Dentigerous Cyst Associted With Supernumerary Tooth In Anterior Maxilla: A Case Report

7/30/2019 Dentigerous Cyst Associted With Supernumerary Tooth In Anterior Maxilla: A Case Report

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Dentigerous Cyst Associted With Supernumerary Tooth

In Anterior Maxilla: A Case ReportSatya Narain,1 Anubha Gulati2

Introduction

The dentigerous cyst is defined as a cyst that originates by the separation of thefollicle from around the crown of unerrupted tooth. This is the most common type ofdevelopmental odontogenic cyst. The pathogenesis of this cyst is uncertain, butapparently it develops by accumulation of fluid between the reduced enamelepithelium and the tooth crown. It occurs most commonly in the second and third

decade of life and typically involves the mandibular third molar, the maxillary caninesand the mandibular premolars.

Dentigerous cyst around supernumerary teeth accounts for 5% of all dentigerous cystsand mostly involves a mesiodens in the anterior maxilla [1]. In the present case thesupernumerary tooth was located between maxillary central and lateral incisor.

CASE REPORT: A 9 year old male child presented with a painless hard tissue swellingon right side of anterior palate. Duration of swelling was three months. There was nochange in swelling since the patient initially noticed it. On examination there was slightenlargement of right side of anterior hard palate which was hardly perceptible and wasnontender with overlying mucosa normal. Buccal side of involved region wasnormal(Figure 1, 2).Patient was in mixed dentition stage, right permanent lateral

incisor was missing clinically while its contra lateral counterpart had erupted in mouth.OPG X-ray revealed a supernumerary tooth between maxillary right central and lateralincisor (Figure3). On maxillary occlusal view X-ray there was a radiolucent lesionsurrounding a radiopaque distorted tooth like structure in right anterior palate (Figure4). These radiographic appearances suggested a diagnosis of supernumerary toothcausing dentigerous cyst. CT scan (in axial, coronal and sagittal planes) was performed.The lesion in alveolar process of maxilla was found to be nonenhancing.The contentswere of fluid attenuation and showed the supernumerary tooth (Figure 5, 6, 7). Lesionwas enucleated along with the supernumerary tooth under local anesthesia.Supernumerary tooth had a distorted morphology with a dilacerated root (Figure 8, 9).Histopathological examination revealed a cystic lumen lined with stratified squamousepithelium over a connective tissue stroma (Figure10).Correlation of clinical,radiological and histological findings confirmed the diagnosis of dentigerous cyst .

IJCDSMARCH, 2012 3(1) 2012 Int. Journal of Clinical Dental Science

ABOUT THE AUTHORS

1. Dr Satya Narain

Associate Professor,Oral And MaxillofacialSurgery,Dr H.S. Judge Institute OfDental Sciences AndHospital, Panjab UniversityChandigarh.

2. Dr Anubha Gulati

Associate Professor,Oral Pathology,Dr H.S. Judge Institute OfDental Sciences AndHospital, Panjab UniversityChandigarh.

Corresponding Author:

DrSatya Narain

Associate Professor, OralAnd Maxillofacial Surgery,Dr H.S. Judge Institute OfDental Sciences AndHospital, Panjab UniversityChandigarh.

[email protected]

A stract

Dentigerous cyst is a developmental odontogenic cyst which originates through alterations of

the reduced enamel epithelium in a unerupted tooth or a developing tooth bud. These cysts

rarely associate with supernumerary teeth. The purpose of this article is to describe a rare case

of dentigerous cyst associated with supernumerary tooth in anterior maxilla in a child. This case

report is different from previously reported cases as the supernumerary tooth is located

between maxillary central and lateral tooth and not with a mesiodens.

Key words: Dentigerous cyst, Supernumerary tooth, anterior maxilla.

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CASE REPORT
mailto:[email protected]:[email protected]:[email protected]


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Figure 1, 2. Intraoral view showing slight enlargement right side of palate, buccal side appear normal, right permanent

lateral incisor is missing.

Figure 3. OPG X-ray showing a supernumerary tooth, no radiolucency is visible around it.

Figure 4.occlusal x-ray revealed radiolucent lesion surrounding a supernumerary tooth.

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Figure 5, 6, 7. CT Axial, sagittal and coronal view depicting the extent of lesion.

Figure 8, 9. Intraoperative view and surgical specimen.

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Figure10. Histophotomicrograph of lesion showing stratified epithelial lining the cystic lumen, connective tissue stroma is

also seen. (Haematoxylin and eosin stain original magnification 40 X).

