This document presents two case studies of patients with dentigerous cysts in the maxilla. The first case involves a 26-year-old male with a swelling in the upper front tooth region. Examination and radiographs revealed a dentigerous cyst associated with teeth 11 and 21. The cyst was enucleated and pathology confirmed the diagnosis. The second case involves a 73-year-old male with pain and swelling in the upper front teeth region. Examination found a diffuse palatal swelling and missing tooth 11. Radiographs showed a dentigerous cyst associated with teeth 11 and 12. The patient underwent cyst enucleation and extraction of the impacted tooth. Both patients recovered well post-operatively without

1. DENTIGEROUS CYST IN ANTERIOR
MAXILLA: A RARE ENTITY
-CASE SERIES
Presenting by :
Anitha Chesetti
Oral Medicine And Radiology
GSL Dental College And Hospital

2. CASE- 1

3. OP No : 2212030009
Age : 26 years
Name : P Suresh
Gender : Male
Address : Yanam

4. Chief complaint:
 Complaints of swelling in upper front tooth region since 1 month
History of Present Illness:
 The present complaint started 1 month ago as a small swelling in the
upper front tooth region which gradually progressed to present size,
with no associated pain and secondary changes.
 Patient gives history of same swelling in the upper front tooth region
1 year ago and visited nearby dentist and he was advised biopsy and
underwent biopsy (Biopsy report revealed benign cystic lesion) &
swelling has not subsided.
 Patient again visited a nearby hospital 1 month ago, advised root canal
treatment and patient didn’t undergo treatment, swelling has not
subsided and he further visited GSL dental hospital for further
treatment.

5. Past Medical History:
 No relevant past medical history
Past dental history:
 1st dental visit 1 and half year ago – swelling in upper front tooth region
Family History :
 No relevant family history

6. Appetite:
Normal
Bowel and bladder:
Normal
Micturition :
Normal
Oral Hygiene Habits:
Brushes once daily
with tooth brush
and tooth paste
Deleterious habits :
No H/O
Sleep :
Normal
Personal history;
Marital status: Married

7.  Mental Status: Coherent, Conscious and Cooperative on dental chair
General Appraisal:
 Gait : Normal Gait
 Posture : Erect
 Built : Moderately built
 Nourishment : Moderately nourished
GENERAL PHYSICAL EXAMINATION :

8.  Hair:
 Skin:
 Face:
 Eyes/Eyebrows:
 Ears:
 Nose:
 Lips:
 Nails:
No Abnormality Detected
Peripheral signs
 Anemia
 Cyanosis:
 Clubbing:
 Icterus:
Not Detected

9. Vital signs
 Pulse rate : 68 beats/min
 B.P : 120/70 mmHg
 Respiratory rate : 18 breaths / min
 Temperature : 98.3 ⁰ F
 Height : 5’6”
 Weight : 53kgs

10. EXTRA ORAL EXAMINATION
Head : No abnormality detected
Face : No abnormality detected
Jaws : No abnormality detected
TMJ : No clicking sounds,
No crepitus
No deviation
Well coordinated & synchronous bilateral movements
Muscles of Mastication : No abnormality detected
Salivary Glands : No abnormality detected
Regional Lymph Nodes : No regional lymph nodes were palpable

11. INTRAORAL EXAMINATION
SOFT TISSUE EXAMINATION
 Lips , Alveolar &
Buccal Mucosa : No Abnormality Detected
 Labial Mucosa : NODULAR GROWTH ON LABIAL FRENUM
 Palate : No Abnormality Detected
 Tongue : No Abnormality Detected
 Floor Of The Mouth : No Abnormality Detected
 Gingiva & Coral pink in color, firm in consistency
 Periodontium : Calculus + stains +

12. HARD TISSUE EXAMINATION
Dental caries : 36,37,38,46,47,48
Filled teeth : Nil
Attrition : 31,32,41,42,43
Abrasion : Nil
Erosion : Nil
Mobility : Nil
Fractures : Nil
Root stumps : 16
Occlusion : No Derranged occlusion

