Management of a dentigerous cyst in the right mandible: A case report with radiographic, histopathological and immunohistochemical insights

Introduction: Dentigerous cysts are developmental odontogenic cysts originating from the reduced enamel epithelium and characteristically enveloping the crowns of unerupted or impacted teeth. They represent the second most prevalent odontogenic cystic lesion of the jaws, with a marked predilection for the mandibular third molar region. Although frequently asymptomatic and detected incidentally during routine radiographic examination, progressive cystic enlargement may result in bone destruction, tooth displacement, and neurosensory disturbances.
Case description: This report presents the clinical, radiographic, surgical,  histopathological and immunohistochemical features of a dentigerous cyst associated with an impacted right mandibular third molar in a 36-year-old female patient. The patient reported mild intraoral swelling accompanied by intermittent, non-specific pain. Panoramic and CBCT imaging revealed a well-defined unilocular radiolucency attached to the cemento-enamel junction of the impacted tooth. Surgical management consisted of complete enucleation of the cystic lesion with simultaneous extraction of the associated tooth. 
Histopathological and immunohistochemical analyses confirmed the diagnosis, demonstrating thin, non-keratinized stratified squamous epithelial lining, CK19 positivity, low Ki-67 proliferation index, and absent p53 expression. 
Conclusion: This case underscores the importance of radiographic surveillance of impacted teeth and confirms that surgical enucleation with tooth extraction remains a definitive and effective treatment modality for dentigerous cysts when the associated tooth lacks functional value. A diagnostic algorithm is proposed to guide clinicians in evaluation and management.