Giant Dentigerous Cyst in a Child Treated with Minimally Modified Invasive Marsupialization and Decompression: A Case Report with 30 months Follow-up

Giant Dentigerous Cyst in a Child Treated with Minimally Modified Invasive Marsupialization and Decompression: A Case Report with 30 months Follow-up | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Giant Dentigerous Cyst in a Child Treated with Minimally Modified Invasive Marsupialization and Decompression: A Case Report with 30 months Follow-up Wenlong Li, Shukai Sun, Mingjun Wang, Xin Xue, Lu Yang, Fengjiao Yang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5734422/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Dentigerous cysts are a type of inflammatory odontogenic cyst that arises from tissues surrounding an unerupted or impacted tooth. If left untreated, they can grow into a substantial size, resulting in cortical expansion and facial asymmetry. It can cause the roots of the affected teeth to be absorbed, affecting the stability of the teeth and resulting in tooth loosening and displacement. In severe cases, the teeth may fall out. In addition, if the cyst becomes infected, there will be obvious pain and swelling in the local area, and even fistulas may form with pus flowing out, causing pain to patients. For the treatment of dentigerous cysts, enucleation is typically indicated for dentigerous cysts involving fewer than two teeth. Dentigerous cysts involving more than two teeth usually require marsupialization and decompression. In recent years, some researchers have attempted minimally invasive treatment, but it is difficult for roots that have completed development and have a large inclination angle to spontaneously sprout. However, for children, owing to their potential for growth and development, the treatment methods are not exactly the same as those for adults. Case presentation we present a case of a 12-year-old girl with a 33.1 mm *20.3 mm * 33.6 mm dentigerous cyst in the mandibular second premolar region. The 35 tooth roots were fully developed and horizontally impacted, with the highest point being lower than the neck of the adjacent tooth. Given that the child was still in the mixed dentition stage, a marsupialization and drainage procedure, i.e., extraction of 75, was performed. Surprisingly, it aligned naturally into the dental arch at 2.5-year follow-up. Conclusions We provide a new method for the minimally invasive treatment of large dentigerous cysts in children.In adolescents with dentigerous cysts, even if the area of the dentigerous cysts is large, the root of the inherited permanent tooth is fully developed, and the inclination angle of the tooth is large, it is still possible to make it naturally erupt through marsupialization and decompression. Dentigerous cysts Marsupialization Decompression Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1. Introduction Dentigerous cysts, also known as follicular cysts, are prevalent odontogenic cysts of the jaw, with an incidence ranging from approximately 0.9–7.3%, and they are slightly more common in men than in women [ 1 , 2 ]. They often arise from tissues surrounding an unerupted or impacted tooth. Dentigerous cysts occur after the formation of the crown or root, following the accumulation of fluid between the enamel epithelium and the crown surface. Untimely treatment may induce significant expansion that could result in cortical expansion and facial asymmetry. It can cause the roots of the affected teeth to be absorbed, affecting the stability of the teeth and resulting in tooth loosening and displacement. In severe cases, the teeth may fall out. In addition, if the cyst becomes infected, there will be obvious pain and swelling in the local area, and even fistulas may form with pus flowing out, causing pain to patients. The clinical diagnosis relies primarily on radiographic examination, which is characterized by a radiolucent unilocular cavity of variable size, clear borders, and the presence of sclerosis at the crowns of unerupted teeth [ 3 – 5 ]. Currently, there are two primary surgical modalities for managing dentigerous cysts. One method, called enucleation, involves the removal of both the impacted teeth and the cyst [ 6 – 8 ]. While this surgical approach ensures radical removal of the cyst, it also results in extraction and the absence of impacted permanent teeth. Another surgical approach is marsupialization and decompression, which creates a surgical wound in the cystic cavity for drainage and decompression without performing tooth extraction surgery. This strategy may allow the affected tooth to erupt normally and establish occlusal relationships, thereby maintaining the integrity of the dent–maxillary system. However, this approach is prone to recurrence or persistence of the lesion [ 9 ]. Enucleation is typically indicated for dentigerous cysts involving fewer than two teeth [ 10 , 11 ]. Dentigerous cysts involving more than two teeth usually require marsupialization and decompression. However, orthodontic treatment at a later stage becomes necessary when root development is complete or when impacted teeth fail to erupt. Here, we present a case involving a 33.1 mm *20.3 mm * 33.6 mm dentigerous cyst in a child who fully developed 35 that were horizontally impacted, with the highest point being lower than the neck of the adjacent tooth. Surprisingly, via extraction of 75, the permanent teeth gradually aligned into the dental arch through marsupialization and decompression treatment. 