Dentigerous cyst associated with an impacted anterior maxillary supernumerary tooth

A dentigerous cyst is a developmental odontogenic cyst which develops from the reduced enamel epithelium in an impacted permanent tooth and is rarely associated with supernumerary teeth. The purpose of this article was to report the case of an 8-year-old Korean boy with a dentigerous cyst associated with an impacted anterior maxillary supernumerary tooth and its dental management.     

Dentigerous cyst containing multiple impacted teeth: a rare case report

The dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. It is one of the most prevalent types of odontogenic cysts associated with erupted, developing, or impacted tooth, particularly the mandibular third molars, the other teeth that are commonly affected are maxillary canines. The present case report is unique as it enclosed three permanent maxillary teeth: the central incisor, lateral incisor, and canine that had to be extracted during surgical enucleation of the cyst.     

Carcinoma arising from reduced enamel epithelium

Intra-osseous squamous cell carcinomas are considered to be derived from odontogenic epithelium. Except for an associated benign odontogenic tumor or a cyst, evidence for an odontogenic origin is only circumstantial. In a 73-year-old male, an intra-osseous squamous cell carcinoma in the mandible could be shown to have originated from reduced enamel epithelium. There were no histological features substantiating the odontogenic origin, other than the continuity of tumor epithelium with reduced enamel epithelium surrounding the crown of an impacted molar tooth. Thus, it is concluded that the odontogenic derivation of an intra-osseous squamous cell carcinoma in the jaw cannot be inferred from specific histological features, but should be based on the exclusion of an oral cavity lining epithelial origin. Still more proof is the demonstration of continuity of the carcinoma with odontogenic epithelium, be it normal, cyst lining or benign odontogenic tumor.     

Carcinoma arising from reduced enamel epithelium

Intra-osseous squamous cell carcinomas are considered to be derived from odontogenic epithelium. Except for an associated benign odontogenic tumor or a cyst, evidence for an odontogenic origin is only circumstantial. In a 73-year-old male, an intra-osseous squamous cell carcinoma in the mandible could be shown to have originated from reduced enamel epithelium. There were no histological features substantiating the odontogenic origin, other than the continuity of tumor epithelium with reduced enamel epithelium surrounding the crown of an impacted molar tooth. Thus, it is concluded that the odontogenic derivation of an intra-osseous squamous cell carcinoma in the jaw cannot be inferred from specific histological features, but should be based on the exclusion of an oral cavity lining epithelial origin. Still more proof is the demonstration of continuity of the carcinoma with odontogenic epithelium, be it normal, cyst lining or benign odontogenic tumor.     

Simultaneous adenomatoid odontogenic and keratocystic odontogenic tumours in a patient with Gorlin‐Goltz syndrome

Gorlin and Goltz described a syndrome in which multiple basal cell carcinomas, odontogenic keratocysts and bifid ribs occurred in combination. The jaw keratocysts are a consistent feature of ‘Gorlin‐Goltz’ or naevoid basal cell carcinoma syndrome. Central nervous system and ocular involvement occurred together with the fairly typical facial features of frontal bossing and hypertelorism. This case report documents the pathology associated with an impacted maxillary canine tooth in a boy with Gorlin‐Goltz syndrome. The patient presented for investigation of the failure of eruption of the right permanent maxillary canine tooth. Radiographic investigation showed the presence of a well circumscribed radiolucency located around the crown of an impacted right maxillary canine tooth. The patient's medical history revealed a medulloblastoma that was treated 13 years ago. The right maxillary canine tooth and associated peri‐coronal tissue were removed under general anaesthetic. A diagnosis of a keratocystic odontogenic tumour with an associated adenomatoid odontogenic tumour was made. The common differential diagnoses for a peri‐coronal radiolucency in the maxilla that need to be considered by dentists include a dentigerous cyst, follicular keratocystic odontogenic tumour and adenomatoid odontogenic tumour. A rare case of both keratocystic odontogenic tumour and associated follicular adenomatoid odontogenic tumour is described in a patient with naevoid basal cell carcinoma syndrome.     

