The dentigerous cyst as a potential the confusion has probably arisen for three

ameloblastoma reasons. First, an ameloblastoma, like an OKC,

may involve an unerupted tooth, particularly
Numbers of workers have a third molar at the angle of the mandible,
claimed that many ameloblas- and this may be incor- rectly interpreted as a
tomas arise in dentigerous dentigerous cyst on radiographs (Fig. 4.14).
cysts but the present author has When subsequently the lesion is removed and
seen no evidence to support diagnosed histologically as an
such a contention. Indeed, the ameloblastoma, the erro- neous conclusion
fact that dentigerous cysts are may be reached that the ameloblastoma
rarer in South African blacks, developed from the dentigerous cyst.
The second possible reason for believing that many
compared with whites, whereas
ameloblastomas develop from dentigerous
ameloblastomas are very much
cysts is that biopsies of ameloblastomas may
more common in blacks
be taken of an expanded locule lined
(Meerkotter, 1969; Shear and
apparently by a thin layer of epithelium. If
Singh, 1978) provides con-
the surgeon’s provisional diagnosis is
trary evidence. While
dentigerous cyst because of the radiological
ameloblastomas, being of
picture, the pathologist may well regard such
odonto- genic epithelial origin,
histological features as consistent with this
may theoretically arise from
diagnosis. When the tumour is removed
dentigerous cyst lining as well
entirely and a diagnosis of ameloblastoma is
as any other odontogenic
made, once again this may be misinterpreted
epithelium, the belief that it
as having developed from a dentigerous cyst.
commonly arises in this sit-
Third, as Lucas (1954) has pointed out,
uation and that the dentigerous
apparently iso- lated islets or follicles of
cyst should therefore be
epithelium are sometimes found
regarded as pre-
ameloblastomatous, should be
viewed with caution. Much of

in the cyst wall some distance from the epithelial lining. These have been interpreted as
ameloblastoma although they bear only a superficial resemblance to the tumour.
It is likely that in the past, cases of unicystic ameloblas- toma may have been
misdiagnosed as dentigerous cysts. This lesion has now been well documented in the litera-
ture as a benign cystic neoplasm, and is not explored further in this book.
Treatment
Much of the literature on the treatment of dentigerous cysts has dealt with the procedures
followed in handling these lesions in children. The emphasis is on conservative surgical
treatment, combined with orthodontics, in order to retain the involved teeth and to ensure
eruption into normal occlusion. Hyomoto et al. (2003) performed a ret- rospective
investigation into the eruption of teeth associ- ated with dentigerous cysts involving 47
mandibular premolars and 11 maxillary canines in pre-adolescent children. In one group,
81% of the mandibular premo- lars and 36% of the maxillary canines erupted success- fully
about 100 days after marsupialisation without traction. In the second group, the teeth had
either under- gone orthodontic traction, or the cysts had been removed entirely together
with the associated tooth. The authors suggested that a period of 100 days after
marsupialisation was the critical time for deciding whether to extract or to use traction.
The eruption potential, they contended, was closely related to root formation, so that teeth
with incomplete root formation had good potential to erupt, whereas those with fully
formed roots could not. They recommended that on the basis of their study, position,
 angulation and root maturity of the cyst-related teeth should be considered in the
treatment plan.
Other research papers and case reports supporting similar treatment
approaches are those of Miyawaki et al. (1999), Counts et al. (2001), Bodner
(2002), Jones et al. (2003), Jena et al. (2004) and Marchetti et al. (2004).
Motamedi and Talesh (2005) have detailed their expe- rience in treating 40
large dentigerous cysts involving three or more teeth, referred to them over an
11-year period. Their view was that dentigerous cysts were usually easy to treat
when small, but that the more extensive cysts were more difficult to manage.
Their treatment approaches were based on patient age, cyst site and size,
involvement of vital structures by the cyst, and the potential for normal eruption
into occlusion of the impacted tooth involved. Aspiration with a 16 or
18 gauge needle was performed to confirm that they were dealing with cysts and
not tumours, and these were followed by incisional biopsies to make definitive
histological diagnoses.
Cyst enucleation along with extraction of the impaction(s) was indicated in 34 patients. In these
patients the impacted teeth were deemed unlikely to be useful, or lacked space for eruption.
Cyst enucleation with preservation of the impacted tooth was indicated in six patients: five by
enucleation of the cyst while preserving the associated maxillary or canine teeth, while one was
treated by decompression. These teeth erupted normally when root formation was incomplete.
Orthodontics was used in cases requiring aided eruption or alignment. Decompression was used
in only one case where there was an extensive cyst in an 11 year old girl involving the
mandibular body and angle, and impinged on the inferior alveolar nerve and term germs