Diagnosis and surgical management of impacted mandibular canines associated with a dentigerous cyst and odontoma: A case report

Abstract

In dental practice, impacted canines are common clinical conditions that compromise tooth mobility, thereby severely affecting functionality and esthetics. They also represent a significant challenge, particularly when associated with odontogenic pathologies such as dentigerous cysts and odontomas. These entities, despite benign, can cause complications, including tooth displacement, root resorption, and alterations in normal eruption, compromising both esthetics and function. We present the case of a 15-year-old female patient with no relevant medical history who attended for orthodontic treatment planning. Computed tomography scans revealed bilateral impaction of the mandibular canines, associated with radiolucent images consistent with dentigerous cysts. A mixed radiolucent-radiopaque image was also observed in the area of the lower right first premolar, suggesting an odontoma. Surgical management was proposed, including enucleation of the cysts, removal of the odontoma, and placement of orthodontic appliances on the exposed canines to facilitate their movement. Histopathological analysis confirmed the diagnosis of two dentigerous cysts and one compound odontoma. In the surgical follow-up, the intervention area evolved satisfactorily, with no signs of complications, such as infection, delayed healing, or recurrence of the lesion. One of the most complex clinical challenges is managing impacted mandibular canines when associated with odontogenic pathologies. The implementation of advanced diagnostic tools such as computed tomography, along with appropriate surgical techniques and strategic orthodontic planning, effectively addresses these clinical presentations. Timely multidisciplinary treatment promotes the resolution of associated pathologies and optimizes dental alignment, contributing to improved masticatory function and facial esthetics. These comprehensive approaches are essential to ensure predictable and successful outcomes in certain complex cases.

Keywords: canine impaction; case report; dentigerous cyst; odontoma; oral pathology; oral surgery.

Figure 1.

Results from radiographic studies. (a) Orthopantomography showing two well-defined radiolucent lesions ~15 and 11 mm in diameter, respectively, with well-defined radiopaque margins around the crowns of teeth 33 and 43, characteristic of cysts. (b) Cone-beam CT demonstrating well-defined unilocular radiolucent lesions associated with teeth 33 and 43. (c) A mixed radiolucent and radiopaque image with defined radiopaque borders at the middle third of the right first premolar, indicating an odontoma. (d) CT scan showing cystic cavities surrounding each of the canines. CT: computed tomography.

Figure 2.

Surgical procedures used. (a) Intraoral clinical evaluation revealed the absence of permanent teeth 33 and 43 and the presence of deciduous canines 73 and 83. (b) An intrasulcular incision from 36 to 45 made to elevate a full-thickness mucoperiosteal flap. (c) Extraction of the deciduous canines, and a circular osteotomy performed using a surgical handpiece to create a bony window and expose the entities. (d) Osteotomy performed to expand the area corresponding to tooth 43 for improved visibility. (e) The identified odontoma. (f) A button cemented to the exposed coronal portion of the canines, and wires connected from the button to the orthodontic appliance.

Figure 3.

Histopathological sections confirming the presence of an odontoma and two dentigerous cysts. (a) Compound odontoma characterized by a hamartomatous proliferation of dental tissues. Histologically, the lesion exhibits enamel matrix (black arrow), tubular dentin (white arrow), pulp-like connective tissue, and islands of odontogenic epithelium arranged in a manner resembling rudimentary tooth structures (arrowhead). These elements are embedded within a moderately dense fibrous stroma. (b) Dentigerous cyst (left side): histological section shows a cystic cavity lined by nonkeratinized stratified squamous epithelium, five to eight cell layers thick (black arrow), supported by adjacent fibrous connective tissue. (c) Dentigerous cyst (right side): cystic structure lined by nonkeratinized squamous epithelium, one to two cell layers thick (black arrow). The underlying connective tissue stroma is fibrous, with focal myxoid changes (white arrow).