Research Article National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 11-14

Dentigerous cyst: A retrospective study of 20 cases in S.

S. Medical College Rewa, Madhya Pradesh
Geeta Mishra TripathiA, Ajay PillaiB, Shaji ThomasC, Syed FaizelD
AAssistant professor, Department of Dentistry, S.S.Medical College Rewa (M.P.)
India
BReader, Department of Oral and Maxillofacial Surgery, PDA Bhopal (M.P.)
CProfessor, Department of Oral and Maxillofacial Surgery, PCDS & RC Bhopal
(M.P.)
DSenior lecturer, Department of Oral and Maxillofacial Surgery, Ideas Dental
College, Gwalior (M.P.)

Manuscript Reference
Number: Njmdr_247_14

Abstract:
A retrospective study was done for the features of dentigerous cyst clinically,
radiographically, and histologically, reported in dental Department. of S. S. Medical
College Rewa (M.P.) for the period of 1 year from January 2013 to January 2014. Male
were more affected than female in the ratio of 1.85: 1. Anterior region were more
involved than posterior region. The most common clinical features were alveolar
bone swelling, and pain. Radiographic appearance showed radiolucency associated
with an un-erupted tooth. In 2 cases dentigerous cyst was associated with non-vital
deciduous teeth. Histologically 1 case shows ameloblastic variation.
Key Words: Dentigerous cyst, impacted tooth, Anterior and posterior region of
mandible.

Introduction:

Date of submission: 12 April 2014

Date of Editorial approval: 14 April 2014
Date of Peer review approval: 19 April 2014
Date of Publication: 30 June 2014
Conflict of Interest: Nil; Source of support: Nil
Name and addresses of corresponding author:
Dr. Geeta mishra tripathi
MDS, Astt. Professor
Deptt. Of dentistry.
S.S.medical college Rewa (M.P.)
Email: geeta.tripathi75@gmail.com
Phone no.: 9425124285

Odontogenic cysts in children are rare with

only 1% of the radicular cysts and 9% of
the dentigerous cysts occurring in the first
decade of life [1]. A dentigerous cyst is
an epithelial-lined developmental cavity
that encloses the crown of an unerupted
tooth at the cementoenamel junction.
Dentigerous cysts are the second most
common odontogenic cysts after radicular
cysts, accounting for approximately
24% of all true cysts in the jaws [2]. The
frequency of dentigerous cyst formation
has been estimated to constitute 1.44 per
100 unerupted teeth [3].
In case of mandibular third molars, the
frequency of impaction is roughly the
same as that of cyst formation, whereas
maxillary third molars have a much
higher frequency of impaction than cyst

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involvement, suggestion that this tooth has

a much lower relative risk of developing
a dentigerous cyst than its mandibular
counterpart [4]. Similarly the risk of cyst
formation around the crowns of unerupted
mandibular first premolars, maxillary
incisors, or mandibular second molars is
very high, although the frequency of failure
of eruption of these teeth is extremely low
[5].
Dentigerous cysts are frequently discovered
when radiographs are taken to investigate a
failure of tooth eruption, a missing tooth or
mal-alignment. There is usually no pain or
discomfort associated with the cyst unless it
becomes secondarily infected. Radiographs
show a unilocular, radiolucent lesion
characterized by well-defined sclerotic
margins and associated with the crown
of an unerupted tooth. While a normal
follicular space is 3 to 4 mm, a dentigerous

National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 11-14

cyst can be suspected when the space is more than 5 mm

[6]. The aim of the present study is to find the incidence,
clinico- pathological variation of dentigerous cyst.

Materials and method:

All cases were taken from dental department of S.S.
Medical College Rewa (M.P.) for the period from January
2013 to January 2014. All cases diagnosed clinically and
histologically as dentigerous cyst were analyzed according
to the age, sex, duration, site distribution, clinical
presentation, radiographic appearance and histopathologic
details.

Surgical procedures:

Figure 3: Marsupialization done

Results:
From the total of 70 cases of cystic lesion, 20 cases were
diagnosed as dentigerous cyst (28.57%). The age of the
patients ranged from 5 to 60 years, with a peak incidence
in the second decade of life. The males were affected more
than the females with a ratio of (1.85:1) (Table 1).

11 cases were done under general anaesthesia and 9 cases

in local anaesthesia. Intraoral approach was used in all
cases. Buccal flap were raised. 15 cases were enucleated
together with impacted teeth as shown in figure 1 &2, and 5
cases were marsupilized as shown in figure 3. Healing was
uneventful; the surgical site showed good wound healing.
Patient was under follow up for 3 months; by this time no
patient had other complaint except in one case in which
parasthesia was present.

