Relative incidence of odontogenic cysts. Dentigerous cyst is labeled at top right.
A dentigerous cyst, also known as a follicular cyst, is an epithelial-lined developmental cyst formed by accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth.[2][3][4] It is formed when there is an alteration in the reduced enamel epithelium and encloses the crown of an unerupted tooth at the cemento-enamel junction. Fluid is accumulated between reduced enamel epithelium and the crown of an unerupted tooth.
Dentigerous cysts are the second[5] most prevalent type of odontogenic cysts after radicular cyst. Seventy percent of the cases occur in the mandible. Dentigerous cysts are usually painless. The patient usually comes with a concern of delayed tooth eruption or facial swelling. A dentigerous cyst can go unnoticed and may be discovered coincidentally[6][7][5] on a regular radiographic examination.
Pathogenesis
Odontogenesis happens by means of a complex interaction between oral epithelium and surrounding mesenchymal tissue. Abnormal tissue interaction during this process can result in ectopic tooth development. Ectopic tooth eruption may result due to pathological process, such as a tumor or cyst or developmental disturbance. The pathogenesis of dentigerous cyst is still controversial.
The accumulation of fluid either between the reduced enamel epithelium and enamel or in between the layers of enamel organ seems to be the key to the formation of dentigerous cysts.
A potentially erupting tooth on an impacted follicle can obstruct the venous outflow, inducing rapid transudation of serum across the capillary walls.
Main suggested that this may exert pressure,[8] causing the accumulation of fluid. On the contrary, Toiler[9] suggested that the breakdown of proliferating cells of the follicle after impeded eruption is likely to be the origin of the dentigerous cyst. The breakdown products may result in increased osmotic tension, resulting in cyst formation.
The exact histogenesis of dentigerous cysts remains unknown, but most authors favor a developmental origin from the tooth follicle. In 1928, Bloch-Jorgensen[10] suggested that the overlying necrotic deciduous tooth is the origin of all dentigerous cysts. The resultant periapical inflammation might spread to involve the follicle of the unerupted permanent successor, an inflammatory exudate ensued with resultant dentigerous cyst formation. He reported 22 cases of follicular cysts and stated that in each case a deciduous tooth or the remnants thereof was found in direct contact with the cyst cavity and that the related deciduous tooth always was diseased.
Azaz and Shteyer[11] similarly suggested that the persistent and prolonged periapical inflammation caused chronic irritation to the follicle of the successors. This may trigger and hasten the formation of a dentigerous cyst developing around the permanent teeth. They reported five cases of dentigerous cysts which involved the second mandibular premolar in four children aged 8 to 11 years old. These children were referred for extraction of carious, nonvital primary molars with swelling of the surrounding soft tissue. Occlusal radiographs showed buccal expansion of bone at the affected site. The primary teeth were not in direct contact with the underlying dentigerous cyst.
It has been suggested that dentigerous cysts may be either extrafollicular or intrafollicular in origin. There were three possible mechanisms exist. Firstly, surrounding the crowns of affected teeth, the intrafollicular developmental dentigerous cysts may be formed. These cysts may be secondarily inflamed and infected as a result of periapical inflammation spreading from non vital deciduous predecessors. Benn and Altini [8](1996) claimed that this possibility was unlikely as all the cases reported were not associated with tooth impaction.
Secondly, radicular cysts developed at the apices of non vital primary teeth. These radicular cysts may fuse with the follicles of the unerupted successors, causing the eruption of the successors into the cyst cavity. This may result in the formation of extrafollicular dentigerous cyst. Shear regarded this to be exceptionally rare because radicular cyst is uncommon in the primary dentition.
The third possibility is that periapical inflammation could be of any source but usually from a non vital deciduous tooth spreading to involve the follicles of unerupted permanent successors. The inflammatory exudate causes separation of reduced enamel epithelium from the enamel with resultant cyst formation.
