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VOLUME 24 , ISSUE 10 ( October, 2023 ) > List of Articles


An Observational Study on Cystic Alterations in Normal Dental Follicles Associated with Impacted Lower Third Molar for Early Intervention

Sruthi T Sundaran, Roshni Abida, Sachin A Aslam, Mathew P Cherian, Sooraj Soman, Tom Thomas

Keywords : Cystic changes, Dental follicle, Pathologic alterations, Pericoronal radiolucency, Radiographically normal impacted teeth

Citation Information : Sundaran ST, Abida R, Aslam SA, Cherian MP, Soman S, Thomas T. An Observational Study on Cystic Alterations in Normal Dental Follicles Associated with Impacted Lower Third Molar for Early Intervention. J Contemp Dent Pract 2023; 24 (10):809-812.

DOI: 10.5005/jp-journals-10024-3552

License: CC BY-NC 4.0

Published Online: 05-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To evaluate the cystic changes in the radiographically normal dental follicle associated with impacted mandibular third molar. Materials and methods: This study was conducted on 80 patients. Samples were selected using a convenient sampling technique from the patients who had impacted mandibular third molars in Pell and Gregory's positions B and C, with follicular space less than 2.5 mm in diameter. After surgical removal of an impacted tooth, the dental follicle was sent for histopathologic evaluation. Results: Pathologic alterations were found in 19% of cases out of 80 samples. Odontogenic keratocystic and dentigerous cystic changes were found in 7% of cases. A statistically significant cystic alteration was found in female patients and distoangular impacted teeth. Conclusion: This study shows a significant cystic alteration in the radiologically normal dental follicles. Clinical and radiographic features alone may not be a reliable indicator of the absence of pathology. Early intervention of impacted teeth will help to reduce morbidity due to the development of pathology. Clinical significance: This study will help educate patients on the risks of retaining impacted teeth, based on scientific facts, in order to minimize the risks and to assess the correlation of pathologic alterations with the depth of impaction and angular position of the impacted tooth.

  1. Pippi R, Fino F, Bosco D. Pathological tissue in follicles of surgically exposed un-erupted teeth: Which is the fate? Oral Surg 2020;13(3):206–211. DOI: 10.1111/ors.12476.
  2. Mortazavi H, Baharvand M. Jaw lesions associated with impacted tooth: A radiographic diagnostic guide. Imaging Sci Dent 2016;46(3):147–157. DOI: 10.5624/isd.2016.46.3.147.
  3. Bilodeau E, Collins B. Odontogenic cysts and neoplasms. Surg Pathol Clin 2017;10(1):177–222. DOI: 10.1016/j.path.2016.10.006.
  4. Bastos V, Gomez R, Gomes C. Revisiting the human dental follicle: From tooth development to its association with unerupted or impacted teeth and pathological changes. Dev Dyn 2021;251(3): 408–423. DOI: 10.1002/dvdy.406.
  5. Rakprasitkul S. Pathologic changes in the pericoronal tissues of unerupted third molars. Quintessence Int 2001;32(8):633–638. PMID: 11526892.
  6. Rados P, da Silva V, Meyer G, et al. Pericoronal follicles revealing unsuspected odontogenic cysts and inflammatory lesions: A retrospective microscopy study. Indian J Dent Res 2020;31(1):80–84. DOI: 10.4103/ijdr.IJDR_459_18.
  7. Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res 2013;4(2):e1. DOI: 10.5037/jomr.2013.4201.
  8. Adaki S, Yashodadevi B, Sujatha S, et al. Incidence of cystic changes in impacted lower third molar. Indian J Dent Res 2013;24(2):183–187. DOI: 10.4103/0970-9290.116674.
  9. Adelsperger J, Campbell JH, Coates DB, et al. Early soft tissue pathosis associated with impacted third molars without pericoronal radiolucency. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontol 2000;89(4):402–406. DOI: 10.1016/s1079-2104(00) 70119-3.
  10. Damante JH, Fleury RN. A contribution to the diagnosis of the small dentigerous cyst or the paradental cyst. Pesqui Odontol Bras 2001;15(3):238–246. DOI: 10.1590/s1517-74912001000300010.
  11. Baykul T, Saglam A, Aydin U, et al. Incidence of cystic changes in radiographically normal impacted lower third molar follicles. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontol 2005;99(5): 542–545. DOI: 10.1016/j.tripleo.2004.08.010.
  12. D'Angeli G, Zara F, Belloni A, et al. Cone beam computer tomography and histological evaluation of dental follicle of impacted lower third molar germs in teens: A histo-radiographic correlation study in a case series. Appl Sci 2021;11(12):5682. DOI: 10.3390/app11125682.
  13. Cabbar F, Güler N, Comunoğlu N, et al. Determination of potential cellular proliferation in the odontogenic epithelia of the dental follicle of the asymptomatic impacted third molars. J Oral Maxillofac Surg 2008;66(10):2004–2011. DOI: 10.1016/j.joms.2008.06.011.
  14. Yıldırım G, Ataoğlu H, Mihmanlı A, et al. Pathologic changes in soft tissues associated with asymptomatic impacted third molars. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, Endodontol 2008;106(1): 14–18. DOI: 10.1016/j.tripleo.2007.11.021.
  15. Simşek-Kaya G, Özbek E, Kalkan Y, et al. Soft tissue pathosis associated with asymptomatic impacted lower third molars. Med Oral Patol Oral Cir Bucal 2011;16(7):e929–e936. DOI: 10.4317/medoral.17128.
  16. Mesgarzadeh A, Esmailzadeh H, Abdolrahimi M, et al. Pathosis associated with radiographically normal follicular tissues in third molar impactions: A clinicopathological study. Indian J Dent Res 2008;19(3):208–212. DOI: 10.4103/0970-9290.42952.
  17. Masdoose SMH, Nasher AT, El-Zine MA, et al. Histologic and radiographic study of pathologic change in complete impacted third molars dental follicles. Univ J Pharm Res 2021;6(1):43–48. DOI: 10.22270/ujpr.v6i1.539.
  18. National Institute for Health and Care Excellence. Guidance on the Extraction of Wisdom Teeth. TA1. London: NICE; 2000.
  19. Dodson TB, Gonzalez ML. American Association of Oral and Maxillofacial Surgeons’ Anesthesia and Third Molar Extraction Benchmark Study: Rationale, methods, and initial findings. J Oral Maxillofac Surg 2016;74(5):903–910. DOI: 10.1016/j.joms.2015. 11.032.
  20. Namgyel T, Chaiyasamut T, Suphangul S, et al. Histopathological features assessment of suspected pathologic pericoronal tissue of embedded teeth. J Oral Maxillofac Surg, Med, Pathol 2020;32(4): 316–322. DOI: 10.1016/j.ajoms.2020.02.002.
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