13. ON INSPECTION:
1. SOFT TISSUE
 A solitary dome shaped swelling of size measuring approximately 0.5x1
cm is seen in the upper front tooth region extending mediolaterally
0.5cm from labial frenum on both sides.
 Superoinferiorly from the depth of labial sulcus to marginal gingiva of
11,21
 Overlying mucosa is smooth with a bluish hue and surrounding mucosa
is normal
2. HARD TISSUE
 Teeth at the site of lesion were present and intact
EXAMINATION OF THE SPECIAL LESION

14. ON PALPATION:
1. SOFT TISSUE
All inspectory findings irt number, site, size, shape and extent
were confirmed
On palpation, swelling is soft in consistency , non-tender,
non compressible, non reducible, non pulsatile and no
discharge on provocation
2. HARD TISSUE
Teeth associated with lesion were not mobile

15. SUMMARY OF CLINICAL FINDINGS

16. DIAGNOSIS
PROVISIONAL DIAGNOSIS
 Benign non-odontogenic cyst
DIFFERENTIAL DIAGNOSIS
 Hemangioma
 A V malformation
 Nasolabial cyst irt 11, 21
OTHER DIAGNOSIS:
 Chronic generalized gingivitis
 Rootstump irt 16
 Dental caries irt 36,37,38,46,47,48
 Localised attrition irt 31 32 33 41 42 43

17. INVESTIGATIONS
IOPA IRT 11 21 MAXILLARY OCCLUSAL RADIOGRAPH

18. OPG

19.  Dentigerous cyst irt 11, 21
DIFFERENTIAL DIAGNOSIS
 Adenamatoid odontogenic tumour
 CEOC
RADIOLOGICAL DIAGNOSIS

20. TREATMENT PLAN
 Cyst enucleation along with
extraction of supernumerary
tooth
 Endodontic treatment irt 11 12
13 21 22 23

21. HISTOPATHOLOGICAL REPORT
 Odontogenic cystic lining epithelium exhibiting 1-2
layers thickness.
 Epithelial connective tissue junction is flat with
absence of rete ridges
 Few goblet cells were seen
 Underlying connective tissue shows dense collagen
bundles with minimal inflammatory cell infiltrate
 Few dilated blood capillaries are also seen

22. FINAL DIAGNOSIS
 Dentigerous cyst irt 11,21
POST OPERATIVE FOLLOW UP
1 WEEK FOLLOWUP 1 MONTH FOLLOWUP

23. POST OPERATIVE OPG

24. CASE- 2

25. OP No : 2104100002
Age : 73 years
Name : B Satya Prasad
Gender : Male
Address : Rajahmundry

26. CHIEF COMPLAINT: Complaints of pain and swelling in his upper front
teeth region since 2 months
HISTORY OF PRESENT ILLNESS:
The present complaint started 2 months ago as mild, intermittent
throbbing pain in his upper front teeth region associated with a
swelling of peanut size gradually progressed to present size that
subsided on its own
There was no associated discharge/bleeding/paresthesia/ulceration
with the swelling
There were 3-4 episodes of swelling associated with pain in past 2
months and subsided on its own
Patient had visited a near by dentist with same chief complaint 10days
ago and was advised to get further investigations to proceed with the
treatment procedures

27. Past Medical History:
 Known diabetic and is on medication since 3 years
Past dental history:
 1st dental visit- 3 years ago – underwent extraction in upper front tooth region
Family History :
 No relevant family history

28. Appetite:
Normal
Bowel and bladder:
Normal
Micturition :
Normal
Oral Hygiene Habits:
Brushes once daily
with tooth brush
and tooth paste
Deleterious habits :
No H/O
Sleep :
Normal
Personal history;
Marital status: Married

29.  Mental Status: Coherent, Conscious and Cooperative on dental chair
General Appraisal:
 Gait : Normal Gait
 Posture : Erect
 Built : Moderately built
 Nourishment : Moderately nourished
GENERAL PHYSICAL EXAMINATION :

30.  Hair:
 Skin:
 Face:
 Eyes/Eyebrows:
 Ears:
 Nose:
 Lips:
 Nails:
No Abnormality Detected
Peripheral signs
 Anemia
 Cyanosis:
 Clubbing:
 Icterus:
Not Detected

31. Vital signs
 Pulse rate : 74 beats/min
 B.P : 140/70 mmHg
 Respiratory rate : 17 breaths / min
 Temperature : 98.6 ⁰ F
 Height : 5’10”
 Weight : 54kgs

