This patient was referred to my office for endodontic evaluation. The patient had a prior RCT with some localized, intermittent pain & swelling.
My clinical exam revealed #31 normal to percussion, perio defect on distal >14mm. Radigraphs revealed resorption of the distal root, and extensive bone loss on the distal of #31. Due to the strange resorptive pattern and bone loss around the impacted wisdom tooth, the tooth was referred to a surgeon for evaluation.
The oral surgeon performed an incisional biopsy with extraction #32. The lesion was diangosed as a dentigerous cyst. Following this diagnosis, the patient was again seen for a excisional biopsy.
Pathology Review: Dentigerous Cyst is the most common developmental odontogenic cyst. It is a cyst that comes from the separation of the follicle from an uneruped tooth. This cyst encloses the crown of an unerupted tooth and is attached to the tooth at the cemento-enamel junction. These cysts are most commonly involve the Md third molars and secondly the Mx canines. These cysts can grow quite large and can cause painless expansion of the bone and also displace an involved tooth. About half of the time, this cyst will cause root resorption. Treatment includes enucleation of the cyst with the removal of the unerupted tooth. Marsupialization occasionally done with very large cysts to decompress the cyst. Prognosis is excellent and recurrence is rare if completely removed. There has been some discussion of dentigerous cysts that have undergone neoplastic transformation to ameloblastoma or other neoplasm. (Source: Waldron, Charles. Oral & Maxillofacial Pathology, 493-495, 1995)