Korean J Orthod.  2020 Jan;50(1):63-71. 10.4041/kjod.2020.50.1.63.

Comprehensive orthodontic treatment of a young girl with an odontogenic keratocyst and impacted teeth in the mandible

• Baik WK
• Baik HS
• Choi SH

• KMID: 2468642
• DOI: http://doi.org/10.4041/kjod.2020.50.1.63

Abstract

Odontogenic keratocysts (OKCs) are one of the most aggressive cysts in the oral and maxillofacial area because of their high recurrence rate and infiltrative behavior. In growing patients with OKCs, a radical treatment approach might cause numerous complications, including the disturbance of jaw growth and loss of the involved tooth. This case report describes successful comprehensive orthodontic treatment combined with marsupialization of the cyst in a young girl who exhibited an OKC with impacted teeth. The 10-year-old girl presented with an OKC extending from the mandibular symphysis through the left mandibular body, with ectopic impaction of the mandibular left canine and first premolar, as well as congenitally missing bilateral mandibular second premolars. Interestingly, spontaneous improvement of the positions of the ectopic impacted teeth, along with a reduction in the size of the cyst, occurred during marsupialization. The sequential use of removable and fixed appliances enabled orthodontic traction of the impacted teeth. The treatment outcome was stable at 2.5 years after the end of the treatment. We speculate that comprehensive orthodontic treatment combined with marsupialization can be an effective treatment strategy for patients with OKCs, especially when they are encountered in young, growing patients with impacted teeth.

Keyword

Odontogenic keratocyst; Marsupialization; Impacted teeth; Orthodontic traction

MeSH Terms

Bicuspid
Child
Female*
Humans
Jaw
Mandible*
Odontogenic Cysts*
Recurrence
Tooth
Tooth, Impacted*
Traction
Treatment Outcome

Figure

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  Figure 1 A, Panoramic radiograph acquired before marsupialization of the cyst. B, Pretreatment computed tomographic images acquired before marsupialization of the cyst.

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  Figure 2 A, Panoramic radiographs acquired 3 months after the initiation of marsupialization of the cyst. B, Panoramic radiographs acquired 9 months after the initiation of marsupialization of the cyst. C, Computed tomographic images acquired 9 months after the initiation of marsupialization showing a reduction in the size of the cyst. D, Schematic illustration of the impacted teeth during marsupialization of the cyst.

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  Figure 3 Pre-orthodontic treatment facial and intraoral photographs.

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  Figure 4 Pre-orthodontic treatment cast models.

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  Figure 5 Pre-orthodontic treatment radiographs. A, Lateral cephalogram; B, panoramic radiograph.

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  Figure 6 A, A removable appliance design. Six hooks were added to the appliance to control the direction of the force. B, Intraoral photographs showing treatment progress with a removable appliance. C, After 6 months of wearing the removable appliance.

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  Figure 7 A, Intraoral photographs showing treatment progress with fixed orthodontic appliances. B, After correcting the axis of the distally tipped mandibular incisors and obtaining space for the restoration of the mandibular left second premolar.

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  Figure 8 Posttreatment facial and intraoral photographs.

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  Figure 9 Posttreatment cast models.

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  Figure 10 A, Posttreatment lateral cephalogram. B, Superimpositions before and after orthodontic treatment. C, Posttreatment panoramic radiograph.

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  Figure 11 Post-retention radiographs acquired 2.5 years after debonding. A, Lateral cephalogram; B, panoramic radiograph.

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