Diagnosis and surgical management of impacted mandibular canines associated with a dentigerous cyst and odontoma: A case report

Abstract

In dental practice, impacted canines are common clinical conditions that compromise tooth mobility, thereby severely affecting functionality and esthetics. They also represent a significant challenge, particularly when associated with odontogenic pathologies such as dentigerous cysts and odontomas. These entities, despite benign, can cause complications, including tooth displacement, root resorption, and alterations in normal eruption, compromising both esthetics and function. We present the case of a 15-year-old female patient with no relevant medical history who attended for orthodontic treatment planning. Computed tomography scans revealed bilateral impaction of the mandibular canines, associated with radiolucent images consistent with dentigerous cysts. A mixed radiolucent-radiopaque image was also observed in the area of the lower right first premolar, suggesting an odontoma. Surgical management was proposed, including enucleation of the cysts, removal of the odontoma, and placement of orthodontic appliances on the exposed canines to facilitate their movement. Histopathological analysis confirmed the diagnosis of two dentigerous cysts and one compound odontoma. In the surgical follow-up, the intervention area evolved satisfactorily, with no signs of complications, such as infection, delayed healing, or recurrence of the lesion. One of the most complex clinical challenges is managing impacted mandibular canines when associated with odontogenic pathologies. The implementation of advanced diagnostic tools such as computed tomography, along with appropriate surgical techniques and strategic orthodontic planning, effectively addresses these clinical presentations. Timely multidisciplinary treatment promotes the resolution of associated pathologies and optimizes dental alignment, contributing to improved masticatory function and facial esthetics. These comprehensive approaches are essential to ensure predictable and successful outcomes in certain complex cases.