2. Case Presentation A 12-year-old girl was brought to our department on February 19, 2022, following an accidental discovery of a cyst in the lower left posterior tooth during a dental checkup at another hospital one month ago. Notably, 75 patients had undergone endodontic treatment three years prior. The child presented bilateral maxillofacial symmetry with no signs of fever, facial swelling, or face pain. Oral examination revealed gingival congestion with slight redness on the labial side of tooth 75 and visible filling on the occlusal surface and secondary caries. Tooth examination revealed that the tooth was stable (Fig. 1 ). Tooth #36 has caries. The cone-beam computed tomography (CBCT) findings revealed root resorption in tooth 75, characterized by a low-density shadow in the distal and occlusal surfaces. Notably, 75 displayed a low-density shadow measuring approximately 33.1 mm *20.3 mm * 33.6 mm at the root, which affects 34 and 36 teeth with clear boundaries, with 35 being horizontally buried in the buccal and lingual directions and the crown facing the lingual side. The 35 roots had already developed completely. The buccal cortical bone of tooth 75 appeared discontinuous, while no evident abnormalities were observed in the lingual cortical bone (Fig. 2 A-D). The final diagnosis for the low-density shadow observed at the root of tooth 75 was a dentigerous cyst. The proposed treatment plan involved continuously rinsing the tooth socket with physiological saline following the extraction of tooth 75. If the cyst persists, enucleation is considered a substitutional intervention. The patient and her parents were duly informed of the diagnosis and treatment plan, and their consent was obtained before the procedures. However, they refused when we told the parents that tooth #36 needed to be treated. The initial treatment involved the extraction of tooth 75 under local anesthesia with articaine, followed by cotton ball occlusion to stop bleeding. The patient subsequently received weekly hospital visits for irrigation. Direct contact with the cyst’s bottom was possible during irrigation, and the exudate could be effectively flushed out. Reexamination at 1.5 months postoperatively revealed that the cusp of tooth 35 had been partially exposed (approximately 25%), with further exposure observed at the 2-month reevaluation. At the 6-month postoperative follow-up, the teeth had erupted and approached the occlusal plane. By the 12-month postoperative mark, tooth 35 had fully erupted to the occlusal plane, and the cystic cavity was filled with newly formed bone (Fig. 5 ). By the 30-month postoperative mark, the position of tooth 35 remained stable. 3. Discussion Radicular cysts or dentigerous cysts may manifest in deciduous teeth following dental caries or root canal treatment. A study involving histological evaluation of dentigerous cysts during the mixed dentition stage revealed that 93.6% of the observed cases were associated with inflammation. These findings suggest that inflammatory changes in the root apices of deciduous teeth can lead to dentigerous cysts in the underlying permanent teeth [ 12 ]. On the basis of this information, removing the source of inflammation, which is tooth 75 in this case, is the basic treatment procedure. Previous studies have generally recommended marsupialization and decompression for cysts involving more than two teeth and enucleation for those affecting fewer than two teeth. In this case, if enucleation is used, the loss of tooth 35 will result in increased later repair or orthodontic costs. Conventional marsupialization and decompression, involving incisions, gauze packing, or obturators, may result in complications such as halitosis and necessitate more frequent revisits. In this case, the deciduous molar was extracted, and short irrigation with normal saline was carried out upon discovering the dentigerous cyst. This approach minimized trauma and facilitated the spontaneous eruption of the successional permanent teeth. Postoperative observation revealed good growth of the alveolar bone around the permanent tooth. The extraction of deciduous teeth, akin to decompression, represents a conservative technique for treating odontogenic cysts. It preserves permanent teeth, maintains pulp vitality, and safeguards crucial structures such as the inferior alveolar nerve. The impact of root development on the eruption of permanent teeth after marsupialization and decompression remains controversial. A subset of studies suggest that teeth with immature roots are more likely to contribute to tooth eruption [ 13 ]. Moreover, Kokich et al. surmised that teeth lose their potential for eruption once the apical cap is closed [ 14 ]. These studies are primarily grounded in the notion that teeth with immature roots exhibit more eruption dynamics than those with complete root development. However, some studies have shown that the degree of root development is not linked to the likelihood of tooth eruption [ 15 ]. For example, in a study comparing the eruption of dentigerous cyst-associated mandibular second premolars with that of cyst-free premolars, it was found that cyst-associated mandibular second premolars erupted significantly faster [ 16 ]. These findings suggest that factors other than root development alone may influence the eruption dynamics of teeth in dentigerous cysts. In the present