Dentigerous Cyst
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Dentigerous Cyst

Odontogenic Cysts And Tumors

Oral Pathology And Medicine

DENTIGEROUS CYST

Contributed By: Dr. Himani

DEFINITION:-

Dentigerous cyst can be defined as an odontogenic cyst that surrounds the crown of an impacted tooth; caused by fluid accumulation between the reduced enamel epithelium and the enamel surface resulting in the cyst in which the crown is located within the lumen.


PREVALENCE:-

  • This is one of the most common type of developmental odontogenic cyst- 20% of all jaw cyst.
  • 10% of impacted teeth have formed a dentigerous cyst.
  • Frequency in the general population has been estimated at 1.44 cyst for every 100 unerupted teeth.


CLINICAL FEATURES:

  • The cyst is usually associated initially with crown of an impacted, embedded or unerupted tooth.
  • Dentigerous cyst may also found enclosing a complex compound odontoma or involving a supernumerary tooth.
  • Most common site:-
    • Mandibular third molar
    • Maxillary third molar
    • Maxillary cuspid areas

(since these are most commonly impacted teeth)

  • Age:- Second and third decade of life.
  • Sex:- Male predilection.
  • Most dentigerous cyst are solitary.

Bilateral and multiple cyst are usually found in association with number of syndromes including

  • Cleidocranial dysplasia
  • Maroteaux- lamy syndrome.
  • Dentigerous cyst is capable of becoming an aggressive lesion.
  • Cystic involvement of an unerupted mandibular third molar may result in “hollowing out” of entire ramus extending  up to coronoid process and condyle.
  • In case cyst is associated with a maxillary cuspid, expansion of anterior maxilla often occurs & may superficially resemble an acute sinusitis or cellulitis.
  • No pain or discomfort is associated with the cyst unless it becomes secondarily infected.

RADIOGRAPHIC FEATURES:-

  • Three radiological variations of dentigerous cyst are seen radiographically:-
    • Central type
    • Lateral type
    • Circumferential type

Central type:-

In this type the crown is enveloped symmetrically.

Central Type Dentigerous Cyst

Lateral type:-

This type of radiographic appearance results from dilation of follicles on one aspect of crown.

Circumferential type:-

This type results when the follicle expands in a manner in which the entire tooth appears to be involved by the cyst.

 


HISTOLOGIC FEATURES:-

  • It is usually composed of thin connective tissue wall with a thin layer of stratified squamous epithelium lining the lumen.
  • Rete peg formation generally absent unless it is secondarily infected.
  • Inflammatory cells and infiltration of connective tissue is common.
  • Presence of Rushton bodies within the lining epithelium is usually seen with the cyst exhibiting inflammation.
  • The content of cystic lumen is thin, watery yellow fluid, occasionally blood tinged.

TREATMENT:-

Treatment usually is dictated by size of lesion:-

  • Smaller lesions are surgically removed entirely
  • Marsupilization :-  The large cyst which involves severe bone loss are treated by marsupilization.

COMPLICATIONS:-

  • Ameloblastoma
  • Squamous cell carcinoma
  • Mucoepidermoid carcinoma

REFERENCE:-

  1. Shafer’s Textbook of Oral Pathology, 7th edition, pg no-259-264
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