Comprehensive Case Study: Diagnosis and Management of a Dentigerous Cyst in the Mandibular Third Molar

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Dentigerous Cyst

Dentigerous Cyst

Full Dental Analysis and Diagnosis

Location

Typically found around the mandibular third molars or maxillary canines.
In this X-ray, the lesion appears surrounding the lower left third molar, expanding within the mandibular bone.

Radiographic Appearance

A well-defined unilocular radiolucency with a smooth, corticated border.
The cyst is attached to the cementoenamel junction (CEJ) of the unerupted tooth.
Some surrounding bone resorption is visible due to cystic expansion.

Symptoms and Clinical Signs

  • Swelling in the jaw region

  • Pain or pressure sensation as the cyst enlarges

  • Tooth displacement or root resorption of adjacent teeth

  • Sometimes asymptomatic and discovered incidentally on X-ray

Diagnosis

Provisional Diagnosis: Dentigerous Cyst associated with impacted third molar
Differential Diagnoses:

  • Odontogenic keratocyst (OKC)

  • Unicystic ameloblastoma

  • Radicular cyst (if adjacent to a non-vital tooth)

Confirmatory Test:
Histopathological examination after surgical removal confirms diagnosis.

Treatment Plan

1. Radiographic Evaluation
Perform panoramic and periapical radiographs to define cyst boundaries.

2. Surgical Intervention

  • Enucleation: Complete removal of the cystic lining and involved tooth (for moderate size cysts).

  • Marsupialization: For large cysts, to decompress gradually before full removal.

3. Follow-Up
Regular radiographs at 3, 6, and 12 months to ensure bone regeneration.
Maintain oral hygiene and prevent postoperative infection.

Healing Time Frame

  • Initial healing: 2–3 weeks (soft tissue)

  • Bone remodeling: 3–6 months

  • Full recovery: Up to 12 months depending on cyst size and bone loss

Issues That May Scale Up if Untreated

  • Expansion leading to jaw fracture

  • Secondary infection of the cyst cavity

  • Tooth root resorption of adjacent teeth

  • Possible transformation to ameloblastoma or other neoplastic lesions (rare)

  • Facial asymmetry or malocclusion

Comments

This case shows a classic dentigerous cyst presentation. It is essential to have it addressed promptly to prevent bone weakening and secondary infection. Early surgical management leads to excellent prognosis and bone regeneration.

 

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