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Intraosseous arteriovenous malformations (AVM) are uncommon high-flow vascular malformation that can affect the maxilla or mandible. AVM may present with aspecific and misleading signs and symptoms. The diagnosis is often accidental and bleeding may represent the first symptom. Radiographically, there are few characteristic features and misdiagnosis is easy. Here we report the case of a young male affected by arteriovenous fistula on the right side of the mandible initially misdiagnosed as a cystic lesion. The patient underwent transarterial embolization of the vascular malformation and subsequently the lesion was surgically removed. 1-year follow-up showed complete healing of the mandibular bone and absence of recurrence. Intraosseous arteriovenous malformations are rare entities. However, due to their harmfulness, both clinicians and radiologists must be aware of this type of lesion and should always consider them in the differential diagnosis of osteolytic lesions. [ABSTRACT FROM AUTHOR]

Nasopalatine duct cyst, which is also known as incisive canal cyst, is the most common developmental cyst of the maxilla. It arises from the proliferation of the remnants of the nasopalatine duct stimulated by trauma or infection. In this article, the authors report a rare case of an extensive nasopalatine duct cyst in a 57-year-old Male associated with non-vital tooth. Clinical examination revealed facial asymmetry associated with swelling that is painful and tender. Correlating clinical and radiological findings, a diagnosis of nasopalatine duct cyst was formed, and the histopathological examination confirmed the diagnosis of nasopalatine duct cyst. This case highlights the importance of knowing that nasopalatine duct cyst can be associated with non-vital teeth, challenging the assumption that they are exclusively associated with vital teeth. [ABSTRACT FROM AUTHOR]

Introduction: A former study on orthopantomograms from young children with abnormal dental development (not canine ectopia) demonstrated that the tooth bud of the mandibular canine, compared to a stable longitudinal canine axis, could be located normally, anteriorly or posteriorly, with close relation to the first premolar. Aim: The aim of the present study is to analyse on orthopantomograms if the canine axis can demonstrate where the ectopic mandibular canine started tooth formation. Materials: The material consists of orthopantomograms with ectopic mandibular canines and presence of primary mandibular canines from 47 cases (29 cases 9–21 years old and 18 cases with unknown ages). The primary canines demonstrated from minor apical resorption to more severe apical resorption. Methods: Based on canine maturity, location of the canine axes and the interrelationships between the roots of the permanent canine and first premolar, the location from where the canine started tooth formation was determined. Canine maturity. Maturity stage below half root length and maturity stage above half root length revealed that 11 ectopic canines had less than half root length and 36 cases more than half root length. Canine axes. The canine axis, through the length of the primary canines Ax, is inserted on drawings of the orthopantomograms using the tracing programme Inkscape®. Interrelationship between roots. By visual inspection, the distance between the canine and first premolar was designated close distance, normal distance and extended distance. Results: The results are divided into 3 groups. Group 1: The initial site of the permanent ectopic canine is located within the canine axis (6 cases). Group 2: The initial site of the permanent ectopic canine is located posterior to the canine axis (36 cases). Group 3: The initial site of the permanent ectopic canine is located anterior to the canine axis (5 cases). Conclusion: The study explained that the canine axis could divide cases of ectopic canines into three groups according to the location from where tooth formation starts. For getting closer to the pattern of the ectopic canine eruption, it is necessary to analyse series of orthopantomograms taken from the same individual over several years. [ABSTRACT FROM AUTHOR]

To detect predictive factors for the occurrence of complications associated with unerupted maxillary canines (C). A total of 83 cone beam computed tomograms (CBCT), made from November 1, 2021 to October 31, 2022, have met the inclusion criteria, whereby 110 unerupted C were detected. Independent variables were: gender, age, and C position. Outcome variables were detected complications: external root resorption (ERR) and dilaceration of adjacent tooth, ERR and dilaceration of C, dentigerous cyst, canine ankylosis, and adjacent teeth malposition. Chi-square test and logistic regression analysis were used to examine the relationship between income variables and detected complications. Vertical position of unerupted C showed as predictor for adjacent tooth dilacerations and malposition. Chance for dilaceration increases 5.5-fold with C position at the middle third of lateral incisor (LI) root, while chance of malposition increases 23.4-fold with its supra-apical position to the LI root, in comparison to the C position occlusal to the LI cemento-enamel junction. Age is a predictive factor for dentigerous cysts, with decreasing the chance of their occurrence 1.5-fold with each additional year of age. Early evaluation of the vertical position and timely treatment of C are decisive steps in preventing complications. [ABSTRACT FROM AUTHOR]

Dentigerous cysts are known as the second most common type of cyst in the jaws. The cyst is one of the lesions occurred frequently in the posterior body of the mandible and is often related to the unerupted third molar and forms around the crown of the unerupted tooth attaching at the cementoenamel junction. Such characteristic appearances are the diagnostic points differentiating from ameloblastoma or odontogenic keratocyst. However, it would be hard for us to diagnose it as a dentigerous cyst if the lesion does not show its typical appearance. We experienced two cases of dentigerous cysts which did not form around the crown of the unerupted tooth on radiologically. Both cysts were relatively large and resorbed adjacent teeth roots. Therefore, an ameloblastoma or an odontogenic keratocyst was suspected rather than a dentigerous cyst as the imaging diagnosis. The biopsy revealed that the lesion was a "dentigerous cyst" in one of the cases and "developmental cyst with inflammation" in another case. After the excision, the histopathological diagnosis was a dentigerous cyst with inflammation in both cases. This report shows the two cases of dentigerous cysts focusing on panoramic radiography and CT images. Also, we discuss the differential diagnosis by reconsidering those diagnostic points. [ABSTRACT FROM AUTHOR]

The objective of this study was to review the clinical, radiologic, and histologic aspects of cases of dentigerous cysts metamorphosing into different entities along with comments on the molecular factors involved in the process. A series comprising 8 cases of dentigerous cysts was performed retrospectively along with a comprehensive literature review. Two cases of dentigerous cyst converting into mucous metaplasia were included, out of which one case was transformed into ameloblastoma after a year. The other two cases were reported as acanthomatous and unicystic ameloblastoma, whereas four transitioned to AOT. The complete review of cases and literature with molecular profiling concluded that the lining of dentigerous cysts has the potential for transforming into benign odontogenic tumors. Therefore, a careful clinical and histopathological examination is crucial for the correct diagnosis. Also, a thorough molecular understanding of the cystic lining is required. [ABSTRACT FROM AUTHOR]

