Conservative surgical-orthodontic treatment of a young patient with a dentigerous cyst

The dentigerous cyst is the second most common type of developmental odontogenic cyst, accounting for approximately 20% of all true cysts of the jaws. It develops in two ways: by accumulating fluid between the reduced enamel epithelium (REE) and the crown of an embedded tooth, or by accumulating fluid between layers of the REE. Dentigerous cysts are asymptomatic, except if secondarily infected, and are generally discovered through a panoramic radiographic examination. Dentigerous cysts can reach a considerable size after some time, and can cause expansion of the cortical bone followed by facial asymmetry, pain, tooth displacement and root resorption.

The diagnosis of the dentigerous cyst includes clinical, radiographic, and histopathological aspects. Radiographically, the lesion presents as a radiolucent, unilocular area with well-defined borders, and is associated with an embedded tooth. A normal follicular space measures 3 to 4 mm; when a follicular space measuring more than 5 mm is observed, a dentigerous cyst is suspected7. The histopathological criteria include the presence of a fibrous capsule with minimal inflammatory cells and covered by stratified squamous nonkeratinized epithelium with 4 to 6 layers of cells.