Removal of dentigerous cysts

One of the more common pathologies in the jawbone is the development of dentigerous cysts. These are spherical formations, surrounded by a connective tissue capsule and filled with fluid. Their main source is inflammation, taking place in the area of the tooth root apex and in the area of retained teeth. A characteristic feature of cyst growth is the absence of symptoms such as pain. Only when the cyst reaches a very large size can it cause tooth loosening, tooth displacement, facial asymmetry and other symptoms. The insidious course of cyst development makes the most common way to detect them a radiograph, usually a pantomogram, performed for other reasons or a routine dental check-up. Despite the lack of initial symptoms, an alveolar cyst is a condition that requires intervention. As it grows, it weakens the bone structure, even threatening to fracture a jaw. If the cyst becomes infected, an acute purulent condition develops. In extreme cases, the cyst can be the starting point of cancerous changes.

If we are dealing with a cyst developing at teeth with pulp disease, the first step is endodontic treatment, which can cause spontaneous withdrawal of the lesion by removing the causative agent. According to various studies, the success rate of such treatment reaches up to 50%.

When the cyst does not disappear after endodontic treatment, or when it reaches a large size, a surgical procedure, called extraction, is necessary. The dental surgeon performs it under local anesthesia. Depending on the clinical situation and the condition of the tooth, this can be done in several ways:

• Removal of the tooth and then the cyst through the post-extraction alveolus,
• Accessing the cyst after dehiscence of the mucosa and bone, removing the cyst and then resecting the root apex.

In the case of cysts developing in the area of retained teeth, the procedure involves the simultaneous removal of the tooth and the cyst. This is done under local anesthesia and essentially looks very similar to the chiselling of a retained tooth. The difference is that there is a larger area of bone that needs to be cleared of cyst fragments.

Post-operative recommendations coincide with those given after a tooth extraction (link to tooth extraction). In addition, the patient should avoid biting hard foods during the first period after cyst extraction.