Volume-2, Issue-4, Page 11-14 Research Article National Journal of Medical and Dental Research, July-September 2014: Volume-2,
Dentigerous cyst: A retrospective study of 20 cases in S. S. Medical College Rewa, Madhya Pradesh Geeta Mishra Tripathi A, Ajay Pillai B, Shaji Thomas C, Syed FaizelD A Assistant profes professor sor,, Department of Dentistry Dentistry,, S.S.Medical College Rewa (M.P (M.P.) .) India B Reader,, Department of Oral and Maxillofacial Surgery Reader Surgery,, PDA Bhopal (M.P (M.P.) .) C Professor Profes sor,, Department of Oral and Maxillofacial Surgery Surgery,, PCDS & RC Bhopal (M.P.) DSenior lecturer, Department of Oral and Maxillofacial Surgery, Ideas Dental College, Gwalior (M.P.) Manuscript Reference Number: Njmdr_247_14
Abstract:
A retrospecve study was done for the features of dengerous cyst clinically, radiographically, and histologically, reported in dental Department. of S. S. Medical College Rewa (M.P.) for the period of 1 year from January 2013 to January 2014. Male were more aected than female in the rao of 1.85: 1. Anterior region were more involved than posterior region. The most common clinical features were alveolar bone swelling, and pain. Radiographic appearance showed radiolucency associated with an un-erupted tooth. In 2 cases dengerous cyst was associated with non-vital deciduous teeth. Histologically 1 case shows ameloblasc variaon. Key Words: Dengerous cyst, impacted tooth, Anterior and posterior region of mandible.
Introduction:
Date of submission: 12 April 2014 Date of Editorial approval: 14 April 2014 Date of Peer review approval: 19 April 2014 Date of Publication: 30 June 2014 Conict of Interest: Nil;
Source of support: Nil
Name and addresses of corresponding author:
Dr. Geeta mishra tripathi MDS, Astt. Professor
Odontogenic cysts in children are rare with only 1% of the radicular cysts and 9% of the dentigerous cysts occurring in the rst decade of life [1]. A dentigerous cyst is an epithelial-lined developmental cavity that encloses the crown of an unerupted tooth at the cementoenamel junction. Dentigerous cysts are the second most common odontogenic cysts after radicular cysts, accounting for approximately 24% of all true cysts in the jaws [2]. The frequency of dentigerous cyst formation has been estimated to constitute 1.44 per 100 unerupted teeth [3].
Deptt. Of dentistry. S.S.medical college Rewa (M.P.) Email: geeta.tripathi75@g
[email protected] mail.com Phone no.: 9425124285
In case of mandibular third molars, the frequency of impaction is roughly the same as that of cyst formation, whereas maxillary third molars have a much higher frequency of impaction than cyst
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involvement, suggestion that this tooth has a much lower relative risk of developing a dentigerous cyst than its mandibular counterpart [4]. Similarly the risk of cyst formation around the crowns of unerupted mandibular rst premolars, maxillary incisors, or mandibular second molars is very high, although the frequency of failure of eruption of these teeth is extremely low [5]. Dentigerous cysts are frequently discovered when radiographs are taken to investigate a failure of tooth eruption, a missing tooth or mal-alignment. There is usually no pain or discomfort associated with the cyst unless it becomes secondarily infected. Radiographs show a unilocular, radiolucent lesion characterized by well-dened sclerotic margins and associated with the crown of an unerupted tooth. While a normal follicular space is 3 to 4 mm, a dentigerous
National Journal of Medical and Dental Research, July-September 2014: Volume-2, Volume-2, Issue-4, Page 11-14
cyst can be suspected when the space is more than 5 mm [6]. The aim of the present study is to nd the incidence, clinico- pathological variation of dentigerous cyst.
Materials and method: All cases were taken from dental department of S.S. Medical College Rewa (M.P.) for the period from January 2013 to January 2014. All cases diagnosed clinically and histologically as dentigerous cyst were analyzed according to the age, sex, duration, site distribution, clinical presentation, radiographic appearance and histopathologic details.
Figure 3: Marsupialization done
Results: From the total of 70 cases of cystic lesion, 20 cases were diagnosed as dentigerous cyst (28.57%). The age of the patients ranged from 5 to 60 years, with a peak incidence in the second decade of life. The males were affected more than the females with a ratio of (1.85:1) (Table 1).
Surgical procedures: 11 cases were done under general anaesthesia and 9 cases in local anaesthesia. Intraoral approach was used in all cases. Buccal ap were raised. 15 cases were enucleated together with impacted teeth as shown in gure 1 &2, and 5 cases were marsupilized as shown in gure 3. Healing was uneventful; the surgical site showed good wound healing. Patient was under follow up for 3 months; by this time no patient had other complaint except in one case in which parasthesia was present. present.