Background: Dentigerous cysts are the second most common form of a developmental cyst. These cysts might be the cause of ectopic teeth. Dentigerous cysts associated with ectopic teeth in the maxillary sinus are seldom seen in clinical practice. Case presentation: We reported a 23-year-old woman who presented with nasal obstruction and facial pain on the left side 4 months ago. Three courses of antibiotics and analgesia were prescribed for her without improving the presenting features. Furthermore, extraction of the left upper second premolar and second molar, but the condition persisted. An orthopantogram and computerized tomography scan revealed the ectopic position of the left third upper molar tooth, which was embedded in a cystic lesion occupying the whole maxillary sinus. Removal of the cystic lesion with the ectopic tooth was performed with a Caldwell-Luc procedure. The histopathological evaluation confirmed the diagnosis of a dentigerous cyst. The presenting symptoms were resolved following surgery with no intra- or postoperative complications. Conclusion: We are reporting another case of a dentigerous cyst occupying the whole left maxillary sinus with an ectopic left third upper molar tooth. Reporting such a case will enrich the literature regarding this rare clinical entity. [ABSTRACT FROM AUTHOR]

Purpose: We used proteomic sequencing and experimental verification to identify the potential ferroptosis-related proteins in ameloblastoma. Methods: Samples of ameloblastoma (n = 14) and normal gingival tissues (n = 5) were collected for proteomic sequencing to identify differentially expressed proteins (DEPs) in ameloblastoma. Ferroptosis-related genes were downloaded from FerrDb V2, which were then compared with DEPs to obtain ferroptosis-related DEPs (FR-DEPs). A functional enrichment analysis was performed, and a protein–protein interaction network was built. The hub proteins were screened using the Cytoscape software, and potential drugs targeting them were retrieved from the DrugBank database. A hub protein was selected for immunohistochemical validation, and its expression was assessed in ameloblastomas, odontogenic keratocysts, dentigerous cysts, and normal gingival tissues. The primary ameloblastoma cells were cultured to explore the effect of the protein on the migratory properties of the tumour cells. Results: A total of 58 FR-DEPs were screened, and six hub proteins were identified: mTOR, NFE2L2, PRKCA, STAT3, EGFR, and CDH1. Immunohistochemical analysis showed that mTOR expression was upregulated in ameloblastomas compared with that in odontogenic keratocysts, dentigerous cysts, and normal gingival tissues. p-mTOR was highly expressed in ameloblastomas, with a positivity rate of 83.3%. In addition, rapamycin, an inhibitor of mTOR, can inhibit the migratory capacity of primary cultured ameloblastoma cells. Conclusion: Our results revealed the ferroptosis-related proteins in ameloblastomas and their underlying biological processes. Additionally, mTOR was overexpressed and was found to be associated with the aggressiveness of ameloblastomas, which may be a potential target for future treatments. [ABSTRACT FROM AUTHOR]

Purpose : In this study, we prospectively investigated the relationship between bone marrow edema (BME) and odontogenic cysts and explored the possibility of using dual-energy computed tomography (DECT) as an auxiliary tool for the diagnosis of odontogenic cysts. Methods: This cross-sectional study included 73 patients who underwent the DECT scan and surgery for odontogenic cysts or odontogenic tumors. The virtual noncalcium (VNCa) computed tomography (CT) values and CT values were measured at several sites. The predictor variable was diagnosis, and the other variables included age, sex, and sites. The primary outcome was VNCa CT value. Variables were tested using the chi-square test or the Kruskal–Wallis test. The VNCa CT and CT values were tested using the Scheffe test for multiple comparisons. All variables were analyzed as independent variables affecting the VNCa CT values around the lesion in the multiple regression analysis. Result: There were 35 men and 38 women. The mean patient age was 50.0 ± 19.5 years (range: 8–86). The VNCa CT values (− 6.2 ± 34.3) around the lesion in patients with RCs were significantly higher than those in patients with dentigerous cysts (− 44.4 ± 28.6) and odontogenic keratocysts (− 67.3 ± 19.5). In multiple regression analysis, the VNCa CT values around the lesion showed a significant positive correlation with histological results (regression coefficient: − 0.605, P < 0.001). Conclusion: The presence of BME is associated with radicular cysts, and DECT can be used as an auxiliary tool for radicular cyst diagnosis. [ABSTRACT FROM AUTHOR]

Dentigerous cysts involves erupted or developing teeth in decreasing order of frequency as mandibular third molars, the maxillary canines, the maxillary third molars with rare involvement of the central incisors & are usually asymptomatic but becomes symptomatic with symptoms such as swelling, mild sensitivity, tooth mobility and displacement when it reaches size > 2 cm in diameter. Dentigerous cysts are seen most commonly in 20–30 years age group with relative low frequency in children with proportion of 4–9% of these cysts occur in the first 10 years after birth. Hospital based study conducted in the Department of ENT at Ashwini Rural medical college & Hospital, Solapur in which we have reported a series of three cases of dentigerous cyst in paediatric patients. Dentigerous Cysts in our study were associated with maxillary permanent lateral incisor, mandibular permanent premolar, Mandibular second molar tooth in pediatric age group. Provisional diagnosis of Dentigerous cyst based on clinical, radiological & biochemical study but Histopathological examination confirms the diagnosis. Dental orthopentamogram aids in diagnosing and localizing the Dentigerous cyst and ct face in all views helps to see bony effects and complications due to expansion of Dentigerous cyst. Enucleation of the cystic lesion followed by extraction of the offending teeth is a suitable treatment modality for Dentigerous cyst associated with maxilla and mandible giving adequate balance between complete removal of cyst & giving chance for eruption of unerupted teeth. [ABSTRACT FROM AUTHOR]

