IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(4):276–280

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IP Indian Journal of Orthodontics and Dentofacial Research

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Case Report
Inflammatory dentigerous cyst management in paediatric patient followed by
management of impacted maxillary canine with 1 year follow up: A rare case
report
Gaurav Gupta 1, *, D K Gupta2 , Neelja Gupta3 , Priyanka Gupta4 , Richa Gupta5 ,
Devanshi Sankhla6
1 Dept. of Paediatric and Preventive Dentistry, Jaipur Dental College, Jaipur, Rajasthan, India
2 Dept. Oral and Maxillofacial Surgery, Wisdom Dental Clinics, Jaipur, Rajasthan, India
3 Dept. Cosmetic and Aesthetic Dentist, Wisdom Dental Clinics, Jaipur, Rajasthan, India
4 Dept. of Pedodontics and Preventive Dentistry, RUHSCDS Govt Dental College, Jaipur, Rajasthan, India
5 The Tooth Clinic, Bareilly, Uttar Pradesh, India
6 Wisdom Dental Clinics, Jaipur, Rajasthan, India

ARTICLE INFO ABSTRACT

Article history: Cysts of jaw present as swellings of jaws and midface. Of different varieties, dentigerous cyst is most
Received 28-09-2022 common type of noninflammatory odontogenic cyst. Dentigerous cysts are generally associated with
Accepted 16-11-2022 crowns of impacted or unerupted permanent teeth. Here we present a case of dentigerous cyst in 13-year-
Available online 29-12-2022 old female child, which was successfully treated with conservative therapy. Patient also reported after
one and half year with protruding teeth and retained deciduous right upper canine & impacted permanent
canine. This case report also presents orthodontic management of retained deciduous canine and impacted
Keywords: permanent canine.
Dentigerous cyst
Conservative therapy This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons
Protruding teeth Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon
Retained deciduous canine the work non-commercially, as long as appropriate credit is given and the new creations are licensed under
Impacted permanent canine the identical terms.
Orthodontic management For reprints contact: reprint@ipinnovative.com

1. Introduction decade of life. 6

In general, cysts of jaw commonly present as swellings It is also been reported that progressing inflammation
of jaws and midface. A sine qua non for development of from root apex of deciduous tooth brings about development
dentigerous cyst is usually an unerupted tooth. Frequency of dentigerous cyst around unerupted permanent tooth. 7
of dentigerous cyst formation has been calculated as 1.44 in This finding suggests that teeth treated with RCT for
every 100 unerupted teeth. 1–3 pulpal and periapical infection may become involved in
Dentigerous cyst is defined as cyst that originates by development of dentigerous cyst. 8
separation of follicle from around crown of unerupted Younger patients with unerupted or impacted teeth,
tooth. 4 They are generally associated with crowns of have more predilections for dentigerous cysts. 9 Their
impacted or unerupted permanent teeth, but they can be early recognition and treatment is imperative to prevent
associated with an odontoma or developing tooth, and even further proliferation leading to osseous deformities and
deciduous teeth. 3,4 Dentigerous cysts are more common in gross destruction. Dentigerous cyst may enlarge and extend
male patients 5 and frequently occur during 2nd and 3r d posteriorly to involve ramus, or anteriorly into body of
* Corresponding author. mandible to involve roots of adjacent teeth. It can also
E-mail address: dr.gauravgupta99@gmail.com (G. Gupta). expand into antrum displacing involved teeth posteriorly or

https://doi.org/10.18231/j.ijodr.2022.048
2581-9356/© 2022 Innovative Publication, All rights reserved. 276
 Gupta et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(4):276–280 277

toward orbital floor. CBCT was adviced which revealed an unilocular well-
Marsupialization is treatment of choice, for dentigerous defined radiolucency associated with an impacted deciduous
cysts involving unerupted favourably positioned teeth to 2nd molar and retained permanent 2nd premolar extending
contemplate for smooth uneventful eruption of underlying up to inferior alveolar nerve [Figure 1]. Histopathologic
teeth, however, for longstanding large lesions with teeth examination of aspirated biopsy showed cystic lesion, and
in unfavourable positions; enucleation of cyst along with presumptive diagnosis of dentigerous cyst was made.
removal of offending teeth remains gold standard. 10 Enucleation of cyst was considered as treatment of
After mandibular 3r d molars, maxillary canines are choice for minimize damage. Prior to surgery, routine blood
second most commonly impacted teeth, 11 with palatal and urine examinations were carried out and, results were
impactions prevailing over buccal impactions. 12 Treatment within normal limits.
approaches are aimed at canines’ correct occlusion, as well After obtaining an informed consent, surgical
as function and aesthetics of dentition and can be divided intervention was performed under local anaesthesia.
into preventive and surgical. Pathology involved retained deciduous 2nd molar and
Most common treatment procedure in children and retained permanent 2nd premolar extending up to Inferior
adolescents is surgical exposure followed by orthodontic Alveolar Nerve. Treatment procedure involved removal of
appliance treatment, where, as a rule, primary canines are deciduous 2nd molar and retained permanent 2nd premolar.
left in place until orthodontist has moved impacted tooth to Flap was reflected along with thinned-out bone. The
this region. contents of cyst were evacuated, and cystic cavity was
thoroughly irrigated to remove any residual fragments and
Failure of eruption of mandibular canine is an unusual
debris. The cavity was then packed with iodoform-dressing.
event. It has been suggested that eruption disturbances
Patient was periodically recalled for iodoform dressing
of mandibular canine are most often caused by local
for 2 months. The evacuated surgical specimens were
factors such as mechanical obstruction (supernumerary
histopathological examined to confirm diagnosis of
tooth/cyst/tumour), insufficient space in dental arch and
dentigerous cyst. Patient was advised to maintain good oral
tooth-arch size discrepancy. Systemic factors such as
hygiene and a chlorhexidine mouth rinse was prescribed.
genetic disorders, endocrine deficiencies and previous
Radiographic follow-up revealed sufficient bone filling with
irradiation of the jaws also have been suggested to play a
increased bone density from margin to centre of the defect.
major role. 13
[Figure 2]
The purpose of this paper is to present a case of
dentigerous cyst with unusual a paediatric patient and
its conservative management. In this paper we have also
illustrated orthodontic management of retained deciduous
canine and impacted permanent canine.

