Dentigerous cyst associated with an impacted mesiodens: report of 2 cases
A 46-year-old male visited our department with chief complaints of pain and swelling in the maxillary anterior region of the jaw for the past 3 years. Prior to visiting our department, the patient had visited a dental institute and had undergone endodontic treatment of his maxillary anterior teeth. The swelling had regressed slightly after the treatment; however, the swelling started increasing gradually in size and had reached the present size. The swelling was also accompanied by dull, throbbing pain from 1 month prior to the visit. On clinical examination, solitary diffused extraoral swelling was seen in the upper anterior region of the face. It was anteroposteriorly extending from the tip of the nose to 1 cm lateral to the left ala of the nose and superoinferiorly extending from the ala-tragus line to the inferior border of the upper lip. The tip of the nose was slightly deviated towards the right along with elevation of the left nasolabial fold ().\nOn intraoral examination, solitary well-defined intraoral swelling measuring about 3.5 cm×3 cm was seen in the maxillary anterior labial vestibule extending from the maxillary right lateral incisor to the maxillary left canine. The swelling was roughly oval in shape. The swelling was tender on palpation and fluctuant in consistency (). The maxillary right and left central incisors and the right lateral incisor showed the presence of a temporary restoration. The maxillary central and lateral incisors were tender on percussion ().\nOn radiographic examination, an intraoral periapical radiograph showed the presence of large, well-defined, corticated periapical radiolucency along with an impacted mesiodens. Root resorption was seen with the right central incisor. A radiopaque filling material was seen in the root canals of the right and left central incisors and the right lateral incisors (). Maxillary topographic occlusal radiograph showed a well-defined, round, corticated radiolucency in the anterior maxillary region. The radiolucency was not associated with the apices of the teeth. A dilacerated supernumerary tooth was seen lying horizontally in the radiolucent lesion (). Panoramic radiograph showed a well-circumscribed, corticated, oval, radiolucent lesion in the anterior maxilla, extending from the mesial root surface of the right first premolar to the distal root surface of the left canine (). A provisional diagnosis of the infected dentigerous cyst was made on the basis of the patient's history, clinical examination, and radiographic examination. The lesion was surgically enucleated along with the removal of the impacted mesiodens. Histopathologic examination confirmed the diagnosis of an infected dentigerous cyst ().