An aggressive dentigerous cyst in a seven-year-old child

A review of literature indicates that very few of these cysts are found in children less than ten years of age, in spite of the fact that the cysts are associated with the eruption and/or formation of the secondary dentition. Although dentigerous cysts are rare in the first decade of life, a thorough review of a child's initial radiographs is of obvious importance as indicated by this case report. Of prime importance in this matter is the age at which the initial panoramic radiographic examination is performed on a child. According to the guidelines recommended by the American Academy of Pediatric Dentistry, the first panoramic radiographic examination should be performed following the eruption of the first permanent tooth. In this case, the appropriate radiographic survey was not conducted. A proper survey should include: Proper exposure of the film. Proper development of the film. Proper interpretation of the film. This child had a quadrant of dentistry performed three months prior to the discovery of the lesion. The previous dental provider noted that a panoramic radiograph had been exposed. It is unclear whether all of the aforementioned steps were followed or completed in order for the provider to obtain the information needed to render a diagnosis, and to properly refer this patient for a more in-depth examination of her mandibular swelling. The mere fact that this child's right mandibular first molar was fully erupted and the left one had not erupted at all, would be reason enough to take a panoramic radiograph to investigate the cause of the clinical absence of the contralateral first molar. This article has presented a case in which a proper panoramic radiographic examination performed at the time of eruption of the first permanent tooth may have led to an earlier diagnosis of the cyst, and thus might have prevented the loss of multiple permanent teeth.

P53 protein expression in odontogenic cysts

p53 protein seems to be related to the suppression of cell proliferation. p53-positive tissues seem to have a higher proliferative activity than p53-negative ones. Odontogenic keratocyst (OKC) has a different behavior from other types of cysts because it is more aggressive, with a tendency to recurrence. Twenty-two dentigerous cysts, 24 radicular cysts, and 20 OKCs were used in the present study. Two dentigerous cysts (9.1%), 2 radicular cysts (8.3%), and 9 OKCs (45%) expressed the p53 protein. The differences between the three groups were statistically significant (p = 0.003). In 10 cases of OKCs epithelial dysplasia was found. One of the 10 OKCs without dysplasia and 8 of the 10 OKCs with dysplasia were p53-positive: the difference between the two groups was statistically significant (p = 0.007). The overexpression of p53 protein was not on the other hand correlated with the occurrence of multiple, bilateral, and recurrent OKCs. Moreover the distribution of p53-positive cells was parabasal in contrast with other types of cysts. These qualitative and quantitative differences in proliferative activity in OKCs seem to point to an alteration in cell cycle control.

[Ameloblastoma of the maxillary sinus. Apropos of a case]

The ameloblastoma is benign odontogen tumour developed from epithelial remains of MALASSEZ. Because of the inclination to invade in an inexorable way all the surrounding tissues and of the faculty of recurrence after removal, one attributes him the qualifier of good-hearted tumour to local wickedness. The mandibulary localization is the most frequent. Toward the maxillary, it is mostly observed in the tuberosity region. The authors report in the work one case of ameloblastoma developed from the pericoronal cyst of an intrasinusal ectopic canine tooth.

Follicular or dentigerous (tooth-containing) cyst in the premaxilla of an otherwise edentulous 65-year-old man

A unilocular follicular or dentigerous cyst (FDC) with a diameter of 12 mm was observed incidentally in the premaxilla of a midsagittal section of the head of a 65-year-old cadaver. The mucosal lining of the cyst was grey in color and granular in texture: the osseous walls had a thickness of less than 1 mm. In the floor of the cyst, a slender, fully developed incisor tooth was fixed in a horizontal position. The alveolar processes of the maxilla and mandible were completely edentulous. Postmortem computer tomography showed the cyst in an osteolytic lesion of the premaxilla, and histology revealed a lining of non-keratinized stratified squamous epithelium supported by a lamina propria of dense connective tissue.

