Marsupialization and functional obturator placement for treatment of dentigerous cyst in child: A successful blend

Abstract

The Dentigerous Cysts (DCs) are considered the most common developmental Odontogenic cysts (OCs), they are related to the crown of unerupted impacted tooth. These cysts are usually asymptomatic; however, some cases complain of facial asymmetry, teeth displacement, root resorption of adjacent teeth, and pain if inflammation occurs. Radiographic examination usually reveals a unilocular radiolucency with sclerotic borders and surrounding the crown of an unerupted tooth. Classically, DCs are treated with enucleation and extraction of the involved tooth. However, owing to the high prevalence of these cysts in children, marsupialization is followed as a line of treatment that permits the eruption of the permanent tooth involved. This article presents a case of left mandibular DC in a 7.5 years boy. Marsupialization was the treatment modality chosen with a precisely fitted functional and removable acrylic obturator provided, where a 12-months follow-up revealed complete uneventful healing of the lesion alongside eruption of the involved tooth.

Graphical abstract

Highlights

  • In children, DC usually surrounds the crown of unerupted permanent tooth.

  • Marsupialization of DC in children permits the eruption of permanent tooth involved.

  • A precisely fitted acrylic obturator is a cornerstone in the treatment of child DC.

  • Adherence to the follow-up schedule is mandatory for the success of treatment of DC.

Introduction

Odontogenic cysts (OCs) comprise up to 90% of jaw cysts [ ]. These can be defined as pathological cavities that are lined by an epithelium originating from the process of odontogenesis and filled with fluid or semifluid content [ ].

The classification of OCs has been widely debatable [ ]. However, according to the World Health Organization (WHO), they can be simply classified as inflammatory or developmental [ ], where the radicular cysts represent the most prevalent inflammatory OCs while the Dentigerous Cysts (DCs) are considered the most common developmental OCs [ ].

The most commonly presenting type of DCs is related to the crown of an unerupted, impacted tooth and attaches it to the cementoenamel junction. The other type, called eruption cyst, overlies an erupting tooth. Both are mostly found overlying first permanent molars or deciduous incisors [ ].

DCs are usually small and discovered during routine radiographic examination of the jaw. These cysts, in most cases, are asymptomatic, however if infected, pain is elicited. DCs rarely assume large sizes displacing the associated impacted teeth and causing marked expansion of the cortices of the jaw with an “eggshell-crackling” or “frog-belly” phenomenon upon palpation. Moreover, root resorption of adjacent teeth does exist, albeit neurosensory deficits are uncommon [ ].

Classically, DCs are treated with enucleation and extraction of the involved tooth [ ]. Nevertheless, owing to the high prevalence of these cysts in children, marsupialization is better followed as a line of treatment that permits the eruption of the permanent tooth involved, where children possess a great regenerative potential allowing tooth with incomplete root development to maintain the eruptive strength [ ].

The aim of this article is to present a case of dentigerous cyst in a child presenting with a swelling related to the lower left quadrant and its surgical treatment, as well as the placement and evaluation of the role of a functional acrylic obturator.

Case description

A 7.5-year-old boy was referred to the Pediatric Dentistry Department, Faculty of Dentistry, Cairo University, complaining of severe pain related to teeth 74 and 75. Clinically intraoral examination revealed a compressible swelling of the buccal cortical plates of the alveolar ridge related to the lower left quadrant. Dentition was mixed with other carious teeth 54, 55, 56, 84, 85.

The radiographic findings, panoramic radiograph ( Fig. 1 ) and cone beam computerized tomography (CBCT) ( Fig. 2 ), revealed a well-defined radiolucent lesion, with sclerotic margins, completely associated with the crown of the unerupted mandibular left first permanent premolar. The root of the adjacent lower first and second primary molars were also involved in the lesion, with the presence of root resorption. There was no sensorineural or motor deficit at the facial structures. Following the clinical and radiographic examination, a provisional diagnosis of the dentigerous cyst was made.

Fig. 1
Pre-operative panoramic radiograph showing a radiolucent unilocular lesion with sclerotic margins associated with an unerupted 1st left mandibular premolar.

Fig. 2
CBCT revealing a cyst involving an unerupted tooth located in the lower left mandibular region.

Written informed consent was obtained from the child’s parents for all imaging exams, for the planned treatment modality, and for the publication of the data presented in this paper.

Considering the age of the patient and vicinity to the lower border of mandible, marsupialization of the cystic cavity was planned to preserve the unerupted tooth. Surgical intervention was carried out under general anesthesia in the Oral and Maxillofacial Department, Faculty of Dentistry, Cairo University. The primary mandibular left first and second molars were extracted before the exposure of the cyst cavity by opening a flap. After the flap opening process, the cyst cavity was identified ( Fig. 3 ), and the contents of the cyst were removed and sent for histopathologic evaluation where the diagnosis of dentigerous cyst was confirmed. The surgical procedure was completed with no complications and analgesics were prescribed when needed.

Mar 21, 2021 | Posted by in Oral and Maxillofacial Surgery | Comments Off on Marsupialization and functional obturator placement for treatment of dentigerous cyst in child: A successful blend
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