Dentigerous cyst is a type of odontogenic cysts and generally occurs in the ages of twenties or thirties. Dentigerous cyst always includes a tooth which cannot complete the eruption process and occurs around the crown by the fluid accumulation between the layers of enamel organ. In rare cases, dentigerous cyst occurs in the first decade of life and develops in an immature permanent tooth as a result of a chronic inflammation of overlying nonvital primary tooth.These cyst often show no symptoms, and they are generally detected by a radiographic examination to find the reason for the delayed eruption.

1. DENTIGEROUS
CYST
Presented by
Dr. Rahul Srivastava
Professor
Rama Dental College Hospital
& Research Centre, Kanpur

2. Dentigerous Cyst (DC)
The term dentigerous means “containing tooth,”
and this is the characteristic description of the
cyst. A dentigerous cyst surrounds the crown of
an unerupted tooth, expands the follicle and is
characteristically attached to the cemento-
enamel junction of the unerupted tooth.

3. It is caused by alteration of reduced enamel
epithelium after the completion of amelogenesis,
which results in fluid accumulation between
epithelium and tooth crown.

4. Etiology of Dentigerous Cyst
 The pathogenesis of dentigerous cyst is still
controversial.
 Three feasible mechanisms have been proposed for
histogenesis of the cyst by Benn and Altini:
A- They proposed that developmental dentigerous
cyst might form a dental follicle and might become
secondarily inflamd, a source of inflammation being
a non-vital tooth.

5. B- The second mechanism they proposed was
formation of a radicular cyst at an apex of a non-
vital deciduous tooth followed by eruption of its
permanent sucessor into the radicular cyst resulting
in a dentigerous cyst of extrafollicular origin.
C- Follicle of permanent successor might get
secondarily infected from either periapical
inflammation of a non-vital predecessor or other
source leading to a dentigerous cyst formation.

6. Clinical features
 Dentigerous cysts accounts for one of the most
common odontogenic cysts, frequently seen with
embedded unerupted teeth, supernumerary teeth,
and odontomes.
 Occurrence of dentigerous cysts with deciduous
teeth is a rare phenomenon.

7.  They are more frequent in the second and third
decades of life, with a male preference and the
mandible being the most influenced region.
 Males are more affected with an incidence rate
of 1.6:1.
 These cysts can lead to cortical bone expansion,
swelling, tooth mobility and displacement.

8.  Cystic involvement of an unerupted mandibular
third molar may result in a ‘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.
 Cyst associated with a maxillary cuspid,
expansion of the anterior maxilla often occurs and
may superficially resemble an acute sinusitis or
cellulitis.

9.  Dentigerous cyst occuring in association with
supernumerary tooth and mesiodens has been
occasionally seen.
 About 5% of all dentigerous cysts are attributed
by the dentigerous cysts with supernumerary teeth.
They usually occur in the maxillary anterior region
in association with mesiodens.

10.  Dentigerous cysts usually are solitary, however,
bilateral and multiple cysts may be seen with
syndromes such as :
 Gardner's syndrome.
 Mucopolysaccharidosis.
 Maroteaux-Lamy syndrome.
 Basal cell nevus syndrome.
 Cleidocranial dysplasia.

11.  Enamel hypoplasia seen when a dentigerous
cyst commences at an early stage of development
of the involved tooth whereas in cases where the
cyst originating after the completion of tooth
development, enamel hypoplasia is not a
significant factor.

12. Radiographic Features:
While a normal follicular space is 3–4 mm, a
dentigerous cyst can be suspected when the space
is more than 5 mm.
Radiographically, the dentigerous cyst usually
occurs as a well-defined unilocular radiolucency,
often with a sclerotic border.

13. As the epithelial lining is derived from the
reduced enamel epithelium, this radiolucency,
typically and characterstically surrounds the crown
of the tooth.
A large dentigerous cyst may sometimes resemble
a multilocular process, as bone trabeculae may be
seen within the radiolucency.
However, mostly dentigerous cysts are grossly and
histopathologically unilocular processes and
probably are never truly multilocular lesions.

14. A B C
A dentigerous cyst (a) unilocular and crown side
type; (b) multilocular type; (c) whole-tooth type.

15. Three types of dentigerous cyst have been
described radiographically:
(a) The central variety in which the tooth crown is
enclosed by the radiolucency, and the crown
protrudes into the cystic lumen.
(a) The lateral variety in which the cyst occurs
laterally along the tooth root, thus, partially
surrounding the crown.

16. (c) The circumferential variety exists when the cyst
not only surrounds the crown, but also extends
down along the root surface, thus, giving the
impression of the tooth within the cyst.