case, the roots developed, the cusps of the successional permanent teeth were exposed at the 2-month follow-up, and the cystic cavity rapidly reduced to 15 mm * 10 mm * 10 mm at the 4-month follow-up when tooth eruption was achieved. Hence, despite the mature root, eruption of the successional permanent teeth was observed. We speculate that the growth of bone may promote natural changes in tooth orientation. Moreover, there is no occlusal interference in the process of tooth eruption, the dentigerous cyst-associated teeth are not deeply buried, and the patient is young. These factors affect the fast and uneventful eruption of permanent teeth[ 17 – 20 ]. Studies of impacted premolars with dentigerous cysts have shown that the angle between the long axis of the tooth and the cementoenamel junction line of the adjacent tooth tends to be much greater (60.2 ± 19.6°) in the erupting group than in the nonerupting group. [ 21 ]. Notably, an angle of less than 40° between the long axis of the cyst-associated tooth and the adjacent cementoenamel junction is associated with difficulty in eruption. In the present case involving tooth 35, the angle between the long axis of the successional tooth and the adjacent cementoenamel junction was nearly parallel. At the 4-month and 6-month follow-ups, the angle reached 45% and 90%, respectively. Eventually, it self-corrects to align completely within the dental arch following eruption. 4. Conclusion The permanent teeth were preserved in the present case, and the patient did not experience symptoms such as numbness. Continuous observation over one year from the beginning of treatment indicated normal pulp vitality and a normal location. However, the long-term status of pulp vitality requires ongoing monitoring. In adolescents with dentigerous cysts, even if the area of the dentigerous cysts is large, the root of the inherited permanent tooth is fully developed, and the inclination angle of the tooth is large, it is still possible to make it naturally erupt through marsupialization and decompression. Declarations Ethics approval and consent to participate Informed consent about clinical management was obtained from the patient in this case. Written informed consent for publication of their details was obtained from the patient and was compliant with the hospital. Consent for publication Written informed consent for publication was obtained from the patient's parents to publish all the clinical data and any accompanying images, and written consent to publish this information was obtained from the study participants. Competing interests The authors declare that they have no competing interests. Funding This work was supported by grants from the National Natural Science Foundation of China (81771095 and 82071235), the Key R&D Program of Shanxi Province (2021KWZ-26), the State Key Laboratory of Military Stomatology (2020ZA01), and the Shaanxi Provincial Health Research Innovation Ability Improvement Plan Team Support Project (2023TD-01). Author Contribution W.L.,S.S. and L.W. participated in the clinical decision-making and data collection during the patient’s treatment process. M. W., X.X., L.Y., F. Y. ,T.Z.are involved in specifc procedures during treatment. All authors read and approved the fnal manuscript. Acknowledgments We thank the patient and all the clinical staff who participated in the treatment of the patient. Availability of Data and Materials Not applicable. References Regezi JA, Sciubba JJ, Jordan RCK. Oral pathology: clinical pathologic correlations. 6th ed. St Louis: Saunders Elsevier; 2011. pp. 237–51. Buyukkurt MC, Omezli MM. Miloglu O,Dentigerous cyst associated with an ectopic tooth in the maxillary sinus: a report of 3 cases and review of the literature.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 109: 67–71. Buyukkurt MC, Omezli MM, Miloglu O. Dentigerous cyst associated with an ectopic tooth in the maxillary sinus: a report of 3 cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:67–71. 10.1016/j.tripleo.2009.07.043 . Ustuner E, Fitoz S, Atasoy C, Erden I, Akyar S. Bilateral maxillary dentigerous cysts: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:632–5. Tournas AS, Tewfik MA, Chauvin PJ, Manoukian JJ. Multiple unilateral maxillary dentigerous cysts in a nonsyndromic patient:a case report and review of the literature. Int J Pediatr Otorhinolaryngol Extra. 2006;1:100–6. Smith JL 2nd, Kellman RM. Dentigerous cysts presenting as head and neck infections. Otolaryngol Head Neck Surg. 2005;133:715–7. Tournas AS, Tewfik MA, Chauvin PJ, Manoukian JJ. Multiple unilateral maxillary dentigerous cysts in a nonsyndromic patient:a case report and review of the literature. Int J Pediatr Otorhinolaryngol Extra. 2006;1:100–6. Martínez-Pérez D, Varela-Morales M. Conservative treatment of dentigerous cysts in children: a report of 4 cases. J Oral Maxillofac Surg. 2001;59:331–3. Ertas U, Yavuz MS. Interesting eruption of 4 teeth associated with a large dentigerous cyst in mandible by only marsupialization. J Oral Maxillofac Surg. 2003;61:728–30. Wakolbinger R, Beck-Mannagetta J. Long-term results after treatment of extensive odontogenic cysts of the jaws: a review. Clin Oral Invest. 2016;20:15–22. Anavi Y, Gal G, Miron H, Calderon S, Allon DM. (2011). Decompression of odontogenic cystic lesions: clinical long-term study of 73 cases. Oral Surgery Oral Medicine Oral Pathology Oral Radiology & Endodontics, 112(2), 164–9. Shibata Y, Asaumi J, Yanagi Y, Kawai N, Hisatomi M, Matsuzaki H, Konouchi H, Nagatsuka H, Kishi K. Radiographic examination of dentigerous cysts in the transitional dentition. Dentomaxillofac Radiol. 