Conservative Treatment by Marsupialization of Dentigerous Cysts in Children: Report of three Cases

Special Article - Oral & Maxillofacial Surgery

Austin J Dent. 2017; 4(2): 1067.

Conservative Treatment by Marsupialization of Dentigerous Cysts in Children: Report of three Cases

Durmuslar S¹*, Durmuslar MC² and Nale T¹

¹Department of Pediatric Dentistry, Bülent Ecevit University, Turkey

²Department of Oral and Maxillofacial Surgery, Bülent Ecevit University, Turkey

*Corresponding author: Durmuslar S, Department of Pediatric Dentistry, Faculty of Dentistry, Bülent Ecevit University, Esenköy, Zonguldak, Turkey

Received: January 23, 2017; Accepted: February 25, 2017; Published: February 28, 2017

Abstract

Dentigerous cyst is the most common developmental odontogenic cyst. The standard treatment is enucleation of the cyst and extraction of the involved tooth. However, if the patient is a child, marsupialization may be advisable to allow eruption of a cyst-associated unerupted tooth, as a conservative and definitive treatment. This case report presents three cases of dentigerous cysts in children.

Two of the cases, lesions were detected at the right side of the mandible and associated with second primary molar and unerupted second premolar. One of the cases the lesion was detected at the right side of the maxilla and associated with first primary molar and unerupted first premolar. Patients were treated by extraction of the primary molars and marsupializing the cyst cavities. At 9 months follow up visits showed that the cystic lesions had resolved and the premolars were ready to erupt.

Because of the children have a great regenerative potential in bony structure and the teeth with incomplete root development maintain the eruptive strength, marsupialization is a conservative approach for treating dentigerous cysts in children.

Keywords: Dentigerous Cyst; Marsupialization; Unerupted tooth; Children

Introduction

Dentigerous cyst is benign and asymptomatic odontogenic cyst of the jaws. It is characterized by a unilocular radiolucent lesion that encloses or displaced unerupted teeth [1]. There are fluid accumulation between the reduced enamel epithelium and the crown with expansion of the tooth follicle [2-5]. This often causes cortical bone expansion, displacement of adjacent and involved teeth, resorption of teeth roots, tooth mobility and sensitivity if it reaches a size larger than 2 cm in diameter. Dentigerous cyst remain initially completely asymptomatic unless when infected [6,7].

Enucleation and marsupialization are the treatment options of dentigerous cysts. Marsupialization may be advisable for the involvement permanent tooth as cyts in children. This therapy allow the eruption of the permanent tooth involved. Because incomplete root development maintain the eruptive force [2,3,8,9].

This case report presents three cases of dentigerous cysts which were associated with primary teeth caries in children. This article emphasizes that success of conservative approach of dentigerous cysts in children.

Case Presentation

Case 1

A 6-years-old girl was referred to the department of pediatric dentistry with an intermittent pain associated with tooth decay. Extraoral examination revealed no facial asymmetry. Intraoral examination revealed a hard submucosal mass and bone expansion of the buccal cortical plate of the alveolar ridge on the right side of the mandible which was caused deletion of the buccal folder. Radiographic examination showed a unilocular radiolucency surrounding the right mandibular primary and permanent molars and displacing the unerupted 2nd premolar to the lower border of mandible (Figure 1A). At first, the contents of the swelling, serous and bloody liquid material, were aspirated and sent for histopathological evaluation. A provisional diagnosis of inflammatory type of dentigerous cyst was made on the basis of the clinical and radiographic findings.

Considering the age of the patient and the size of the cyst, marsupialization of the cystic cavity with preservation of all the involved permanent teeth was planned. After signing informed consent, the patient was treated by extraction of the right mandibular primary molars and marsupialization of the cystic cavity under local anesthesia. A plastic device made of anesthetic cartridges were inserted in the cystic cavity on the top of alveolar crest and sutured to the mucosa for creating a window with drain for irrigate the cystic cavity (Figure 1B).The drain was shortened as the cystic cavity volume was decreased.