Clinical features
The dentigerous cyst commonly involves a single tooth and rarely affects multiple teeth. The most frequently involved tooth is the mandibular third molar followed by the maxillary canine, but they may be associated with supernumerary or ectopic tooth. Any permanent tooth can be involved. Regezi and Sciubba[6] stated that the impacted teeth were most commonly seen in the third molar and maxillary canine teeth, and hence dentigerous cysts occur most frequently in these teeth. The involved teeth may be displaced into ectopic positions. In the maxilla, these teeth are often displaced into the maxillary sinus.[12] Classic symptoms of sinus disease such as headache, facial pain, purulent nasal discharge or nasolacrimal obstruction[12] may occur when maxillary sinus is involved.
According to a study, 45.7 percent of dentigerous cysts involved mandibular third molar.[8] On the other hand, only 2.7 percent of dentigerous cysts involved the maxillary premolar. Mourshed stated that the incidence of dentigerous cyst has been reported as 1.44 in every 100 unerupted teeth,[12] so dentigerous cysts involving the premolars are rare.
Dentigerous cysts most commonly occur in the 2nd and 3rd decades of life.[13][14][15] Males have been reported to be more prevalent than females with a ratio of 1.8:1. These cysts can also be found in young children and adolescents. The age of presentation of these cysts range from 3 years to 57 years with a mean of 22.5 years.
These cysts are commonly single lesions. Bilateral and multiple dentigerous cysts are very rare although they have been reported. Bilateral or multiple dentigerous cysts have been reported in Maroteaux-Lamy syndrome, cleidocranial dysplasia and Gardner's syndrome[16][17] In the absence of these syndromes, the occurrence of multiple dentigerous cysts is rare. Sometimes multiple dentigerous cysts are suggested to be induced by prescribed drugs. The combined effect of cyclosporine and a calcium channel blocker[18] is reported to cause bilateral dentigerous cyst
Dentigerous cyst is potentially capable of becoming an aggressive lesion. The possible sequelae of continuous enlargement of dentigerous cyst are expansion of the alveolar bone, displacement of teeth, severe root resorption of teeth,[5] expansion of buccal and lingual cortex[7] and pain.
Early detection and removal of the cysts is essential to reduce morbidity since dentigerous cyst can attain considerable size without any symptoms. Patient who presents with unerupted teeth should be thoroughly examined with radiographic examinations to check our for dentigerous cysts. Panoramic radiographs may be indicated for this purpose. CT imaging becomes necessary for extensive lesion.
Pathologic analysis of the lesion is important for the definitive diagnosis even though radiographs provide valuable information.
Histopathologic features
Histopathology of dentigerous cyst.
The histopathologic features of dentigerous cyst are dependent on the nature of the cyst, whether it is inflamed or not inflamed.
Non-inflamed dentigerous cyst
The specimen will present with loosely arranged fibrous connective tissue wall that contains considerable glycosaminoglycan ground substance. Small islands or cords of inactive-appearing odontogenic epithelial rests are usually scattered within the connective tissue and most commonly located near the epithelial lining. These rests may appear numerous in the fibrous connective tissue wall occasionally, which may be misinterpreted as ameloblastoma by some pathologists who are unfamiliar with oral lesions. The epithelial lining is composed of two to four layers of flattened non-keratinizing cells, with a flat epithelium and connective tissue interface.
Inflamed dentigerous cyst
Occurrence of inflamed dentigerous cyst is fairly common. Histologic examination reveals a more collagenized fibrous connective tissue wall, with a variable infiltration of chronic inflammatory cells. Cholesterol slits and their associated multinucleated giant cells may be present and are generally associated with the connective tissue wall. The cyst is lined mostly or entirely by non-keratinizing squamous epithelium which display varying amounts of hyperplasia with the development of anastomosing rete ridges and more definite squamous features. Dentigerous cysts presenting with these features may histologically be indistinguishable from radicular cysts. A keratinized surface is occasionally present, which must be differentiated from those observed in the odontogenic keratocyst(OKC). Focal areas of mucus cells or rarely, ciliated columnar cells may be found in the epithelial lining of dentigerous cysts. In addition, small nests of sebaceous cells infrequently may be present within the fibrous connective tissue wall. These mucous, ciliated and sebaceous elements are postulated to represent the multipotentiality of the odontogenic epithelial lining in a dentigerous cyst.
