What Factors Differentiate Dentigerous Cysts from Other Pathologic Entities in Pericoronal Radiolucent Lesions?

Abstract

Odontogenic tissue associated with impacted teeth has the potential to differentiate into a wide variety of cysts and tumors.1 Dentigerous cysts are the most common pericoronal lesion.2 Other lesions, such as the ameloblastoma or odontogenic keratocyst, can have a similar relationship but require differing treatment. Data regarding the likelihood of an enlarged pericoronal radiolucency being a dentigerous cyst versus other pathologic entity on histologic analysis is not well-known. The purpose of this study was to evaluate the histopathologic outcomes of these lesions and identify factors predictive of their diagnosis.This was a retrospective cohort study of patients with radiolucent pericoronal lesions who underwent treatment at a tertiary care center between 2005 and 2019. Patients included in the study had a pericoronal radiolucency measuring at least 5mm from the crown edge, a histopathologic diagnosis, and available clinical records. Patients with recurrent lesions, radiolucencies less than 5mm, and/or systemic diagnosis associated with maxillofacial pathology (e.g., nevoid basal cell carcinoma syndrome, Noonan syndrome) were excluded. The primary predictor variable was lesion size (≥ 2cm and < 2cm). The primary outcome variable was histopathologic diagnosis (dentigerous cyst versus other pathologic entity). Descriptive statistics were computed for all study variables, and bivariate analyses were performed for all lesions in the cohort. Covariates associated with histopathologic diagnosis at a significance level of P < .15 were used to generate a multiple logistic regression model. Due to the potential for bias from clustering of data from patients with multiple lesions, a generalized linear mixed model with logistic link function was used. A P-value of less than .05 was considered statistically significant.The study sample was comprised of 258 subjects with 280 histopathologic specimens. There were 218 dentigerous cysts (77.9%) and 62 other pathologic entities (22.1%) consisting of 11 unique diagnoses. There was 1 diagnosis of a malignant lesion (0.40%). The cohort was 60.4% male, 76.1% white, and had a mean age of 40.5±18.7 years (range 5-88 years). Most lesions were associated with posterior teeth (95.7%) in the mandible (83.6%). Lesions ≥ 2cm were 3.20 times more likely to be diagnosed as another pathologic entity (P ≤ .001). After adjusting for jaw, pain, history of infection, cortical perforation, expansion, and multiple lesions, younger age (P ≤ .001, OR = 0.950, 95% CI = 0.929-0.972) and lesion size as a continuous variable (P = .007, OR = 1.06, 95% CI = 1.02-1.11) were independent predictors of other pathologic entities.The majority of pericoronal radiolucent lesions were dentigerous cysts. Age and lesion size were the only independent predictors of histopathologic diagnosis in the regression model. Younger age and increasing lesion size increased the odds of a diagnosis other than dentigerous cyst. As other diagnoses more likely require additional treatment, the surgeon may use the information in this study to better educate the patient as well as to consider an incisional biopsy prior to definitive treatment if an atypical lesion is suspected.