Case Report

ERA’S JOURNAL OF MEDICAL RESEARCH

VOL.5 NO.1

DOI:10.24041/ejmr2018.66

CASE REPORT: ACCIDENTAL FINDING OF DENTIGEROUS CYST IN

UNERUPTED MAXILLARY INCISOR

Mayur Vilas Limbhore, Shandilya Ramanojam, Viren Patil, Priyadarshini Banerjee, Kalyani Gelada

Department of Oral and Maxillofacial

Bharati Vidyapeeth Dental College, Katraj, Pune, Maharashtra, India-411030

ABSTRACT

Received on : 30-04-2018

Accpected on : 18-05-2018

Dentigerous cysts form by accumulation of fluid between reduced enamel

Address for correspondence

epithelium and the crown of an unerupted tooth. They cause several

Dr. Mayur Vilas Limbhore

difficulties such as swelling, non-eruption of the involved teeth, and

Department of Oral and Maxillofacial

displacement of adjacent teeth, and thus require early detection and prompt

Bharati Vidyapeth Dental College

treatment. Treatment ranges from marsupialisation to enucleation. We report

a case of a 20-year-old boy with an impacted central incisor in the maxillary

Email: dr.mayur.limbhore18@gmail.com

region. The tooth was completely placed in proximity to the nasal floor.

Contact no: +91-8552887325

Surgical removal of the impacted central incisor was performed under local

 

 

anesthesia without disturbing the floor of the nose and granulation tissue

 

 

was sent for hisptopathological diagnosis. Hisptopathological diagnosis reveals dentigerous cyst. KEYWORDS: Impacted central incisor, Dentigerous cyst.

INTRODUCTION

buccal aspect of maxillary arch.

Impacted maxillary central incisors have a major effect

 

 

on the dental and facial aesthetics of an individual. The

 

 

impaction of the maxillary central incisor is uncommon

 

 

and only few cases have been reported (1). The order of

 

 

frequency of the impacted teeth are mandibular 3rd

 

 

molar, maxillary 3rd molar, maxillary cuspid,

 

 

mandibular cuspid, mandibular premolar, maxillary

 

 

premolar and maxillary central and lateral incisors (2).

Fig.1: Intraoral View Of The Patient Showing The

The impaction of maxillary incisors can be classified

into palatally impacted incisors, labially impacted

Unerupted Maxillary Permanent Right Central Incisor

incisors and vertically impacted incisors3. The

 

 

 

are

 

 

subdivisions under labially impacted incisors

 

 

labially horizontal, labially inclined and labially

 

 

inverted. The subdivisions under impacted palatal

 

 

incisors are palatally inclined and palatally horizontal

 

 

(3).

 

 

 

CASE REPORT

 

 

A 20-year-old male patient reported with the chief

 

 

complaint of unerupted upper right front tooth. Patient

Fig. 2: Orthopantomogram Showing Supernumerary

was known case of asthma is was on medication for same

since childhood. Also medical fitness was achieved form

Tooth And An Impacted Maxillary Right Central Incisor

physician. Dental history and intra oral examination

 

 

revealed missing maxillary permanent right central incisor

 

 

and which as replaced by supernumerary teeth (Fig. I).

 

 

An Orthopantomogram demonstrated an impacted

 

 

permanent right central incisor (Fig. II). OPG

 

 

followed by CBCT was taken to locate the exact

 

 

position of unerupted right central incisor. Thereby

 

 

correlating with the clinical and diagnostic finding

 

 

unerupted maxillary central incisor was placed on

Fig. 3: Cone Beam Computed Tomography

 

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CASE REPORT: ACCIDENTAL FINDING OF DENTIGEROUS CYST IN UNERUPTED MAXILLARY INCISOR

Cont...Fig. 3: Cone Beam Computed Tomography

Fig. 4: Operative View Showing Impacted

Maxillary Right Central Incisor On The Labial Side..

The treatment plan comprised of surgical removal of the permanent maxillary impacted incisor. With the patient under local anesthesia, full thickness mucoperiosteal flap on the buccal side was reflected. After careful elevation of the flap, adequate amount of bone was removed using the periosteal elevator and straight elevator and the impacted permanent maxillary impacted incisor (Fig. IV) was exposed.