Odontogenic keratocyst in maxillary sinus with invasive behaviour

Odontogenic keratocyst is a cystic lesion characterized by a high rate of recurrence. This report describes a rare case of ciliated epithelium-lined odontogenic keratocyst in the maxilla of a 27-year-old female. Panoramic radiography showed a lytic lesion on the right maxilla associated with an impacted molar tooth. Computerized tomography image revealed the involvement of the lesion with the right maxillary sinus, destroying the sinus floor. Histopathologically, the typical keratinized epithelial-lined cyst of odontogenic keratocyst abruptly changed into a ciliated epithelium, suggesting the fusion of both these epithelia rather a metaplastic transformation. The biological behaviour of odontogenic keratocysts is discussed.     

Adenomatoid odontogenic tumor: a report of an unusual maxillary lesion.

Adenomatoid odontogenic tumor is an odontogenic tumor that appears in the anterior portion of the jaws and more frequently, in the anterior maxilla usually in association with the crowns of inclused teeth. A case report of adenomatoid odontogenic tumor with an associated impacted right maxillary first premolar is presented. Under general anesthesia the lesion and the impacted tooth were removed. There was no recurrence at the 1 -year follow-up.     

Benign cementoblastoma: a case report

In the past the benign cementoblastoma was recognized in the World Health Organization's classification of odontogenic tumours as one of the cementoma neoplasias. Recently the benign cementoblastoma is included into Mesenchyme and/or odontogenic ectomesenchyme, with or without odontogenic epithelium odontogenic tumours. Benign cementoblastoma has characteristic radiologic and microscopic features and it appears to be fused to the tooth roots. Symptoms may be totally absent, and when they do occur, pain and swelling are frequent findings. The final diagnosis is usually made histopathologically, but the clinical diagnosis is comparatively easy if it is examined radiographically. The tumour has unlimited growth potential. Most frequently tends to be associated with an erupted permanent tooth, most often the first molar: rarely has an association with an impacted or partial impacted tooth been reported. This case represents a case of benign cementoblastoma associated with a partially impacted mandibular third molar.     

应用CBCT回顾分析牙源性上颌窦病变

［摘要］ 目的 通过回顾CBCT资料评估牙源性上颌窦炎的影像学表现及最易引起牙源性上颌窦炎的牙位。方法 将500例CBCT资料分为正常上颌窦、牙源性上颌窦病变、非牙源性上颌窦病变和无法判断来源的上颌窦病变,并进行统计学分析。结果 牙源性上颌窦炎的影像学表现是发生龋病、不良修复体的上颌后牙或对应牙位有未愈合的拔牙创,无论其是否伴有根尖周病变,该病变牙相应上颌窦底黏膜会呈局部隆突性增厚影像。牙源性上颌窦炎发病率占常人的12.4%,占上颌窦病变病人的48.6%。上颌第一磨牙最易引起牙源性上颌窦炎。发生上颌窦炎,即黏膜增厚>2 mm的病例中,黏膜平均增厚(6.11±4.43) mm。结论 牙源性因素占上颌窦炎发病因素的一半;上颌第一磨牙最易引起牙源性上颌窦炎;CBCT能清晰反映上颌窦的解剖解构及上颌窦炎所引起的变化。     

Dentigerous cyst associated with multiple complex composite odontomas

Odontomas are considered to be hamartomatous malformations rather than true neoplasms. This most common odontogenic lesion results from the growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts. Dentigerous cyst is an epithelium-lined sac enclosing the crown of an unerupted tooth. Apparently, the dentigerous cyst arises by the accumulation of fluid between reduced enamel epithelium and the tooth crown. Occasionally it is associated with supernumerary tooth or odontoma. We report a case of dentigerous cyst associated with complex composite odontoma and an impacted lateral incisor in a 30-year-old male patient.     

