CASE REPORT A 17-year-old male patient was referred by an orthodontist for evaluation of a cystic radiolucency surrounding the crown of impacted 47 observed on a routine OPG [Figure ]A. The OPG showed an unerupted 47 with a well-demarcated radiolucency around the coronal portion of the tooth, suggestive of a dentigerous cyst. The tip of the roots of forty seven appeared to be impinging on the inferior alveolar canal. Also, the margins of the lesion were in close proximity to the distal root of 46 and the mesial root of forty eight. The patient was asymptomatic and examination did not reveal any abnormalities. He was advised surgical removal of the cyst alongwith impacted tooth and was prescribed a CBCT as part of the presurgical workup to aid in preserving the adjacent teeth and preventing nerve damage.{Figure } Based on the findings of CBCT study, the nerve was traced carefully and identified lingual to the roots and just touching the apex of the roots of forty seven. Also, the tip of the distal root of 46 was seen close to the lesion and hence an intentional RCT was performed. Tooth 48 was preserved and kept under observation. The CBCT images revealed that the roots of the impacted tooth were intimately associated with the inferior alveolar canal. This information, which was not revealed on the OPG [Figure ]B-D, enabled the surgeon to employ the necessary high level of intrasurgical care and dissect the tooth with minimal trauma to the nerve. The cyst was enucleated and fixed in 10% formalin. Histological examination identified it as a dentigerous cyst. There were no postoperative complications and on a recent follow-up visit, the patient did not exhibit any symptoms of neural damage such as anesthesia/paresthesia or tingling or burning sensation
Posted on: Mon, 20 Oct 2014 17:25:00 +0000
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