One or several areas of nodular thickening may be seen on the luminal surface in the gross examination of the fibrous wall of a dentigerous cyst. Careful examination of these areas microscopically is mandatory to rule out the presence of early neoplastic change.
As the dental follicle surrounding the crown of an unerupted tooth usually is lined by a thin layer of reduced enamel epithelium, this may render it difficult to distinguish a small dentigerous cyst from a normal or enlarged dental follicle based on microscopic features alone.[21]
Imaging features
As the epithelial lining is derived from the reduced enamel epithelium,[22] on radiographic examination, a dentigerous cyst appears as a unilocular radiolucent area that is associated with just the crown of an unerupted tooth and is attached to the tooth at the cementoenamel junction. Dentigerous cysts may also involve odontomas, which by their nature also have tooth crowns. The radiolucency is generally well defined and well corticated. The radiolucency often have a sclerotic border indicating bony reaction, but a secondarily infected cyst may display ill-defined borders. However, a large dentigerous cyst may give the impression of a multilocular process due to the persistence of bone trabeculae within the radiolucency.
The cyst-to-crown relationship presents several radiographic variations which are explained as follows:[21]
Central variant
This is the most common variant which the cyst surrounds the crown of the tooth and the crown projects into the cyst.
Lateral variant
This variant is usually associated with a mesioangular impacted mandibular third molar that is partially erupted. The cyst develops laterally along the root surface and partially surrounds the crown.
Circumferential variant
The cyst surrounds the crown and extends for some distance along the root surface so that a significant portion of the root appears to lie within the cyst, as if the tooth was erupting through the centre of the cyst.
The radiographic distinction between an enlarged dental follicle and a small dentigerous cyst can be difficult and fairly arbitrary. Generally, any pericoronal radiolucency that is greater than 3–4mm in diameter is considered suggestive of cyst formation.
Some dentigerous cysts may result in considerable displacement of the involved tooth. Infrequently, a third molar may be displaced to the lower border of the mandible or into the ascending ramus. On the other hand, maxillary anterior teeth may be displaced into the floor of the nasal cavity, while other maxillary teeth may be displaced through the maxillary sinus to the floor of the orbit. Furthermore, larger cysts can lead to resorption of adjacent unerupted teeth. Some dentigerous cysts may also grow to considerable size and produce bony expansion that is usually painless, unless secondarily infected. However, any particularly large dentigerous radiolucency should clinically be suspected of a more aggressive odontogenic lesion such as an odontogenic keratocyst or ameloblastoma. For this reason, biopsy is mandated for all significant pericoronal radiolucencies to confirm the diagnosis.
The role of CT (computerized tomography) imaging in the evaluation of cystic lesions has been well-documented. CT imaging aids to rule out solid and fibro-osseous lesions, displays bony detail, and provides precise information about the size, origin, content, and relationships of the lesions.[23]
On CT imaging, a mandibular dentigerous cyst appears as a well-circumscribed unilocular area of osteolysis that incorporates the crown of a tooth. Displacement of adjacent teeth may be seen and they may be partly eroded. Dentigerous cysts in the maxilla often extend into the antrum, displacing and remodeling the bony sinus wall. Large cysts which may project into the nasal cavity or infratemporal fossa and may elevate the floor of the orbit can be noted on CT imaging. In the mandible, buccal or lingual cortical expansion and thinning are noted.[24]
On MR imaging, the contents of the cyst display low to intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The tooth itself is a zone of signal void. The lining of the cyst is thin with regular thickness and may show slight enhancement after contrast injection.[24]
Treatment and prognosis
The treatment of choice for dentigerous cyst is enucleation along with extraction of the impacted teeth.[21] If eruption of the unerupted tooth is considered feasible, the tooth may be left in place after partial removal of the cyst wall. Orthodontic treatment may subsequently be required to assist eruption. Similarly, if displacement of the associated tooth by the cyst has occurred and extraction may prove to be difficult, orthodontic movement of the tooth to a more advantageous location for extraction may be accomplished. Marsupialization may also be used to treat large dentigerous cysts. This permits the decompression of the cyst, with a resulting decrease in the size of the bone defect. The cyst can then be excised at a later date, with a less extensive surgical procedure.
