Saving a Tooth: How Orthodontic Traction Helped Treat a Developing Dentigerous Cyst
A Gentle, Tooth-Preserving Approach to a Common Jaw Cyst
Dentigerous cysts are among the most common jaw cysts found in children and young adults. They are usually silent growing quietly around an unerupted tooth until they reach a size large enough to be noticed on routine X-rays. While many cases are treated with surgical removal of both the cyst and the affected tooth, researchers continue to explore more conservative options that preserve natural teeth whenever possible.
A recent case report published in BMC Oral Health (2023) presents an alternative approach: using orthodontic traction combined with natural decompression to treat a developing dentigerous cyst without extracting the involved tooth.
Understanding the Problem: What Is a Dentigerous Cyst?
A dentigerous cyst forms when fluid accumulates around the crown of an unerupted tooth. Although painless, it can become quite large and lead to complications such as:
Bone expansion
Displacement of nearby teeth
Malocclusion
Nerve pressure or discomfort
Failed tooth eruption
Because these cysts start small and grow slowly, early detection through panoramic radiographs is key.
The Case: A 14-Year-Old Patient With an Unerupted Lower Second Molar
The report describes a 14-year-old female who visited the orthodontic clinic with concerns about her dental appearance. Clinical examination showed that all permanent teeth were erupting normally except for the lower right second molar, which remained unerupted.
Imaging revealed a well-defined radiolucent area surrounding the tooth consistent with a dentigerous cyst.
A surgeon initially recommended the standard approach:
extraction of the impacted molar + cyst enucleation + bone removal.
However, given the patient’s young age and the potential for natural bone healing, the team considered a more conservative plan.
The Conservative Plan: Orthodontic Traction + Decompression
Instead of removing the tooth, the clinicians opted for a tooth-preserving strategy:
1. Surgical Exposure
The impacted second molar was surgically exposed, allowing access to the tooth.
2. Orthodontic Attachment
A small orthodontic tube was bonded to the visible surface of the tooth.
3. Guided Eruption
Using light nickel-titanium wires, the tooth was gently pulled toward the dental arch.
4. Natural Decompression
As the tooth moved, the cyst opening remained connected to the oral cavity.
This prevented fluid re-accumulation and allowed the cyst to shrink gradually.
Within four months, the tooth had erupted enough to be included in the main orthodontic archwire. Follow-up X-rays confirmed:
Complete disappearance of the cyst
Healthy bone regeneration
No surgical defect
Full eruption of the second molar
No recurrence even three years later
Why This Matters: Benefits of the Conservative Approach
This case highlights several advantages:
Tooth preservation: The permanent molar was saved instead of extracted.
Reduced surgical trauma: No extensive bone removal was required.
Improved bone healing: Decompression encourages natural bone regeneration.
Functional and psychological benefits: Keeping permanent teeth supports proper chewing and dental development especially important for young patients.
Lower recurrence risk: Maintaining the cyst opening prevents fluid build-up.
The report demonstrates that for selected patients particularly growing adolescents orthodontic traction combined with decompression can be a safe and effective alternative to more invasive surgery.
Conclusion
This case report provides encouraging evidence that dentigerous cysts associated with developing teeth can be managed successfully through minimally invasive, tooth-preserving methods. Guided eruption paired with decompression not only resolved the cyst but also ensured the healthy eruption of the second molar, offering a strong argument for conservative management when conditions are favorable.
Original Article
El-Beialy AR, BinRahima AM, Al Shhab M, Mostafa Y. Orthodontic management of a developing dentigerous cyst related to lower second molar: a case report. BMC Oral Health. 2023;23:1004.
DOI: https://doi.org/10.1186/s12903-023-03731-3