorative treatment is being planned following orthodontic treatment to restore for patients tooth to simulate the missing UL1.
CPD/Clinical Relevance: This case encourages the appropriate referral of young patients with dentigerous cysts to achieve a satisfactory outcome.
Article
A dentigerous cyst is one that encloses the crown of an unerupted tooth by expansion of its follicle.1 It is the most prevalent type of developmental odontogenic cyst with about 1.44 cases in every 100 unerupted teeth2 comprising almost 20% of all odontogenic cysts and 60% of developmental odontogenic cysts.3 In the paediatric population, they account for 30% of the total number.4 It is most frequently encountered in association with impacted third molar teeth in the lower jaw, their distribution is directly compared to the frequency of impacted teeth. These cysts develop most commonly around the crown of an unerupted impacted tooth and attach to it at the cemento-enamel junction.5
On imaging, dentigerous cysts are usually present as a well-defined and unilocular radiolucency surrounding the crown of an unerupted or impacted tooth. They have a thin, regular sclerotic margin and can expand the overlying cortical plate. They are sometimes identified on orthopantomographic imaging as an incidental finding. An expanding peri-coronal lesion containing the crown of an impacted tooth projecting into the cystic cavity is considered pathognomonic and often, no further imaging is indicated unless there are other features, such as displacement of adjacent teeth and/or evidence of other pathology, for example resorption.6
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