Delayed eruption: The importance of early recognition
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A 19-year-old male presented with an unerupted lower right second molar (LR2M) and partially erupted lower left second molar (LL2M). He had consulted the same dentist since the age of 10 but had recently moved to a different area and registered with a new practice who prompted his referral. His OPG taken aged 10 years was available and showed the presence of unerupted all four third molars and all four-second molars. There were no signs of cystic changes in dental follicles.

At his initial assessment, the patient complained of no symptoms. The OPG showed a large unilocular, radiolucent lesion of the right angle of the mandible in the region of the lower right third molar (LR3M) and LR2M. The lower left third molar (LL3M) and both upper third molars (UR3M, UL3M) also showed associated radiolucent areas with a cystic appearance. The CT scan showed LR2M roots were intimately associated with the IAN, causing narrowing of the nerve and its canal. The roots of LR3M were lying above the IAN canal. The patient underwent staged enucleation of all four cysts, surgical removal of all four third molars , and coronectomy of LR2M over two general anesthetic episodes. Histopathological examination revealed loose fibrous tissue with some myxoid areas. Odontogenic epithelial rests and some reduced enamel epithelium were both presents for all lesions. The pathology report concluded that all four abnormalities were compatible with DCs.

Six weeks following his second procedure, the patient reported paresthesia of his right lingual nerve which subsided by the time of his three-month review. At 12 months, the intentionally retained root portion of the LR2M appeared to have started to migrate away from the IAN. He had no ongoing symptoms at this point. The patient was reviewed at 24 months to ensure no recurrence of the cysts. The OPG demonstrated bony healing in all four quadrants, including around the retained roots of the LR2M, and no evidence of recurrence. The patient was then discharged.

Source: https://www.idoriums.com/edpanel/media/Z07_Journal of Case Reports and Images in Dentistry/2019/pdf/100030Z07LC2019.pdf
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