Orthodontic and Surgical Treatment of an Impacted Tooth in a Large Dentigerous Cyst

Standard treatment of a dentigerous cyst involves enucleation of the cyst and extraction of the involved teeth. The aim of this case report was to present an alternative combined surgical and orthodontic treatment of an impacted mandibular premolar within a large dentigerous cyst. An 11-year-old female patient was referred to the orthodontic clinic due to a swelling of the left lower jaw. Radiographic evaluation revealed a large dentigerous cyst with an impacted premolar. A CBCT scan showed a radiolucency in close proximity to the roots of the adjacent teeth. In the initial stage of treatment, the cyst was marsupialized. Spontaneous eruption of the impacted tooth was observed following decompression of the cyst, and orthodontic treatment was used to bring the impacted tooth into a proper occlusion. Total surgical and orthodontic treatment time was 19 months. Class I canine and molar occlusion with complete permanent dentition was achieved through combined surgical and orthodontic treatment. No recurrence was observed, and the position of the mandibular premolar was judged successful. Marsupialization of a dentigerous cyst and orthodontic traction may be an appropriate alternative method for treating impacted teeth in young patients with no tooth resorption.