DISCUSSION: A cystic swelling of hard palate may bethe result of different kind of cysts: odontogenic,nonodontogenic or bone cysts. In our patient the

cystic swelling was because of dentigerous cystassociated with a supernumerary tooth.Differential diagnosis of sharply marginatedradiolucent lesions of the maxilla include radicular cyst,dentigerous cyst, keratocyst, fissural cyst, simple bonecyst, aneurismal bone cyst or even tumor such asameloblastoma. The characteristic feature of the lesioninvolving an unerupted tooth crown in the anteriorregion of the maxilla along with the radiographical andhistological examination confirmed the diagnosis ofdentigerous cyst in the present case.The etiology of supernumerary teeth is

unknown[2].One school of thought is of the view thatthey develop from a third tooth bud arising fromdental lamina near the permanent tooth bud orprobably from splitting of permanent bud itself. Thisview is supported by the fact that a supernumerarytooth usually closely resembles the teeth of group towhich it belong. Incidence of supernumerary teeth inthe primary dentition is 0.2-0.8%, with an unknownmale: female ratio. The incidence of the condition inthe permanent dentition is 1.5-3.5%, with a male:female ratio of 2:1 [3].Some studies have reported that dentigerous cystformation arising from supernumerary teeth accountfor 5.29-7% of cases [4, 5]. Sheng et al (2004) in a studyof 166 supernumerary teeth reported cystic change in35% cases (6).According to Asaumi et al dentigerouscyst formation arising from supernumerary teethcomprises 11% of the cases (7).Hurlen and Humerfeltsuggested that dentigerous cysts associated with thesupernumerary teeth occur in 7% of cases [8].Supernumerary tooth may cause problems such asfailure of eruption of tooth, displacement of apermanent tooth, crowding, and development ofpathologies. Removal of the supernumerary tooth isrecommended where central incisor eruption is

delayed, altered or displacement of incisor is present,associated pathology is present [9].Surgical removal of the cyst has been considered asthe preferred choice of treatment. Marsupialisation hasbeen recommended for dentigerous cysts in children

to allow the eruption of unerupted tooth; and shouldbe preferred for large cysts where enucleation andtooth removal might result in damage to nerve and

blood vessels supplying adjacent teeth [10]. In presentcase surgical removal of the impacted supernumerarytooth and enucleation of associated cyst wasperformed. Histological evaluation has beenrecommended, owing to its potential to develop in toan ameloblastoma or mucoepidermoid carcinoma [11].

CONCLUSION: In summary when supernumerarytooth is evident, its effects on adjacent dentition andformation of dentigerous cyst should be carefullyevaluated. Early diagnosis can prevent associatedcomplications.

REFERENCES:1. Dinkar AD, Dawasaz AA, Shenoy S.

Dentigerous cyst associated with multiplemesiodens: A case report. J Indian Soc PedodPrev Dent 2007; 25; 56-59.

2. Grover SB, Singh P, Venkatachalam VP, NekhaN. Mesiodens presenting as a dentigerouscyst: case report. Ind J Radiol Imag 200515:1:69-72.

3. Primosch RE. Anterior supernumerary teeth:assessment and surgical intervention inchildren. Pediatric dentistry 1981; 3:204-215.

4. Hyun HK, lee SH, Kim JW. Clinicalcharacteristics and complications associatedwith mesiodentes. J Oral Maxillofac Surg 2009;67:2639-43.

5. Kessler HP, Kraut RA. Dentigerous cystassociated with an impacted mesiodens. GenDent 1989; 37: 47-49.

6. Wenjie sheng, Peicheng Xu, Yimin Sheng,Zheng Cha.Cystic change of embeddedsupernumerary teeth.Int Chin J Dent 2004:4:78-79.

7. Asaumi JI, Shibata Y ,Yanagi Y,et al.

Radiograghic examination of mesiodens andtheir associated complications.Dentomaxillofacial Radiol 2004; 33; 125-27.

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8. Hurlen B, Humerfelt D. Characteristics ofpremaxillary hyperdontia. A radiographicstudy. Acta Odontol Scand 1985; 43; 75-81.

9. Garvey MT, Barry HJ, Black M. Supernumeraryteeth: an overview of classification, diagnosisand Management. Journal of Canadian DentalAssociation 1999; 65(11): 612-616.

10.Kojima Y, Seo R, Maki K, Kimura M. A case ofdentigerous cyst in a thirteen- year old girl.

Pediatric Oral Maxillofac Surg 2005; 15:26-32.

11.Hyomoto M, Kawakami M, Inove M, Kirita T.Clinical conditions for eruption of maxillarycanines and mandibular premolars associatedwith dentigerous cysts. Am J OrthodDentofacial Orthop 2003; 124: 515-520.

12.Manganaro AM, Cross SE, Startzell JM.Carcinoma arising in a dentigerous cyst withneck metastasis. Head Neck 1997:19:436.

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Dentigerous Cyst Associted With Supernumerary Tooth In Anterior Maxilla: A Case Report

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