Table 1 - Age and sex wise distribution

Age

Number

Male

Female

M:F

0-10

4 (20%)

3 (23.7%)

1 (14.28%)

1.65:1

11-20

11(55%)

7 (53.8%)

4 (57.12%)

0.94:1

21-30

3 (15%)

1 (7.69%)

2 (28.56%)

0.26:1

31-40

0 (0%)

0 (0%)

0 (0%)

0:0

41-50

1 (5%)

1 (7.69%)

0 (%)

1:0

51-60

1 (5%)

1 (7.69%)

0 (%)

1:0

Total

20 (100%)

13 (65%)

7 (35%)

1.85:1

Regarding the site, (14cases 70%) occurred in the maxilla

and (6 cases 30%) in the mandible. However, for the
maxilla, the most common affected site was canine region
(7 cases = 50%). While for the mandible the most common
affected site was molar region (2 cases = 33.3%), and
canine region (2 cases = 33.3%) (Table 2).
Table 2 - Site distribution

Figure 1: Flap Raised

Jaw

Figure 2: Enucleation done

Premolar

Molar

Total

Maxilla

3 (21.42)

Incisor

7 (50%)

Cannne

3(21.42%)

1 (7.14%)

14 (70%)

Mandible

1 (16.66)

2(33.33%)

1(16.66%)

2(33.33%)

6 (30%)

Total

4 (20%)

9 (45%)

4 (20%)

3 (15%)

20 (100%)

The initial presenting symptom (for all 20 patients) was

intra-oral alveolar swelling, associated with pain in all
cases; parasthesia was noted in only 1 case. Moreover, no
cases were recorded as a recurrent case. The dentigerous
cyst appears as circumscribed radiolucency associated with
impacted tooth (Figure4).

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National Journal of Medical and Dental Research, July-September 2014: Volume-2, Issue-4, Page 11-14

Browne [12]. Daley and Wysocki [13] suggested that it

may be related to smaller jaw size in female patients and a
greater tendency for prophylactic extraction of third molar.
Regarding the site, dentigerous cyst in our study occurs
predominantly in the maxillary and mandibular cuspid
area and this finding confirmed by previous studies [5, 14].
However, Main [15], Angela and Mario [16] reported that
the common site for dentigerous cyst was in the mandibular
third molar area.

Figure 4: Dentigerous cyst appears as circumscribed

radiolucency associated with impacted tooth
The majority of the cysts show unilocular radiolucency
(18 cases 90%) whereas 2 cases appear as multilocular. In
addition, 4 cases showed root resorption of the adjacent
tooth. All of the pathologic reports describe a similar
histological picture, showing cyst walls composed of
fibrous tissue and lined by stratified squamous, nonkeratinized epithelium with Rushton bodies. 18 Cases
shows infiltration of chronic inflammatory cell. Moreover,
characteristic ameloblastoma was seen in the wall of 1
dentigerous cyst in a 51 years old male patient.

Discussion:
The DC is the second most common odontogenic cyst, with
periapical cyst being found more commonly. It presents
mostly in the second or third decade of life in the maxillary
or mandibular third molar or maxillary canine regions [7].
It can originate from any tooth, including supernumerary
tooth [8]. The DCs are mostly asymptomatic and may
be found on routine dental radiographic check-up. They
may also cause symptoms like pain or swelling with the
enlargement of the cyst size [9].
The formation of dentigerous cysts appears to be due to
accumulation of fluid either between reduced enamel
epithelium and enamel or in between the layers of enamel
organ [10]. The lesion occurs most often in the second and
third decades of life [11]. This is in harmony with this result
in which the majority of patients were young, 15 out of 20
patients being under the age of 20 years (75%). However,
Brown [12] reported in a study conducted on 81 diagnosed
dentigerous cysts a higher prevalence in the fifth decade
of life.
The present investigation showed that males were affected
more than the females. A similar result was reported by

Clinically, dentigerous cyst occur most often as painless

intra-oral alveolar swelling [16], sometime the cyst
associated with pain [15], but in our cases most were
painful along with intraoral and extra oral swelling. Tooth
mobility and displacement were also observed. Recurrence
of dentigerous cyst is rare [17]. In our study, no case was
recurred.
The histological features of our dentigerous cyst are
similar to those seen elsewhere [18]. Kim and Ellis [19],
showed that the dentigerous cyst may be lined by stratified
squamous epithelium.
Furthermore, the dentigerous cyst may give rise to a
variety of tumors, notably ameloblastoma, squamous
cell carcinoma, mucoepidermoid carcinoma, and rarely
other tumors [17, 20]. In our study, only 1 case shows
ameloblastic characteristic in the lining epithelium of the
cyst.
The dentigerous cyst is frequently well circumscribed
unilocular radiolucency which is often associated with an
unerupted tooth [18, 21]. The cyst appears to have a greater
tendency than other jaw bone cyst to induce root resorption
of adjacent teeth. This finding is supported by this series, in
which the majority of the cases (75%) appear as unilocular
radiolucency and (20%) showed root resorption of adjacent
teeth.
Therefore, every case mimic radiographic appearance
of a dentigerous cyst should be confirmed clinically and
histologically in order to exclude any other aggressive
lesions.

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