A Dentigerous Cyst Associated with Impacted Mandibular Canines: A Rare Case Report

Introduction Cysts of the jaws are defined as pathological cavities lined by epithelium and surrounded by fibrocollagenous connective tissue. Among them, odontogenic cysts arise from odontogenic epithelium, which is derived from the basal layer of the stomodeum. 1 The dentigerous cyst is a developmental odontogenic cyst that encloses the crown of an unerupted tooth at the cementoenamel junction. It represents the second most common odontogenic cyst after the radicular cyst, accounting for approximately 16–24% of all true cystic lesions of the jaws.2 Dentigerous cysts typically occur in younger patients, most often under 20 years of age, and are usually associated with impacted, embedded, or unerupted teeth. The mandibular third molars are the most frequently affected, followed by the maxillary canines and premolars. Clinically, these cysts are often asymptomatic but can attain considerable size, resulting in cortical expansion, erosion, tooth displacement, and root resorption. Radiographically, they present as unilocular radiolucencies with well-defined sclerotic margins surrounding the crown of an unerupted tooth. Histologically, the cyst wall consists of thin fibrous connective tissue with a myxomatous appearance, and the epithelial lining, usually 2–4 cell layers thick, represents reduced enamel epithelium that is characteristically non-keratinized. 3 Management of dentigerous cysts depends on their size, location, and relation to adjacent structures. Treatment modalities include enucleation, marsupialization, and decompression, each with the aim of eliminating the lesion while preserving the associated tooth when possible. This study aims to illustrate a simplified surgical approach for the management of large dentigerous cysts with impacted teeth, which can be effectively performed in an office setting, providing an optimal balance between disease eradication and preservation of oral structures. 4