The prognosis for the dentigerous cyst is excellent, and recurrence is rare.[21] This is related to the exhausted nature of the reduced enamel epithelium,[23] which has differentiated and formed tooth crown enamel before developing into a cyst. Nevertheless, several potential complications must be considered. The possibility that the lining of a dentigerous cyst might undergo neoplastic transformation to an ameloblastoma has been well-documented. Mourshed showed that 33% of ameloblastomas arose from the epithelial lining of a dentigerous cyst.[25] Although undeniably this can occur, the frequency of such neoplastic transformation is low. In addition, a squamous cell carcinoma may rarely arise in the lining of a dentigerous cyst. Transformation from normal epithelial cyst lining to SCC is due to chronic inflammation.[26] It is likely that some intraosseous mucoepidermoid carcinomas develop from mucous cells in the lining of a dentigerous cyst. Malignancy in the cyst wall is usually unexpected at the time of presentation and the diagnosis is usually made following enucleation.[27] Jagged or irregular margins with indentations and indistinct borders are considered to be suggestive of possible malignant change.[28] Due to the potential for occurrence of an odontogenic keratocyst or the development of an ameloblastoma or, more rarely, mucoepidermoid carcinoma, all such lesions, when excised, should be submitted for histopathologic evaluation.
Differential diagnosis
The differential diagnoses of dentigerous cysts are as follows:
This is often multilocular and most commonly located in the body or the ramus of the mandible.[23]
Histologically, the epithelium is uniform in nature, usually four to eight cells in thickness. The basilar layer consists of a palisaded row of cuboidal to columnar cells that may demonstrate hyperchromatism. Characteristically, a corrugated or wavy layer of parakeratin is produced on the epithelial surface and desquamated keratin may be present in the cyst lumen.
Odontogenic keratocysts do not result in the same degree of bony expansion as dentigerous cysts and teeth resorption are less likely to be seen in association with odontogenic keratocysts. In addition, dentigerous cysts are more likely to have smooth periphery and odontogenic keratocysts are more likely to display a scalloped periphery.[29]
The most common radiolucent, benign odontogenic tumor, which may be unilocular or multilocular. It may result in expansion and destruction of the maxilla and mandible. It is not possible to differentiate unicystic ameloblastomas from dentigerous cysts with clinical and radiographic examinations.
Histopathologic examination revealed that the basilar cells in unicystic ameloblastoma become columnar and demonstrate prominent nuclear hyperchromatism. The polarization of nuclei may be away from the basement membrane (reverse polarization). Besides, the superficial epithelial layers may become loosely arranged and resemble the stellate reticulum of the enamel organ.
Also shows similar features as dentigerous cyst; however, the differentiation is by the presence of intra-cystic radio-opaque structures. In younger patients, the periapical radiolucencies associated with deciduous teeth may mimic pericoronal radiolucencies of succedaneous permanent teeth and may result in a false impression of dentigerous cyst. A definitive diagnosis will not be made based on radiographs alone. The diagnosis can only be confirmed by histopathological examination.[29]
A lytic lesion that is most often seen with amorphous calcification.[23]
See also
Teratoma, a type of tumor in which tooth tissue occasionally grows in ectopic places
Related Research Articles
The third molar, commonly called wisdom tooth, is the most posterior of the three molars in each quadrant of the human dentition. The age at which wisdom teeth come through (erupt) is variable, but this generally occurs between late teens and early twenties. Most adults have four wisdom teeth, one in each of the four quadrants, but it is possible to have none, fewer, or more, in which case the extras are called supernumerary teeth. Wisdom teeth may become stuck (impacted) against other teeth if there is not enough space for them to come through normally. Impacted wisdom teeth are still sometimes removed for orthodontic treatment, believing that they move the other teeth and cause crowding, though this is not held anymore as true.
