Multidisciplinary approach for treatment of a dentigerous cyst - marsupialization, orthodontic treatment, and implant placement: a case report

Abstract

Background: Dentigerous cysts are common odontogenic cysts associated with unerupted teeth. We describe a previously unreported case of a multidisciplinary approach using surgical, orthodontic, and implant treatment to establish the occlusion for a patient with a maxillary dentigerous cyst.

Case presentation: An 18-year-old Japanese woman visited our hospital with a chief complaint of gingival swelling in her anterior maxillary region, midline diastema, and tooth crowding. Her main symptom was this gingival swelling. A panoramic radiograph revealed a radiolucent area, 30 mm in diameter, round in shape, and with well-demarcated margins including the maxillary canine. Computed tomography revealed a cystic cavity filled with homogeneous fluid of the same density as water, and a distolingually inclined canine. Our clinical diagnosis was maxillary dentigerous cyst with an unerupted distolingually inclined canine. The selected treatment was marsupialization of the dentigerous cyst, followed by orthodontic traction of the unerupted canine, and simultaneous orthodontic treatment of the midline diastema and tooth crowding. The orthodontic traction failed because the canine did not erupt completely, and the canine was extracted. The treatment plan was then changed to implant treatment after the tooth crowding and midline diastema had been improved. Because the alveolar ridge width was inadequate, the implant was placed after a two-stage implant treatment; therefore, a satisfactory occlusion could be achieved. Our patient did not experience any complications, and the cyst has not recurred. A radiograph taken 7 years after marsupialization of the dentigerous cyst revealed that the cystic cavity had been replaced by new bone.

Conclusions: In general, orthodontic traction of an unerupted tooth after marsupialization should be the best option. However, if orthodontic traction fails, a multidisciplinary approach involving implant treatment may be necessary. We describe a case in which a multidisciplinary approach involving surgical, orthodontic, and implant treatment was used to establish a satisfactory occlusion for a patient with a dentigerous cyst.

Keywords: Dentigerous cyst; Implant; Marsupialization; Multidisciplinary approach; Orthodontic traction; Orthodontic treatment.

Fig. 1

Panoramic radiograph at initial visit. Water-soluble root canal agent seen

Fig. 2

Computed tomography at initial visit. a Axial image. b Frontal image

Fig. 3

Marsupialization (black arrow), midline diastema (yellow circle), and tooth crowding. Temporary crown placed to cover the space (blue arrow)

Fig. 4

Orthodontic treatment performed for traction of unerupted canine and improvement of midline diastema and tooth crowding

Fig. 5

Orthodontic treatment has finished after canine extracted. Tooth crowding and midline diastema have improved. a Frontal view. b Occlusal view. Less bone width (blue arrow)

Fig. 6

Insufficient bone to install implant (blue arrow) on computed tomography, before implant placed. a Less bone width at the alveolar ridge. b Less bone width at their deep area

Fig. 7

Bone augmentation to widen the bone width. a Less bone width (blue arrow). b Autogenous bone harvested from the mandibular ramus placed on the surface of defect area

Fig. 8

On the way to the second operation, a part of the bone (blue arrow) exposed

Fig. 9

Eleven months after bone graft, implant placed

Fig. 10

Final occlusion showing good clinical results. a Frontal view. b Occlusal view. Implant prosthesis (blue arrow)

Fig. 11

Follow-up image. a Implant and suprastructure. b Sufficient bone around implant seen

Fig. 12

a and b Comparison between preoperative and postoperative computed tomography