Decompression of a dentigerous cyst with early postoperative orthodontic traction: a case report

Dentigerous cysts with intracystic impacted teeth are commonly encountered in clinical practice; however, composite lesions concurrently complicated with extracystic transposed permanent teeth, alveolar bone fenestration defects and intracystic supernumerary teeth remain rare. This case report presents an 11-year-old male patient diagnosed with a large left maxillary dentigerous cyst accompanied by multiple dental malformations. A conservative staged therapeutic regimen consisting of cyst decompression combined with early postoperative orthodontic traction was adopted. Radiographic and clinical outcomes revealed complete regression and bony healing of the cystic lesion, successful alignment and repositioning of both intracystic and extracystic impacted transposed permanent teeth, and establishment of stable physiological occlusion. Nevertheless, root resorption developed in the extracystic transposed lateral incisor with preoperative bone fenestration. Based on the unique anatomical defects identified in this case, the present study analyzes the advantages and drawbacks of early orthodontic traction as well as high-risk predisposing factors for root resorption. Individualized clinical decision-making strategies are proposed for analogous complex dentigerous cysts with multiple dental deformities, providing clinical evidence and reference for relevant dental practitioners.