Background: Central incisor impaction is a rare condition with potentially severe clinical and psychological implications for the patient. Treatment techniques vary according to the pretreatment situation and individual factors. The aim of this study was to compare the esthetic outcomes and treatment times between two different approaches. Materials and methods: In this retrospective study, thirty-one consecutive patients (13 boys, 18 girls; average age 9.5 ± 2.3 years) with a total of 34 impacted permanent upper central incisors were included in the study. Patients were divided into two groups according to method of treatment. Group A comprised patients in whom spontaneous eruption occurred after space opening (n = 12), and Group B comprised patients in whom teeth showed no eruption and required treatment with a modified closed eruption method with palatally oriented traction (n = 19). Treatment time and esthetic outcomes were assessed and compared between groups. Results: The mean treatment time was 22.0 ± 6.7 months, and all teeth were successfully aligned. No statistically significant difference in average treatment time was found between groups in baseline characteristics (p > 0.05). The amount of attached gingiva was significantly smaller when compared to contralateral reference teeth in the closed eruption group (Group B; p = 0.03). However, no difference in amount of attached gingiva was found between both groups (p = 0.26). Additionally, no difference in the clinical crown length was found between groups (p = 0.27). Conclusion: The closed eruption method with palatal traction directed at the peak of the alveolar crest provided results comparable to the physiologic tooth eruption. [ABSTRACT FROM AUTHOR]

Background: maxillary cysts of dental origin are not common diagnosis. There is still debate about their perfect treatment method. There are many approaches to manage the odontogenic maxillary cysts; either intraoral, sublabial, or transnasal endoscopic approach. In this study, we present our technique of trans-antral endoscopic assisted excision of maxillary cysts of dental origin with assessing feasibility, results, and complications. Results: Thirty-two patients were reported; 14 dentigerous cysts (43.75%) and 18 dental (radicular) cysts (56.25%). Complete cyst removal could be achieved in all cases without jeopardizing the maxillary sinus drainage through its natural ostium to the nasal cavity. Postoperative pain and facial swelling were mild in all cases and resolved within few days. No tooth loss, Sino nasal symptoms, infection or recurrence was reported throughout follow-up period ranging from 2 to 6 years. Conclusion: Trans-antral endoscopic assisted approach for excision of odontogenic maxillary cyst is a reliable, safe, and effective procedure without recurrence, or permanent negative sequels over the long-term follow-up. [ABSTRACT FROM AUTHOR]

The occurrence of a dentigerous cyst in relation to a supernumerary tooth in the maxilla is extremely rare. We in this case discussion present an even rarer case of a dentigerous cyst in relation to an ectopic supernumerary tooth in the posterolateral wall of the maxillary sinus. An endoscopically assisted multi speciality surgical approach was adopted to minimize morbidity in this complex bony lesion, with the residual bony defect reconstructed with the help of buccal fat pad. [ABSTRACT FROM AUTHOR]

This study reports a rare case of a dentigerous cyst in a malformed tooth in the mandible of a 5-year-old Japanese boy. Panoramic radiography revealed a cystic lesion with hard tissues inside. The patient underwent surgery under general anesthesia. The histopathological diagnosis was dentigerous cyst associated with a malformed tooth. [ABSTRACT FROM AUTHOR]

Sinonasal Organized hematoma (SOH) is a rare, benign condition that can mimic the malignancy of sinonasal region. It typically involves the maxillary sinuswith extra sinus involvement being a rare presentation. . We present two cases of SOH with unususal presentations, posing diagnostic challenges. One case had the organised hematoma over the hard palate, While the other case had an organised hematoma in the nasal cavity. Both the cases underwent thorough preoperative evaluation,  including physical examination and radiology.. . Surgical management was employed in both cases.  Early diagnosis and appropriate intervention are crucial for excellent prognosis. Preoperative diagnosis by clinical suspicion & radiology is essential for adopting a more conservative approach. [ABSTRACT FROM AUTHOR]

Dentigerous cysts, also known as follicular cysts, are among the most common developmental cysts of the gnathic bones. The majority of cases are clinically asymptomatic and discovered incidentally on panographic radiographs during routine dental care. The cyst appears as a radiolucency, classically unilocular, associated with the crown of an unerupted or impacted tooth. Usually diagnosed in the 2nd–3rd decade, third molars of the mandible are the most commonly affected teeth. Histologically, dentigerous cysts demonstrate a fibrous or fibromyxoid connective tissue wall lined by squamous epithelium, classically lacking rete ridges. Inflammation may introduce histologic changes, however. The differential diagnosis includes hyperplastic dental follicle, periapical or radicular cyst, unicystic ameloblastoma, odontogenic keratocyst, and other odontogenic cysts and tumors. While the findings are generally classic and pose no diagnostic dilemma, the diagnosis is best made in the context of the appropriate clinical and radiographic setting. Submitted tissue with a lack of history, to include a detailed relationship with the affected tooth, may result in misdiagnosis and subsequent confusion for the clinician. So, despite its simple features, dentigerous cysts are not uncommonly mischaracterized. Therefore a review of a classic case of dentigerous cyst is presented. [ABSTRACT FROM AUTHOR]

A Japanese male aged 61 presented with persistent pain in the left posterior area of the mandible for several weeks. A panoramic X-ray revealed a unilocular lesion showing characteristics of a dentigerous cyst associated with an impacted third molar. A cystectomy was performed and histopathological examination revealed a cystic lesion with a fibrous wall. The lumen was covered with non-keratinizing squamous cells with obvious intercellular bridges, which were intermingled with partially ciliated goblet-cell-type mucous and columnar cells. Such cystic lesions should be carefully examined to distinguish them from the glandular odontogenic cyst and central mucoepidermoid carcinoma of the jawbone. [ABSTRACT FROM AUTHOR]

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Odontogenic cysts are categorized as inflammatory and developmental. Of the developmental odontogenic cysts, the dentigerous cyst is the most common and by definition is attached to the cervical region of an unerupted tooth. The cyst envelops the crown forming a sac. However, there are other developmental cysts, and rarely, odontogenic tumors, that can have a similar clinical and radiographic presentation as dentigerous cyst, including odontogenic keratocyst, orthokeratinized odontogenic cyst and ameloblastoma, unicystic type. Understanding the key histologic differences of these cysts will aid the pathologist to correctly diagnose these lesions, ensuring appropriate clinical management. [ABSTRACT FROM AUTHOR]

