Delayed eruption of a maxillary canine in an adolescent
14-year-old female
§Chief complaint
Baby canine still present at age 14
§Medical & dental history
- 01Fit and well
- 02Retained deciduous 63
- 03Orthodontic assessment in progress
§Clinical examination
- 01Retained 63 with no mobility; 23 not palpable buccally
- 02Slight palatal fullness in the 23 region
- 03Adjacent teeth vital, no discolouration
- 04No swelling or discharge
§ figuresFigures (3)
Fig. 1dentigerous jaw cyst in the right mandible around and impacted wisdom tooth
“JawCyst (with arrows)” · JawCyst.jpg: Coronation Dental Specialty Group [1] derivative work: Jbarta · CC BY 3.0 · Wikimedia Commons
Fig. 2dentigerous jaw cyst in the right mandible around and impacted wisdom tooth
“JawCyst (with arrows, cropped)” · JawCyst.jpg: Coronation Dental Specialty Group [1] derivative work: Jbarta and M · CC BY 3.0 · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Dentigerous Cyst figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Dentigerous cyst associated with an impacted 23
AOT is the key mimic in this exact location and demographic; it typically shows fine snowflake calcifications and envelopes the root beyond the CEJ, whereas a dentigerous cyst attaches exactly at the CEJ and is entirely radiolucent.
§Investigations
- 01CBCT — pericoronal radiolucency 12 mm around the crown of 23, attachment at the CEJ, palatal position
- 02No calcification within the lesion
- 03Vitality testing of 22 and 24 — vital
§Treatment plan
- 01Marsupialisation of the cyst and exposure of 23
- 02Orthodontic traction to bring 23 into the arch
- 03Extraction of retained 63
§Surgical procedure
- 01Palatal window created and cyst lining marsupialised
- 02Gold chain bonded to 23 and orthodontic traction commenced at 3 weeks
§Histopathology report
Thin non-keratinised epithelial lining 2-4 cells thick with a fibromyxoid wall. Dentigerous cyst.
§Follow-up & outcome
- 0123 erupted into the arch over 14 months of traction
- 02Radiographic resolution of the lucency
- 03Tooth vital with good periodontal support
§Clinical pearls / learning points
- 01In an adolescent, treat the cyst in a way that preserves the tooth — marsupialisation plus traction beats enucleation with extraction.
- 02Radiopaque flecks in a pericoronal lesion in the anterior maxilla suggest AOT.
- 03Always confirm the attachment point at the CEJ on CBCT.
§References
- Neville BW et al. Oral and Maxillofacial Pathology, 5th ed.
§Similar cases
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