PMC5577410_01
Panoramic radiograph showing a well delimited radiolucency on the right side in the posterior region of the maxilla, absence of the first molar (16) and displacement of tooth 17 and 15.
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Furthermore, displacement of the second maxillary right molar and root resorption of the teeth (second and third molars) involved were observed, as well as the absence of the first molar (Fig. 1).
Cone-beam computed tomography showing axial (A) and coronal (B) views, respectively, of the hypodense lesion and erosion of the vestibular and medial maxillary walls.
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A). Axial and coronal views showed erosion of the vestibular and palatine sinus walls (Fig. 2).
Cone-beam computed tomography showing a unilocular well defined lesion in the posterior maxillary region (tooth 17, 18 and absent 16). A and B: Parasagittal views showing root resorption of the tooth 18 and 17 (*), respectively. C and D Some small radiopacities near the second premolar tooth (arrows), suggestive of dental fragments.
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Root resorption of tooth 17 and 18 could be noted in the parasagittal view in the tomograph (Fig. 3B and C). Some radiopacities observed inside the lesion were suggestive of calcification or dental fragments (Fig. 3D and E).
A - Cystic cavity lined by a thin odontogenic epithelium forming cords or islands. Observe the dentinoid material in close contact with the odontogenic epithelium. B- Peripheral basal cells arranged in palisade, while central cells resembled stellate reticulum. C and D - Mineralized material containing dentin, suggestive of odontoma. E and F - Details of tubular dentin with globular calcification pattern, longitudinally cut. G and H - Osteodentin in close association with odontogenic epithelium.
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Microscopic analysis showed a cystic cavity lined by a thin odontogenic epithelium forming cords or islands and with basal cells arranged in palisade, with vacuolated cytoplasm, while central cells resembled stellate reticulum (Fig. 4A and B). Some foci of mineralized dentin characterized by a tubular formation and globular calcification Fig. 4C-F) interlaced with osteodentin containing cells, were detected (Fig. 4G and H).
Post-operative panoramic radiograph, one year after the surgery, showing new formed bone around the region of the first molar tooth (16) and no signs of recurrence.
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The lesion was completely enucleated and during the one-year follow-up period, there were no signs of recurrence, and new formed bone around the first molar tooth region was observed (Fig. 5).