Cystic changes can arise in relation with unerupted lower third molars. This case report describes a large odontogenic keratocyst (OKC) which developed rapidly and aggressively over a short period of 2 years and presented with acute symptoms. The development of a large OKC over the mandible is evidenced by radiographs taken 2 years apart. The OKC was enucleated and the residual cavity was treated with Carnoy’s solution and packed with bismuth iodoform paraffin paste dressing. The impacted third molar and second molar associated with the lesion were also extracted. This case illustrates how rapidly a cyst can develop in association with a previously asymptomatic, unerupted tooth and how quickly a radiographic diagnosis can become out of date. As such, the authors recommend the use of repeated radiographs for monitoring unerupted teeth at a tighter time frame of 6 to 12 months.
There are many conditions affecting the jaws that present with a cystic, radiographic appearance. Odontogenic cysts and tumours have the potential to reach considerable sizes in the jaw. Unicystic ameloblastoma often presents as a large unilocular radiolucency in young individuals, typically at the posterior mandible, and is usually associated with an impacted tooth. Radiographically, the lesion also exhibits minimal peripheral sclerosis. Over 80% of these cystic tumours enclose the crown of a tooth and mimic dentigerous cysts radiographically.1 The roots of the adjacent teeth are usually resorbed. The possibility of an ameloblastoma at the angle of the mandible should not be dismissed until the diagnosis is confirmed by biopsy.
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