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1. International Journal of Oral & Maxillofacial Pathology. 2013;4(2):49-52 ISSN 2231 – 2250
Available online at http://www.journalgateway.com or www.ijomp.org
©2013 International Journal of Oral and Maxillofacial Pathology. Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved
Inflammatory Dentigerous Cyst Associated With Mandibular First Premolar: A Rare Case
Report
Monir Moradzadeh, Shirin Fattahi, Faranak Moradi Abbasabadi, Ahmad Koochaki Pasikhani
Abstract
Dentigerous cysts are benign odontogenic cysts that arise from the dental follicle of an unerupted
or developing tooth. These cysts are the second most common odontogenic cysts after radicular
cysts and they are most frequently associated with impacted mandibular third molar teeth.
Dentigerous cysts involving first premolars are rare. This article presents a rare case of
dentigerous cyst in a nine years old male patient associated with an unerupted mandibular first
premolar.
Key words: Cysts; Dentigerous cyst; Impacted; Jaw cysts; Odontogenic cyst; Tooth.
Monir Moradzadeh, Shirin Fattahi, Faranak Moradi Abbasabadi, Ahmad Koochaki Pasikhani. Inflammatory
Dentigerous Cyst Associated With Mandibular First Premolar: A Rare Case Report. International Journal of
Oral & Maxillofacial Pathology; 2013:4(2):49-52. ©International Journal of Oral and Maxillofacial Pathology.
Published by Publishing Division, Celesta Software Private Limited. All Rights Reserved.
Received on: 31/01/2013 Accepted on: 03/08/2013
Introduction
Dentigerous cysts are benign odontogenic
lesions arising from the completed crown of
impacted, embedded or unerupted teeth.1
They are the second most common type of
odontogenic cysts, and the most common
developmental cysts of the jaws.2
They are
caused by the accumulation of fluid between
the crown and reduced enamel epithelium,
attached at the cemento-enamel junction of
an impacted or unerupted tooth.3,4
Dentigerous cysts may occur at any age
group but the greatest incidence is in the
second and third decade and is uncommon
in the first decade of life. Males are slightly
more likely to develop dentigerous cysts
than females.5,6
The clinical examination reveals a missing
tooth or teeth and occasionally a hard
swelling, sometimes results in a facial
asymmetry or a possible pathologic fracture.
Dentigerous cysts are tentatively diagnosed
on routine dental radiographs.7
They are
mostly associated with an impacted
mandibular third molar and rare lesions of
dentigerous cyst involving the maxillary and
mandibular premolars have been reported in
the literature.8
The following report presents
a rare case of a dentigerous cyst associated
with an unerupted mandibular left first
premolar in a nine year old boy.
Case report
A nine year old boy referred to the
Department of Oral and Maxillofacial
Surgery, Faculty of Dentistry, with a chief
complaint of painless swelling in the lower
jaw for the past six months. Patient’s family
and medical history were noncontributory.
Intra oral examination revealed patient with
mixed dentition and the presence of a
solitary, hard and well-defined swelling in the
left mandibular premolars region.
A panoramic radiograph revealed the
presence of all the permanent teeth without
any supernumerary teeth. There was a well-
circumscribed unilocular radiolucent lesion in
the body of the mandible on the left side,
which was associated with the crown of an
unerupted first premolar (Fig 1a). A
radiographic differential diagnosis of a
dentigerous cyst, an odontogenic keratocyst
and a unilocular ameloblastoma involving
the crown of the unerupted left mandibular
first premolar was made. Aspiration of the
lesion was done and clear yellowish cystic
fluid was obtained.
The cyst was operated under local
anesthesia by intra oral approach and
enucleated along with removal of the
unerupted left mandibular first premolar. The
excised specimen was sent for
histopathological examination. Gross
examination of the specimen showed a
cystic sac attached to the crown of
mandibular first permanent premolar at
cementoenamel junction (Fig 1b).
Microscopic findings revealed the presence
of a cystic lumen lined by two to five layers
of non-keratinized stratified squamous
epithelium which resembled reduced enamel
epithelium with exocytosis and spongiosis.
The epithelium and connective tissue
Case Report

2. ISSN 2231 – 2250 Inflammatory Dentigerous Cyst Associated With... 50
interface was flat. Underlying fibrous
connective tissue wall showed loosely
arranged collagen fibers with islands of
odontogenic epithelium and severe chronic
inflammatory cells infiltration (Fig 1c).