Purpose: Cripto-1 also known as teratoma-derived growth factor 1 (TDGF-1) belongs to the EGF-CFC family of growth factor-like molecules. Cripto-1 is involved with embryonic development and not expressed in adult tissue, but some tumours are accompanied by reactivation. Methods: The aim of this study was to evaluate the immunohistochemical expression of Cripto-1 in most common odontogenic cysts and tumours. Thirty ameloblastomas, 30 keratocysts, 30 dentigerous cysts and two ameloblastic carcinomas were evaluated using the polymeric immunoperoxidase technique. Immunohistochemical expressions were analysed by the IRS (immunoreactive score). Statistical analyses were performed by the Kruskal–Wallis and Mann–Whitney tests (p ≤ 0.05). Results: Age ranged from 9 to 75 years old, with a prevalence of females (n = 49/53.3%). The mandible was the most affected anatomical site (n = 69/75.0%). Cripto-1 immunoexpression was observed in all ameloblastoma, keratocyst and ameloblastic carcinoma cases, although nine dentigerous cyst cases (30%) were negative. Expression scores were higher in ameloblastoma, keratocyst and ameloblastic carcinoma cases (median ranging from 8 to 11) when compared with dentigerous cyst cases (median of 2), with a statistically significant difference (p < 0.001). Conclusions: Cripto-1 is critically important in the progression of several tumours since it is related to significant cell survival and differentiation pathways. The high expression of Cripto-1 in more aggressive odontogenic lesions suggests that this molecule may be involved in the activation of important pathways related to the etiopathogenesis of these lesions. [ABSTRACT FROM AUTHOR]

Evaluation and comparison of odontogenic keratocysts and detigerous cysts immunoexpression and immunostaining intensities of Ki-67 antigen by assessing the whole extent of the epithelium (all epithelium layers in combination) and each layer individually. Ki-67 immunoexpression was evaluated in 15 odontogenic keratocysts and 6 dentigerous cysts using automated methods and the Aperio Technologies Inc. computer system. No statistically significant differences were observed in immunoexpression nor in immunostaining intensities between both lesions. Also, no statistically significant differences were found between odontogenic keratocysts from maxilla versus mandible nor primary versus recurrent. However, odontogenic keratocyst showed a significantly higher cellular proliferation index in the suprabasal layers compared to the basal layer. Assessment of the cellular proliferation index through a computerized system enabled the evaluation of all epithelial tissue without field selection. The increased Ki-67 immunoexpression in suprabasal layers of odontogenic keratocyst suggests a different biological behavior and more aggressive proliferation potential when compared to dentigerous cyst. The same result was found in recurrent odontogenic keratocysts when compared with primary ones. The odontogenic keratocysts of the maxilla and mandible have similar Ki-67 immunoexpression. The evaluation of cellular proliferation only by immunohistochemical analysis with Ki-67 antigen does not provide enough data to elucidate the biological behavior of odontogenic keratocyst. [ABSTRACT FROM AUTHOR]

The purpose of this study is to find out if the biological behavior and the capacity of the odontogenic keratocyst (OKC) in maintaining pathologic cells alive are more similar to the dentigerous cyst or to the ameloblastoma by assessing bcl-2. We searched MEDLINE, Web of Science, and Scopus for immunohistochemical studies reporting OKCs, dentigerous cysts, and ameloblastomas. Risk difference between the lesions expressing bcl-2 was the effect measure and a P value < 0.05 was considered to provide evidence to the effect estimates. OKCs have an estimated difference of 91% in the probability to express the bcl-2 over dentigerous cysts, but there is no difference in the expression of bcl-2 between OKCs and ameloblastomas. The present study demonstrated a great risk difference in the expression of bcl-2 between OKCs and dentigerous cysts and no risk difference between OKCs and ameloblastomas. OKC's growth may indirectly be attributed to the anti-apoptotic effect of bcl-2 in the cystic epithelium and not only to the increase of its intraluminal pressure. Therefore, the classification of this lesion into keratocystic odontogenic tumor should be carefully reconsidered. [ABSTRACT FROM AUTHOR]

Purpose: To assess epidemiological, clinical, and radiographic characteristics of odontogenic cysts (OCs) in a South Brazilian sample and to compare the results with international literature. Methods: For the main study purposes, biopsy and histopathological records were retrospectively analyzed from December 2006 to December 2018, OC cases were selected, and data about clinical characteristics were evaluated. Further, a literature review was performed for similar studies. Results: In the main study, the prevalence of OCs was 11.26% (n = 406), the majority of patients was male (56.73%), and the mean age was 39 ± 17.33 years. Radicular cyst was the most common OC (46.06%), followed by the odontogenic keratocyst (15.02%), dentigerous cyst (14.04%), and paradental cyst (13.55%). Inflammatory OCs were more prevalent in the maxilla (54.84%) and developmental cysts in the mandible (69.92%) (p < 0.05). Individuals with inflammatory OCs were usually older (41.0 ± 15.34 years) than the ones with developmental OC (28.0 ± 19.68 years) (p < 0.05). Regarding the literature review, 22 articles were included. Analysis of pooled data showed that global prevalence of OCs was 11.62% (95%CI = 9.97–13.37), from which radicular cyst was the most common (54.26%; 95%CI = 49.30–59.18), followed by dentigerous cyst (22.94%; 95%CI = 19.22–26.89) and odontogenic keratocyst (11.99%; 95%CI = 8.88–15.49). Furthermore, studies from Asia (72.40%; 95%CI = 70.30–74.40) and South America (68.48%; 95%CI = 64.07–72.72) presented the highest frequencies of inflammatory OCs. Conclusion: The main study showed that the prevalence of OCs was 11.26%, which corroborates with international literature. Considering geographic variability of OC distribution, public health authorities and researchers could use these data for the development of focused prevention interventions, especially with regard to inflammatory OCs. [ABSTRACT FROM AUTHOR]

Background: Odontogenic cysts associated with lower third molar are common. The prognosis for surgical treatment is relatively good. However, postoperative infection discourages the clinicians. Hence, we would like to investigate the factors associated with infection after surgical treatment of cysts associated with the mandibular third molar. Methods: We retrospectively reviewed the medical and radiographic records of 81 patients who were diagnosed with dentigerous cyst or odontogenic keratocyst and underwent cyst enucleation. The factors affecting postoperative infection were divided into host factor, treatment factor, and cystic lesion factor. To identify the factors associated with postoperative infection, we attempted to find out the variables with significant differences between the groups with and without infection. Results: A total of 81 patients (64 male and 17 female) were enrolled in this study. There was no statistical relationship about the postoperative infection between all variables (gender, smoking, diabetes mellitus, age, bone grafting, related tooth extraction, previous marsupialization or decompression, type of antibiotics, cortical perforation associated with cystic lesion, preoperative infection, preoperative cyst size). Conclusions: The results of this study suggest that it is not necessary to avoid bone grafts that are concerned about postoperative infection. [ABSTRACT FROM AUTHOR]

