MARSUPIALIZATION: A conservative approach for treating dentigerous cyst in children in the mixed dentition

Dentigerous cysts are the most common of all developmental odontogenic cysts of the jaws and account for approximately 20-24% of the jaw cysts.

They develop around the crown of an unerupted tooth by expansion of the follicle when fluid collects or a space is created between the reduced enamel epithelium and the enamel of an impacted tooth.

These cysts are always associated with an unerupted tooth or a developing tooth bud and are found most frequently around the crown of the mandibular 3rd molars followed, in order of frequency, by the maxillary canines, maxillary 3rd molars and, rarely, the maxillary central incisors. 

The cyst may cause swelling, teeth displacement, tooth mobility and sensitivity if it reaches a size larger than 2 cm in diameter.

In the radiograph, the dentigerous cysts usually show a well-defined unilocular radiolucency, often with a sclerotic border, surrounding the crown of an unerupted tooth. 

Histologically, the dentigerous cyst consists of a fibrous wall lined by non-keratinized stratified squamous epithelium of myxoid tissue, odontogenic remnants and, rarely, sebaceous cells. 

If untreated, these cysts may cause pathologic bone fracture, impaction of the permanent tooth, bone deformation, ameloblastoma and development of squamous cell carcinoma or mucoepidermoid carcinoma.

3 Topics of interest

The treatment modality indicated for such a cyst is either surgical removal of the cyst, avoiding damage to the involved permanent tooth, or enucleation of the cyst along with removal of the involved tooth, or the use of a marsupialization technique. 

These cases presented here describe the management of dentigerous cysts in children in the mixed dentition.