Hamartomatous proliferations of odontogenic epithelium within the jaws: a potential histogenetic source of intraosseous epithelial odontogenic tumors

BACKGROUND: The jawbone is replete with a vestige of odontogenesis. The overall consensus is that intraosseous remnants of the enamel organ and dental lamina are the only histogenetic option for central epithelial odontogenic tumors. Curiously, incipient tumors or possible precursor conditions of residual odontogenic epithelium have rarely been reported in the literature. METHODS: We microscopically evaluated 39,660 biopsy samples to determine the presence of a tumor-like odontogenic epithelial nodule in the maxilla and mandible. RESULTS: Seven intraosseous specimens that associated with a focal proliferation of odontogenic epithelium were retrieved. Six hamartomatous processes showed four different morphologic patterns comparable with the tumor nests comprising ameloblastoma (n = 1), squamous odontogenic tumor (n=1), calcifying epithelial odontogenic tumor (n=2) and calcifying cystic odontogenic tumor (n=2). Among six lesions, four were the intrafollicular development. The remaining case of interest was multiple hyperplastic clear rests of Malassez in association with an impacted tooth. CONCLUSION: Although it is impossible to predict the fate of these microscopic structures of hamartomatous character, the present case series indicates that any of the dormant embryonic residues of odontogenic epithelium can return to an active state, capable of non-reactive, probably neoplastic proliferation of pathological significance.     

Recurrent calcifying odontogenic cyst involving the maxillary sinus

The calcifying odontogenic cyst is an uncommon lesion that occurs in both jaws, however involvement of the maxillary sinus is rare. The accepted mode of treatment is enucleation with curettage since it is generally believed that recurrence following such treatment is extremely rare. Of the reported cases of recurrent calcifying odontogenic cysts, none have involved the maxillary sinus. This report is of a large recurrent calcifying odontogenic cyst involving the maxillary sinus, eroding the orbital floor as well as anterior and medial walls of the maxillary sinus and displacing an impacted upper canine into the nasal cavity, in a 45-year-old male patient, 8 years after the initial enucleation.     

Odontogenic fibroma like lesions: Clinico-pathological considerations

Radiographically enlarged dental follicle is observed in many cases associated with delayed tooth eruption. Pericoronal radiolucencies are seen in neoplasms (odontogenic fibroma), developmental anomalies (regional odontodysplasia), hamartomatous lesions (odontogenic epithelial hamartoma), opercula of third molars, in follicles associated with unerupted third molars, regional odontodysplasia, in dental follicles around impacted teeth of enamel dysplasia with hypodontia syndrome and amelogenesis imperfecta cases with multiple impactions. Interestingly, operculum and the follicle of these lesions histopathologically are identical to odontogenic fibroma (WHO) type. However, the lack of universally accepted clinic-pathological features for such lesions may hinder their recognition. We report a case of regional odontodysplasia wherein (in which) the impacted canine is surrounded by radiolucency measuring about 1.5–2 cm, histopathologic examination of the excised opercula revealed features reminiscent of central odontogenic fibroma (WHO type) with an abundance of odontogenic epithelium and calcifications. The aim of this paper is to discuss various lesions exhibiting histopathological features similar to odontogenic fibroma, as awareness of the clinicopathological features of such lesions is very important to plan proper treatment.     

Cone-beam computed tomography evaluation of maxillary sinusitis

Introduction

Dental pain originating from the maxillary sinuses can pose a diagnostic problem. Periapical lesion development eliciting inflammatory changes in the mucosal lining can cause the development of a sinusitis. The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone-beam computed tomography (CBCT) scans and to determine whether any tooth or any tooth root was more frequently associated with this disease.

Methods

Eighty-two CBCT scans previously identified as showing maxillary sinus pathosis were examined for sinusitis of odontogenic origin in both maxillary sinuses.

Results

One hundred thirty-five maxillary sinusitis instances with possible odontogenic origin were detected. Of these, 37 sinusitis occurrences were from nonodontogenic causes, whereas 98 instances were tooth associated with some change in the integrity of the maxillary sinus floor. The average amount of mucosal thickening among the sinusitis cases was 7.4 mm. Maxillary first and second molars were 11 times more likely to be involved than premolars, whereas either molar was equally likely to be involved. The root most frequently associated with odontogenic sinusitis is the palatal root of the first molar followed by the mesiobuccal root of the second molar.

