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Important Notice

Year : 2010 | Month : June | Volume : 4 | Issue : 3 | Page : 2601 - 2606 Full Version

Dentigerous Cyst Associated With Supernumerary Teeth: A Report Of Three Cases

Published: June 1, 2010 | DOI:

*Associate Professor, Faculty of Oral Medicine and Maxillofacial Radiology, NTRUHS,AP, (India). **Associate Professor, Faculty of Pediatric Dentistry, NTRUHS, AP,(India). ***Registrar Endodontist, Ministry of Health, Kuwait

Correspondence Address :
Dr. Tenny John
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Mobile: +919848026081


Dentigerous cyst originates by the separation of the follicle from the crown of an unerupted tooth or a developing tooth bud. These cysts seldom associate with supernumerary teeth. The resorption of roots which are adjacent to a supernumerary tooth (mesiodens) or its cyst is a rare complication. The purpose of this article is to describe three rare cases of dentigerous cyst associated with supernumerary teeth and their complications and management.


mesiodens. dentigerous cyst, root resorption, displacement

Dentigerous cyst (DC) is the most common developmental odontogenic cyst which originates from the separation of follicle from the crown of an unerupted tooth or a developing tooth bud (1). It occurs most commonly in the second and third decade of life(2) and typically involves the mandibular third molar, the maxillary canines and the mandibular premolars, followed by supernumerary teeth and the central incisor in the decreasing order of the frequency of involvement (3).

DC around supernumerary teeth accounts for 5% of all dentigerous cysts and mostly involves a mesiodens in the anterior maxilla4. Mesiodentes are common in the anterior palate region (5),(6) and may be erupted or impacted and the direction of the crown may be normal, inverted, or horizontal (7).

The common complications which are associated with these teeth include eruption disturbances and the displacement or rotation of the teeth (8),(9),(10). Supernumerary teeth seldom associate with dentigerous cysts and are uncommon. This article reports three rare cases of dentigerous cysts associated with mesiodens and their complications and management.

Case Report

Case 1
A 22 year old Indian male presented with a swelling in the right maxillary anterior region. On general examination, the patient was apparently healthy and there was no history of systemic diseases or trauma. The swelling was noticed 6 months back, but was ignored by the patient as it was asymptomatic. Clinical examination revealed a soft, fluctuant, painless swelling, extending from the maxillary right central incisor to the right canine in the labial mucobuccal fold. The mucosa overlying the swelling appeared to be intact. The maxillary anterior teeth were non mobile and responded positively to vitality tests. The radiological examination included panoramic, occlusal and periapical radiographs which showed an impacted supernumerary tooth (inverted mesiodens) with a short root apical to the maxillary right central incisor which was associated with a well defined unilocular radiolucent area in the anterior region of the maxilla. Displacement of the roots of the maxillary right lateral incisor and the canine was evident (Figures 1-3) (Table/Fig 1). After clinical and radiographical examination, a diagnosis of dentigerous cyst involving an impacted mesiodens was made. Routine haematological investigations were normal. Extraction of the mesiodens and surgical enucleation of the cyst was done under local anaesthesia. Histological examination of the specimen confirmed the diagnosis of a dentigerous cyst (Figure 4) (Table/Fig 2) .The patient was under follow-up for 6 months and presented no complications.

Case 2
A 24 year old male presented with a swelling in the labial mucobuccal fold between the maxillary central incisors (Figure 5) (Table/Fig 3). Detailed anamnesis revealed that the swelling was slow growing, painless and was of 8 months duration. The overlying mucosa was intact and no bruit or pulsations were observed. The maxillary anterior teeth were non mobile and vital. The maxillary left central and lateral incisors and canine showed mild palatal inclination. Radiographs showed a large well defined radiolucent area involving the crown of an unerupted horizontally positioned mesiodens between the maxillary central incisors. Displacement of the roots of the maxillary left incisors and the canine was clearly evident, resulting in a change in their axial inclination. No evidence of the resorption of the roots was seen (Figures 6-8) (Table/Fig 4). Clinical and radiographical findings were suggestive of dentigerous cyst. Routine haematological investigations were normal. The mesiodens was surgically extracted and the cystic lining was enucleated under local anaesthesia. The post operative healing was uneventful. The patient was under follow-up for six months and presented no complications. Histopathological examination of the specimen confirmed the diagnosis of a dentigerous cyst.

