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Table of Contents   
ORIGINAL RESEARCH  
Year : 2019  |  Volume : 30  |  Issue : 5  |  Page : 751-754
Relative frequency of dentigerous cyst in Iranian population: A 20-year retrospective study


1 Department of Oral and Maxillofacial Pathology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Endodontics, School of Dentistry, Guilan University of Medical Sciences, International Branch, Bandar Anzali, Iran
3 Education Development Office, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
4 Dentist, Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Date of Submission14-Jul-2017
Date of Decision07-Apr-2018
Date of Acceptance14-Aug-2018
Date of Web Publication18-Dec-2019
 

   Abstract 


Purpose: Dentigerous cyst (DC) is the most common type of developmental odontogenic cysts which apparently develops via accumulation of fluid between the reduced enamel epithelium and crown of the tooth. The aim of this study is to analyze the frequency of DC in Iranian population. Materials and Methods: The files of oral pathology, Shahid Beheshti University of Medical Sciences, served as the source of the materials from 1992 to 2012 for this study. All lesions diagnosed as DCs were subjected to microscopic reevaluation. Patient's age, sex, location, and microscopic characteristics were recorded. Based on these data, a descriptive statistical analysis was performed using SPSS 19 software (IBM SPSS Statistics 19, New York, United States) and the results with P < 0.05 were considered as significant. Results: DC accounted for 34.37% of all odontogenic cysts of the jaws during the 20-year period. The mean age of patients was 24.72 years and most cases are diagnosed in the second and third decades of life. The male-to-female ratio was 1.52. About 73.89% of all lesions had occurred in the mandible and 26.11% in maxilla. DCs showed Vickers and Gorlin (ameloblastomatous) changes in 2.36% of cases. The mean age was significantly lower in the premolar area (P = 0.00). Conclusion: Age, sex, and location of DCs in Iranian population are similar to previous studies. In addition, the age of occurrence for this lesion in the premolar region was relatively lower than at other sites. Although the risk of ameloblastic change is low, it should be considered as an important issue.

Keywords: Dentigerous cyst, mandible, maxilla, odontogenic

How to cite this article:
Lotfi A, Shirkavand S, Mokhtari S, Zalani SS, Atarbashi-Moghadam S. Relative frequency of dentigerous cyst in Iranian population: A 20-year retrospective study. Indian J Dent Res 2019;30:751-4

How to cite this URL:
Lotfi A, Shirkavand S, Mokhtari S, Zalani SS, Atarbashi-Moghadam S. Relative frequency of dentigerous cyst in Iranian population: A 20-year retrospective study. Indian J Dent Res [serial online] 2019 [cited 2020 Aug 5];30:751-4. Available from: http://www.ijdr.in/text.asp?2019/30/5/751/273424



   Introduction Top


Cystic and tumoral alterations may arise in dental follicles of impacted teeth, which make the histopathologic evaluation of enlarged follicles an imperative topic.[1] The dentigerous cyst (DC) is defined as a cyst that originates by the separation of the follicle from around the crown of an unerupted tooth and is the commonest type among the developing odontogenic cyst.[2],[3] Small DCs are usually asymptomatic but can produce painless expansion.[2] Radiographically, the DCs typically show a unilocular radiolucency that develops around unerupted teeth crown.[3] This cyst demonstrates nonaggressive behavior.[4] The paramount source to achieve data on the prevalence of odontogenic lesions is from the records of a central referral oral pathology service. Epidemiologic surveys may be useful since they provide valuable details on the incidence, microscopic structures, and demographic characteristics in different countries.[5] The aim of this research is to analyze the relative frequency of DCs in Iranian population.


   Materials and Methods Top


The files of oral and maxillofacial pathology (microscopic reports and slides), faculty of dentistry, Shahid Beheshti University of Medical Sciences served as the source of the materials during a 20-year period from 1992 to 2012 for this retrospective, descriptive, cross-sectional study. All lesions diagnosed as dentigerous or follicular cysts were subjected to microscopic reevaluation. Clinical and histopathologic data, including patient's age, sex, location, and microscopic characteristics such as presence of mucous cells, calcification, odontogenic island, respiratory epithelium, ameloblastic change, and Rushton bodies for this cyst, were recorded. Based on these data, a descriptive statistical analysis (Chi-square, t-test, and ANOVA) was performed using SPSS 19 software (IBM SPSS Statistics 19, New York, United States) and the results with P < 0.05 were considered as significant.


   Results Top


Among 5865 biopsies, 1219 were odontogenic cysts (20.78%), of which 419 were DC (7.14%). DC accounted for 34.37% of all odontogenic cysts of the jaws during the 20-year period. The mean age of patients was 24.72 years (ranged from 4 to 85 years) and most cases are diagnosed in the second and third decades of life. Two hundred and fifty-three cases (60.38%) occurred in men and 166 cases (39.61%) in women. About 73.89% of all lesions had occurred in the mandible and 26.11% in maxilla. Independent t-test showed no significant differences between age and location (P = 0.95). Also, Chi-square test revealed no significant differences between sex and location (P = 0.26). Then, jaws were divided in three parts: anterior, premolar, and molar areas. The molar area was the most common location (45.47%) [Table 1]. The mean age of the molar, premolar, and anterior region was 29.38, 15.40, and 24.99 years, respectively. One-way ANOVA test showed significant differences between age and premolar region (P = 0.00). Histopathologic changes were shown in [Table 2]. Carcinomatous changes were not found. In addition, there were two cases of bilateral DCs, which were not associated with any syndromes or systemic conditions. Among all DCs, 233 cases (55.6%) showed inflammation (60.1% in men and 39.9% in women). The percentage of inflammatory DC in molar, premolar, and anterior region was 41.9%, 34.5%, and 23.6%, respectively.
Table 1: The frequency of DC in the molar, premolar and anterior region of the jaws