17. CT is useful to evaluate large lesions and can
show the origin, size, and internal contents of
the cyst and evaluate the integrity of the cortical
plate and its relationship to the adjacent
anatomic structures.
Significant cortical expansion or thinning of the
buccal and lingual cortical plates may be seen
with larger lesions.

18. MRI plays a key role in the diagnostic process by
providing new information which enabled us to
determine a consistent presumptive diagnosis and
consequently a more coherent surgical approach.
The T1-weighted image of the lesion showed an
intermediate signal, thus not being useful for
determination of the content of the lesion.

19. Nevertheless, T2-weighted image enabled to
observe an intense brightness inside the lesion,
which contributed significantly to the
interpretation of a probable cystic lesion rather
than tumoural.

20. CBCT is similar to panoramic radiography,
however, this exam provides more precise
information on the size, position, and relationship
of the lesion to the surrounding structures. In
classical helical computed tomography, the
content of a DC typically appears as low density
on CBCT (liquid-like).

21. Dentigerous cyst Aspirate:
Aspirate is Clear, pale, straw colored fluid which
contains “Cholesterol crystals” and the protein
content is in excess of 4.0 gm per 100 ml.
Histologic Features
 Composed of a thin connective tissue wall with a
thin layer of stratified squamous epithelium lining
the lumen.
 Rete peg formation is generally absent except in
cases that are secondarily infected.

22.  The connective tissue wall is frequently quite
thickened and composed of a very loose fibrous
connective tissue or of a sparsely collagenized
myxomatous tissue.
An additional finding, especially in cysts which
exhibit inflammation, is the presence of Rushton
bodies within the lining epithelium.

23. Differential diagnosis :
Hyperplastic follicle.
Odontogenic keratocyst.
Ameloblastic fibroma.
Cystic ameloblastoma.
Treatment
Various treatment plans proposed for dentigerous
cysts are:
(a) Surgically removing the cyst. Consideration
should be taken not to damage the associated
permanent tooth.

24. (b) Cyst enucleation along with extraction of the
involved tooth.
(c) Marsupialization technique - involves removal of
the cyst, however, the developing tooth is preserved.
The offending tooth playa a major role in deciding
the type of surgical intervention required for the
dentigerous cyst.

25. Isolated lesions in young patients, where
preservation of the teeth is desirable,
marsupialization is the recommended treatment
option.
Potential Complications
The development of an ameloblastoma either from
the lining epithelium or from rests of odontogenic
epithelium in the wall of the cyst.

26. The development of epidermoid carcinoma from the
same two sources of epithelium.
The development of a mucoepidermoid carcinoma,
basically a malignant salivary gland tumor, from the
lining epithelium of the dentigerous cyst which
contains mucussecreting cells, or at least cells with
this potential, most commonly seen in dentigerous
cysts associated with impacted mandibular third
molars.

27. References
Shear M, Speight P. Cysts of the Oral and
Maxillofacial Regions. 4th ed. Oxford Blackwell
Publishing Ltd.; 2007. p. 5978.
Al-Talabani NG, Smith CJ. Experimental
dentigerous cysts and enamel hypoplasia: their
possible significance in explaining the pathogenesis
of human dentigerous cysts. J Oral Pathol. 1980
Mar;9(2):82–91.

28. Boyczuk MP, Berger JR, Lazow SK. Identifying a
deciduous dentigerous cyst. J Am Dent
Assoc. 1995;126:643–4.
Roberts MW, Barton NW, Constantopoulos G, Butler
DP, Donahue AH. Occurrence of multiple dentigerous
cysts in a patient with the Maroteaux-Lamy syndrome
(mucopolysaccharidosis, type VI) Oral Surg Oral Med
Oral Pathol. 1984;58:169–75.

29. Benn A, Altini M. Dentigerous cysts of inflammatory
origin. A clinicopathologic study. Oral Surg Oral Med
Oral Pathol Oral Radiol Endod. 1996;81:203–9.
Hasan S, Ahmed SA, Reddy LB. Dentigerous cyst in
association with impacted inverted mesiodens:
Report of a rare case with a brief review of literature.
Int J Appl Basic Med Res. 2014 Sep;4(Suppl 1):S61-4.
doi: 10.4103/2229-516X.140748.

30. Terauchi et al An Analysis of Dentigerous Cysts
Developed around a Mandibular Third Molar by
Panoramic Radiographs. Dentistry Journal
2019;7:1-9.
Regezi AJ, Sciubba JJ, Jordan RC. Oral Pathology:
Clinical-Pathologic Correlations. 5th ed. St. Louis:
Saunders; 2008. pp. 242–4.

31. Zerrin E, Husniye DK, Peruze C. Dentigerous cysts
of the jaws: Clinical and radiological findings of 18
cases . J Oral Maxillofac Radiol 2014;2:77-81