Table 1 - Age and sex wise distribution Age
Number
Male
Female
M:F
0-10
4 (20%)
3 (23.7%)
1 (14.28%)
1.65:1
11-20
11(55%)
7 (53.8%)
4 (57.12%)
0.94:1
21-30
3 (15%)
1 (7.69%)
2 (28.56%)
0.26:1
31-40
0 (0%)
0 (0%)
0 (0%)
0:0
41-50
1 (5%)
1 (7.69%)
0 (%)
1:0
51-60
1 (5%)
1 (7.69%)
0 (%)
1:0
Total
20 (100%)
13 (65%)
7 (35%)
1.85:1
Regarding the site, (14cases 70%) occurred in the maxilla and (6 cases 30%) in the mandible. However, for the maxilla, the most common affected site was canine region (7 cases = 50%). While for the mandible the most common affected site was molar region (2 cases = 33.3%), and canine region (2 cases = 33.3%) (Table 2). Table 2 - Site distribution
Figure 1: Flap Raised Jaw
Figure 2: Enucleation done
Incisor
Cannne
Premolar
Molar
Total
Maxilla
3 (2 (21.42)
7 (5 (50%)
3(21.42%)
1 (7 (7.14%)
14 (7 (70%)
Mandible
1 (1 (16.66)
2(33.33%)
1(16.66%)
2(33.33%)
6 (3 (30%)
Total
4 (20%)
9 (45%)
4 (20%)
3 (15%)
20 (100%)
The initial presenting symptom (for all 20 patients) was intra-oral alveolar swelling, associated with pain in all cases; parasthesia was noted in only 1 case. Moreover, no cases were recorded as a recurrent case. The dentigerous cyst appears as circumscribe circumscribed d radiolucency associated with impacted tooth (Figure4).
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National Journal of Medical and Dental Research, July-September 2014: Volume-2, Volume-2, Issue-4, Page 11-14
Browne [12]. Daley and Wysocki [13] suggested that it may be related to smaller jaw size in female patients and a greater tendency for prophylactic extraction of third molar molar.. Regarding the site, dentigerous cyst in our study occurs predominantly predominantl y in the maxillary and mandibular cuspid area and this nding conrmed by previous s tudies [5, 14]. However, Main [15], Angela and Mario [16] reported that the common site for dentigerous cyst was in the mandibular third molar area.
Figure 4: Dentigerous cyst appears as circumscribed radiolucency associated with impacted tooth
The majority of the cysts show unilocular radiolucency (18 cases 90%) whereas 2 cases appear as multilocular. In addition, 4 cases showed root resorption of the adjacent tooth. All of the pathologic reports describe a similar histological picture, showing cyst walls composed of brous tissue and lined by stratied squamous, nonkeratinized epithelium with Rushton bodies. 18 Cases shows inltration of chronic inammatory cell. Moreover, characteristic ameloblastoma was seen in the wall of 1 dentigerous cyst in a 51 years old male patient.
Discussion: The DC is the second most common odontogenic cyst, with periapical cyst being found more commonly commonly.. It presents mostly in the second or third decade of life in the maxillary or mandibular third molar or maxillary canine regions [7]. It can originate from any tooth, including supernumerary tooth [8]. The DCs are mostly asymptomatic and may be found on routine dental radiographic check-up. They may also cause symptoms like pain or swelling with the enlargement enlargeme nt of the cyst size [9]. The formation of dentigerous cysts appears to be due to accumulation of uid either between reduced enamel epithelium and enamel or in between the layers of enamel organ [10]. The lesion occurs most often in the second and third decades of life [11]. This is in harmony with this result in which the majority of patients were young, 15 out of 20 patients being under the age of 20 years (75%). However, Brown [12] reported in a study conducted on 81 diagnosed dentigerous cysts a higher prevalence in the fth decade of life.
Clinically, dentigerous cyst occur most often as painless intra-oral alveolar swelling [16], sometime the cyst associated with pain [15], but in our cases most were painful along with intraoral and extra oral swelling. Tooth mobility and displacement were also observed. Recurrence of dentigerous cyst is rare [17]. In our study, no case was recurred. The histological features of our dentigerous cyst are similar to those seen elsewhere [18]. Kim and Ellis [19], showed that the dentigerous cyst may be lined by stratied squamous epithelium. Furthermore, the dentigerous cyst may give rise to a variety of tumors, notably ameloblastoma, squamous cell carcinoma, mucoepidermoid carcinoma, and rarely other tumors [17, 20]. In our study, only 1 case shows ameloblastic characteristic in the lining epithelium of the cyst. The dentigerous cyst is frequently well circumscribed unilocular radiolucency which is often associated with an unerupted tooth [18, 21]. The cyst appears to have a greater tendency than other jaw bone cyst to induce root resorption of adjacent teeth. This nding is supported by this series, in which the majority of the cases (75%) appear as unilocular radiolucency and (20%) showed root resorption of adjacent teeth. Therefore, every case mimic radiographic appearance of a dentigerous cyst should be conrmed clinically and histologically in order to exclude any other aggressive lesions.
References: The present investigation showed that males were affected more than the females. A similar result was reported by
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