A dentigerous cyst is a fluid-filled sac that develops in the jaw bone or soft tissue that forms over unerupted or partially erupted teeth. More often than not, they do not present symptoms and are detected only during routine radiographic examination. However, if a person does not get the right treatment, cysts can lead to complications. When the area gets inflamed, the patient may experience swelling, pain, displaced teeth, and/or paresthesia (temporary loss of sensation). Dentigerous cysts may grow bigger, causing extensive bone resorption in the jaw and even lead to fracture. The greater the size of the cyst, the higher the risk of neurologic damage.
A 39-year old male with no history of previous infection complained of occasional pain and bilateral swelling of soft tissues distal to the lower second molars. Orthopantomographic evaluation revealed bilateral radiolucency surrounding lower horizontally impacted third molars. Dental CBCT confirmed the positions overlapped with the mandibular canals. Both impacted teeth exhibit enlargement of the dental follicle, provisionally diagnosed as a dentigerous cyst. Removal of the lower third molars and the cystic lesion were the only treatment of choice.
The surgery was done under conscious sedation, a technique in which the use of drugs produces a state of depression of the central nervous system. Conscious sedation retains the patient’s ability to maintain a patent airway independently and continuously. IV medications used were Fentanyl and Midazolam. Local anesthesia used were 2% Lidocaine HCl with 1:100,00 epinephrine and 4% Articaine HCl with 1:100,000 epinephrine. Post-operative radiographs showed complete removal of the lower third molars and the surrounding cystic lesion with no reported post-operative complications experienced by the patient.
