From Impaction to Eruption, Simplified Management of Two Teeth Impacted by a Large Mandibular Cyst: A Clinical Case Report

Background/Objectives: Dentigerous cysts are odontogenic cysts enclosing the crown of an unerupted, developing tooth, therefore disrupting the normal eruption process, leading to tooth impaction. This case report describes the successful multidisciplinary management of a large mandibular clinicoradiographic dentigerous cyst associated with two impacted permanent teeth, highlighting the potential for spontaneous tooth eruption following conservative surgical treatment. Methods: A healthy 14-year-old male presented with a large mandibular cyst associated with two unerupted permanent teeth. Clinical examination revealed mixed, spaced dentition with bilateral Class I molar relationships. Radiographic examination demonstrated a well-defined radiolucent lesion in the mandibular body surrounding the crown of an impacted first premolar and displacing the adjacent permanent canine. As no histopathological examination was performed, the diagnosis was established on clinical and radiographic grounds. Treatment objectives were to resolve the cystic lesion, promote spontaneous eruption of the impacted teeth, achieve alveolar bone regeneration and resolve the associated malocclusion. Marsupialization was performed, followed by periodic clinical and radiographic monitoring. Active orthodontic treatment was initiated 29 months after surgery, once satisfactory spontaneous tooth eruption and bone healing had been achieved. Results: Marsupialization resulted in resolution of the cyst, spontaneous eruption of both impacted permanent teeth, substantial alveolar bone regeneration with restoration of normal trabecular architecture and interproximal bone height, and successful subsequent orthodontic correction of the malocclusion. Conclusions: Conservative management with marsupialization can effectively treat large clinicoradiographic dentigerous cysts in growing patients while preserving the associated teeth and promoting spontaneous eruption and bone regeneration. Careful long-term follow-up and appropriately timed orthodontic intervention can result in favorable functional and radiographic outcomes, supporting a biologically driven, minimally invasive treatment approach, supported by appropriately timed technical interventions.