Ameloblastoma is a rare, benign or cancerous tumor of odontogenic epithelium much more commonly appearing in the lower jaw than the upper jaw. It was recognized in 1827 by Cusack. This type of odontogenic neoplasm was designated as an adamantinoma in 1885 by the French physician Louis-Charles Malassez. It was finally renamed to the modern name ameloblastoma in 1930 by Ivey and Churchill.
The dental follicle, also known as dental sac, is made up of mesenchymal cells and fibres surrounding the enamel organ and dental papilla of a developing tooth. It is a vascular fibrous sac containing the developing tooth and its odontogenic organ. The dental follicle (DF) differentiates into the periodontal ligament. In addition, it may be the precursor of other cells of the periodontium, including osteoblasts, cementoblasts and fibroblasts. They develop into the alveolar bone, the cementum with Sharpey's fibers and the periodontal ligament fibers respectively. Similar to dental papilla, the dental follicle provides nutrition to the enamel organ and dental papilla and also have an extremely rich blood supply.
Commonly known as a dental cyst, the periapical cyst is the most common odontogenic cyst. It may develop rapidly from a periapical granuloma, as a consequence of untreated chronic periapical periodontitis.
An odontogenic keratocyst is a rare and benign but locally aggressive developmental cyst. It most often affects the posterior mandible and most commonly presents in the third decade of life. Odontogenic keratocysts make up around 19% of jaw cysts.
“Lateral periodontal cysts (LPCs) are defined as non-keratinised and non-inflammatory developmental cysts located adjacent or lateral to the root of a vital tooth.” LPCs are a rare form of jaw cysts, with the same histopathological characteristics as gingival cysts of adults (GCA). Hence LPCs are regarded as the intraosseous form of the extraosseous GCA. They are commonly found along the lateral periodontium or within the bone between the roots of vital teeth, around mandibular canines and premolars. Standish and Shafer reported the first well-documented case of LPCs in 1958, followed by Holder and Kunkel in the same year although it was called a periodontal cyst. Since then, there has been more than 270 well-documented cases of LPCs in literature.
Calcifying odontogenic cyst (COC) is a rare developmental lesion that comes from odontogenic epithelium. It is also known as a calcifying cystic odontogenic tumor, which is a proliferation of odontogenic epithelium and scattered nest of ghost cells and calcifications that may form the lining of a cyst, or present as a solid mass.
A glandular odontogenic cyst (GOC) is a rare and usually benign odontogenic cyst developed at the odontogenic epithelium of the mandible or maxilla. Originally, the cyst was labeled as "sialo-odontogenic cyst" in 1987. However, the World Health Organization (WHO) decided to adopt the medical expression "glandular odontogenic cyst". Following the initial classification, only 60 medically documented cases were present in the population by 2003. GOC was established as its own biological growth after differentiation from other jaw cysts such as the "central mucoepidermoid carcinoma (MEC)", a popular type of neoplasm at the salivary glands. GOC is usually misdiagnosed with other lesions developed at the glandular and salivary gland due to the shared clinical signs. The presence of osteodentin supports the concept of an odontogenic pathway. This odontogenic cyst is commonly described to be a slow and aggressive development. The inclination of GOC to be large and multilocular is associated with a greater chance of remission. GOC is an infrequent manifestation with a 0.2% diagnosis in jaw lesion cases. Reported cases show that GOC mainly impacts the mandible and male individuals. The presentation of GOC at the maxilla has a very low rate of incidence. The GOC development is more common in adults in their fifth and sixth decades.
