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INFLAMMATORY DENTIGEROUS CYST: A RARE CASE REPORT
Article · October 2016
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CASE REPORT
INFLAMMATORY DENTIGEROUS CYST: A RARE CASE REPORT
Pradkhshana Vijay1., Ishank Singhal2., Nilesh Pardhe3., Manas Bajpai4 and Deshant Agarwal5 1Departmentof Oral Pathology and Microbiology, Faculty of Dental Sciences, KGMU Lucknow 2Department of Oral & Maxillofacial Surgery, Indraprastha Apollo Hospital New Delhi 3,4Department of Oral Pathology and Microbiology, NIMS Dental College Jaipur 5Department of Onco-Pathology, Bhagawan Mahavir cancer hospital and research centre, Jaipur
ARTICLE INFO ABSTRACT
Article History: Dentigerous cysts are the benign odontogenic cysts arising from the dental follicle of unerupted tooth. th It is the second most common cyst and is mostly associated with impacted mandibular third molar. Received 14 July, 2016 Dentigerous cyst associated with premolars and deciduous tooth is very rare. We report a rare case of Received in revised form 9thAugust, inflammatory dentigerous cyst present in 10 years old male patient with a brief review. 2016 Accepted 27th September, 2016 Published online 28th October, 2016
INTRODUCTION mandible to parasymphysis region of the mandible. Swelling
was non tender & painless, hard in consistency. Dentigerous cysts are benign odontogenic cysts arising from the crown of impacted teeth. [1] They are formed by the fluid accumulation between reduced enamel epithelium and crown, with attachment at the CEJ of impacted tooth. [2, 3] These are the second most common odontogenic cysts. [4] Dentigerous cysts can occur at any age, but most occurrences are in the second and third decade of life and are rare in the first decade of life. Males are more commonly affected than females and are mostly associated with impacted mandibular third molar, first and second premolar and canines. [5, 6] Dentigerous cysts are usually asymptomatic and are mostly diagnosed by routine radiography. Patient may give a history of slowly enlarging swelling. Pain is present in the cases that Fig 1 intraoral examination revealing decayed 85 are secondarily infected.[7] Radiographic findings using Intraoral Periapical Radiograph, Case report revealed a well defined radiolucency, associated with periapical region of 85 and surrounding the CEJ of impacted A 10 years old male patient presented with a chief complaint 45. [Fig 2] Based on the clinical and radiographic features of swelling on right side of face with slight facial deformity provisional diagnosis of radicular cyst was made and since one month. Intraoral inspectory findings revealed a dentigerous cyst was included in the differential diagnosis. solitary swelling, oval in shape, measuring 1x1 cm, with smooth and well defined borders associated with carious 85, Lesion was aspirated which revealed a clear yellowish cystic with normal surface color as that of overlying mucosa. [Fig 1] fluid. [Fig 3] The case was operated through intra oral Swelling was extending from the lower border of the body of approach under local anesthesia and cyst was enucleated with International Journal Of Current Medical And Pharmaceutical Research, Vol. 2, Issue, 10, pp.865-867, October, 2016
removal of the unerupted right mandibular second premolar. DISCUSSION
The excised tissue was sent for histopathological examination. Gross examination of specimen revealed, tissue measuring 2x2 Dentigerous cysts are benign odontogenic cysts related with cm in diameter, red in color, firm in consistency & there was a crowns of impacted permanent teeth. [5,8] These cysts are cystic cavity without any papillary projections or nodules mostly discovered by routine radiography or by swelling of attached at the CEJ of 45. Grossly decayed mandibular affected region in the jaw. The pathogenesis of dentigerous deciduous 2nd molar was also present. [Fig 4] cyst is slight controversial. Three possible mechanisms for pathogenesis have been proposed by Benn and Altini. They suggested that dentigerous cyst form a dental follicle and become secondarily infected, source of infection being non- vital tooth. The second mechanism could be formation of radicular cyst at apex of non-vital primary tooth followed by eruption of its permanent successor into radicular cyst which results in a dentigerous cyst of extrafollicular origin. Also, it is suggested that follicle of permanent tooth may get secondarily infected by periapical inflammation of a non-vital predecessor or some other source leading to a dentigerous cyst. Previous reports of dentigerous cysts related with non-vital deciduous tooth support this mechanism. [6] Present case also indicated that infection of the second primary molar could be the source Fig 2 Iintra oral periapical radiograph showing well defined of inflammation of the dentigerous cyst. Impacted tooth radiolucency involving the periapical region irt 85. 45 is completely surrounded by dentigerous cyst may show enamel hypoplasia enveloped within the radiolucent area. based on the time of beginning of a dentigerous cyst. [9] Enamel hypoplasia is seen when dentigerous cyst begins at an early stage of development of the affected tooth but in cases when the cyst forms after the completion of tooth development, enamel hypoplasia is not a significant Fig 3 FNAC revealing yellowish cystic fluid association. [10, 11] In the present case, the impacted premolar did not show enamel hypoplasia and it may be said that the cyst developed after complete crown formation. Recommended treatment for dentigerous cyst is mostly marsupialization, if the involved tooth might be brought into its normal position in the arch. [12, 13] Enucleation of cyst with removal of the associated tooth is recommended if it shows arrested development or is extensively displaced. [13] In our case, enucleation of the cyst along with the affected Fig 4 gross specimen showing 85 and cyst attached at the CEJ of 45 tooth was done. Microscopic examination revealed non keratinized stratified CONCLUSION squamous epithelium, with thickened cystic wall. The proliferating epithelium was showing arcading pattern. The Dentigerous cyst is most commonly associated with impacted underlying fibrocollagenous connective tissue stroma was third molars. In the present case we reported a rare case of dense and composed of severe chronic inflammatory cell inflammatory dentigerous cyst associated with mandibular infiltrate, chiefly lymphocytes. [Fig 5] second premolar. The case was successfully treated with no complications post operatively.
References 1. Shear M. Cysts of the oral regions (3rd ed). Oxford Wright; 1992;75-89. 2. Benn A, Altini M. Dentigerous cyst of inflammatory origin. A clinicopathological study. Oral Surg Oral Med Oral Pathol 1996;81:203-09. 3. Brook AH, Winter GB. Developmental arrest of Fig 5 photomicrograph showing non keratinized stratified epithelium showing arcading with subepithelial chronic inflammatory cell infiltrate permanent tooth germs following pulpal infection of chiefly composed of lymphocytes. deciduous teeth. Br Dent J 1975;139:9-11. 4. Mourshed F. A roentgenographic study of dentigerous Based on the clinical, radiographic and histopathological cyst. I incidence in a population sample. Oral Surg Oral examination, final diagnosis of inflammatory dentigerous cyst Med OralPathol 1964;18:47-53. associated with impacted right mandibular second premolar 5. Miller CS, Bean LR. Pericoronal radiolucencies with was made. and without radiopacities. Dental Clin North Am 1994;38:51-61.
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