Conclusions

Changes in the maxillary sinuses appear associated with periapical pathology in greater than 50% of the cases. Maxillary first or second molar teeth are most often involved, and individual or multiple roots may be implicated in the sinusitis. The use of CBCT scans can provide the identification of changes in the maxillary sinus and potential causes of the sinusitis.     

Small Central Odontogenic Fibroma Mimicking Hyperplastic Dental Follicle and Dentigerous Cyst

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.     

Non syndromic unilateral dentigerous cyst in a 4-year-old child: A rare case report

Dentigerous cyst is the most prevalent type of odontogenic cyst and is associated with crown of an unerupted or a developing tooth and accounts more than 24% of jaw cysts. Here, we present an interesting case of dentigerous cyst in a 4-year-old boy, which developed around an unerupted maxillary first premolar. Histological examination revealed a cyst with 1-2-cell-thick epithelial lining and presence of inflammatory cells in the connective tissue.     

Dentigerous cyst associated with multiple mesiodens: a case report

Dentigerous cyst is a developmental odontogenic cyst, which apparently develops by accumulation of fluid between reduced enamel epithelium and the tooth crown of an unerupted tooth. When observed with erupted and complete dentition the diagnosis is a surprise; as about 95% of dentigerous cysts involve the permanent dentition and only 5% are associated with supernumerary teeth. The usual age of clinical presentation of dentigerous cyst due to supernumerary tooth is during the first four decades. Mesiodens is a supernumerary tooth situated between the maxillary central incisors. More frequently the mesiodens occurs unilaterally, but it may also be bilateral, while three or more supernumerary teeth in the median region of the palate are more rarely found. We report a rare case of dentigerous cyst in association with multiple mesiodens in a 14-year-old female patient.     

腺牙源性囊肿两例报告及其细胞角蛋白18的表达

目的探讨腺牙源性囊肿衬里上皮的组织学特征及其细胞角蛋白18、19、CK18-mRNA的表达和该囊肿的组织来源。方法对2例腺牙源性囊肿采用常规HE切片、免疫组织化学染色和原位杂交的方法分别进行组织学观察，检测CK18、CK19和CK18-mRNA的表达。结果囊壁内有微小子囊存在，子囊周围有黏液细胞为主的混合性腺体结构。CK18在囊肿衬里上皮呈阳性表达；在子囊的衬里上皮CK18呈阴性，而CK19呈阳性表达；腺体结构中CK18和CK19均呈阳性表达。在原位杂交中CK18-mRNA在所有上皮中均呈不同程度的阳性表达。结论CK18-mRNA及其蛋白的表达差异可能与囊肿上皮细胞的分化有关，腺牙源性囊肿的角蛋白表达谱存在牙源性上皮和腺源性上皮的交叉，可能同时存在牙源性和腺源性分化。     

Unusual odontogenic keratocyst of the maxillary sinus

An odontogenic keratocyst that eroded into the sinus through the maxillary bone and occupied it, showed replacement of the sinus respiratory epithelium by lesional epithelium, and was associated with fungal rhinosinusitis is presented. A review of the literature disclosed that epithelial replacement has been described in 2 previous case reports, although there is no report on the coexistence of odontogenic keratocyst with fungal rhinosinusitis.     

Unusual root development following surgical repositioning of horizontally developing central incisor

Dilaceration is one of the causes of maxillary central incisor eruption failure. If the dilacerated maxillary permanent central incisor is in a horizontal or vertical position and root formation is in early stages, surgical repositioning is frequently the treatment of choice. In this article, the case of a horizontally impacted and dilacerated maxillary central incisor is presented which was treated by surgical repositioning. The tooth developed an unusual form of the root with discontinuity at the middle third region with the coronal and apical parts growing separately. Radiographic and clinical monitoring of the case was regularly performed. The tooth completely erupted in 2 years after the repositioning and even after 6 years of surgery is currently successfully functional in the arch with the malformed root. This article highlights the ability of Hertwig's epithelial root sheath to withstand trauma and its ability to recover.