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Case Report
Conservative Treatment of Dentigerous Cyst by
Marsupialization in a Young Female Patient: A Case Report and
Review of the Literature
1
Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dentistry, Lebanese University, Hadath, Lebanon
2
Department of Anatomy, Cell Biology, and Physiological Sciences, Faculty of Medicine, American University of Beirut,
Beirut, Lebanon
3
Division of Orthodontics and Dentofacial Orthopedics, Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine,
American University of Beirut Medical Center, Beirut, Lebanon
Copyright © 2018 Layal Ghandour et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dentigerous cysts (DCs) are the most prevalent developmental odontogenic cysts that occur in middle-aged individuals. They
frequently originate from the epithelial remnants of tooth-forming organs. Hereby, we present a case of a 13-year-old young
female patient presenting with DC that was treated successfully by marsupialization. The patient’s chief complaint was the
crowding of the anterior teeth. Clinical examination showed that the patient had all her permanent teeth present with a retained
mandibular left second primary molar that was previously treated by pulpectomy. The radiographic examination revealed a
unilocular radiolucent lesion with well-defined margins associated with a mesially-tipped unerupted mandibular left second
premolar. The differential diagnosis confirmed that the lesion was a DC. The treatment consisted of surgical removal of
the DC to allow proper eruption of the permanent tooth and to prevent the lesion from becoming an aggressive one
causing gross expansion of bone with subsequent facial asymmetry, pain, displacement of teeth, and root resorption. A
removable acrylic obturator was delivered to the patient keeping the path clear and guiding the eruption of the premolar
until fully erupted.
(a) (b)
Figure 2: (a) Occlusal radiograph to further investigate the well-defined radiolucent lesion. (b) Periapical radiograph to further investigate the
well-defined radiolucent lesion.
(a) (b)
(c) (d)
Figure 4: Marsupialization of the cystic lesion after extraction of the deciduous second molar, revealing retraction to visualize the surgical site
at first (a), then anesthetizing the site (b), followed by extraction of the primary second molar and drainage (c), and finally opening of the
surgical site after marsupialization (d).
(a) (b)
Figure 5: The acrylic resin obturator to maintain the surgical opening during healing.
Conflicts of Interest
The authors declare that there is no conflict of interest
regarding the publication of this article.
Authors’ Contributions
Samar Bou-Assi, Layal Ghandour, and Hisham F. Bahmad
worked on the case study conception and design. Layal
Ghandour was responsible for getting the clinical data from
medical records. Samar Bou-Assi provided other authors
with explanations about the case reported. Layal Ghandour
and Hisham F. Bahmad were responsible for writing the
Figure 7: Intraoral photo postmarsupialization with the introduction, case presentation, and discussion and editing
mandibular left second premolar completely erupted on the arch. the whole manuscript, in addition to proofreading. Samar
Bou-Assi was responsible for the study supervision and
save a primary tooth has led to the extraction of the perma- conduction of the whole project. All authors contributed to
nent successor after the cyst has spread and was discovered the drafting of the manuscript and critically revised and
by chance. edited the manuscript prior to approving the final draft. All
The material used in pulpectomy and the procedure itself authors approved the final draft of the manuscript.
should be further studied, and the benefit-to-risk ratio before
performing such a treatment should be considered. More- Acknowledgments
over, if the practitioner chooses this option, he should insist
on the importance of regular checkup appointments. In this The authors would like to thank the family of the patient
way, early detection of abnormal pathological cysts would whose case is presented here for granting us their permission
be possible. to publish this case report and the Department of Oral and
Numerous treatment procedures were discussed in the Maxillofacial Surgery, Faculty of Dentistry, for their permis-
literature depending on the age of the patient, severity and sion to disclose this information.
size of the cyst, and the objectives behind the treatment. A
conservative approach should be the first line of treatment References
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