Bilateral Dentigerous Cysts in A Nonsyndromic Patient: A Diagnostic Dilemma Mimicking Odontogenic Keratocyst: A Case Report and Literature Review
Abstract
Dr. Prachi Bheke, Dr. Shiva Kumar H. R., Dr. Amarnath Upasi, Dr. Vinayak G. Naik, Dr. Chatura K. R. and Dr. Kirthi Kumar Rai
Background: Dentigerous cysts are common developmental odontogenic cysts, constituting approximately 24% of all jaw cysts. They typically present as solitary, unilocular radiolucencies associated with the crowns of unerupted teeth, most often involving mandibular third molars, maxillary canines, and premolars. While usually asymptomatic and unilateral, bilateral occurrences are exceedingly rare and often linked to syndromes such as cleidocranial dysplasia or mucopolysaccharidosis. The presence of bilateral dentigerous cysts in nonsyndromic individuals is exceptionally uncommon and may be misdiagnosed due to radiographic similarities with other cystic lesions, particularly odontogenic keratocysts (OKCs), thereby complicating the diagnostic and treatment approach.
Case Report: We report a rare case of a nonsyndromic patient with incidentally detected bilateral dentigerous cysts associated with impacted mandibular third molars. The patient was asymptomatic, and panoramic radiographs revealed well-defined, unilocular radiolucent lesions surrounding the crowns of both impacted teeth. Due to the diagnostic ambiguity, particularly the overlap with OKC radiographic features, surgical enucleation was performed. Histopathological examination confirmed the diagnosis of dentigerous cysts, characterized by a non-keratinized stratified squamous epithelial lining and fibrous capsule with chronic inflammatory infiltrate. No clinical or systemic signs of an underlying syndrome were noted.
Conclusion: This case emphasizes the need to include bilateral dentigerous cysts in the differential diagnosis of multiple jaw radiolucencies, even in nonsyndromic individuals. The diagnostic overlap with OKCs highlights the necessity of correlating radiographic findings with histopathological evaluation to ensure accurate diagnosis. Early identification and appropriate surgical intervention are vital to preventing complications such as infection, bone destruction, or recurrence. Given the rarity of such presentations, continued reporting and literature review are essential to enhance diagnostic clarity and guide effective clinical management.