Surgical Management and Prosthetic Rehabilitation of Dentigerous Cyst Associated with Impacted Mandibular Canine: A Case Report.

The most frequent odontogenic developing cyst linked with an impacted tooth is the dentigerous cyst. They are normally asymptomatic and are identified during routine radiography tests to see if a tooth is missing from the arch. This case report is designed to demonstrate how an enucleated dentigerous cyst with impacted teeth led to the spontaneous recovery of a bone defect without the need for bone graft. The radiographic scan (OPG) 6 months after cystectomy revealed the creation of adequate bone for the insertion of the implants. As a result of this procedure, the patient's functional, physiologic, and psychological demands were addressed, and the cyst recurrence was avoided. Dental implants were the greatest choice for tooth replacement if significant bone regeneration could be achieved. Copyright:

INTRODUCTION

One of the most prevalent types of odontogenic cysts in children is the dentigerous cyst, which develops in the jawbone and is linked to an impacted tooth's crown.[1] As the tooth erupts, the follicle it is pressing on blocks the flow of blood to the capillary wall, which results in fast serum transfusion across the capillary walls.[23]

The proliferative cell death of the follicle after a delayed eruption, according to Toller,[4] is at the probable genesis of the dentigerous cyst. As a result of these breakdown products, the osmotic pressure rises, resulting in cyst development. Another theory claims that the dentigerous cyst is generated by periapical tissue inflammation caused by infection from a temporary precursor tooth that reaches the germ of the permanent tooth, causing fluid buildup.[5]

The cyst shows as a radiolucent region surrounding the unerupted tooth that is normally unilocular with radiopaque boundaries, although big lesions are multiloculated.[6]

Dentigerous cysts are not linked to nerve illnesses caused by malignancy, direct or indirect injury to the neurovascular bundle, or other systemic or neurological conditions.[7] Periapical diseases can sometimes impact the inferior alveolar nerve and cysts of the mandible.[8] Many teeth may need to be extracted when big cysts are present because they can have multiple physical, psychological, and aesthetic implications for the patient.[91011121314] In this study, dentigerous cysts that surround the mandibular permanent canine were surgically removed, and the bone deficiency that resulted was spontaneously repaired without the need for any kind of bone transplant.

REPORT ON THE CASE

Functional and masticatory abnormalities and swelling on the mandibular right side of the face brought the 20-year-old male patient to Dental Office.

There were no dental or craniofacial abnormalities, nor was there any skin or skeletal dysmorphology in the patient. The absence of the right mandibular canine was discovered during an intraoral clinical examination, and the space was closed by the migration of neighboring teeth [Figure 1]. The buccal cortex showed expansion.

Figure 1

Preoperative view

Orthopantomography revealed the impacted mandibular canine and a large, well-defined area of radiolucency with a radiopaque contour around it all the way around. The cyst's radiolucency was superimposed on the remaining bone trabeculae [Figure 2].

Figure 2

OPG of the patient

Unilocular dentigerous cyst was the clinical and radiological diagnosis.

Cysts of this kind are often removed surgically and then submitted to a pathology lab for further examination [Figure 3].

Figure 3

Enucleated cyst along with the tooth

Arch bar was used for the fixation of the remaining teeth. Finally, the bone bed was rejoined to the mucoperiosteal flap using resorbable threads.

Six months after a cystectomy, an OPG revealed that the radiolucency had almost completely disappeared and that enough bone had grown to allow the insertion of implants for prosthetic rehabilitation [Figure 4].

Figure 4

OPG post enucleation

All three of the mandibular premolars—one on each side of the gum—were removed and replaced with titanium implants [Figure 5].

Figure 5

Implants placed

There was a need for ridge split of the bone because of inadequate buccal bone present. All three titanium implants were put to allow new bone to grow around them and stabilize them.

Radiographic tests were used to monitor the progress of implant osseointegration after 6 months of recovery [Figure 6].

Figure 6

RVG of the implants placed

The patient's functional, physiognomic, and psychological needs were satisfactorily met by the use of implants and a fixed partial denture [Figure 7]. The ethical committee approval was taken on 11/ january 2020.

Figure 7

Prosthesis placed

DISCUSSION

There are two main types of developmental non-inflammatory odontogenic cysts: dentigerous cyst, which is the most common type, and dentigerous granulomas, which are the most common cause of radiolucency associated with impacted teeth.[1516]

Both Cleidocranial dysplasia and Maroteaux–Lamy syndrome have been associated with a high prevalence of bilateral, multiple cysts.[17] However, the maxilla accounts for just a small percentage of all cases of dentigerous cysts reported in the dental literature.[18]

Dentigerous cyst begins to develop along the root of the impacted tooth and radiates outwards to include the root of the unerupted tooth.[19] A histological examination of the sore coating is needed to separate this somewhat harmless sore from a more forceful one, for example, an ameloblastoma or focal mucoepidermoid carcinoma.[20]

Enucleation of the dentigerous cyst provides many advantages: a low recurrence rate, quick recovery time, and favorable results regardless of bone grafting procedures.[21] Enucleation and simple closure of the cyst have been shown to result in bone repair even in cases of very large lesions.[22]

CONCLUSIONS

Dental implants are the greatest choice for restoring lost teeth if there is sufficient bone regeneration.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.