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A dentigerous cyst associated with bilaterally impacted mandibular canines in a girl: a case report
© Gonzalez et al; licensee BioMed Central Ltd. 2011
Received: 27 August 2010
Accepted: 23 June 2011
Published: 23 June 2011
A dentigerous cyst is the most common developmental odontogenic cyst and is frequently noted as an incidental finding on radiographs. The most common teeth affected are impacted mandibular third molars and permanent maxillary canines. This case involves a dentigerous cyst encompassing the right and left impacted mandibular canines and crossing the midline. This is, to the best of our knowledge, the first reported case of a dentigerous cyst encompassing non-adjacent teeth and crossing the midline.
The patient presented to our orthodontic clinic for treatment of malocclusion. The patient was a 10-year, one-month-old Caucasian girl with a dentigerous cyst encompassing the right and left impacted mandibular canines and crossing the midline.
This case involves an unusual clinical and radiographic presentation of a dentigerous cyst. It shows a new variant of presentation that medical professionals, specifically dentists and radiologists, should be aware of, since a dentigerous cyst crossing the midline has not been previously reported as far as we are aware. This additional knowledge is important for inclusion on differential diagnosis lists and aids in the development of a proper treatment plan.
Dentigerous cysts are the most common developmental odontogenic cysts, accounting for approximately 25% of all odontogenic cysts of the jaws. They are frequently noted as an incidental finding on radiographs because a majority of these cysts are asymptomatic and are most commonly associated with impacted mandibular third molars and permanent maxillary canines [1, 2]. A dentigerous cyst presents as a well-defined radiolucent entity surrounding the crown of an impacted tooth. The border of the cyst is continuous with the cemento-enamel junction of the impacted tooth. This radiographic finding is pathognomonic for a dentigerous cyst . The occurrence of dentigerous cysts encompassing multiple teeth is uncommon [3–5]. All of the reported cases to date have involved cysts localized to one quadrant of the jaws and have encompassed adjacent teeth. As a dentigerous cyst enlarges, it displaces the affected tooth or teeth apically. Dentigerous cysts enlarge as a result of the accumulation of fluid between the crown of an unerupted tooth and the reduced enamel epithelium.
There were no previous radiographs showing the patient's mandibular anterior teeth to determine whether the cyst originated as a single dentigerous cyst that enlarged and grew to encompass the other impacted canine. There are other reported cases of a dentigerous cyst enlarging and encompassing other adjacent teeth [3–5]. The other possibility is that both impacted canines had enlarging dentigerous cysts that converged, with consequent resorption of the interposing osseous border to create one large, dentigerous cyst that included both teeth. One previous case report described a patient with two adjacent teeth with enlarging dentigerous cysts that still had a bony separation between the two . This finding would lead to the possibility of one dentigerous cyst that enlarged and encompassed the other impacted canine. However, the radiographic findings in that case report showed the border of the dentigerous cyst to be continuous with the cemento-enamel junction of both impacted permanent mandibular canines. On the basis of this radiographic finding, both of these possibilities cannot be ruled out in the absence of previous radiographs.
This case describes the presentation of a dentigerous cyst that has not been previously reported. This new presentation shows that a dentigerous cyst can encompass multiple non-adjacent teeth in addition to the possibility that a dentigerous cyst might also cross the midline. Previously, these two variants would lead to a differential diagnosis not including a dentigerous cyst. This is important for medical professionals to be aware of, specifically dentists and radiologists, so that an accurate differential diagnosis can be made to determine the best treatment for the patient.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
J. Bruce Bavitz was involved in the revisions of the manuscript before submission.
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