Long-term follow-up on keratocysts treated according to a defined protocol

A prospective study was conducted on 82 odontogenic keratocysts (OKCs) diagnosed in 80 patients over a 25 year period. The clinical and radiographic data were correlated, which resulted in an accurate picture of the clinical presentation, relationship with teeth and incidence of lingual perforations in mandibular OKCs. In 40% of the cysts no suspicion had arisen before surgery, in 60% the diagnosis was secured before surgery. This last group of patients was treated according to a defined protocol, with the exception of the maxillary OKCs, which entailed excision of the attached, overlying mucosa and enucleation of the cyst after which the defect was treated with Carnoy's solution. The other patients underwent just enucleation of the cysts. For the first 5 years the patients were seen every year, thereafter every 2 years if possible. Recurrences (9/82) were mainly found in the patients in which the cyst had just been enucleated. Only three cysts recurred in the group treated according to the above mentioned protocol. Most recurrences presented within 5 years, but late recurrences did occur even after 25 years. The aetiology and pathogenesis of OKCs is briefly discussed in the light of the present findings. It is concluded that the suggested treatment protocol and follow-up schedule provides a safe means to manage a lesion that is known to recur and may even give rise to life threatening situations.

Odontogenic carcinoma occurring in a dentigerous cyst: case report and clinical management

This case report describes an unusual odontogenic carcinoma, which was detected during routine periodontal examination. The lesion occurred in a dentigerous cyst associated with an impacted third molar in an otherwise asymptomatic 66-year-old male patient. The impacted tooth and lesion were excised based on evidence of radiographic change and clinical findings. An unusual histopathologic presentation is reported. The treatment provided for this tumor and the management of impacted teeth is reviewed.

Interleukin-1alpha-dependent regulation of matrix metalloproteinase-9(MMP-9) secretion and activation in the epithelial cells of odontogenic jaw cysts

Interleukin-1alpha (IL-1alpha) and matrix metalloproteinase-9 (MMP-9) are thought to be involved in odontogenic cyst expansion. In this study, we investigated the effects of IL-1alpha on the secretion and activation of MMP-9 in odontogenic jaw cysts. An active form of MMP-9 was present in odontogenic keratocyst (6 of 8 cases) fluids more frequently than dentigerous cyst (3 of 10 cases) and radicular cyst (3 of 10 cases) fluids, although proMMP-9 was present in all cyst fluids. Odontogenic keratocyst fragments in explant culture secreted a larger amount of IL-1alpha than dentigerous cyst and radicular cyst fragments in explant culture, and spontaneously secreted both proMMP-9 and an active form of MMP-9. The fragments of dentigerous cysts and radicular cysts secreted a small amount of proMMP-9, but no active form of MMP-9. Exogenously added recombinant human IL-1alpha (rhlL-1alpha) increased the secretion and activation of proMMP-9 in the fragments of dentigerous cysts and radicular cysts. The epithelial cells isolated from odontogenic keratocysts secreted IL-1alpha and proMMP-9 without stimulation. Under the cultivation on a fibronectin-coated dish, rhIL-1alpha increased the secretion of proMMP-9 from the epithelial cells in a dose-dependent manner. Moreover, rhIL-1alpha induced the secretion of proMMP-3 and plasminogen activator urokinase (u-PA) from the epithelial cells, and converted the secreted proMMP-3 to the active form in the presence of plasminogen. The secreted proMMP-9 was also activated in the presence of rhIL-1alpha and plasminogen. Hence, our results suggest that IL-1alpha may up-regulate not only proMMP-9 secretion but also proMMP-9 activation by inducing proMMP-3 and u-PA production in the cyst epithelial cells by autocrine/paracrine regulatory mechanisms.

Early soft tissue pathosis associated with impacted third molars without pericoronal radiolucency

OBJECTIVES

This study was performed to histologically evaluate soft tissue pathosis in pericoronal tissues of impacted third molars that did not exhibit pathologic pericoronal radiolucency.

STUDY DESIGN

One hundred impacted third molars without evidence of abnormal pericoronal radiolucency (follicular space <2.0 mm) were removed for reasons other than participation in this study, and the pericoronal tissues were submitted for histopathologic examination. Specimens were fixed and processed routinely and were stained with hematoxylin and eosin before independent evaluation by each of 2 oral pathologists. A subset of both diseased and healthy tissues underwent additional evaluation for the presence of proliferating cell nuclear antigen (PCNA) for assessment of cellular activity.

RESULTS

Of the specimens submitted, 34% showed squamous metaplasia suggestive of cystic change equivalent to that found in dentigerous cysts. Soft tissue pathosis was significantly higher in patients over 21 years of age (P =.001). Five of 8 diseased specimens demonstrated PCNA uptake, whereas none of 10 healthy specimens were PCNA positive.

CONCLUSIONS

These findings suggest that radiographic appearance may not be a reliable indicator of the absence of disease within a dental follicle. We conclude that the incidence of soft tissue pathologic conditions is higher than generally assumed from radiographic examination alone.