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Table 2: The percent of histopathologic changes in DCs

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   Discussion Top


In this study, DCs accounted for 34.37% of all odontogenic cysts. These findings were consistent with several studies that ranged from 33.2% to 17.33%.[2],[6],[7],[8],[9],[10],[11],[12],[13],[14] Most cases are diagnosed in the second to third decades of life with a mean age of 24.72 years. In addition, 60.38% of cases occurred in men and 39.61% in women with male-to-female ratio: 1.52. This is in accordance with the previous studies.[2],[8],[14],[15],[16],[17],[18] The epithelial lining DC consists of 2–4 layers of flattened nonkeratinizing cells, and the epithelium and connective tissue interface is flat [Figure 1]. Vickers and Gorlin criteria (1-hyperchromatism of basal cell nuclei, 2-palisading and polarization of basal cell nuclei, and 3-cytoplasmic vacuolization) in lining of DCs show progression toward ameloblastic change.[19] In this research, DCs showed these changes in 2.36% of cases. In some studies, rates of ameloblastic-like changes were reported as 1.82% and 3.96%[20],[21] that is similar to our study. Moreover, mucosal metaplasia [Figure 2], odontogenic islands [Figure 3], ciliated cells, dystrophic calcification [Figure 4], and Rushton bodies [Figure 5] were observed in 5.97%, 2.86%, 1.90%, 1.43%, and 1.19% of cases, respectively. In a similar study carried out by Yeo et al.,[17] the presence of Rushton bodies in DCs was 3.4%, mucosal metaplasia 7.6%, and epithelial islands 8.4%. In addition, Brown[22] found that Rushton bodies and mucosal metaplasia accounted for 1.2% and 42% of the cases, respectively, and no ciliated cells were observed. Moreover, Lin et al.[18] mentioned that the prevalence of ciliated cells, Rushton bodies, mucosal metaplasia, and epithelial islands were 3.55%, 3.25%, 2.66%, and 23.07%, respectively. In the study carried out by Takeda et al.,[23] the prevalence of ciliated cells was 10.8% and mucus cell metaplasia was accounted in 23.8% of the cases. The results of our study were consistent with Yeo et al.'s findings[17] but were inconsistent with some studies in the case of mucous cell metaplasia.[22],[23] Also, epithelial islands that reported with Lin et al. were higher than in our study.[18] Carcinomatous changes were not found in our study but Yeo et al. found cellular atypia in 9.2% of cases.[17] In this study, premolars were analyzed separately along with the molars and the anterior region. The most frequent site of the DC was the posterior mandible (41.96%) of which 93.5% were associated with third molars. The mandibular premolar region (20.44%) and the anterior maxilla (14.71%) were the next most frequent sites of occurrence. Similarly, Lin et al.[18] established that the most frequent site of occurrence is the posterior mandible (50%) of which 90.5% was associated with a mandibular third molar. Moreover, in the study of Jones et al.,[9] the results showed that 45% of DCs occur in the posterior mandible. Conversely, Yeo et al.[17] showed that the prevalence of DCs was equal in both jaws and the most prevalent sites were the posterior mandible (42.7%) and the anterior maxilla (38.2%). Interestingly in our study, in premolar region, the age of patients was significantly lower than the mean age of patients that had cysts in the molar or anterior region. This difference could be due to the probability of the formation of DCs. Inflammation is one of the main reasons of the development of this cyst and a DC may develop around the crown of an unerupted permanent premolar as a result of periapical inflammation from an overlying primary tooth.[24] Another finding that was observed in the present study was the high incidence of inflammatory cysts (55.6%) [Figure 6]. Moreover in Yeo et al. study, 42% of the DCs were inflamed.[17] Yet another interesting finding from this study was the presence of bilateral DCs in two cases. Bilateral and multiple DCs are usually found in association with a number of syndromes comprising cleidocranial dysplasia, Maroteaux–Lamy syndrome, and mucopolysaccharidosis. In the absence of the aforementioned syndromes or systemic diseases, bilateral forms of this cyst are very rare.[25],[26]
Figure 1: This non-inflamed DC shows a thin, nonkeratinized epithelial lining (H and E, ×100)

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Figure 2: Stratified squamous epithelial lining containing numerous mucous cells (H and E, ×400)

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Figure 3: Epithelial odontogenic islands in fibrous stroma (H and E, ×400)

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Figure 4: The fibrous wall of inflamed DC shows numerous calcifications and scattered odontogenic islands (H and E, ×100)

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Figure 5: Squamous epithelial cyst lining exhibiting linear Rushton bodies (H and E, ×400)

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Figure 6: The cyst is lined by stratified squamous epithelium, which demonstrates exocytosis. The underlying connective tissue shows severe chronic inflammation and calcification (H&E, ×100)

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   Conclusion Top


Age, sex, and location of DCs in Iranian population are similar to previous studies. In addition, the age of occurrence for this lesion in the premolar region was relatively lower than at the other sites. Although the risk of ameloblastic change is low, it should be considered as an important issue.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Dr. Saede Atarbashi-Moghadam
Department of Oral and Maxillofacial Pathology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Velenjak Street, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_392_17

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