Conservative Approach of a Dentigerous Cyst
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An eight-year-old female patient consulted the Department for dental malocclusion management. The panoramic radiograph performed for the interceptive orthodontic treatment revealed a large unilocular radiolucency repressing the dental germ of the first lower-right premolar (#44) including the lower-right deciduous canine (#83) and associated with a treated root of nonvital lower-right first primary molar (#84). The medical history of the patient did not reveal any specific systematic diseases or previous traumatic injuries in the affected area. The extraoral examination seemed to show no abnormalities while the intraoral examination revealed an imperceptible expansion of the buccal cortical on the alveolar ridge in relation to teeth 83 and 84. Inspection showed a normal-looking mucosa. Palpation was painless with boney consistency. The sagittal and coronal views of the CBCT revealed a 12?mm diameter well-demarcated unilocular radiolucency.

The lesion was identified in the mandibular right region causing expansion of the buccal cortical with no signs of root resorption in the adjacent tooth and surrounding the crown of the unerupted first premolar (tooth 44). The first lower-right premolar germ was forced against the lingual cortical with a mesial angulation. Based on the above-mentioned clinical and radiological findings, a provisional diagnosis of inflammatory DC was made.

The second primary molar and canine were extracted under local anesthesia, and a conservative approach by decompression to preserve the mandibular first premolar was followed. The extraction socket was extended to establish a communication between the cyst and the oral cavities without disturbing the erupting premolar. The cystic fluid was evacuated under irrigation with normal saline solution through the socket. An iodoform gauze was then packed into the lesion cavity, and sutures were placed.

The patient and her parents were advised to follow post-surgical instructions, rinsing the opening cyst twice a day with saline solution. For the first 48 hours, postoperative care included the use of a cold pack. For pain management, 200?mg dexibuprofen three times a day was prescribed for the young patient. Two days postoperatively, an impression was made before gently removing the gauze which helped to prevent the alginate from getting into the bone cavity. Then, a removable space maintainer acting as an acrylic obturator was designed. During the surgical procedure, a tissue sample was taken for biopsy. Microscopically, the cyst was lined with cuboidal nonkeratinized stratified epithelium resembling reduced enamel epithelium, and the underlying connective tissue capsule showed chronic inflammatory cell infiltration. The histopathological examination confirmed the initial diagnosis of the inflammatory DC.

The acrylic obturator remained until the eruption of tooth 44 was visualized using a subsequent radiographic evaluation. The follow-up appointments were scheduled every three months post-surgery. The three-month postoperative radiograph showed a reduction in radiolucency associated with a gradual spontaneous eruption of the tooth.