Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 13

“The oral surgeon removed a root fragment of what was assumed to be tooth D as well as another piece of random deformed tooth structure. The cyst, along with what appeared to be tooth No. 7 (deformed), was surgically enucleated and the specimen was sent off for biopsy. Results came back as . . .” Breakthrough Clinical’s Editorial Director Stacey Simmons, DDS, gives her differentials, definitive diagnosis, and recommended treatment for the oral pathology case she presented last month.

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This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

Last month, I presented this pathology case:

A healthy seven-year-old male presents for his new-patient exam. A radiolucency was noted in the No. 7 area on the panoramic radiograph; subsequent occlusals were referred to for a better view where the lesion appeared to focalize around the coronal portion of No. 7. Furthermore, there was an ill-defined radiopacity within the osseous tissue, under the area where primary tooth D would be located. The area was not tender to palpation nor was there any expansion noted in the vestibular area. Mom reported that the patient had trauma to the area a few years back while playing.

Read the complete details of the case and view photos here.

Here are my differentials, definitive diagnosis, and recommended treatment . . .

Differential diagnoses:

  • Dentigerous cyst
  • Incisive canal cyst

Definitive diagnosis: benign dentigerous (follicular) cyst (DC)

The most common form of pericoronal radiolucencies are dentigerous cysts. (1) DCs are “caused by fluid accumulation between the enamel surface and the reduced enamel epithelium, resulting in a cyst in which the crown is located within the lumen and root(s) outside;” (2) the underlying reasoning is unknown. The most common teeth affected are mandibular 3rd molars, maxillary canines, mandibular premolars, and the maxillary canines. (1,2) It is not uncommon for a DC to displace the unerupted tooth and often any adjacent teeth. Typically, DCs are painless and slow growing; however, pain will manifest if swelling and inflammation are present.

ALSO BY DR. STACEY SIMMONS | Diagnosis and treatment for Breakthrough Clinical oral pathology case: No. 11

Recommended treatment:

Recommended treatment is complete surgical enucleation. Recurrence is uncommon, but the area must be monitored in the future as there is the potential for residual cysts, ameloblastomas, mucoepidermoid carcinoma, and squamous cell carcinomas to arise from any potentially remaining cells. (1,2)

In this particular case, the patient was referred to an oral surgeon, who removed a root fragment of what was assumed to be tooth D as well as another piece of random deformed tooth structure. The cyst, along with what appeared to be tooth No. 7 (deformed), was surgically enucleated and the specimen was sent off for biopsy. Results came back as a benign dentigerous cyst. Tooth No. 8—although rotated—appeared to be unaffected.

The patient is being seen by an orthodontist for early interventional orthodontics; treatment options for replacement of tooth No. 7 are being considered as part of his long-term treatment plan.

ALSO BY DR. STACEY SIMMONS | Diagnosis and treatment for Breakthrough Clinical pathology case: No. 9

This article first appeared in the newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS. Subscribe here.

References

1. Wood NK, Goas PW. Differential Diagnosis of Oral and Maxillofacial Lesions. St. Louis, MO: Mosby; 1997:283–284.
2.Saap JP, Eversold L, Wysocki G. Contemporary Oral and Maxillofacial Pathology. St. Louis, MO: Mosby; 1997:42–43.

Stacey L. Simmons, DDS, is in private practice in Hamilton, Montana. She is a graduate of Marquette University School of Dentistry. Dr. Simmons is a guest lecturer at the University of Montana in the Anatomy and Physiology Department. She is the editorial director of PennWell's clinical dental specialties newsletter, DE's Breakthrough Clinical with Stacey Simmons, DDS, and a contributing author for DentistryIQ, Perio-Implant Advisory, and Dental Economics. Dr. Simmons can be reached at ssimmonsdds@gmail.com.

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