Dentigerous cyst with an impacted canine in an unusual position-a case report

A dentigerous cyst is a type of an odontogenic cyst associated with the crown of an impacted, embedded or unerupted tooth. In this article, we report a case of dentigerous cyst with an impacted canine in an unusual position which was surgically removed.

Case report of a pigmented dentigerous cyst and a review of the literature on pigmented odontogenic cysts

This paper reports the first case of a dentigerous cyst containing melanin-pigment and melanocytes in the lining epithelium, and the first case of a odontogenic cyst with macroscopically visible pigmentation in the cyst wall. The patient was a 29-year-old Japanese male with a cystic lesion in the left retromolar area of the mandible. Pathologic examination revealed the lesion to be a dentigerous cyst with or without mild surface keratinization, and numerous granules of melanin-pigment were distributed in the basal cells of the epithelial lining. Furthermore, dendritic melanocytes were scattered in the basal layer. Review of the literature revealed that pigmented odontogenic cysts are uncommon, and only 11 cases have been documented; eight were odontogenic keratocyst, one was a gingival cyst, one was a botryoid odontogenic cyst, and one was a lateral periodontal cyst. The possible origin of melanocytes in odontogenic lesions is discussed.

Immunohistochemical study of bcl-2 protein, Ki-67 antigen and p53 protein in epithelium of glandular odontogenic cysts and dentigerous cysts

The aim of the present study was the evaluation of the immunohistochemical expression of the apoptosis-inhibiting protein bcl-2, the cell-cycle-related antigen Ki-67 and the p53 protein, which is involved both in cell cycle and apoptosis regulation, in the lining epithelium of glandular odontogenic cysts of the jaws. Formalin-fixed and paraffin-embedded tissue sections of three glandular odontogenic cysts and six dentigerous cysts were immunostained with a standard avidin-biotin peroxidase procedure, after microwave antigen retrieval. The glandular odontogenic cysts showed immunoreactivity for bcl-2 protein in the basal and suprabasal layers, while staining in dentigerous cysts was basal or focal. Most mucous cells and superficial cuboidal cells were negative. The percentage of Ki-67- or p53-positive cells was lower in glandular odontogenic cysts compared with dentigerous cysts. The findings suggest that the biological behavior of glandular odontogenic cysts may be associated with deregulation of cell death in the lining epithelium, while cell proliferation and p53 status do not seem to play a significant role.

Collagen fibres in the wall of odontogenic keratocysts: a study with picrosirius red and polarizing microscopy

The collagen in the walls of 15 keratocysts was studied histochemically by staining sections with picrosirius red and examining them with polarizing microscopy. This was compared to 15 cases of dentigerous cyst and 15 cases of radicular cyst. Polarization colours of the collagen fibres were recorded according to their width. No differences were found between the polarization colours of thin fibres (<0.8 microm) in all three lesions; the polarization colours of thick fibres (1.6-2.4 microm) in keratocysts were significantly more greenish-yellow when compared with those of dentigerous cysts and radicular cysts. The staining of the collagen fibres in the keratocysts is similar to that reported in odontogenic neoplasms, which suggests that the stroma of keratocysts could be regarded not just as a structural support of the cyst wall, but as playing a part in the neoplastic behaviour of the cyst.

Pathologic change in soft tissues associated with radiographically 'normal' third molar impactions

Our aim was to evaluate the incidence of histological abnormalities in soft tissues surrounding impacted third molar teeth when there were no pathological conditions apparent on the corresponding radiographs. Ninety-six dental follicles were collected from third molar teeth of 63 patients. No tooth had a follicular space greater than 2.4 mm as measured on the panoramic radiograph. Specimens were examined by each of three oral pathologists, and only those independently diagnosed as cystic by all three pathologists were considered diseased. A diagnosis of dentigerous cyst was made in 31 cases; 22 of 60 mandibular specimens (37%) and nine of 36 maxillary specimens (25%) were affected. No disease other than dentigerous cyst was seen. We conclude that the incidence of dentigerous cyst associated with impacted third molar teeth is higher than reported in radiographic studies alone. The importance of histological diagnosis of dentigerous cyst should be evaluated further in the light of this unexpectedly high incidence of microscopic disease.

Squamous cell carcinoma arising in the epithelial lining of a dentigerous cyst

The dentigerous cyst is a common oral lesion arising as a developmental anomaly during amelogenesis. In rare instances, the epithelial lining of these cysts may give rise to squamous cell carcinoma (SCC). Fewer than 50 cases of this rare entity have been reported in the world literature to date. We present an additional case of SCC arising in a dentigerous cyst with a rationale for our treatment approach. In addition, we offer a review of the literature and a review of the clinical, histologic, and radiographic findings associated with this finding. We discuss epidemiologic data and treatment options.

