The possible sequelae of continuous enlargement of dentigerous cyst are expansion of the alveolar bone, displacement of teeth, severe root resorption of teeth, expansion of buccal and lingual cortex and pain. Potential complications are development of cellulitis, deep neck infection, ameloblastoma, epidermoid carcinoma or mucoepidermoid carcinoma. Investigations
Early detection and removal of the cysts is essential to reduce morbidity since dentigerous cyst can attain considerable size without any symptoms. Patient who presents with unerupted teeth should be thoroughly examined with radiographic examinations to check our for dentigerous cysts. Panoramic radiographs may be indicated for this purpose. CT imaging becomes necessary for extensive lesion. Pathologic analysis of the lesion is important for the definitive diagnosis even though radiographs provide valuable information. Histopathologic Features
The histopathologic features of dentigerous cyst are dependent on the nature of the cyst, whether it is inflamed or not inflamed. Non-inflamed dentigerous cystThe specimen will present with loosely arranged fibrous connective tissue wall that contains considerable glycosaminoglycan ground substance. Small islands or cords of inactive-appearing odontogenic epithelial rests are usually scattered within the connective tissue and most commonly located near the epithelial lining. These rests may appear numerous in the fibrous connective tissue wall occasionally, which may be misinterpreted as ameloblastoma by some pathologists who are unfamiliar with oral lesions. The epithelial lining is composed of two to four layers of flattened non-keratinizing cells, with a flat epithelium and connective tissue interface. Inflamed dentigerous cystOccurrence of inflamed dentigerous cyst is fairly common.
In the mandible, buccal or lingual cortical expansion and thinning are noted.On MR imaging, the contents of the cyst display low to intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The tooth itself is a zone of signal void. The lining of the cyst is thin with regular thickness and may show slight enhancement after contrast injection. Treatment and Prognosis
The treatment of choice for dentigerous cyst is enucleation along with extraction of the impacted teeth. If eruption of the unerupted tooth is considered feasible, the tooth may be left in place after partial removal of the cyst wall. Orthodontic treatment may subsequently be required to assist eruption. Similarly, if displacement of the associated tooth by the cyst has occurred and extraction may prove to be difficult, orthodontic movement of the tooth to a more advantageous location for extraction may be accomplished. Marsupialization may also be used to treat large dentigerous cysts. This permits the decompression of the cyst, with a resulting decrease in the size of the bone defect. The cyst can then be excised at a later date, with a less extensive surgical procedure. The prognosis for the dentigerous cyst is excellent, and recurrence is rare. This is related to the exhausted nature of the reduced enamel epithelium, which has differentiated and formed tooth crown enamel before developing into a cyst. Nevertheless, several potential complications must be considered. The possibility that the lining of a dentigerous cyst might undergo neoplastic transformation to an ameloblastoma has been well-documented.