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ISSN-0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2010:2(1):28-30

INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME.2 ISSUE.1JAN-MARCH 2010 28

Bilateral Maxillary Dentigerous CystsA Case Report

Kannan.N1, Patil Rajendra

2, Sreenivasulu.P

3

Abstract:A dentigerous cyst is the second most common Odontogenic cyst, after radicular cyst. It encloses the

crown of an unerupted tooth at the cementoenamel junction; the mandibular third molars are the most

commonly affected &maxillary canines are next commonly affected. This cyst accounts for approximately 24%

of all true cysts of the jaws, and their frequency in the general population has been estimated at 1.44 cysts for

every 100 unerupted teeth. This paper reports the presentation of a bilateral maxillary dentigerous cyst and its

incidence present in the literature.

Key Words: Dentigerous Cyst, Maxilla, Odontogenic cyst etc.

Received on: 5th December 2009 Accepted on: 22 February 2010

Introduction:A dentigerous cyst is the second most common

odontogenic cyst, after radicular cyst(1). It

encloses the crown of an unerupted tooth at thecementoenamel junction; the mandibular third

molars are the most commonly affected

&maxillary canines are next commonly affected

(1-3). They usually present in the 2nd or 3rd decades

of life and rarely seen during childhood(2, 4). Most

of the dentigerous cysts are single and solitary(2,

4).

Bilateral and multiple cysts are usually

found in association with a number of syndromes

including Cleidocranial Dysplasia and Maroteaux-

Lamy syndrome(2-5). In the absence of these

syndromes, bilateral dentigerous cysts associated

with the mandibular third molars are rare. This cyst

accounts for approximately 24% of all true cysts of

the jaws, and their frequency in the general

population has been estimated at 1.44 cysts for

every 100 unerupted teeth. There is usually no pain

or discomfort associated with the cyst unless it

becomes secondarily infected(6, 7).

Case report:A 32 years-old male patient presented to the

Department of Oral Medicine & Radiology of

Narayana Dental College & Hospital, Nellore with

a complaint of pain and pus discharge from upper

left back region of the jaw since 6months. The

swelling subsided after taking some medication

and subsequently pus discharge started. On extra-oral examination diffuse swelling was seen in the

left cheek region which measured 1x1cm. On

palpation swelling was soft in consistency & non

tender. Right & Left submandibular lymphnodes

were palpable, mobile& non tender.

Cite This Article: Kannan.N, Patil Rajendra,Sreenivasulu.P. Bilateral Maxillary Dentigerous Cysts

A Case Report. Int J Dent Clinics [Internet]. 2010 Jan-March [cited Date of Citation]; Vol 2(1):28-32.

On intra-oral examination there was an

over-retained 53 and missing 23. Intra-orally there

was partial obliteration of upper left buccal

vestibular sulcus region extending from 24 to 26region which was tender on palpation. Sinus

opening with pus discharge on digital pressure was

seen from left buccal vestibular sulcus region

adjacent to 26. On aspiration with fine needle pus

and blood were observed.

Maxillary cross sectional Occlusal and

Panoramic Radiograph revealed bilaterally

impacted permanent maxillary right and left

canines with well defined radiolucencies around

the both canines with & sclerotic border extending

mesial aspect of 15 crossing the midline and upto

mesial aspect of 26. On careful examination there

was a thin sclerotic line demarcating the lesions

into two individual radiolucent areas. Based on

clinical findings and radiographic features we

reached provisionally diagnosis of Bilateral

Dentigerous cysts.

Surgical Enucleation of the cysts along

with extraction of the impacted canines was done

under local anesthesia and specimen sent for

histopathological examination.

Microscopic examination revealed patchy

cystic lining made up of a thin nonkeratinized

stratified squamous epithelium with focal areas

exhibiting arcading, proliferating epithelium.

Chronic inflammatory changes & increased

vascularity were noted in the sub-epithelial fibro-cellular connective tissue. The histopathological

findings were confirmative of the diagnosis of

Bilateral Infected Dentigerous Cysts in relation to

13 & 23. The patient was prescribed a combination

of amoxicillin250mg and cloxacillin250mg thrice

daily for control of the infection and diclofenac

sodium 50mg twice daily for the control of the

pain. Intra Oral Photograph showing partial

CASE REPORT

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obliteration of vestibular sulcus with intra oral

sinus openingMaxillary cross sectional Occlusal

view showing radiolucencies around the impacted

canines

Figure 1 Front view, Figure 2 Birds view, Figure 3 Intra oral

view, Figure 4 Occlusal view

Discussion:

A dentigerous cyst is defined as an

epithelium lined pathological cavity arising fromthe enamel organ due to an alteration in the

reduced enamel epithelium and enclosing the

crown of an unerupted tooth at the cementoenamel

junction(2, 8). Dentigerous cysts are the second

most common odontogenic cysts(2). They account

for approximately 24% of all true cysts in the

jaws(4-6, 9). Cysts involve impacted, unerupted

permanent teeth, supernumerary teeth, odontomas,

and rarely they may involve deciduous teeth. They

were usually seen in the second and third decades.