2. Case Report
A 13-year-old girl reported to clinic, with chief complaint
of swelling in the lower left posterior region of the face
which was present since 1 month. Patient also complained
of numbness of lower lip from left side. Otherwise, the child Fig. 2: Follow up OPG
was physically healthy with no significant medical history.
Clinical history revealed that swelling started as small The patient reported to clinic after one and half year,
painless nodule which increased to present size over a with complain of protruding teeth. Extra oral examination,
period of 1 month. Past dental history suggested that pulp patient’s profile was convex and lips were competent. Intra
therapy had been performed on deciduous 2nd molar. oral examination [Figure 3a,b,c] revealed:

1. The patient was in late mixed dentition stage. Dental

age corresponded to 10–13 years of age.
2. Fair oral hygiene of patient.
3. Retained deciduous right upper canine & impacted
permanent canine.
4. The patient had increased overjet and overbite.

Clinical evaluation, decision was taken by the patient and

her family to undergo a closed flap procedure with bonding
Fig. 1: Pre-operative CBCT of an orthodontic button and attachment of an orthodontic
278 Gupta et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(4):276–280

Fig. 5: a,b

After 1 year follow-up was done, occlusion was stable

and patient was satisfied and happy with treatment the
results. (Figure 6)
Fig. 3: a-d:

traction chain to the wire ligation to surgically expose the

canine and mechanically guide it into its normal position in
the dental arch and correct protrusion of teeth.
Main treatment objective was to guid eruption of
impacted teeth to obtain functional occlusion with minimal
impact on soft tissue profile. Extraction of upper 1st
premolar on both side and lower right 2nd premolar was
done to gain space and 0.022×0.028-inch Roth prescription.
Preadjusted Edgewise appliance was bonded to available
Fig. 6: 1 year follow -up OPG
teeth. A soldered lingual arch wire was placed in upper
arch to conserve anchorage. Light continuous wires were
placed progressing from 0.016 NiTi, 0.018 NiTi, 16×22
NiTi and finally 17×25 SS wire. Then orthodontic forces 3. Discussion
were applied to attachment to move impacted tooth into Dentigerous cysts appear to have greater tendency to cause
occlusion. After sufficient eruption of impacted teeth root resorption of adjacent teeth compared to radicular cysts
occurred, NiTi overlay wires tied into brackets. Treatment or odontogenic keratocysts. 14 Cysts developing in growing
was later focused on finishing with well-interdigitated child will enlarge much more rapidly than in adult, and
posterior occlusion in both arches. [Figure 4 a,b,c,d,e,f,g,h,i] lesions 40 to 50 mm in diameter can develop in a 3- to 4-
year period, although patients may only give history of a
slowly enlarging swelling. 15
In an infected cyst, borders may be ill-defined. There
may be difficulty distinguishing small cyst from normal
tooth follicle. It has been suggested that any follicular
space of >4 mm should prompt a strong suspicion for
dentigerous cyst. However, differential diagnosis should
include ameloblastoma, odontogenic keratocyst, and other
odontogenic tumors, such as adenomatoid odontogenic
tumor in anterior radiolucencies and ameloblastic fibroma
in posterior jaws of young patients. 16
Therapy for cyst is determined by its aetiology and
localization, which, on one hand, means that causal tooth
must be treated or removed and on other that cystic
Fig. 4: a-i: Intra-oral photographs during treatment lining, which secretes cystic content, must be excised. 17
This statement fits well with treatment characteristics of
The entire treatment was completed in 19 months. After dentigerous cyst.
debonding, upper and lower Hawley retainers were given. Among various surgical treatment modalities to treat
[Figure 5a,5b] Impacted teeth were properly aligned and dentigerous cyst, enucleation of cyst is most widely
the patient finished with a significantly improved functional accepted procedure. Marsupialization is another treatment
and aesthetic result. Post-treatment results were very good, modality, which is usually employed for large dentigerous
patient was happy with results. cysts due to its significant size, possibility of destruction of
 Gupta et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(4):276–280 279

surrounding tissue and concern for potential of pathologic 5. Conflict of Interest

fracture.
The authors declare that they have no conflict of interest.
A horizontally impacted tooth is considered tedious
because of following reasons (1) unfavorability of eruption,
(2) high anchorage requirements and (3) loss of vitality due 6. Source of Funding
to movement of teeth over further places. A horizontally None.
impacted tooth in mandible is even more problematic
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280 Gupta et al. / IP Indian Journal of Orthodontics and Dentofacial Research 2022;8(4):276–280

Author biography Richa Gupta, Consultant

Devanshi Sankhla, Associate Dentist

Gaurav Gupta, Professor https://orcid.org/0000-0003-3895-059X

D K Gupta, Senior Consultant Cite this article: Gupta G, Gupta DK, Gupta N, Gupta P, Gupta R,
Sankhla D. Inflammatory dentigerous cyst management in paediatric
Neelja Gupta, Senior Consultant patient followed by management of impacted maxillary canine with 1
year follow up: A rare case report. IP Indian J Orthod Dentofacial Res
Priyanka Gupta, Senior Demonstrator 2022;8(4):276-280.