Eruption of mandibular second premolar following enucleation of an inflammatory cyst The Journal of Clinical Pediatric Dentistry Volume 27, Number 1/2002 19 INTRODUCTION C ysts, as occurrences in the jaws, manifest as epithelium-lined sacs filled with fluid or soft material. The dentigerous cyst or follicular cyst, is an odontogenic cyst associated with the crown of an impacted, embedded, unerupted, or developing tooth. The cyst enclosing the crown of the unerupted tooth is attached to the cervical region of the tooth. 1,7 Regezi and Sciubba cite the highest incidence of dentigerous cysts during the second and third decades, while Takagi and Koyama report most dentigerous cysts in patients younger than 20 years of age. 1,2 Patients are often adolescents in the mixed dentition stage and males are reported to develop dentigerous cysts more often than females. 1,6 Dentigerous cysts occur predominantly in the third molar regions of the mandible, the maxillary canine region, and the third molar region of the maxilla. 2,6 This is not surprising, as these teeth are the most frequently impacted. 1,5 Maxillary and mandibular premolars have also been associated with dentigerous cysts. 2,7,14 Kaban explains that follicular cysts have a predilection for the mandibular premolar region in children, and the third molar region in teenagers and adults. 3 The prevalence of dentigerous cyst development in the mandible near the region of the second primary molars has been linked to the observations that second primary mandibular molars are associated with greater caries susceptibility and more treatment. The close physical relationship between a second primary mandibular molar and the follicle of the successor has been associated with a facilitated spread of infection. 10 Formation of dentigerous cysts can result in two histopathologically distinct variants, noninflamed or inflamed, which are the result of two distinct etiologies, developmental or inflammatory. 6,7 Regezi and Sciubba describe the process of cyst development due to a pro- liferation of the enamel organ remnant or reduced enamel epithelium. 1 The accumulation of fluid between the remnants of the enamel organ and the subjacent tooth crown occurs shortly after complete formation of the crown. 7 The inflammatory mode of dentigerous cyst development is the result of intrafollicular spread of periapical inflammation from an overlying infected pri- mary tooth. Persistent and prolonged inflammation causes chronic irritation to the unerupted tooth’s den- tal sac, inducing or hastening epithelial proliferation of follicular tissues and cystic transformation. 7 Expansion of dentigerous cysts is related to epithe- lial proliferation, release of bone-resorbing factors, and a secondary increase in cyst fluid osmolality resulting from passage of inflammatory cells and desquamated epithelial cells into the cystic lumen. 1,6,7 Dentigerous cysts can achieve significant size and are frequently associated with cortical bone expansion and erosion. 1,6 Tooth displacement, malocclusion, and facial asymme- try are also associated with the lesion. 5,6 Patients are generally asymptomatic. According to Ziccardi et al., dentigerous cysts are often discovered as an “incidental radiographic finding or when acute inflammation or infection develop.” 6 Delayed eruption of permanent teeth can be an indication of odontogenic cyst formation. 1,3 When a child presents with teeth that have not erupted appropriately according to schedule, a panoramic radiograph is the most useful tool for detecting cysts associated with impacted teeth. 3 Zic- Orthodontically guided eruption of mandibular second premolar following enucleation of an inflammatory cyst: case report David M. Rubin* / Denise Vedrenne** / Jason E. Portnof*** This case study describes the surgical management of an inflammatory cyst combined with the ortho- dontically assisted eruption of an impacted mandibular second premolar. J Clin Pediatr Dent 27(1): 19-24 2002 * David M. Rubin, D.D.S., Associate Professor and Director, Department of Oral and Maxillofacial Surgery, NSUCDM ** Denise Vedrenne, D.D.S., M.S., Assistant Professor and Chair, Department of Pediatric Dentistry, NSUCDM *** Jason E. Portnof, D.M.D., Resident in Oral and Maxillofacial Surgery,New York Presbyterian Hospital/Cornell Campus. Send all correspondence to Dr. Denise Vedrenne, Department of Pediatric Dentistry, Nova Southeastern University College of Dental Medicine, 3200 South University Dr., Ft. Lauderdale, FL 33328-2018 U.S.A.