According to WHO criteria, radiographic
feature and histopathologic findings the
diagnosis was inflamed dentigerous cyst
associated with the unerupted first premolar.
The patient remained under follow-up for
one year and no complications were
observed.
Figure 1: The sectional panoramic radiograph showing a well-circumscribed, unilocular
radiolucent lesion in the body of the mandible, on the left side in relation to the crown of
unerupted mandibular left first premolar (a). The gross specimen showing the relation of the cyst
to the crown of first premolar (b), however the hematoxylin and eosin stained photomicrograph
under low power view showing the lining epithelium which is thin and non-keratinized with
exosytosis and spongiosis along with inflammation in the cyst wall (c).
Discussion
Dentigerous cysts are developmental cysts
that enclose crown of an unerupted tooth at
cemento-enamel junction and thus they are
also named “tooth containing cysts”.9
These
cysts are the second most common type of
odontogenic cysts and make up an
estimated 14% to 24% of all jaw cysts.2,10
The exact histopathogenesis of these cysts
is unknown. They are believed to be caused
by expansion of dental follicles resulting
from accumulation of fluid in the space
between the tooth crown and epithelial
components.11
The highest incidence of
dentigerous cysts occurs during the second
and third decades and they are rarely seen
during childhood.2,12
Shear has estimated
that about 9% of dentigerous cysts occur in
the first decade of life.13
Our patient was only
nine years old at the time of presentation.
However in the only reported case by Muthu
kumar et al the age of the patient was 62
years. The sex predilection of dentigerous
cyst is 1.6:1 in favor of male2,15
, and the
prevalence is higher for whites than for
blacks.14
Dentigerous cyst most commonly develops
around the crown of the third mandibular
molar tooth.14
But in this case, mandibular
first premolar was found to be the cause of
the dentigerous cyst. In our review of the
literature, we have found only one case of
dentigerous cyst associated with mandibular
first premolar (Fig 4).15
Dentigerous cysts are
typically asymptomatic and may be large,
destructive, expansile lesions of bone.16
In
present case, the cyst was painless and was

3. 51 Monir Moradzadeh, et al. ISSN 2231 - 2250
discovered during investigation of
asymptomatic swellings.
On radiographic examination, dentigerous
cysts appear as unilocular radiolucent area,
with well-defined and often sclerotic borders,
associated with the crown of an unerupted
tooth. The borders may be ill-defined when
infected.5,14
Diagnosis should not be made
on radiographic evidence alone but should
include both macroscopic and microscopic
examination of the lesion. The
histopathological examination of cyst in the
present case showed thin and non-
keratinized lining epithelium, resembling
reduced enamel epithelium overlying a
fibrous connective tissue capsule in most of
the areas.5
In presence of inflammation the
capsule shows foci of chronic inflammatory
cells14
and the lining epithelium
corresponding to these areas shows an
increase in thickness.2,14
So this case was
diagnosed as an inflammatory dentigerous
cyst.
Treatment of choice for dentigerous cysts is
removal of the associated tooth and
enucleation of the soft tissue component.2
Complete removal of the cyst is extremely
important because ameloblastoma,
squamous cell carcinoma and
mucoepidermoid carcinoma have been
reported as potential complications of
untreated dentigerous cysts.17
Conclusion
Dentigerous cyst is most commonly seen in
association with impacted third molars. In
this case report we have presented a rare
case of inflammatory dentigerous cyst
associated with mandibular first premolar.
The case was successfully treated. Post
operatively there was no complication.
Acknowledgement
We would like to acknowledge all the staff
members for their support and guidance.
Author Affiliations
1.Dr.Monir Moradzadeh, Associate Professor,
2.Dr.Shirin Fattahi, Assistant Professor,
3.Dr.Faranak Moradi Abbasabadi, Post-graduate
Student, 4.Dr.Ahmad Koochaki Pasikhani, Post-
graduate Student, Department of Oral and
Maxillofacial Pathology, Faculty of Dentistry,
Tabriz University of Medical Sciences, Tabriz,
Iran.
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Corresponding Author
Dr.Shirin Fattahi,
Department of Pathology,
Dentistry Faculty,
Daneshgah Street, Tabriz,
Eastern Azerbaijan, Iran.
Fax: +984113307953,
Mob: +989143150165,
E-mail: Shirin_Fattahi@yahoo.com
Source of Support: Nil, Conflict of Interest: None Declared.