Case 3
A 46 year old male presented with a labial swelling (midline) in the anterior region of the maxilla (Figure 9) (Table/Fig 5). The swelling was of 10 months duration and was slow growing. The patient gave a history of occasional pain which was associated with the swelling. Intra oral examination revealed multiple decayed molars. Root stumps were present in relation to 17 and 27. Further, 46, 37 and 28 were severely decayed. Generalized moderate to severe calculus and stains were noticed. The maxillary left central and lateral incisors were not carious and did not respond to vitality tests. A provisional diagnosis of a radicular cyst in relation to the maxillary left central incisor was made. On further investigation, the radiographs revealed a large radiolucent area in the anterior maxilla, involving one of the two impacted supernumerary teeth (mesiodens) with short roots and were suggestive of a dentigerous cyst. Further, root resorption of 21 and 22 was evident (Figures 10-11) (Table/Fig 6) .Routine haematological and biochemical tests were normal. Maxillary left incisors (21),(22) were endodontically treated and were obturated with gutta-percha. Then, under general anaesthesia, surgical extraction of the impacted supernumerary teeth and enucleation of the cyst was done, followed by retrograde filling of 21 and 22 with mineral trioxide aggregate. The post operative course was uneventful. The histological examination of the specimen was suggestive of a dentigerous cyst.


Literature reports the prevalence of the mesiodens to be in the range of 0.15% to 2.2% of the population (7). The mesiodens can erupt or remain impacted and often cause developmental and eruption disturbances of permanent teeth which are adjacent to them, leading to crowding, displacement, diastema and in some cases, radicular resorption and dentigerous cyst formation (7),(8),(9),(10). All the three cases described here presented cyst formation involving the mesiodens. In addition, displacement of the adjacent teeth was seen in two cases and one patient showed evidence of root resorption.

Some studies have reported that dentigerous cyst formation arising from supernumerary teeth account for 5.29-7% of the cases(11),(12),(13). Asaumi et al (2004)(14) reported a prevalence of 11% and suggested that mesiodentes impacted for prolonged periods of time possess a higher risk of forming dentigerous cysts. Resorption of roots adjacent to a supernumerary tooth (mesiodens) or its cyst is a rare complication (7),(10),(11). In case three presented here, the resorption of the roots of the teeth adjacent to a dentigerous cyst involving the mesiodens was evident. The possible reason for this may be related to the longer duration of the impacted mesiodens and the associated lesion.

Differential diagnosis of radicular cyst, odontogenic keratocyst and adenomatoid odontogenic tumour was considered in our cases. Histological evaluation of the lesion has been recommended, owing to its potential to develop into an ameloblastoma or mucoepidermoid carcinoma (15),(16). The characteristic feature of the lesion involving an unerupted tooth crown in the anterior region of the maxilla along with the radiographical and histological examination confirmed the diagnosis of dentigerous cyst in all the three cases.

Management of a supernumerary tooth depends on the type and position of the tooth and its effect on the adjacent teeth. Removal of the supernumerary has been recommended where there is evidence of the associated pathology, eruption disturbances, displacement of the incisors or where the spontaneous eruption of the supernumerary tooth has occurred (17).

Surgical removal of the cyst has been considered as the preferred choice of treatment. Marsupialization has been recommended for dentigerous cysts in children to allow the eruption of unerupted tooth; and should be preferred for large cysts where enucleation and tooth removal might result in damage to the nerve and blood vessels supplying the adjacent teeth (15),(16). In all the three cases, surgical removal of the impacted mesiodens and enucleation of the associated cyst was performed.

When the supernumerary tooth is evident, the direction of the crown, the location, the influence on adjacent teeth, the resorption of adjacent roots and the formation of dentigerous cysts should be carefully evaluated (18). Conventional radiographical examination involving panoramic, occlusal and periapical views have been used to locate their exact position for proper treatment plan and surgical removal. Computed tomography (CT) and Cone-beam CT have emerged as diagnostic techniques to assess supernumerary teeth.

Early detection comprising of a thorough clinical and radiographical examination is necessary for accurate diagnosis to prevent associated complications.

Key Message

Early detection comprising of a thorough clinical and radiographical examination is necessary for accurate diagnosis, to provide appropriate management and to prevent associated complications.


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