Multi‐disciplinary management of an unusual presentation of bilateral mandibular dentigerous cysts in a non‐syndromic child

Abstract

AbstractAimBilateral dentigerous cysts of the mandible are extremely rare in non‐syndromic patients with <30 cases reported in the literature with only one involving successful orthodontic alignment of the affected teeth. This case aims to highlight a rare bilateral presentation of dentigerous cysts in a non‐syndromic child in addition to encouraging clinicians to consider multi‐disciplinary care for the management of cysts not only for successful resolution of the cystic spaces but also for subsequent successful orthodontic alignment of severely displaced teeth.Material and MethodsA 12‐year old boy was referred to the paediatric dental department at the Edinburgh Dental Institute regarding partially erupted mandibular first permanent molars with suppuration and periodontal pocketing of 12mm. Radiographic examination revealed bilateral unilocular radiolucencies of the mandible associated with the partially erupted first and unerupted second permanent molars. The treatment to date includes oral hygiene advice, bilateral incisional biopsies and marsupialisation of the lesions under general anaesthetic, expose and bond procedures of the impacted mandibular second permanent molars and maxillary and mandibular fixed appliances.ResultsBoth the first and second lower permanent molars have been successfully aligned within the arch. Histological analysis has confirmed the diagnosis of bilateral dentigerous cysts of the mandible although provisional diagnosis included bilateral keratocysts.This patient has had both clinical and radiographic follow‐up in the paediatric dental, oral surgery and orthodontic departments over a 4‐year period.ConclusionThis is a highly unusual presentation of bilateral mandibular dentigerous cysts in a non‐syndromic child. Successful multi‐disciplinary care between the paediatric, oral surgery and orthodontic departments yielded an extremely favourable outcome for this challenging case. Paediatric dentists should be aware of this unusual presentation, the subsequent appropriate referral pathway and the promising feasibility of successful orthodontic alignment of the affected teeth.