2004;33(1):17–20. 10.1259/dmfr/24148363 . Hyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515–20. Kokich VG, Mathews DP. Surgical and orthodontic management of impacted teeth.[J]. Dent Clin North Am. 1993;37:181–204. Yahara Yoshie,Kubota Yasutaka,Yamashiro Takahiro. Eruption prediction of mandibular premolars associated with dentigerous cysts.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108: 28–31. Miyawaki S, Hyomoto M, Tsubouchi J, et al. Eruption speed and rate of angulation change of a cyst-associated mandibular second premolar after marsupialization of a dentigerous cyst[J]. Am J Orthod Dentofac Orthop. 1999;116(5):578–84. Hyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515–20. Yahara Yoshie,Kubota Yasutaka,Yamashiro Takahiro. Eruption prediction of mandibular premolars associated with dentigerous cysts.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108: 28–31. Hyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515–20. Yahara Yoshie,Kubota Yasutaka,Yamashiro Takahiro. Eruption prediction of mandibular premolars associated with dentigerous cysts.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108: 28–31. Hyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515–20. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5734422","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":396185665,"identity":"6c5fa89d-433c-4756-af17-5c70a2f8b9ac","order_by":0,"name":"Wenlong Li","email":"","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wenlong","middleName":"","lastName":"Li","suffix":""},{"id":396185666,"identity":"3f42ce07-27f5-4e85-915c-87f6c7b8a453","order_by":1,"name":"Shukai Sun","email":"","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shukai","middleName":"","lastName":"Sun","suffix":""},{"id":396185667,"identity":"99bb8c04-0532-42c4-90d6-30474e1f91a4","order_by":2,"name":"Mingjun Wang","email":"","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mingjun","middleName":"","lastName":"Wang","suffix":""},{"id":396185668,"identity":"57ad21e3-3efd-4354-ac59-e57f6c33a8df","order_by":3,"name":"Xin Xue","email":"","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Xue","suffix":""},{"id":396185669,"identity":"4baa74d8-fe51-4cbf-82e7-866272777830","order_by":4,"name":"Lu Yang","email":"","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Yang","suffix":""},{"id":396185670,"identity":"828ff1f0-9e35-46ac-97f5-82492550ee0c","order_by":5,"name":"Fengjiao Yang","email":"","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Fengjiao","middleName":"","lastName":"Yang","suffix":""},{"id":396185671,"identity":"4257ac50-4723-4419-a60e-de796e9b3f75","order_by":6,"name":"Tianyu Zhang","email":"","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tianyu","middleName":"","lastName":"Zhang","suffix":""},{"id":396185673,"identity":"40db8aaa-5034-4315-a510-054862e69d27","order_by":7,"name":"Li-an Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuUlEQVRIiWNgGAWjYBACPmYwZcMP4bIRoYUNoiVNsoF4LRDqMCla2JmfPeZtOy+hO+2MAcOHssMM/LMbCDmMzdyYt+22hNntHAPGGecOM0jcOUBIC4OZdG7b7TqQFmbetsMMBhIJhLSwfwNqOQe2hfkvcVp4QLYcgGhhJFJLmfSfc8lALWkFB3vOpfNI3CCghZ//+DbJGWV2QC3JGx/8KLOW459BQAsKOADEPCSoHwWjYBSMglGACwAAKAQ47k/8DVEAAAAASUVORK5CYII=","orcid":"","institution":"National Clinical Research Center for Oral Diseases, The Fourth Military Medical University","correspondingAuthor":true,"prefix":"","firstName":"Li-an","middleName":"","lastName":"Wu","suffix":""}],"badges":[],"createdAt":"2024-12-30 09:38:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5734422/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5734422/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72796735,"identity":"b213c177-328e-48e8-8590-01a1678b6623","added_by":"auto","created_at":"2025-01-02 09:07:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":264269,"visible":true,"origin":"","legend":"\u003cp\u003eAt the initial visit, visible filling of the 75° occlusal surface was observed, along with a defect in the tooth body and secondary caries.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5734422/v1/c0163947a3a39c9dade923f6.png"},{"id":72796737,"identity":"4bd34dce-9f90-4601-80f2-13215cf9867d","added_by":"auto","created_at":"2025-01-02 09:07:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":596588,"visible":true,"origin":"","legend":"\u003cp\u003eThe initial CBCT image revealed a giant dentigerous cyst. Seventy-five roots were absorbed.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5734422/v1/e2a8ef8049d5a83a75d8401d.png"},{"id":72798779,"identity":"d8ee8a94-d052-491b-824a-69644f3c803e","added_by":"auto","created_at":"2025-01-02 09:15:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":280583,"visible":true,"origin":"","legend":"\u003cp\u003e(A) At the 1.5-month follow-up, the cusp of tooth 35 erupted. (B) At the 2-month follow-up, tooth 35 showed further eruption of the cusp.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5734422/v1/2e8369408aba17c61873379a.png"},{"id":72798780,"identity":"2cfc13bd-bada-42c0-8f9e-2f2f99b479aa","added_by":"auto","created_at":"2025-01-02 09:15:16","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":195298,"visible":true,"origin":"","legend":"\u003cp\u003eAt the 6-month follow-up, notable progress was observed as tooth 35 had successfully erupted and reached the occlusal plane.