ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):77-78

©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 3 ISSUE 1 JANUARY-MARCH 2011 77

Dentigerous Cyst Associated With Mesiodens: A Rare Case Report Chandramani.B.More., Hetul Patel

Abstract

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation

of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. Dentigerous cyst

associated with supernumerary tooth and mesiodens is rare. The usual age of clinical presentation of

dentigerous cyst due to supernumerary tooth is during the first four decades. We report a rare case of

dentigerous cyst in association with mesiodens in a young male.

Key Words: Dentigerous Cyst;Mesiodens;Odontogenic Cyst;Supernumerary Tooth

Received on: 13/ 09/2010 Accepted on: 13/10/2010

Introduction

Dentigerous simply means ‘containing

teeth’.(1) A dentigerous cyst is one which

encloses the crown of an unerupted tooth by

expansion of its follicle and is attached to the

neck.(2) Dentigerous cysts are the most common

benign odontogenic cysts of developmental type

that are usually single in occurrence. However

multiple dentigerous cysts are also reported.

They are usually associated with an impacted

tooth and develop after the complete formation

of the crown. They most commonly involve the

mandibular third molars or the maxillary canine,

followed by the mandibular premolars. The

involvement of incisors and supernumerary teeth

are rare.(3) This paper report a rare case of

dentigerous cyst in association with mesiodens in

a young male.

Case Report

A healthy boy of sixteen years

presented with a chief complaint of painful

swelling on the right side of the face since 8-10

days. Initially the swelling was small with

occasional dull pain. The swelling and pain had

gradually increased leading to discomfort. His

systemic history, trauma and family history were

not significant. Extra oral examination showed

gross asymmetry of the face due to the swelling

on the right side. The swelling was hard, diffuse,

tender and of ovoid shape approximately

measuring around 4cm x 5cm extending from

midline and right lateral wall of the nose, mildly

obliterating the nasolabial fold and philtrum of

the lip to about 1 cm inferior to the infraorbital

margin and outer canthus of the eye. Mild

obliteration of right nare was observed. The lips

were incompetent. The right submandibular

lymph node was palpable and tender. Intra-oral

examination revealed a well-defined hard, tender

and ovoid swelling involving labial and palatal

aspect of right central incisor to second premolar

with labial and palatal cortical plates expansion

leading to obliteration of labial vestibule.

Palatally, the swelling extended from palatal

rugae and palatal gingiva to the center of the

hard palate approximately measuring 3x2.5 cm.

There were no visible or palpable pulsations. All

the involved teeth were vital and tender. Based

on the history and clinical examination, a

provisional diagnosis of Radicular cyst involving

11, 12 and 13 was established.

The differential diagnosis of dentigerous

cyst with an impacted supernumerary tooth was

considered. Routine laboratory parameters were

normal. FNAC of the swelling showed straw

coloured brownish fluid and on Cytologic

examination nonspecific inflammatory cells were

noted. Intra oral periapical radiograph, cross-

sectional occlusal view (Fig 1) and panoramic

radiograph showed a well-defined and unilocular

radiolucent lesion approximately measuring

4x3.5 cm, attached to the crown of the unerupted

inverted mesiodens in the right alveolar process

of the anterior maxilla. Also a supernumerary

tooth was noted on the left side of the palate.

This radiographic appearance suggested a

diagnosis of dentigerous cyst associated with

mesiodens.

Figure 1 Occlusal view Figure 2 CT

Non contrast CT in axial and coronal

planes showed fluid filled unilocular lesion along

with crown of mesiodens in the maxillary

alveolar process (Fig 2). The Surgical resection

of the lesion along with removal of mesiodens

CASE REPORT

ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 2011:3(1):77-78

©INTERNATIONAL JOURNAL OF DENTAL CLINICS VOLUME 3 ISSUE 1 JANUARY-MARCH 2011 78

and histopathological examination (Fig 3)

confirmed the diagnosis of dentigerous cyst

associated with mesiodens. The patient is under

follow up since six months and no complications

are observed.

Figure 7- Photomicrograph (HandE stained

specimen with x 10 magnification)

Discussion

A dentigerous cyst can be defined as

one that encloses the crown of an unerupted

tooth by expansion of its follicle and is attached

to its neck. They account for more than 24% of

jaw cysts.(4)The substantial majority of

dentigerous cysts involves the mandibular third

molar and the maxillary permanent canine,

followed by the mandibular premolars, maxillary

third molars and rarely the central incisors,

supernumerary teeth and mesiodens.(2)

Dentigerous cyst most commonly occurs in

second and third decade of life.

Daley and Winsock have recommended

the following guidelines for the diagnosis of a

dentigerous cyst: 1) a Pericoronal radiolucency

>4 mm in greatest width, 2) histologically,

fibrous tissue lined by nonkeratinized stratified

squamous epithelium and 3) a surgically

demonstrable cystic space between the enamel

and the overlying tissue. Of these, the third is the

most critical, but all the three must be

satisfied.(4)

Mesiodens is known to have a cone

shaped crown and a short root as seen in our

patient. It is a rare entity with a reported

incidence of 0.15 to 1.9% and has a slight male

predominance. Most mesiodens are located

palatally to the permanent incisors. Only a few

lie in the dental arch or labially to the permanent

incisors. Resorption of the adjacent roots by

mesiodens or its cyst is a rare complication. (5)

Dentigerous cyst is one of the most

common developmental odontogenic cysts which

is usually detected on routine radiographic

examination. Developing dentigerous cyst is

difficult to distinguish from normal follicle. The

pericoronal radiolucencies more than 4 mm

should be considered cystic, until proven

otherwise.(6)

Conclusion

Dentigerous cyst rarely involves central

incisors, supernumerary teeth and mesiodens.

The diagnostic feature of this cyst is the presence

of unerupted / impacted tooth in its cavity. Authors Affiliations: 1. Dr. Chandramani.B.More,

M.D.S, Professor & Head, 2. Dr. Hetul. J. Patel,

Department of Oral Medicine & Radiology, K. M.

Shah Dental College & Hospital, Sumandeep

University, Gujarat, India.

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Address for Correspondence

Dr. Chandramani. B. M.,M.D.S .,

Professor & Head,

Department of Oral Medicine & Radiology,

K. M. Shah Dental College & Hospital,

Sumandeep University,

Vadodara,Gujarat, India.

Email: drchandramanimore@rediffmail.com

Source of Support: Nil, Conflict of Interest: None Declared

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