Unicystic ameloblastoma: Diagnostic challenges and uncommon treatment strategy: Case report

Unicystic ameloblastoma (UA) is frequently associated with an impacted tooth with a challenging diagnosis and decision making. The aim of this article is to emphasize a novel approach of treatment with tooth reimplantation after conservative treatment.

A 7-year-old boy consulting with a chief complaint of swelling in the upper left front region. Intraoral examination revealed a non-tender swelling extending from 61 to 63. Radiographic examination showed a well-defined, unilocular radiolucency associated to tooth 21. Initial diagnosis was a dentigerous cyst and was treated conservatively (enucleation and tooth reimplantation). Final diagnosis was an UA, intraluminal form. After 6 years, no signs of recurrence were observed, and teeth 21 and 22 showed healthy root development.

UA is the least encountered variant of all types of ameloblastomas and more commonly affects the mandible's posterior region than the maxilla. Differential diagnosis in the presence of radiolucent images is a dilemma, especially when a tooth is impacted in association with the lesion. Decision-making can be challenging, particularly regarding the appropriateness of initial radical extensive surgery in children. We opted to a conservative treatment. This procedure resulted in fewer complications and preserved the permanent teeth and as much bone as possible to avoid aesthetic deformities.

This case report focuses on a novel approach to the treatment of UA. This case report confirms that for UA conservative treatment is possible, with preservation of tooth and alveolar bone, particularly in young patients.