Dentigerous cyst (DC) is the most common developmental cyst that occurs in either jaw with a reported frequency of 18.1% (Jones et al. J Oral Pathol Med 35:500–507, 2006). DC literally means a tooth bearing cyst, and it is named due to the fact the it is almost always associated with an impacted or unerupted tooth in the jaw. The most common tooth involved by DC is mandibular third molar, since it is most common tooth to get impacted, followed by mandibular canine, maxillary third molars and mandibular premolars and less commonly maxillary central incisor. However, the association of mandibular second molar is unusual with an incidence of about 1.1%. We report a case of a 28 years old male diagnosed with an impacted mandibular third molar associated with DC and its surgical management. [ABSTRACT FROM AUTHOR]

Purpose: Surgical ciliated cyst of the maxilla is a rare complication following surgical procedures or trauma involving the maxillary sinus. The surgical ciliated cyst of the maxilla is a rare lesion and appears as a delayed complication after surgery in the maxillary sinus, midface osteotomies, traumatic tooth extraction and maxillary fractures. Case report and literature review: We report a case that occurred 5 years after a maxillary sinus surgery in a Caucasian Female. A well-defined unilocular radiolucency in the right anterior maxilla was noted in cone beam image associated to osteosynthesis material. The lesion was completely excised, and upon histological examination, findings were consistent with Ciliated cyst. The PubMed database was searched for PMC within the last 15 years. Results: Together with the current case, we found 18 reports including 21 patients describing PMC. It wasdiagnosed at a mean time of 22 years after causal surgery at a mean age of 47 years. The main radiologicalsign was a unilocular radiolucency. Discussion: This lesion may present histologically different epithelial linings, but respiratory epithelium was the most frequent. The most important clinical and pathological features of these conditions are also discussed. Conclusion: Although surgical ciliated cysts have only rarely been reported after orthognathic surgery, anincreased awareness of this possibility is necessary to avoid delays in diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: Apical periodontitis can appear clinically as apical granulomas or radicular cysts. There is evidence that immunologic factors are involved in the pathogenesis of both pathologies. In contrast to radicular cysts, the dentigerous cysts have a developmental origin. Macrophage polarization (M1 vs M2) is a main regulator of tissue homeostasis and differentiation. There are no studies comparing macrophage polarization in apical granulomas, radicular cysts, and dentigerous cysts. Materials and methods: Forty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray (TMA) of the 87 consecutive specimens was created, and CD68-, CD11c-, CD163-, and MRC1-positive macrophages were detected by immunohistochemical methods. TMAs were digitized, and the expression of macrophage markers was quantitatively assessed. Results: Radicular cysts are characterized by M1 polarization of macrophages while apical granulomas show a significantly higher degree of M2 polarization. Dentigerous cysts have a significantly lower M1 polarization than both analyzed periapical lesions (apical granulomas and radicular cysts) and accordingly, a significantly higher M2 polarization than radicular cysts. Macrophage cell density in dentigerous cysts is significantly lower than in the periapical lesions. Conclusions: The development of apical periodontitis towards apical granulomas or radicular cysts might be directed by macrophage polarization. Radicular cyst formation is associated with an increased M1 polarization of infiltrating macrophages. In contrast to radicular cysts, dentigerous cysts are characterized by a low macrophage infiltration and a high degree of M2 polarization, possibly reflecting their developmental rather than inflammatory origin. Clinical relevance: As M1 polarization of macrophages is triggered by bacterial antigens, these results underline the need for sufficient bacterial clearance during endodontic treatment to prevent a possible M1 macrophage-derived stimulus for radicular cyst formation. [ABSTRACT FROM AUTHOR]

Objective: Prevalence of cysts and tumors related to impacted third molars has been considered important because the risk justifies prophylactic extraction. This retrospective study aimed to evaluate the prevalence of cysts or tumors associated with impacted mandibular third molars (IMTMs) according to patients' age and gender. Methods: Over the period from August 2006 to August 2011, 20,802 third molars from 17,535 patients were removed. Among these, IMTMs without cysts nor tumors were classified as non-pathology group, and IMTMs with cysts and tumors were classified into pathology group. The prevalence of IMTMs and associated cysts or tumors was analyzed in patient groups stratified by age and gender. The pathology group patients were also classified according to histopathological findings and the corresponding age groups. Results: Radiographic signs of disease were detected for 176 lesions (0.846 %) in 165 patients. Of these, 135 (76.4 %) lesions were diagnosed as dentigerous cysts, 31 (17.6 %) as keratocysticodontogenic tumors, and 10 (5.7 %) as ameloblastomas. The prevalence of cysts or tumors tended to increase after 50 years of age, such as 7.27 % in 6th decades, 18.60 % in 7th decades, and 11.53 % in 8th decades, with a male predominance in older patients. Conclusions: IMTMs in old age patients more than 50 years old has high possibilities of developing cyst or tumors especially in male patients. However, these results should not be used as the only evidence for justifying prophylactic extraction, and further studies should investigate the survival rate of IMTMs without any pathologic in older populations. [ABSTRACT FROM AUTHOR]

A dentigerous cyst is an odontogenic cyst that develops from reduced enamel epithelium and is associated with the crown of an impacted tooth. It is the second most common cyst after radicular cysts. It is mostly seen in the second and third decades of life and is rarely encountered in children. Dentigerous cysts are most common in mandibular molars, and are rare in premolars and canines. They are usually asymptomatic, unless they are secondarily infected. Cone beam computed tomography (CBCT) is a state-of-the-art three-dimensional imaging modality used in all areas of dentistry specifically for maxillofacial imaging. Because of its features, the role of CBCT has been extended from diagnosis to surgical management. This report describes a case of a dentigerous cyst in a 12-year-old patient involving an impacted right mandibular second premolar, a rare entity. Using CBCT, canal mapping was performed to extricate the extension of the cyst with the mandibular canal, helping the surgeon during surgical management. The present report also highlights the role of CBCT in the preoperative assessment and management of dentigerous cysts. [ABSTRACT FROM AUTHOR]

