Combined Surgical and Orthodontic Treatment for Eruption of the Impacted Premolar Due to a Dentigerous Cyst

The dentigerous cyst (DC) is a prevalent developmental odontogenic cyst, characterized by an epithelial-lined pathological cavity that is closely related to an unerupted or impacted tooth crown. This cyst is predominantly observed in third molars, maxillary canines, and premolars, and is typically asymptomatic. However, over time bone resorption, minimal bone expansion and tooth displacement may occur. In this case, a 14-year-old female patient was referred to our clinic for a routine radiographic and clinical examination. Radiographic examination revealed an impacted mandibular second premolar tooth and a cystic appearance around the crown of an impacted premolar tooth. CBCT slices showed that the tooth had a close proximity to the mental foramen. After a fine needle aspiration biopsy, the histopathological examination showed that the lesion was an odontogenic cyst which was latterly reported as a dentigerous cyst with the anamnesis and radiographic features. Surgery was planned for the patient under local anesthesia. The visible part of the cyst was removed, the crown of the tooth was exposed and an orthodontic button was placed. The orthodontic force was applied 3 weeks following the surgery to extrude the tooth. After 10 months, the tooth had erupted to the occlusion. Since dentigerous cysts attach to the tooth at the enamel-cementum junction, they can be treated by occlusion of the related tooth. It has been shown that successful treatment can be performed with a conservative approach with surgical and orthodontic planning. In this way, since there is no need for extraction and prevent a possible nerve injury.