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5734422/v1/b8dce0c2d10ab17ad0d1d649.png"},{"id":72796747,"identity":"11eb6fc4-9bfa-4c8c-b9f6-f20ed01fadde","added_by":"auto","created_at":"2025-01-02 09:07:16","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":214156,"visible":true,"origin":"","legend":"\u003cp\u003eAt the 12-month follow-up, tooth 35 had fully erupted. The angle between the long axis of the tooth and the cementoenamel junction line of the adjacent tooth tends to be 90°.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5734422/v1/c002f48c4cffca80194f6487.png"},{"id":72796746,"identity":"1c0292f7-9517-46f8-96de-5f07d81c2ead","added_by":"auto","created_at":"2025-01-02 09:07:16","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":193110,"visible":true,"origin":"","legend":"\u003cp\u003eAt the 30-month follow-up, tooth 35 was stable\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5734422/v1/84bcbfd70d6188d7055224d8.png"},{"id":73281774,"identity":"8d9b554e-b02a-41d9-9210-a1b08ba303a0","added_by":"auto","created_at":"2025-01-08 12:39:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2544889,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5734422/v1/46ccf17c-2258-4f75-9313-0aad096ffebb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Giant Dentigerous Cyst in a Child Treated with Minimally Modified Invasive Marsupialization and Decompression: A Case Report with 30 months Follow-up","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eDentigerous cysts, also known as follicular cysts, are prevalent odontogenic cysts of the jaw, with an incidence ranging from approximately 0.9\u0026ndash;7.3%, and they are slightly more common in men than in women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. They often arise from tissues surrounding an unerupted or impacted tooth. Dentigerous cysts occur after the formation of the crown or root, following the accumulation of fluid between the enamel epithelium and the crown surface. Untimely treatment may induce significant expansion that could result in cortical expansion and facial asymmetry. It can cause the roots of the affected teeth to be absorbed, affecting the stability of the teeth and resulting in tooth loosening and displacement. In severe cases, the teeth may fall out. In addition, if the cyst becomes infected, there will be obvious pain and swelling in the local area, and even fistulas may form with pus flowing out, causing pain to patients. The clinical diagnosis relies primarily on radiographic examination, which is characterized by a radiolucent unilocular cavity of variable size, clear borders, and the presence of sclerosis at the crowns of unerupted teeth [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, there are two primary surgical modalities for managing dentigerous cysts. One method, called enucleation, involves the removal of both the impacted teeth and the cyst [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. While this surgical approach ensures radical removal of the cyst, it also results in extraction and the absence of impacted permanent teeth. Another surgical approach is marsupialization and decompression, which creates a surgical wound in the cystic cavity for drainage and decompression without performing tooth extraction surgery. This strategy may allow the affected tooth to erupt normally and establish occlusal relationships, thereby maintaining the integrity of the dent\u0026ndash;maxillary system. However, this approach is prone to recurrence or persistence of the lesion [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Enucleation is typically indicated for dentigerous cysts involving fewer than two teeth [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Dentigerous cysts involving more than two teeth usually require marsupialization and decompression. However, orthodontic treatment at a later stage becomes necessary when root development is complete or when impacted teeth fail to erupt.\u003c/p\u003e \u003cp\u003eHere, we present a case involving a 33.1 mm *20.3 mm * 33.6 mm dentigerous cyst in a child who fully developed 35 that were horizontally impacted, with the highest point being lower than the neck of the adjacent tooth. Surprisingly, via extraction of 75, the permanent teeth gradually aligned into the dental arch through marsupialization and decompression treatment.\u003c/p\u003e"},{"header":"2. Case Presentation","content":"\u003cp\u003eA 12-year-old girl was brought to our department on February 19, 2022, following an accidental discovery of a cyst in the lower left posterior tooth during a dental checkup at another hospital one month ago. Notably, 75 patients had undergone endodontic treatment three years prior. The child presented bilateral maxillofacial symmetry with no signs of fever, facial swelling, or face pain. Oral examination revealed gingival congestion with slight redness on the labial side of tooth 75 and visible filling on the occlusal surface and secondary caries. Tooth examination revealed that the tooth was stable (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Tooth #36 has caries.