This paper discusses the treatment of impacted permanent incisors and unerupted ectopic canine associated with a dentigerous cyst in mixed dentition that was successfully managed by the combined approach of decompression followed by enucleation, primary closure, autotransplantation and endodontic therapy which enabled the utilization of teeth which were hitherto nonfunctional, transferred to an optimal functional and esthetic position. Decompression is a less invasive technique which reduces the cystic pressure, avoids a more stressful surgical procedure and necessity for general anesthesia. It gives more pleasing results as the body's own mechanism heals the defect gradually. Autotransplantation of teeth induces bone formation around the root with the help of viable periodontal ligament on their root surface. In this case, bone lost by cyst was regenerated and lamina dura was appreciable in the follow up radiographs and transplanted teeth are functioning well. [ABSTRACT FROM AUTHOR]

Heat shock proteins (HSPs) work as molecular chaperones that can assist cells to deal with stressful situations. Members of the HSP70 family can regulate cell growth and transformation and are involved in the maintenance of cellular homeostasis. In view of the distinct clinical behavior of odontogenic lesions, the objective of the present study was to investigate the immunohistochemical expression of HSP70 in these lesions. In this study, 70 formalin-fixed paraffin-embedded tissue blocks of odontogenic lesion-16 unicystic ameloblastomas (UAs), 17 solid ameloblastomas (SAs), 18 odontogenic keratocysts (OKCs), and 19 dentigerous cysts (DCs)-were reviewed by immunohistochemistry for HSP70 staining. In this study, HSP70 immunostaining was evident in all groups of the specimen. Mean percentage of HSP70 staining in SAs (84.2 ± 11.3) and OKCs (83.4 ± 6.8) were significantly higher than UAs (64.4 ± 9.8) and DCs (12.6 ± 10.2) ( p = 0.00). But, there was no statistically significant difference between HSP70 expression in SAs and OKCs. The result of this study proposes that high expression rate of HSP70 has a role in the pathogenesis of ameloblastoma and OKC and is one of the reasons for the aggressive behavior of ameloblastoma and high recurrence role of OKC, reinforcing the classification of OKC as an odontogenic tumor. [ABSTRACT FROM AUTHOR]

Adenomatoid odontogenic tumor (AOT) is an uncommon benign tumor of odontogenic origin composed of odontogenic epithelium in a variety of histopathological patterns. These lesions are usually solid but are occasionally cystic. AOT has been reported to occur in association with odontogenic cysts. Very few cases have been described that arise in association with a dentigerous cyst. A systematic search of the English-language medical literature in PubMed and Medline search (keywords adenomatoid odontogenic tumor, dentigerous cyst) data bases revealed only ten such cases. The present case is very unique, exceptional and first of this kind that occurred in the posterior mandible associated with an impacted lower first premolar in a 19-year old female patient. The intraosseous follicular AOT, as this case reported here, frequently resemble dentigerous cysts. There is an uncertainty whether the lining of an associated cyst represents a true dentigerous cyst, cystic change within an AOT or may represent a distinct entity. We believe that this case represents an odontogenic cyst with neoplastic change. Hence, in such cases, the final diagnosis should be made on the basis of histological examination of extensive tissue sampling of entire excised tissue specimen. Further studies to determine whether the AOT derived from an odontogenic cyst could represent a distinct variant are to be done. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical outcome of a treatment protocol performed in children with unerupted permanent maxillary central incisors, including surgical removal of any related obstruction and traction initiation in one stage, under fully repositioned flap, combined with pre- and post-operative orthodontics for space creation and final alignment. Methods: Forty-six patients aged 7.3-12.7 years (mean = 9.44 ± 1.36) having 54 impacted maxillary central incisors were reviewed. The study group included 37 patients fully treated by us and nine referrals with eruption failure of impacted incisors following previous surgical removal of various obstructions. Detailed patient's clinical and radiographic data were recorded. Results: Aetiology of unerupted incisors included 9 patients with odontomas, 24 with supernumerary teeth, 1 with skeletal lack of space, 1 with a dentigerous cyst, 4 with dilaceration, 1 with severe incisor MIH, 5 with luxation injuries to primary predecessors and 1 with coexisting dilaceration and odontoma. The total treatment time following the standardised protocol ranged from 5 to 21 months (mean 9.88 ± 3.10), while the time needed using different approaches (no pre-operative orthodontics or obstruction removal and then to wait over an assessment period) ranged from 12 to 18 months (mean 15 ± 2.12) and 17 to 30 months (mean 23.73 ± 5.14), respectively ( p < 0.05). The time needed for full alignment depended on the inclination, the height of the impacted tooth ( p = 0.001) and the patient's age ( p = 0.002). Additionally, the absence of pre-operative orthodontics for space creation dramatically increased treatment time ( p = 0.018). In contrast, the maturity of the impacted tooth and the developmental stage of the anterior teeth did not affect treatment time. Finally, when the location of the impacted tooth and the space availability allowed waiting for spontaneous eruption, treatment time was not statistically different from that of the main treatment protocol ( p = 0.545). Conclusions: The studied treatment protocol appears ideal for successful results and minimum treatment time. Space creation followed by surgical removal of any obstruction together with orthodontic traction initiation produces excellent results, while waiting for spontaneous eruption is indicated only in cases of favourable patient's age and tooth location. Treatment initiation with operation in the absence of the required eruption space is not recommended, whereas in unfavourable cases obstruction removal without simultaneous orthodontic traction increases dramatically the total treatment time and requires an unnecessary second operation for traction. [ABSTRACT FROM AUTHOR]

Dentigerous cysts are one of the common cysts of the jaws. Bilateral dentigerous cysts generally occur in association with a developmental syndrome or systemic diseases. Bilateral dentigerous cyst in absence of a syndrome is rare and to date only 18 cases have been reported. After reviewing the literature, no case reports of dentigerous cysts involving all the quadrants of the jaws were reported. As far as our knowledge, this is the first case to be reported. [ABSTRACT FROM AUTHOR]