32. EXTRA ORAL EXAMINATION
Head : No abnormality detected
Face : No abnormality detected
Jaws : No abnormality detected
TMJ : No clicking sounds,
No crepitus
No deviation
Well coordinated & synchronous bilateral movements
Muscles of Mastication : No abnormality detected
Salivary Glands : No abnormality detected
Regional Lymph Nodes : No regional lymph nodes were palpable

33. SOFT TISSUE EXAMINATION
Lips, Labial Mucosa &
Buccal Mucosa : No abnormality detected
Vestibule : No abnormality detected
Palate : A DIFFUSE SWELLING IS PRESENT
Tongue : No abnormality detected
Floor Of The Mouth : No abnormality detected
Gingiva : pale pink in color, soft and edematous in consistency,
Stains +, Calculus ++
Periodontium : Mobility (grade III)- 41,42,(grade-II) - 22,24
(grade I) - 17, 15, 14, 13, 21, 22, 23, 24
INTRA ORAL EXAMINATION:

34. HARD TISSUE EXAMINATION
Missing Teeth : 11
Dental caries : 36
Filled teeth : 17, 24, 27
Attrition : Generalized attrition
Abrasion : Nil
Erosion : Nil
Mobility : Nil
Fractures : Nil
Root stumps : Nil
Occlusion : No deranged occlusion

35. EXAMINATION OF THE SPECIAL LESION:
INSPECTION:
1. SOFT TISSUE
 A solitary diffuse swelling of size approximately 1x1cm is present on the palatal
region.
 Extending antero-posteriorly from incisive papilla region to posteriorly 2mm in
front of palatal rugae
 Mediolaterally towards right side 1mm away from mid-palatal raphe to 2mm
away from marginal palatal gingiva of 13
 Overlying mucosa is edematous and erythematous, surrounding mucosa is
normal
2. HARD TISSUE
 Tooth at the site of lesion was absent

36. PALPATION :
1. SOFT TISSUE
• All inspectory findings regarding site, size, shape and extent are confirmed
• On palpation, swelling is non-tender, soft in consistency, non compressible, non
reducible and non pulsatile
• There was no discharge on provocation
2. HARD TISSUE
• Tooth at the site of lesion was absent

37. SUMMARY OF CLINICAL FINDINGS

38. PROVISIONAL DIAGNOSIS:
 Benign odontogenic cyst in upper front tooth region irt 11 12
DIFFERENTIAL DIAGNOSIS:
 Dentigerous cyst
 Adenomatoid odontogenic tumor
OTHER DIAGNOSIS:
 Chronic generalized periodontitis
 Partially edentulous irt 11
 Dental caries irt 36

39. INVESTIGATIONS
IOPAR IRT 11 21 12 22 MAXILLARY OCCLUSALRADIOGRAPH

40. OPG

41. AXIAL SECTION SAGGITAL SECTION CORONAL SECTION
CBCT

42. TREATMENT PLAN:
 Advised cyst enucleation with Extraction Of supernumerary Tooth Irt 11
HISTOPATHOLOGY
GROSSING OF THE SPECIMEN HISTOLOGY SLIDE
BIOPSY SITE

43. HISTOPATHOLOGY REPORT
 The underlying connective tissue shows dense collagen fibres with minimal inflammatory cell
infiltrate consisting of lymphocytes.
 Areas of dystrophic calcifications were also noticed
FINAL DIAGNOSIS : Dentigerous Cyst

44. FOLLOW UP AFTER 7 DAYS
FOLLOW UP AFTER 15 DAYS
POST OPERATIVE FOLLOW UP

45. POST OPERATIVE FOLLOW UP
FOLLOW UP AFTER 1 MONTH

46. DISCUSSION
 Cyst is defined ‘a pathological cavity having fluid, semifluid or gaseous
contents and which is not created by the accumulation of pus’
(Kramer (1974) )
 Odontogenic cysts - arising from the odontogenic epithelium and
Non odontogenic(Fissural cysts) - arising from the oral epithelium
trapped between fusing processes during embryogenesis
 Dentigenous cyst (follicular, pericoronal) –
“An odontogenic cyst that surrounds the crown of an impacted tooth;
caused by fluid accumulation between the reduced enamel
epithelium and the enamel surface, resulting in a cyst in which the
crown is located within the lumen”
Rajendran, A., & Sundaram, S. (2014). Shafer’s textbook of oral pathology. Elsevier Health Sciences Apac.

