Comprehensive Management of Impacted Teeth in Cystic Lesions of the Jaws

Cystic lesions in the jaws are frequently associated with impacted teeth, and include dentigerous cysts, odontogenic keratocysts, unicystic ameloblastoma and adenoid odontogenic tumours. The most common treatment modality is enucleation of cysts with removal of the impacted tooth. Marsupialisation is a more conservative treatment modality than enucleation and is considered the first-line treatment, especially in the initial management of benign cystic lesions during the mixed dentition period. Depending on the size of the lesion, the position of the impacted tooth and the available space, the majority of teeth can erupt spontaneously after marsupialisation. A multidisciplinary approach has been used in recent years for management of these lesions. Orthodontic traction is sometimes performed on the impacted tooth to guide tooth eruption postoperatively. When an impacted tooth or teeth within cystic lesions are preserved and functional occlusion is obtained, the patient's quality of life can improve significantly. Prospective clinical trials with a larger patient cohort are necessary to determine the clinical benefit of the conservative approach with marsupialisation or surgical-orthodontic treatment of impacted teeth in cystic lesions since only studies of small groups of patients or case reports have been published to date.