Desmoplastic fibroma (DF) is a rare, well-differentiated fibrous tumor, which is slow in growth but has an aggressive potential. In its clinical and radiographic presentation it mimics many unusual pathologies of the jaws. This case report presents a DF in the mandible, which in its clinical presentation and radiographic appearance mimicked a dentigerous cyst highlighting the importance of detailed histopathological examination in the diagnosis of jaw pathologies. [ABSTRACT FROM AUTHOR]

Dentigerous cysts are generally associated with the crowns of impacted or unerupted permanent teeth and are more common in males, in the second and third decades of life. Most dentigerous cysts are mainly developmental in origin but may not be similar for all cases. The purpose of this paper is to present a case of dentigerous cyst with unusual presentation in a 7 year old girl and discuss the variation in etiology, presentation of such a cyst and in its management. [ABSTRACT FROM AUTHOR]

Odontogenic cysts and tumors are quite common occurrences in jaw bones, although both of them occurring together are rare. The epithelial lining of odontogenic cyst has a potential to transform into neoplastic conditions like squamous cell carcinoma and mucoepidermoid carcinoma, and odontogenic tumors like ameloblastoma and adenomatoid odontogenic tumor. However, the frequency of such cases being encountered is very less. Here, we report a case of adenomatoid odontogenic tumor (AOT) associated with a dentigerous cyst around the crown of an unerupted lateral incisor (follicular variant), in a 14-year-old boy. We also attempt to unravel its mechanism of cytodifferentiation and tumor progression. The origin and nature of such kind of lesions (i.e., independent development of multiple pathologies as a single lesion in a single location, single pathology giving rise to another pathology or a distinct entity/new variant) cannot be explained with certainty at this point of time. The molecular mechanism of tumor development needs to be further elucidated in order to conclude that a different entity called 'hybrid' AOT exists. [ABSTRACT FROM AUTHOR]

Epithelial-mesenchymal transition (EMT) is a process which is associated with a loss of intercellular adhesion, acquired mesenchymal shape, and increased motility by epithelial cells. Twist is one of the key regulators of EMT. In view of the distinct clinical behavior of odontogenic lesions, the objective of the present study was to investigate the immunohistochemical expression of Twist in these lesions. In this study, 70 formalin-fixed, paraffin-embedded tissue blocks of odontogenic lesion consisting of 16 unicystic ameloblastomas (UA), 17 solid ameloblastomas (SA), 18 odontogenic keratocysts (OKC), and 19 dentigerous cysts (DC) were reviewed using immunohistochemistry for Twist staining. In this study, Twist immunostaining was evident in all groups of the specimens except the dentigerous cyst group. Twist expression was seen in 58.8 % (10/17) of SA, 50 % (8/16) of UA, and 44.4 % (8/18) of OKCs. 23.5 % of SA, 18.8 % of UA, and 16.7 % of OKCs showed Twist expression in more than 50 % of cells. Statistical analysis showed that Twist expression levels were significantly higher in ameloblastomas (SA and UA) and OKCs than dentigerous cysts ( P = 0.002). There were no significant differences between Twist expression in SAs, UAs, and OKCs ( P > 0.05). The results of this study propose that the high expression rate of Twist plays a role in the pathogenesis of ameloblastomas and OKCs and might be one of the reasons for the aggressive behavior of ameloblastomas and high recurrence of OKCs and could reinforce the classification of OKC as an odontogenic tumor. [ABSTRACT FROM AUTHOR]

Objective: This study aimed at clarifying whether we can differentiate dentigerous cysts with calcified substances from other odontogenic tumors that include calcification and the crown of an unerupted tooth by CT findings. Methods: We retrospectively selected histopathologically confirmed cases that included calcified substances and the crown of an unerupted tooth inside. There were 22 cases with eight pathological categories. Besides seven odontogenic tumors, we included dentigerous cysts, which were usually recognized without calcification within the lesions. We divided the cases into two groups: 14 cases of odontogenic tumors and 8 cases of dentigerous cysts. Cases were analyzed for various CT findings such as continuity with the alveolar crest, bone sclerosis around the lesion, and sizes and shapes of high CT value substances, as well as demographic factors. Comparisons between the groups for each analytical factor were performed. Results: Dentigerous cysts with dystrophic calcification showed unique CT findings such as bone sclerosis around the lesion, continuity with the alveolar crest, and small scattered calcified substances near the crown of an unerupted tooth, compared with typical dentigerous cysts and other odontogenic tumors. On the other hand, odontogenic tumors showed various patterns in the location and distribution of high CT value substances, and we could only differentiate odontoma using its very high CT values. Conclusion: Although the patterns of calcification were not the main characteristic findings, it may be possible to differentiate dentigerous cysts with dystrophic calcification from odontogenic tumors by their other characteristic CT findings, and unnecessary extensive surgery can also be avoided. [ABSTRACT FROM AUTHOR]

The epithelial lining of odontogenic keratocysts exhibits either parakeratosis or orthokeratosis. In 2005, the WHO classified odontogenic keratocysts with parakeratosis as keratocystic odontogenic tumors (KCOT). Odontogenic keratocysts with orthokeratosis were not classified as odontogenic tumors, but instead referred to as orthokeratinized odontogenic cysts (OOC). To clarify the difference between these two lesions, we investigated their biological characteristics using immunohistochemical studies for cytokeratins (CK) in KCOT and OOC as well as in dentigerous cysts (DC), radicular cysts (RC) and dermoid cysts (DMC). We examined twenty-five cases of KCOT, fifteen cases each of OOC, DC and RC, and ten cases of DMC. We studied the immunohistochemical expression of CK10, 13, 17 and 19. To evaluate the immunohistochemical staining pattern, we divided the epithelial lining of the lesions into three layers (surface layer: su, spinous layer: sp, basal layer: ba). For CK10, most OOC and DMC specimens of su and sp were positive. For CK13 and 19, most KCOT, DC and RC specimens of su and sp were positive. For CK17, most KCOT specimens of su and sp were positive. The percentages of total CK expression of su and sp, and ba of CK19 differed significantly between the lesions ( P < 0.001). These results support the hypothesis that OOC originate from not the odontogenic apparatus, but the oral epithelial component. [ABSTRACT FROM AUTHOR]