47.  Dentigerous cyst develops around the crown of an unerupted tooth
by accumulation of fluid either between the reduced enamel
epithelium and enamel
 This fluid accumulation occurs as a result of the pressure exerted by
an erupting tooth on an impacted follicle, which obstructs the
venous outflow and thereby induces rapid transudation of serum
across the capillary wall.
 Two types of dentigerous cysts occur( Ben and Altini)
First type - Developmental in origin,
Occurs in mature teeth
Result of impaction
Second type - Inflammatory in origin
Occurs in immature teeth
Result of inflammation from a non-vital deciduous
tooth or some other source spreading to involve the
tooth follicle
Önay Ö, Süslü AE, Yılmaz T. Huge dentigerous cyst in the maxillary sinus: a rare case in childhood. Turkish archives of otorhinolaryngology. 2019 Mar;57(1):54.

48.  Most common developmental odontogenic cysts -
24% of the jaw cysts
 Second most common odontogenic cysts of the jaws
next to radicular cyst (54.2%)
 2nd and 3rd decades of life with Male prediliction
 Mandible – 70% and Maxilla – 30%
 Associated with the mandibular 3rd molar (45.7%),
followed by maxillary canines and mandibular
premolars , maxillary third molars, maxillary incisors
(1.5%) and supernumerary teeth(5-6%) and
mesiodens
Guruprasad Y, Chauhan DS, Kura U. Infected dentigerous cyst of maxillary sinus arising from an ectopic third molar. Journal of clinical imaging science. 2013;3(Suppl 1).

49.  Mourshed stated that only 1.44% of impacted teeth undergo
dentigerous cyst transformation
 So dentigerous cysts involving the permanent central incisor
are rare( 44 Cases)
 Clinically, it is often asymptomatic; it is discovered as incidental
radiographic finding or when acute inflammation, or swelling
develops but have the potential to become extremely large
and cause cortical expansion and erosion
 Expansion of the bone, facial asymmetry, extreme
displacement of teeth, severe root resorption of adjacent teeth
and pain are all possible sequelae of continuous enlargement
of the cyst
Arakeri G, Rai KK, Shivakumar HR, Khaji SI. A massive dentigerous cyst of the mandible in a young patient: a case report. Plastic and Aesthetic Research. 2015 Sep 15;2:294-8.

50.  Cystic involvement of an unerupted mandibular third
molar - ‘hollowing-out’ of the entire ramus extending
up to the coronoid process and condyle as well as in
expansion of the cortical plate due to the pressure
exerted by the lesion and sometimes comes to lie
compressed against the inferior border of the
mandible.
 Cyst associated with a maxillary cuspid - expansion
of the anterior maxilla and resemble an acute
sinusitis or cellulitis
Nagarajan N, Jayachandran S, Jayaram V, Nisha A. Dentigerous Cyst in the Maxillary Anterior Region of a Pediatric Patient. Annals of the National Academy of Medical Sciences (India). 2021 Jan;57(01):58-61.

51.  Radiographically, If the follicular space on radiograph is more than 5 mm, an
odontogenic cyst can be suspected
 It usually occurs as a well-defined unilocular radiolucency, often with a
sclerotic border around the impacted crown of the tooth
 The cyst to crown relationship in a dentigerous cyst can show different
variations (Thoma-Robinson-Bernier)
• Central variety - The cyst surrounds the crown of the tooth with the
crown projecting into the cyst(mandibular 3rd molar, maxillary canine)
• Lateral variety - When the cyst grows laterally along the root surface
surrounding the crown partially (mandibular 3rd molar)
• Circumferential variety - a considerable amount of root appears to lie
within the cyst along with the crown that is surrounded by the cyst
Nagarajan N, Jayachandran S, Jayaram V, Nisha A. Dentigerous Cyst in the Maxillary Anterior Region of a Pediatric Patient. Annals of the National Academy of Medical Sciences (India). 2021 Jan;57(01):58-61.