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe cone-beam computed tomography (CBCT) findings revealed root resorption in tooth 75, characterized by a low-density shadow in the distal and occlusal surfaces. Notably, 75 displayed a low-density shadow measuring approximately 33.1 mm *20.3 mm * 33.6 mm at the root, which affects 34 and 36 teeth with clear boundaries, with 35 being horizontally buried in the buccal and lingual directions and the crown facing the lingual side. The 35 roots had already developed completely. The buccal cortical bone of tooth 75 appeared discontinuous, while no evident abnormalities were observed in the lingual cortical bone (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-D).\u003c/p\u003e\u003cp\u003eThe final diagnosis for the low-density shadow observed at the root of tooth 75 was a dentigerous cyst. The proposed treatment plan involved continuously rinsing the tooth socket with physiological saline following the extraction of tooth 75. If the cyst persists, enucleation is considered a substitutional intervention. The patient and her parents were duly informed of the diagnosis and treatment plan, and their consent was obtained before the procedures. However, they refused when we told the parents that tooth #36 needed to be treated.\u003c/p\u003e \u003cp\u003eThe initial treatment involved the extraction of tooth 75 under local anesthesia with articaine, followed by cotton ball occlusion to stop bleeding. The patient subsequently received weekly hospital visits for irrigation. Direct contact with the cyst\u0026rsquo;s bottom was possible during irrigation, and the exudate could be effectively flushed out. Reexamination at 1.5 months postoperatively revealed that the cusp of tooth 35 had been partially exposed (approximately 25%), with further exposure observed at the 2-month reevaluation. At the 6-month postoperative follow-up, the teeth had erupted and approached the occlusal plane. By the 12-month postoperative mark, tooth 35 had fully erupted to the occlusal plane, and the cystic cavity was filled with newly formed bone (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). By the 30-month postoperative mark, the position of tooth 35 remained stable.\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eRadicular cysts or dentigerous cysts may manifest in deciduous teeth following dental caries or root canal treatment. A study involving histological evaluation of dentigerous cysts during the mixed dentition stage revealed that 93.6% of the observed cases were associated with inflammation. These findings suggest that inflammatory changes in the root apices of deciduous teeth can lead to dentigerous cysts in the underlying permanent teeth [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. On the basis of this information, removing the source of inflammation, which is tooth 75 in this case, is the basic treatment procedure.\u003c/p\u003e \u003cp\u003ePrevious studies have generally recommended marsupialization and decompression for cysts involving more than two teeth and enucleation for those affecting fewer than two teeth. In this case, if enucleation is used, the loss of tooth 35 will result in increased later repair or orthodontic costs. Conventional marsupialization and decompression, involving incisions, gauze packing, or obturators, may result in complications such as halitosis and necessitate more frequent revisits. In this case, the deciduous molar was extracted, and short irrigation with normal saline was carried out upon discovering the dentigerous cyst. This approach minimized trauma and facilitated the spontaneous eruption of the successional permanent teeth. Postoperative observation revealed good growth of the alveolar bone around the permanent tooth. The extraction of deciduous teeth, akin to decompression, represents a conservative technique for treating odontogenic cysts. It preserves permanent teeth, maintains pulp vitality, and safeguards crucial structures such as the inferior alveolar nerve.\u003c/p\u003e \u003cp\u003eThe impact of root development on the eruption of permanent teeth after marsupialization and decompression remains controversial. A subset of studies suggest that teeth with immature roots are more likely to contribute to tooth eruption [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, Kokich et al. surmised that teeth lose their potential for eruption once the apical cap is closed [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. These studies are primarily grounded in the notion that teeth with immature roots exhibit more eruption dynamics than those with complete root development. However, some studies have shown that the degree of root development is not linked to the likelihood of tooth eruption [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. For example, in a study comparing the eruption of dentigerous cyst-associated mandibular second premolars with that of cyst-free premolars, it was found that cyst-associated mandibular second premolars erupted significantly faster [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These findings suggest that factors other than root development alone may influence the eruption dynamics of teeth in dentigerous cysts. In the present case, the roots developed, the cusps of the successional permanent teeth were exposed at the 2-month follow-up, and the cystic cavity rapidly reduced to 15 mm * 10 mm * 10 mm at the 4-month follow-up when tooth eruption was achieved. Hence, despite the mature root, eruption of the successional permanent teeth was observed. We speculate that the growth of bone may promote natural changes in tooth orientation. Moreover, there is no occlusal interference in the process of tooth eruption, the dentigerous cyst-associated teeth are not deeply buried, and the patient is young. These factors affect the fast and uneventful eruption of permanent teeth[\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies of impacted premolars with dentigerous cysts have shown that the angle between the long axis of the tooth and the cementoenamel junction line of the adjacent tooth tends to be much greater (60.2\u0026thinsp;\u0026plusmn;\u0026thinsp;19.6\u0026deg;) in the erupting group than in the nonerupting group. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Notably, an angle of less than 40\u0026deg; between the long axis of the cyst-associated tooth and the adjacent cementoenamel junction is associated with difficulty in eruption. In the present case involving tooth 35, the angle between the long axis of the successional tooth and the adjacent cementoenamel junction was nearly parallel. At the 4-month and 6-month follow-ups, the angle reached 45% and 90%, respectively. Eventually, it self-corrects to align completely within the dental arch following eruption.\u003c/p\u003e"},{"header":"4. Conclusion","content":"\u003cp\u003eThe permanent teeth were preserved in the present case, and the patient did not experience symptoms such as numbness. Continuous observation over one year from the beginning of treatment indicated normal pulp vitality and a normal location. However, the long-term status of pulp vitality requires ongoing monitoring. In adolescents with dentigerous cysts, even if the area of the dentigerous cysts is large, the root of the inherited permanent tooth is fully developed, and the inclination angle of the tooth is large, it is still possible to make it naturally erupt through marsupialization and decompression.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eInformed consent about clinical management was obtained from the patient in this case. Written informed consent for publication of their details was obtained from the patient and was compliant with the hospital.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e Written informed consent for publication was obtained from the patient's parents to publish all the clinical data and any accompanying images, and written consent to publish this information was obtained from the study participants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis work was supported by grants from the National Natural Science Foundation of China (81771095 and 82071235), the Key R\u0026amp;D Program of Shanxi Province (2021KWZ-26), the State Key Laboratory of Military Stomatology (2020ZA01), and the Shaanxi Provincial Health Research Innovation Ability Improvement Plan Team Support Project (2023TD-01).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eW.L.,S.S. and L.W. participated in the clinical decision-making and data collection during the patient\u0026rsquo;s treatment process. M. W., X.X., L.Y., F. Y. ,T.Z.are involved in specifc procedures during treatment. All authors read and approved the fnal manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe thank the patient and all the clinical staff who participated in the treatment of the patient.\u003c/p\u003e\u003ch2\u003eAvailability of Data and Materials\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRegezi JA, Sciubba JJ, Jordan RCK. Oral pathology: clinical pathologic correlations. 6th ed. St Louis: Saunders Elsevier; 2011. pp. 237\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuyukkurt MC, Omezli MM. Miloglu O,Dentigerous cyst associated with an ectopic tooth in the maxillary sinus: a report of 3 cases and review of the literature.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2010, 109: 67\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuyukkurt MC, Omezli MM, Miloglu O. Dentigerous cyst associated with an ectopic tooth in the maxillary sinus: a report of 3 cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:67\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.tripleo.2009.07.043\u003c/span\u003e\u003cspan address=\"10.1016/j.tripleo.2009.07.043\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUstuner E, Fitoz S, Atasoy C, Erden I, Akyar S. Bilateral maxillary dentigerous cysts: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:632\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTournas AS, Tewfik MA, Chauvin PJ, Manoukian JJ. Multiple unilateral maxillary dentigerous cysts in a nonsyndromic patient:a case report and review of the literature. Int J Pediatr Otorhinolaryngol Extra. 2006;1:100\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith JL 2nd, Kellman RM. Dentigerous cysts presenting as head and neck infections. Otolaryngol Head Neck Surg. 2005;133:715\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTournas AS, Tewfik MA, Chauvin PJ, Manoukian JJ. Multiple unilateral maxillary dentigerous cysts in a nonsyndromic patient:a case report and review of the literature. Int J Pediatr Otorhinolaryngol Extra. 2006;1:100\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMart\u0026iacute;nez-P\u0026eacute;rez D, Varela-Morales M. Conservative treatment of dentigerous cysts in children: a report of 4 cases. J Oral Maxillofac Surg. 2001;59:331\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErtas U, Yavuz MS. Interesting eruption of 4 teeth associated with a large dentigerous cyst in mandible by only marsupialization. J Oral Maxillofac Surg. 2003;61:728\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWakolbinger R, Beck-Mannagetta J. Long-term results after treatment of extensive odontogenic cysts of the jaws: a review. Clin Oral Invest. 