A rare case of impacted mandibular premolar associated to dentigerous cyst and periodontal lesion clinical management and histological analysis

Background: Dental cysts, particularly dentigerous cysts (DCs), are a common pathological condition affecting the jawbone. The literature categorizes DCs based on histology and associates them with impacted teeth, often leading to complications. However, the occurrence of DCs in the elderly and their association with mandibular premolars is not well-documented, presenting a knowledge gap in dental pathology and management. Objective: This case report aims to present a rare clinical case of an impacted mandibular premolar associated with a dentigerous cyst and a periodontal lesion, detailing the clinical management, radiographic diagnosis, histopathologic analysis, and surgical intervention. Case presentation: A 65-year-old male patient presented with pain and mobility in tooth 36. Clinical examination, radiographic imaging, and histological analysis were conducted to diagnose and plan the treatment—the treatment involved enucleation of the DC and extraction of the impacted tooth. Histological examination was performed using hematoxylin and eosin staining to determine the nature of the cyst. Results: The patient’s postoperative recovery was uneventful, with complete remineralization of the site after one year. Histological findings indicated a significant inflammatory infiltrate, predominantly lymphocytes, suggesting a periodontal cyst. The impacted mandibular premolar association with a DC in an elderly patient is rare, with the literature reporting a higher frequency of such cysts in younger demographics. Conclusions: The case report contributes to the existing literature by highlighting the successful management of a rare case of an impacted mandibular premolar with a dentigerous cyst and periodontal lesion. It emphasizes the importance of accurate diagnosis and individualized treatment planning in managing complex dental cyst cases. It suggests a conservative approach to prevent surgical risks, especially near critical anatomical structures.