Cysts are located in the posterior mandible in 75%

of the cases. Most frequently involved teeth are the

mandibular third molars and maxillary canines(4,

6, 8, 9). It develops by accumulation of fluid

between the reduced enamel epithelium and the

tooth crown. Most dentigerous cysts are

developmental in origin, with a slight male

predilection M:F= 1.57:1.00.(10) There is usually

no pain or discomfort associated with the cyst,

unless it becomes secondarily infected. A

dentigerous cyst can be suspected when the

follicular space is more than 5 mm (11, 12).

Radiographically dentigerous cyst shows

a unilocular area that is associated with the crown

of an unerupted tooth. The radiolucency has well-

defined sclerotic borders, with bucco-lingual

expansion of cortical plates. A large dentigerous

cyst may give the impression of being multilocular,

because of the persistence of bone trabeculae

within radiolucency. There are several cyst-to-

crown radiographic variations are present. The

central variety is common; the cyst surrounds the

crown of the tooth crown projects into the cyst.

The lateral variety is usually associated withmesio-angular impacted mandibular third molars

that are partially erupted. In the circumferential

variant, cyst surrounds the crown and extends for

some distance along the root; significant portion of

the root appear to lie within the cyst(10).

Conclusion

Our patient presented with a painless left

facial swelling. Over a period of several weeks, the

expanding lesion in the left cheek, with additional

imaging and histologic examination, revealed itself

to be a dentigerous or follicular cyst associated

with impacted canines.

Table 1.Depicting age & gender wise reported cases of bilateral and multiple dentigerous cysts along with treatmentdone(1)Author Year Gender Age

(yrs)

Location Treatment

Myers 1943 Female 19 Permanent mandibular right & left third molars Enucleation

Henefer 1964 Female 52 Permanent maxillary right & left canines Enucleation

Stamback 1970 Male 09 Permanent mandibular right & left third molars Enucleation

Callaghan 1973 Male 38 Permanent mandibular right & left third molars Enucleation

Burton and Scheffer 1980 Female 57 Permanent mandibular right & left third molars Enucleation

Swerdloff and Cols 1980 Female 07 Permanent mandibular right & left third molars Enucleation

Crinzi 1982 Female 15 Permanent mandibular right & left third molars Enucleation

McDonnell 1988 Male 15 Permanent mandibular 2nd premolar / 2nd molar (sidenot informed)

Enucleation

Eidinger 1989 Male 15 Permanent mandibular right & left third molars Enucleation

ONeil, Mosby, and Lowe 1989 Male 05 Permanent mandibular right & left third molars Enucleation

Banderas and Cols 1996 Male 38 Permanent mandibular right & left third molars Enucleation

Sands and Tocchio 1998 Female 03 Primary mandibular right &left central incisors/Permanent mandibular right & left first molars

Enucleation

Ko, Dover, and Jordan 1999 Male 42 Permanent mandibular right & left third molars Enucleation

De Biase and Cols 2001 Male 08 Permanent mandibular right & left third molars Enucleation

Shah, Thuau, and Beale 2002 Male 39 Permanent mandibular right & left third molars No treatment

Ustuner and Cols 2003 Male 06 Permanent maxillary right & left canines Enucleation

Batra and Cols 2004 Female 15 Permanent mandibular right and left third

molars/second premolar (side not informed)

Enucleation

Freitas and Cols 2006 Male 14 Permanent mandibular right & left 2nd & 3rd molars Enucleation

Cury and Cols 2008 Male 05 Permanent mandibular right & left third molars Enucleation

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Figure 4 Panoramic Radiograph showing radiolucenciessurrounding the impacted maxillary canines

Although dentigerous cysts are more often

found in the mandible, they may occur, as in our

patient, in the maxilla. Histologic examination of

the cyst lining is essential to differentiate this

relatively benign lesion from a more aggressive

lesion, such as an ameloblastoma or an

odontogenic keratocyst, both of which require

aggressive resection to prevent recurrence. Most

reports of dentigerous cysts are found in thesurgical literature (dental, oral/facial, or

otolaryngology) are in mandible, with few reports

in the maxilla. Our patient is a reminder to general

pediatricians to include the dentigerous cyst in the

differential diagnosis of painless midfacial facial

swelling.Authors Affiliations: 1. Dr. N. Kannan, Professor &Head, 2. Dr. Rajendra Patil, Professor, 3. Dr. P.Sreenivasulu, Postgraduate scholar, Department ofOral Medicine & Radiology, Narayana Dental College& Hospital, Chinthareddypalem, Nellore-524002,

Andhra Pradesh, India.

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Address of the Corr esponding Author

Prof. Dr. N. Kannan MDS

Professor & Head,

Department of Oral Medicine & Radiology

Narayana Dental College & Hospital,

Chinthareddypalem, Nellore-524002

Andhra Pradesh, India

Tel: +919849282098

Fax: 0861-2305092

E mail: [email protected]

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