An ameloblastic fibroma is a fibroma of the ameloblastic tissue, that is, an odontogenic tumor arising from the enamel organ or dental lamina. It may be either truly neoplastic or merely hamartomatous. In neoplastic cases, it may be labeled an ameloblastic fibrosarcoma in accord with the terminological distinction that reserves the word fibroma for benign tumors and assigns the word fibrosarcoma to malignant ones. It is more common in the first and second decades of life, when odontogenesis is ongoing, than in later decades. In 50% of cases an unerupted tooth is involved.
An odontoma, also known as an odontome, is a benign tumour linked to tooth development. Specifically, it is a dental hamartoma, meaning that it is composed of normal dental tissue that has grown in an irregular way. It includes both odontogenic hard and soft tissues. As with normal tooth development, odontomas stop growing once mature which makes them benign.
The calcifying epithelial odontogenic tumor (CEOT), also known as a Pindborg tumor, is an odontogenic tumor first recognized by the Danish pathologist Jens Jørgen Pindborg in 1955. It was previously described as an adenoid adamantoblastoma, unusual ameloblastoma and a cystic odontoma. Like other odontogenic neoplasms, it is thought to arise from the epithelial element of the enamel origin. It is a typically benign and slow growing, but invasive neoplasm.
The globulomaxillary cyst is a cyst that appears between a maxillary lateral incisor and the adjacent canine. It exhibits as an "inverted pear-shaped radiolucency" on radiographs, or X-ray films.
Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:
An odontogenic infection is an infection that originates within a tooth or in the closely surrounding tissues. The term is derived from odonto- and -genic. The most common causes for odontogenic infection to be established are dental caries, deep fillings, failed root canal treatments, periodontal disease, and pericoronitis. Odontogenic infection starts as localised infection and may remain localised to the region where it started, or spread into adjacent or distant areas.
Odontogenic cyst are a group of jaw cysts that are formed from tissues involved in odontogenesis. Odontogenic cysts are closed sacs, and have a distinct membrane derived from rests of odontogenic epithelium. It may contain air, fluids, or semi-solid material. Intra-bony cysts are most common in the jaws, because the mandible and maxilla are the only bones with epithelial components. That odontogenic epithelium is critical in normal tooth development. However, epithelial rests may be the origin for the cyst lining later. Not all oral cysts are odontogenic cysts. For example, mucous cyst of the oral mucosa and nasolabial duct cyst are not of odontogenic origin.
A cyst is a pathological epithelial lined cavity that fills with fluid or soft material and usually grows from internal pressure generated by fluid being drawn into the cavity from osmosis. The bones of the jaws, the mandible and maxilla, are the bones with the highest prevalence of cysts in the human body. This is due to the abundant amount of epithelial remnants that can be left in the bones of the jaws. The enamel of teeth is formed from ectoderm, and so remnants of epithelium can be left in the bone during odontogenesis. The bones of the jaws develop from embryologic processes which fuse, and ectodermal tissue may be trapped along the lines of this fusion. This "resting" epithelium is usually dormant or undergoes atrophy, but, when stimulated, may form a cyst. The reasons why resting epithelium may proliferate and undergo cystic transformation are generally unknown, but inflammation is thought to be a major factor. The high prevalence of tooth impactions and dental infections that occur in the bones of the jaws is also significant to explain why cysts are more common at these sites.
Periapical periodontitis or apical periodontitis (AP) is an acute or chronic inflammatory lesion around the apex of a tooth root, most commonly caused by bacterial invasion of the pulp of the tooth. It is a likely outcome of untreated dental caries, and in such cases it can be considered a sequela in the natural history of tooth decay, irreversible pulpitis and pulpal necrosis. Other causes can include occlusal trauma due to 'high spots' after restoration work, extrusion from the tooth of root filling material, or bacterial invasion and infection from the gums. Periapical periodontitis may develop into a periapical abscess, where a collection of pus forms at the end of the root, the consequence of spread of infection from the tooth pulp, or into a periapical cyst, where an epithelial lined, fluid-filled structure forms.
