RE: Dentigerous cyst - referral not an option!

Steve Leonard — Thu, 03 Mar 2022 12:09:28 GMT

Just an update on this case.

Surgery went well. Histo came back supporting dentigerous cyst. The lining of the cyst was very fragile but I found gentle blowing with air on a loose edge peeled it off nicely.

Thanks for the input

steve

RE: Dentigerous cyst - referral not an option!

Rob Davis — Mon, 13 Dec 2021 17:04:24 GMT

Is 106 visible or is it unerupted? If unerupted then I agree this is probably a dentigerous cyst, but other odontogenic cysts or neoplasias are also possible.

If it is a cyst, then raise a large flap for decent visualisation. There should be an obvious epithelial lining with needs to be removed. Sometimes they peel out nicely in one piece, but sometimes they are more difficult particularly if the walls of the cyst are irregular. I would be using a periosteal elevator or Lucas curette to peel it away. In theory leaving any epithelium behind could cause ongoing cyst formation, but I have never seen this. Personally I don't fill the cavity, but I know some do and it would not be wrong to do so, but if costs are an issue then leave if to fill with blood clot alone (allograft or bioglass etc are expensive). As long as the lining is removed it will fill in fine.

I suspect from the radiograph that 107 will need to go to as it looks as though the cyst is involving the roots (looks like you have a supernumary root here too so make sure you get them all!). Ideally the cyst lining should be sent for histopath to confirm the clinical diagnosis.