Circumferential dentigerous cyst associated with oronasal inverted mesiodens: case report

Abstract

Introduction: the dentigerous cyst is a developmental odontogenic cyst characterized by surrounding the crowns of unerupted or developing teeth whose exact pathogenesis is still unknown. These lesions are rarely associated with supernumerary teeth, accounting for 5 to 6% of all reported dentigerous cysts; 90% develop around mesiodens in the anterior maxilla, with few reports associated with inverted mesiodens. Additionally, few cases of variants of circumferential dentigerous cysts have been identified, which surround the tooth, being a rare entity whose differential diagnosis represents a challenge. Objective: to present the case of a rare circumferential variant of the dentigerous cyst of oronasal localization associated with an inverted supernumerary tooth in the upper maxilla. Case report: a 43 years old male patient, systemically healthy, reports pressure in the anterior maxilla. Clinically, vestibular and palatine tumor mass of firm consistency, covered by regular mucosa, is felt. Radiographic examination revealed a cortical osteolytic area with radiopaque foci. In addition, a CBCT showed a cystic lesion, cranially related to an inverted mesiodens. A decompression cannula is installed, and an incisional biopsy is performed. Histopathological analysis shows a cystic membrane with non-keratinized squamous epithelial lining and dystrophic calcifications foci. Therefore, the dentigerous cyst diagnosis is proposed. After six months, a control was performed with panoramic radiography and CBCT; a decrease in lesion size was observed. The consequent surgical enucleation is performed with the subsequent filling of the bed with lyophilized bone without recurrences at six months. Conclusion: due to the clinical behavior of this lesion and its particular location, clinical examinations, imaging, and histopathological studies are essential to formulate a correct diagnosis and treatment plan.