Ameloblastic carcinoma is a rare form of malignant odontogenic tumor, that develops in the jawbones from the epithelial cells that generate the tooth enamel. It is usually treated with surgery; chemotherapy has not been proven to be effective.
Periapical granuloma, also sometimes referred to as a radicular granuloma or apical granuloma, is an inflammation at the tip of a dead (nonvital) tooth. It is a lesion or mass that typically starts out as an epithelial lined cyst, and undergoes an inward curvature that results in inflammation of granulation tissue at the root tips of a dead tooth. This is usually due to dental caries or a bacterial infection of the dental pulp. Periapical granuloma is an infrequent disorder that has an occurrence rate between 9.3 to 87.1 percent. Periapical granuloma is not a true granuloma due to the fact that it does not contain granulomatous inflammation; however, periapical granuloma is a common term used.
The ameloblastic fibro-odontoma (AFO) is essentially a benign tumor with the features characteristic of ameloblastic fibroma along with enamel and dentin. Though it is generally regarded as benign, there have been cases of its malignant transformation into ameloblastic fibrosarcoma and odontogenic sarcoma. Cahn LR and Blum T, believed in "maturation theory", which suggested that AFO was an intermediate stage and eventually developed during the period of tooth formation to a complex odontoma thus, being a hamartoma.
↑ Gillette, Roy; Weinmann, Joseph P. (1958-06-01). "Extrafollicular stages in dentigerous cyst development". Oral Surgery, Oral Medicine, Oral Pathology. 11 (6): 638–645. doi:10.1016/0030-4220(58)90010-0. ISSN0030-4220. PMID13553316.
↑ Azaz, B.; Shteyer, A. (January 1973). "Dentigerous cysts associated with second mandibular bicuspids in children: report of five cases". ASDC Journal of Dentistry for Children. 40 (1): 29–31. ISSN1945-1954. PMID4567385.
↑ Zhang, L. L.; Yang, R.; Zhang, L.; Li, W.; MacDonald-Jankowski, D.; Poh, C. F. (September 2010). "Dentigerous cyst: a retrospective clinicopathological analysis of 2082 dentigerous cysts in British Columbia, Canada". International Journal of Oral and Maxillofacial Surgery. 39 (9): 878–882. doi:10.1016/j.ijom.2010.04.048. ISSN1399-0020. PMID20605411.
1 2 3 4 Neville, Brad W.; Damm, Douglas D.; Allen, Carl M.; Chi, Angela C. (2015-05-13). Oral and maxillofacial pathology (4thed.). St. Louis, Missouri. ISBN9781455770526. OCLC908336985.{{cite book}}: CS1 maint: location missing publisher (link)
↑ Douglas R., Gnepp (2009). Diagnostic surgical pathology of the head and neck (2nded.). Philadelphia, Pennsylvania: Saunders/Elsevier. ISBN978-1-4377-1951-2. OCLC460904310.
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↑ Chaisuparat, Risa; Coletti, Domenick; Kolokythas, Antonia; Ord, Robert A.; Nikitakis, Nikolaos G. (February 2006). "Primary intraosseous odontogenic carcinoma arising in an odontogenic cyst or de novo: A clinicopathologic study of six new cases". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 101 (2): 194–200. doi:10.1016/j.tripleo.2005.03.037. ISSN1079-2104. PMID16448921.
1 2 Dhupar, A.; Yadav, S.; Dhupar, V.; Mittal, H. C.; Malik, S.; Rana, P. (February 2017). "Bi-maxillary dentigerous cyst in a non-syndromic child – review of literature with a case presentation". Journal of Stomatology, Oral and Maxillofacial Surgery. 118 (1): 45–48. doi:10.1016/j.jormas.2016.12.001. ISSN2468-7855. PMID28330574.
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