Fig. 5: Post-Operative

Cont...Fig. 5: Post-Operative

The impacted permanent maxillary impacted incisor was extracted and extraction socket was inspected for any pathology. Extracted teeth consisted of granulation tissue and was sent for histopathological diagnosis. The buccal mucoperiosteal flap was repositioned and sutured with vicryl 3-0 sutured and there was no oronasal communication.. After a week, the healing was normal and the sutures were removed. Histopathology report reveals dentigerous cyst in relation to impacted right central incisor.

DISCUSSION

Dentigerous cyst can be defined as one which encloses the crown of an unerupted tooth and is attached at the cemento-enamel junction (4). According to a revised definition it is a cyst arising by separation of follicle from around the anatomical crown of an unerupted tooth within the jaws 5. Dentigerous cyst is the most common developmental cyst of the oral cavity and accounts for more than 24% of jaw cysts. It occurs most commonly in second (6) and third decade of life

(4). The dentigerous cyst develops around an unerupted tooth by accumulation of fluid between the reduced enamel epithelium and the enamel. It has been suggested that the pressure exerted by a potentially erupting tooth on an impacted follicle obstructs the venous outflow and there by induces rapid transudation of serum capillary walls. The increased hydrostatic pressure of this pooling fluid separates the follicle from the crown with or without reduced enamel epithelium (6) Mourshed et al states that 1.44 per cent of impacted teeth may undergo dentigerous cyst transformation (5). The site of occurance in descending order is as follows; Mandibular Third Molar, Maxillary Permanent Canine, Mandibular Premolars And Maxillary Third Molars. Its association with central incisor as reported by Shear is 1.5% and by Daley and Wysockias 0.1-0.6%. The Literature reports an incidence of dentigerous cyst as 1.5% with central incisor and 45.7% with mandibular third molars, making the former a rare occurance (6). Unlike other

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odontogenic cysts, the epithelial cells that line the lumen of dentigerous cyst are reduced enamel epithelium origin and possess an unusual ability to undergo metaplastic transition into other epithelial cell types because of this unusual ability, the epithelial lining often contains focal areas of orthokeratinization or a mixture of mucin-secreting and ciliated cells. On occasion some untreated dentigerous cysts rarely but have potential to develop odontogenic tumor like ameloblastoma and malignancy like oral squamous cell carcinoma and mucoepidermoid carcinoma (7). Dentigerous cyst associated with anterior teeth will result in failure of eruption and leads to esthetic and orthodontic problems. Absence of central incisor can have an impact of social stigma affecting the psychology of the person.

CONCLUSION

In conclusion, the surgical management of an impacted central incisor tooth pose challenges to the maxillofacial surgeon. A simple yet effective line of management remains extraction of the same. Since, the amount of such reported cases of dentigerous cyst involving impacted maxillary central incisor is negligible, the given case report intends to add value to Literature.

REFERENCES

1.Nuvvula S, Pavuluri C, Mohapatra A, Nirmala S. Atypical presentation of bilateral supplemental

maxillary central incisors with unusual talon cusp. J Indian Soc Pedod Prev Dent . 2011;29:149–154.

2.Aitasalo K, Lehtinen R, Oksala E. An orthopantomographic study of prevalence of impacted teeth. Int J Oral Surg . 1972;1:117–120.

3.Wang XC, Hu RD. Imaging classification of maxillary im¬pacted central incisors. Shanghai Kou Qiang Yi Xue. 2012;21(2):185–189.

4.Dentigerous cyst - a case report. Murali Mohan, K.V. and Radhika, D. and Naga Sujatha, D. and Ramesh, T. Indian Journal of Public Health Research and Development. 2012; 3(3): 90-92.

5.A case of odontogenic inflammatory dentigerous cyst in a calf: Macroscopic and histopathological findings. Alcigir, M.E. and Vural, S.A. Bulgarian Journal of Veterinary Medicine. 2012; 15(2): 137- 141.

6.Ectopic canine associated with a dentigerous cyst in the maxilla. Thakur, J.S. and Mohindroo, N.K. and Sharma, D.R. and Minhas, R.S. and Thakur, A. Ear, Nose and Throat Journal. 2011; 90(6).

7.Non syndromic bilateral maxillary dentigerous cysts: Review of literature and report of an unusual case. Vikram Prabhakar,Simarpreet Virk Sandhu. International Journal of Pediatric Otorhinolaryngology Extra. 2011; 6(1): 5.

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How to cite this article : Limbhore MV., Ramanojam S., Patil V., Banerjee P., Gelada K., Case Report: Accidental Finding Of Dentigerous

Cyst In Unerupted Maxillary Incisor. EJMR2018;5(1):74-76.

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