52.  The content of the cyst lumen is usually a thin,
watery yellow fluid, occasionally blood tinged.
 Histologically, the dentigerous cyst is usually
composed of a thin fibrous connective tissue
wall lined by nonkeratinized stratified
squamous epithelium consisting of myxoid
tissue, odontogenic remnants and rarely
sebaceous cells.
 Rete peg formation is generally absent except
in cases that are secondarily infected.
Rohilla M, Marwah N, Tyagi R. Anterior maxillary dentigerous cyst. International journal of clinical pediatric dentistry. 2009 Jan;2(1):42.

53. Differential diagnosis
1.Unicystic Ameloblastoma - They will grow laterally away from the tooth in comparison to dentigerous
cyst, which envelop the tooth symmetrically and is more common in the premolar-molar area
2.Adenomatoid odontogenic tumor- rare and usually occur in the maxillary anterior region, Cystic lining is
not attached to CEJ, it involves the uneruptedtooth
3.Calcifying odontogenic Cyst - it may occur as a pericoronal radiolucency and may contain evidences of
calcification, Cystic lining is not attached to CEJ, it involves the unerupted tooth
4.Odontogenic keratocyst - does not expand the bone to the same extent, is less likely to resorb teeth
and may attach further apically on the root instead at the cementoenamel junction
5.Hyper plastic follicle - if the follicular space is more than 5 mm, a dentigerous cyst is suspected

54.  These are usually solitary however bilateral and multiple
cysts - syndromes such as basal cell nevus syndrome,
mucopolysaccharidosis, Gardner’s syndrome, cleidocranial
dysplasia, bifid rib syndrome and prolonged concurrent use
of cyclosporine & calcium channel blockers
 Various treatment plans proposed for dentigerous cysts are:
(a) Cyst enucleation along with extraction of the
involved tooth.
(b) Marsupialization technique - involves removal of
the cyst, however, the developing tooth is
preserved.
 Potential Complications : untreated Dentigerous cyst may
transform into tumours like mural ameloblastoma, and has
the potential of developing into malignancies like squamous
cell carcinoma and mucoepidermoid carcinoma
Nagarajan N, Jayachandran S, Jayaram V, Nisha A. Dentigerous Cyst in the Maxillary Anterior Region of a Pediatric Patient. Annals of the National Academy of Medical Sciences (India). 2021 Jan;57(01):58-61.

55.  Dentigerous cyst is a common developmental odontogenic
cyst, mostly seen in relation with impacted mandibular third
molars and maxillary canines
 Usually, they are asymptomatic and this delays the diagnosis
 Prompt diagnosis and treatment is mandatory to prevent
dreadful complications
 A dentigerous cyst associated with an anterior tooth will
result in failure or eruption of the tooth and therefore lead to
esthetic and orthodontic problems
CONCLUSION

56. REFERENCES
1. Shear, M., & Speight, P. (2008). Cysts of the oral and maxillofacial regions (4th ed.). Wiley-Blackwell.
2. Rajendran, A., & Sundaram, S. (2014). Shafer’s textbook of oral pathology. Elsevier Health Sciences Apac.
3. Nagarajan N, Jayachandran S, Jayaram V, Nisha A. Dentigerous Cyst in the Maxillary Anterior Region of a Pediatric
Patient. Annals of the National Academy of Medical Sciences (India). 2021 Jan;57(01):58-61.
4. Rohilla M, Marwah N, Tyagi R. Anterior maxillary dentigerous cyst. International journal of clinical pediatric dentistry.
2009 Jan;2(1):42.
5. Cura N, Hanttash A, Inceoglu B, Orhan K, Oncul AM. Dentigerous cysts in four quadrants of a nonsyndromic patient:
case report and literature review. Oral Radiology. 2015 Jan;31:49-58.
6. Arakeri G, Rai KK, Shivakumar HR, Khaji SI. A massive dentigerous cyst of the mandible in a young patient: a case
report. Plastic and Aesthetic Research. 2015 Sep 15;2:294-8.
7. Guruprasad Y, Chauhan DS, Kura U. Infected dentigerous cyst of maxillary sinus arising from an ectopic third molar.
Journal of clinical imaging science. 2013;3(Suppl 1).
8. Önay Ö, Süslü AE, Yılmaz T. Huge dentigerous cyst in the maxillary sinus: a rare case in childhood. Turkish archives of
otorhinolaryngology.2019Mar;57(1):54
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