Case reports Annals and Essences of Dentistry

DENTIGEROUS CYST AS MID PALATAL SWELLING: A CASE REPORT

Yadav N.S1 1.Director and Professor.2 2.Post graduate student

Associate ProfessorPreeti Nair3 3. Professor and Head

Guruprasad R 4.

Department of Oral Medicine and Radiology, People’s College of Dental Sciences and Research Centre, Bhopal-462037, Madhya Pradesh

ABSTRACT

Dentigerous cyst is a developmental odontogenic cyst which originates through alterations of the reduced enamelepithelium in an unerupted tooth after the crown has been fully formed. Dentigerous cysts associated withsupernumerary teeth are rare and constitute 5–6% of all dentigerous cysts. Supernumerary teeth should be examinedvery carefully to prevent possible effects on adjacent regular teeth and possible cystic development. We report a rarecase of mid palatal swelling due to a dentigerous cyst associated with an impacted supernumerary in an elderlypatient.KEY WORDS:Dentigerous Cyst, Supernumerary Tooth, Mid palatal swelling

INTRODUCTION

Dentigerous cyst is a developmentalodontogenic cyst which originates throughalterations of the reduced enamel epithelium in anunerupted tooth after the crown has been fullyformed. About 95% of dentigerous cysts involve thepermanent dentition. Dentigerous cysts aroundsupernumerary teeth account for 5% of alldentigerous cysts, most developing around amesiodens in the anterior maxilla and palate1.

Supernumerary teeth are present in 0.8% ofprimary dentitions and in 2.1% of permanentdentitions. One of the rare problems associated withsupernumerary teeth is the formation of dentigerouscyst2. The usual age of clinical presentation ofdentigerous cyst due to supernumerary tooth is inthe first 4 decades. The highest incidence ofdentigerous cysts occurs during the second andthird decades (Shear, 1992).

Dentigerous cysts are usually associatedwith unerupted teeth of the permanent dentition.When observed with erupted and complete dentitionthe diagnosis is a surprise. We report a rare case ofmid palatal swelling due to a dentigerous cystassociated with an Impacted supernumerary teethin an adult.

Case reportA 26 year old male, reported with a chief

complaint of swelling in the palate since 6 months.The swelling which was initially about the size of apeanut gradually increased to attain the presentsize. There was no history of trauma and it was notassociated with any pain, just a local discomfort.

A solitary oval shape swelling was presentin the center of palate measuring 2.5cm in diameterwhich was pink in color with bluish hue and marginswere well defined (Fig 1). On palpation swelling wasfirm in consistency except in center where a hardmass was palpable, it did not blanch on pressureand was fixed to underlying bone. A provisionaldiagnosis of mid palatine cyst was made. Thedifferential diagnosis included neurofibroma,maxillary tori, tumor arising from minor salivarygland and dentigerous cyst arising fromsupernumerary teeth.

Vitality test was done for all the maxillaryteeth with electric pulp tester which did not elicit anyabnormal response. An occlusal radiograph wastaken which showed a well defined pericoronalunilocular radiolucency which was surrounding aradiopaque mass resembling supernumerary tooth(Fig 2). The radiographic diagnosis of dentigerous

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Case reports Annals and Essences of Dentistry

cyst arising from supernumerary tooth was made.An aspiration of the lesion yielded an amber colouraspirate.

The patient was operated under localanesthesia and enucleation was done (Fig 3).

Histopathological examination of the enucleatedspecimen revealed an Odontogenic cystic liningwhich confirmed the diagnosis of a dentigerous cyst(Fig 4).

Fig.1: Swelling in mid palate Fig.2.Pericoronal radiolucency in mid palatalregion

DiscussionNext to the radicular cyst, the dentigerous

cyst is the second most common type ofodontogenic cyst and is always associated with thecrown of an impacted, embedded, or otherwiseunerupted tooth 3. A cystic swelling of the hardpalate may be the result of different kinds of cysts:Odontogenic, Non Odontogenic or Bone cysts.Dentigerous cyst is associated with mesiodensusually located in anterior maxilla or palate but inthis case it was caused by a maxillary impactedsupernumerary tooth, leading to the swelling in themid palatal region. Hence it should be carefullydifferentiated from other mid palatal swellings.

Radiographic appearance of dentigerouscyst is that of a well-defined pericoronal radiolucent

lesion, which may be unilocular or multilocular inappearance4. In addition to its potential for bonedestruction and because of the multipotential natureof this epithelium derived from the dental lamina,several entities may arise in or be associated withthe wall of a dentigerous cyst.

Treatment of dentigerous cyst depends on size,location, disfigurement & often requires variablebone removal to ensure total removal of the cyst,especially in cases of large ones5. Thus treatmentfor dentigerous cysts is surgical removal6. Becauseof the potential for occurrence of an odontogenickeratocyst or the development of anameloblastoma7 or mucoepidermoid carcinoma, all

Fig.3. Enucleation of the cyst Fig.4. Photomicrograph showing epithelial lining

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Case reports Annals and Essences of Dentistry

such lesions, when removed, should be submittedfor histopathologic evaluation.

CONCLUSION

A rare case of dentigerous cyst arising fromimpacted supernumerary tooth and presenting as amidpalatal swelling was described. It should becarefully distinguished from other mid palatalswellings.

References

1. 1.Von Arx T: Anterior maxillary supernumerary teeth-A clinical and radiographic study; Australian DentalJournal 1992; 37(3): 189-195.

2. Lustmann J, Bodner L: Dentigerous cysts associatedwith supernumerary teeth; Int J Oral Maxillofac Surg1988; 17:100 - 102.

3. Regezi JA, Sciubba JJ. Oral Pathology: Clinical-Pathologic Correlations. Philadelphia:Saunders,1989;p 306.

4. Asaumi JI, Shibata Y, Yanagi Y, et al: Radiographicexamination of mesiodens and their associatedcomplications; Dentomaxillofacial Radiolology 2004;33(2): 125-127.

5. Primosch RE: Anterior supernumerary teeth:assessment and surgical intervention in children;Pediatric Dentistry 1981; 3: 204-21.

6. Kessler HP, Kraut RA: Dentigerous cyst associatedwith an impacted mesiodens; General Dentistry 1989;37(1):47-49.

7. Gardner DG, Corio RL: Plexiform unicysticameloblastoma - A variant of ameloblastoma with alow recurrence rate after enucleation. Cancer 1984;53(8): 1730-1735.

Corresponding Author

Dr NS YADAVDirector and professor

Department of Oral MedicinePeople’s College of Dental Sciences and

Research Centre, Bhopal-462037,Madhya Pradesh

Ph. No;917554005342

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E-mail; nsyadavdr@gmail.com