Central odontogenic fibroma has been defined as a benign odontogenic tumor, representing the intraosseous counterpart of a peripheral odontogenic fibroma. The odontogenic fibroma is a rare tumor. Differential diagnosis of radiolucent lesions in the molar-premolar region of mandible which involve impacted tooth may include central odontogenic fibroma, hyperplastic dental follicle, dentigerous cyst, unicystic ameloblastoma, and keratocystic odontogenic tumor. We describe an example of a small central odontogenic fibroma mimicking hyperplastic dental follicle and dentigerous cyst, resulting in uneruption of a primary tooth. [ABSTRACT FROM AUTHOR]

Dentigerous cysts are one of the common cysts of the jaws and are associated with the crowns of permanent teeth, most frequently with impacted mandibular third molars. Bilateral dentigerous cysts generally occur in association with a developmental syndrome or systemic diseases. Bilateral dentigerous cysts in absence of a syndrome is a rare condition. There are only 18 cases reported in the literature till date (Dinkar et al. J Indian Soc Pedod Prev Dent 25:56-59, 2007). There are no cases reported with multiple dentigerous cyst involving all the four quadrants. [ABSTRACT FROM AUTHOR]

Objectives: It is known that the magnetic resonance (MR) imaging features of dentigerous cysts (DCs) are the same as those of other cysts. The cavities of DCs generally show low signal intensity (SI) on T1-weighted imaging (T1WI). However, in our experience, DCs often show high SI on T1WI, rendering them difficult to distinguish from keratocystic odontogenic tumors (KCOTs). In this study, we evaluated seven cases of DC and 23 cases of KCOT to assess whether MR imaging can provide additional information for the differential diagnosis of DC and KCOT. Methods: Two trials were evaluated. The first trial was an analysis of the cystic cavity SI on T1WI. To compare the SI between patients, we performed T1WI with contrast (T1c). The second trial analyzed the SI uniformity ( U) on T1WI, T2-weighted imaging (T2WI), and short inversion time inversion recovery (STIR) images of the cystic cavity, because it has been reported that an MR imaging feature of KCOT is heterogeneous SI. Statistical analyses were performed using the Mann-Whitney U test and a receiver operating characteristic (ROC) curve. Results: The T1c values of DCs were significantly higher than those for KCOTs. The U values on T1WI and STIR images were significantly higher for DCs than for KCOTs. The T1c cutoff values (0.66 and 0.84) and U cutoff values for T1WI (82.1 %) and STIR images (79.8 %) were determined from the ROC analyses. Conclusions: T1c and U values provide useful additional information for the differential diagnosis of DC and KCOT. [ABSTRACT FROM AUTHOR]

Objectives: This study was performed to evaluate the three-dimensional radiographic variation in mandibular odontogenic cystic lesions after decompression. Materials and methods: Pre- and post-decompression computed tomography (CT) evaluations in 20 patients affected by keratocysts ( n = 10), dentigerous cysts ( n = 9) and ameloblastoma ( n = 1) were analysed using software designed for three-dimensional measurement of volumes; the results were correlated with treatment duration, age, sex and histological type. Results: The mean (range) decompression time was 5.70 (3-12) months. The mean (SD) pre- and post-decompression volumes were 9.50 (7.74) and 4.65 (4.34) cm, respectively ( P < 0.001), with a mean (SD) reduction of 49.86 % (19.34 %). The volume reduction was positively correlated with the duration of decompression ( P < 0.001), whereas no correlations with other variables were found ( P = 0.2357). The median monthly reduction in cyst volume was 11.34 % (mean, 13.52 %; range, 4.45-30.43 %) ( P < 0.001). Conclusions: This three-dimensional CT investigation demonstrated the effectiveness of decompression in the treatment of mandibular odontogenic cystic lesions and showed a positive correlation between the duration of treatment and volume reduction. Clinical relevance: Decompression treatment, which is simple to perform and generally well-accepted by patients, is a reliable method to considerably reduce the volume of mandibular odontogenic cystic lesions before surgical removal. Extended decompression time seems to improve results of the reduction process. [ABSTRACT FROM AUTHOR]

Dentigerous cysts are the second most common odontogenic cysts after radicular cysts and are most commonly seen in association with third molars and maxillary canines. Only 5 % of dentigerous cysts involve supernumerary teeth of which mesiodens is the most frequent type. This paper presents a case of dentigerous cyst associated with a mesiodens that caused a painless swelling in the upper lip of a 45-year-old male. The patient was treated surgically by enucleation of the total cyst and surgical extraction of the mesiodens with the patient under local anesthesia. [ABSTRACT FROM AUTHOR]

Ameloblastoma is the most frequently encountered neoplasm derived from residual odontogenic epithelial components and is characterized by a benign but locally invasive behavior with a high tendency to recur. Unicystic ameloblastoma (UCA), a variant of ameloblastoma, is a single cystic cavity which shows ameloblastomatous differentiation in the lining. Unicystic ameloblastoma has been reported in the literature to be the most commonly occurring odontogenic tumor in the third decade of life. Unilocular ameloblastoma (UA) occurs in a younger age group with slightly more than 50 % of cases occurring in patients in the second decade of life. This article reports a case of UCA in a 12-year-old boy with excellent healing after enucleation. [ABSTRACT FROM AUTHOR]

Background: Dentigerous cyst develops in the follicular tissue surrounding the impacted lower third molar. A study was carried out to know the incidence of Association of Dentigerous cyst with radiographically normal impacted lower third molars and to draw the attention of the Oral Surgeons towards the prophylactic removal of impacted third molars. Methods: A prospective study was done on 30 patients with impacted lower third molars which were indicated for extraction. The follicle tissue surrounding the impacted tooth was subjected for histopathologic investigations. Only those teeth with a radiographic finding of pericoronal space of less than 2.5 mm were considered. Two Oral Pathologists reviewed the slides for any changes suggestive of cystic pathology. Results: Pathologic changes suggestive of Dentigerous cyst was found in 7 of the 30 follicular tissue sent for histopathologic testing. It was found to be statistically significant ( P < 0.001). Conclusion: This study shows statistically high incidence of Dentigerous cyst association with radiographically normal impacted lower third molar teeth. Hence the Oral and Maxillofacial surgeons should consider histopathologic evaluation and radiographic diagnosis in the management of impacted lower third molars. Prophylactic extractions of normal impacted lower third molars should be considered as a treatment option. [ABSTRACT FROM AUTHOR]