2016;20:15\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnavi Y, Gal G, Miron H, Calderon S, Allon DM. (2011). Decompression of odontogenic cystic lesions: clinical long-term study of 73 cases. Oral Surgery Oral Medicine Oral Pathology Oral Radiology \u0026amp; Endodontics, 112(2), 164\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShibata Y, Asaumi J, Yanagi Y, Kawai N, Hisatomi M, Matsuzaki H, Konouchi H, Nagatsuka H, Kishi K. Radiographic examination of dentigerous cysts in the transitional dentition. Dentomaxillofac Radiol. 2004;33(1):17\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1259/dmfr/24148363\u003c/span\u003e\u003cspan address=\"10.1259/dmfr/24148363\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKokich VG, Mathews DP. Surgical and orthodontic management of impacted teeth.[J]. Dent Clin North Am. 1993;37:181\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYahara Yoshie,Kubota Yasutaka,Yamashiro Takahiro. Eruption prediction of mandibular premolars associated with dentigerous cysts.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108: 28\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyawaki S, Hyomoto M, Tsubouchi J, et al. Eruption speed and rate of angulation change of a cyst-associated mandibular second premolar after marsupialization of a dentigerous cyst[J]. Am J Orthod Dentofac Orthop. 1999;116(5):578\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYahara Yoshie,Kubota Yasutaka,Yamashiro Takahiro. Eruption prediction of mandibular premolars associated with dentigerous cysts.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108: 28\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYahara Yoshie,Kubota Yasutaka,Yamashiro Takahiro. Eruption prediction of mandibular premolars associated with dentigerous cysts.[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108: 28\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHyomoto M, Kawakami M, Inoue M, et al. Clinical conditions for eruption of maxillary canines and mandibular premolars associated with dentigerous cysts[J]. Am J Orthod Dentofac Orthop. 2003;124(5):515\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dentigerous cysts, Marsupialization, Decompression","lastPublishedDoi":"10.21203/rs.3.rs-5734422/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5734422/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDentigerous cysts are a type of inflammatory odontogenic cyst that arises from tissues surrounding an unerupted or impacted tooth. If left untreated, they can grow into a substantial size, resulting in cortical expansion and facial asymmetry. It can cause the roots of the affected teeth to be absorbed, affecting the stability of the teeth and resulting in tooth loosening and displacement. In severe cases, the teeth may fall out. In addition, if the cyst becomes infected, there will be obvious pain and swelling in the local area, and even fistulas may form with pus flowing out, causing pain to patients. For the treatment of dentigerous cysts, enucleation is typically indicated for dentigerous cysts involving fewer than two teeth. Dentigerous cysts involving more than two teeth usually require marsupialization and decompression. In recent years, some researchers have attempted minimally invasive treatment, but it is difficult for roots that have completed development and have a large inclination angle to spontaneously sprout. However, for children, owing to their potential for growth and development, the treatment methods are not exactly the same as those for adults.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003ewe present a case of a 12-year-old girl with a 33.1 mm *20.3 mm * 33.6 mm dentigerous cyst in the mandibular second premolar region. The 35 tooth roots were fully developed and horizontally impacted, with the highest point being lower than the neck of the adjacent tooth. Given that the child was still in the mixed dentition stage, a marsupialization and drainage procedure, i.e., extraction of 75, was performed. Surprisingly, it aligned naturally into the dental arch at 2.5-year follow-up.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe provide a new method for the minimally invasive treatment of large dentigerous cysts in children.In adolescents with dentigerous cysts, even if the area of the dentigerous cysts is large, the root of the inherited permanent tooth is fully developed, and the inclination angle of the tooth is large, it is still possible to make it naturally erupt through marsupialization and decompression.\u003c/p\u003e","manuscriptTitle":"Giant Dentigerous Cyst in a Child Treated with Minimally Modified Invasive Marsupialization and Decompression: A Case Report with 30 months Follow-up","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-02 09:07:11","doi":"10.21203/rs.3.rs-5734422/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"90d9fabd-bf6c-488b-a88d-b7c99d76fb36","owner":[],"postedDate":"January 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-08T12:38:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-02 09:07:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5734422","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5734422","identity":"rs-5734422","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}