Odontogenic cysts related to pulpotomized deciduous molars: clinical features and treatment outcome

OBJECTIVE

The purpose of this study was to assess the morbidity and outcomes associated with large cysts that developed in conjunction with pulpotomized deciduous molars.

STUDY DESIGN

This retrospective study was based on the files of 18 patients who were referred to 2 oral surgery departments during a 10-year period (1986-1996). The inclusion criteria were large cyst lesions (>1 cm in diameter) and complete documentation. Data regarding symptoms at presentation, histologic and radiologic features, treatment modalities, morbidity, and outcomes were analyzed.

RESULTS

An equal gender distribution of patients was found, as were a later development in males (12+/-2 years in boys, 9+/-2 years in girls) and a 5:1 ratio favoring the mandible over the maxilla. Treatment included enucleation (12 patients) and marsupialization (6 patients). The morbidity was high and included loss of permanent teeth (3 patients), extensive loss of alveolar bone (3 patients), use of flaps (2 patients), and adjuvant orthodontic treatment (9 patients).

CONCLUSION

Failure of early detection and treatment of cysts that develop in conjunction with pulpotomized deciduous molars can cause considerable morbidity. Therefore, periodic clinical and radiologic follow-up until the eruption of succedaneous teeth is recommended.

Adenomatoid odontogenic tumor arising in a dental cyst: report of unusual case

The case of an adenomatoid odontogenic tumor developing over a dentigerous cyst is reported. A 12-year-old boy was referred by his pediatric dentist to the service of Oral and Maxillofacial Surgery of the Asturias Central Hospital (Spain) for evaluation of a radiolucent image compatible with a dentigerous cyst. Microscopic examination revealed the presence of an adenomatoid odontogenic tumor located over the linear epithelium of a dentigerous cyst. Based on the literature, the clinico-pathological, diagnostic, radiological and therapeutic characteristics of the case are commented in detail.

A retrospective study of oral and maxillofacial biopsy lesions in a pediatric population from southern Taiwan

This is a retrospective study of biopsied oral lesions (N = 534) in a pediatric population (0-15 years old) in southern Taiwan. In this study, we included 6% of the 9672 biopsies performed from 1985 through 1996. The lesions were divided into three groups according to patients' ages, 0-5 years old; 6-10 years old; and 11-15 years old The majority of the samples were from the oldest age group (273/518). With the exclusion of normal tissues (N = 26), 518 samples were classified into four categories: inflammatory lesions, cystic lesions, tumor or tumor-like lesions, and other lesions. The largest number of lesions occurred in the inflammatory lesion group (46%). The 12 most frequently occurring lesions contributed about 78% of all the biopsies in the three age groups (0-15 years old). Frequencies of the lesions of mucous extravasation phenomenon, dentigerous cyst, fibrous dysplasia, and odontonia in our three pediatric age groups showed a significant proportion in the biopsies of the same lesions in the group of patients of all ages. These information may be valuable for both epidemiology and teaching.

Eruption cysts: retrospective clinical study of 36 cases

The eruption cyst is a lesion associated with an erupting tooth. It appears as a transparent, bluish, blue or blue-black swelling of the alveolar mucosa, over a temporal or permanent tooth in eruption. The analysis of the thirty-six eruption cysts cases studied, corresponding to twenty-seven patients, revealed that their most frequent location is in the maxillary permanent dentition, and that they mostly occur in a single presentation, and in an age-range of between five and nine years. Six cases out of the twenty-seven patients studied showed the characteristic of presenting two or more eruption cysts, and in three of these cases, the lesions were bilateral, symmetrical and simultaneous. Two other patients had been previously diagnosed with cyst diseases. This would suggest that, in addition to the possible infection-trauma origin, there is in some cases the possibility of a predisponent tendency.

[Dentigerous cysts. Developmental aspects. Apropos of 3 cases]

Dentigerous cysts, also called follicularor corono-dental cysts, are malformative odontogenic cysts in the WHO classification of odontogenic tumors. We review the general characteristics of these frequent odontogenic tumors which always occur in associated with an included tooth. Diagnosis is based on clinical features, X-ray findings and pathology results. We report the evolutive aspect in three patients of different ages.