The use of the trans operative image intensifier in the removal of an unerupted tooth due to an extensive cystic lesion: Clinical case report




Odontogenic cysts; Fluoroscopy; Jaw.


The late diagnosis of odontogenic cystic lesions is common due to their asymptomatic growth. Among the treatments proposed in the literature, currently the decompression or marsupialization is indicated to reduce the size of the cyst, for subsequent complete enucleation of the lesion. The use of image intensifier during the transoperative period is commonly performed for orientation and localization of foreign bodies, firearm projectiles or fractured needles, and is hardly reported in studies to aid in the treatment of odontogenic cysts. The present article aims to report a clinical case of a young patient diagnosed with odontogenic keratorcyst, who underwent marsupialization treatment and subsequent cyst enucleation. During the transoperative, it was difficult to locate the unerupted tooth associated with the lesion, due to the large displacement to the base of the mandible. Thus, the image intensifier was used to locate and remove the tooth. Transoperative complications are common, especially when dealing with extensive cystic lesions, due to the degree of difficulty. The use of techniques and equipment that provide benefits in facilitating and speeding up the surgical procedure leads to a reduction in patient morbidity. The use of image intensifier is feasible in unusual situations, both for the location of foreign bodies and teeth in atypical locations.


Canevaro, L. (2009). Aspectos físicos e técnicos da radiologia intervencionista. Revista Brasileira de Física Médica, 3(1), 101-115.

Deus, C. B. D. d., Silva, J. V. U., Oliva, A. H. d., Silva, W. P. P. d., Santos, A. M. d. S., Lima Neto, T. J. d., & Souza, F. Á. (2021). Síndrome de Gorlin Goltz: relato de um caso raro com extenso ceratocisto comprimindo nervo óptico. Research, Society and Development, 10(2), e9410212315.

Faulkner, K., & Marshall, N. W. (1993). The relationship of effective dose to personnel and monitor reading for simulated fluoroscopic irradiation conditions. Health Phys, 64(5), 502-508.

Gans, B. J., Kallal, R. H., Helgerson, A. C., & Verona, S. R. (1982). The image intensifier in oral and maxillofacial surgery. Journal of oral and maxillofacial surgery, 40(11), 726-729.

Gay-Escoda, C., Camps-Font, O., López-Ramírez, M., & Vidal-Bel, A. (2015). Primary intraosseous squamous cell carcinoma arising in dentigerous cyst: Report of 2 cases and review of the literature. Journal of clinical and experimental dentistry, 7(5), e665.

Güven, O., Keskln, A., & Akal, Ü. K. (2000). The incidence of cysts and tumors around impacted third molars. International journal of oral and maxillofacial surgery, 29(2), 131-135.

Jihong, Z., & Congfa, H. (2014). The advanced techniques of dentoalveolar surgery. West China Journal of Stomatology, 32(3).

Johnson, L. M., Sapp, J. P., & McIntire, D. N. (1994). Squamous cell carcinoma arising in a dentigerous cyst. Journal of oral and maxillofacial surgery, 52(9), 987-990.

Mintz, S., Allard, M., & Nour, R. (2001). Extraoral removal of mandibular odontogenic dentigerous cysts: a report of 2 cases. Journal of oral and maxillofacial surgery, 59(9), 1094-1096.

Montevecchi, M., Checchi, V., & Bonetti, G. A. (2012). Management of a deeply impacted mandibular third molar and associated large dentigerous cyst to avoid nerve injury and improve periodontal healing: case report. J Can Dent Assoc, 78(2), 59-62.

Mulinari-Santos, G., Bonardi, J. P., Fabris, A. L. d. S., Puttini, I. d. O., Coléte, J. Z., Duailibe-de-Deus, C. B., Faverani, L. P., Garcia Júnior, I. R., & Souza, F. Á. (2018). Use of an image intensifier for the localization and removal of a foreign body in the lower lip. Archives of Health Investigation, 7(6).

Panneerselvam, K., Parameswaran, A., Kavitha, B., & Panneerselvam, E. (2017). Primary intraosseous squamous cell carcinoma in a dentigerous cyst. South Asian journal of cancer, 6(03), 105-117.

Park, S.-S., Yang, H.-J., Lee, U.-L., Kwon, M.-S., Kim, M.-J., Lee, J.-H., & Hwang, S.-J. (2012). The clinical application of the dental mini C-arm for the removal of broken instruments in soft and hard tissue in the oral and maxillofacial area. Journal of Cranio-Maxillofacial Surgery, 40(7), 572-578.

Queiroz, S. B. F., Moreira Jr, R., Farina, C. G., Moreira, R., da Silva, A. K. A., & Coppedê, A. R. USo da fluoroscopia intraoperatória para guiar a colocação de implantes zigomáticos.

Rajkumar, B., Boruah, L. C., Thind, A., Jain, G., & Gupta, S. (2014). Dental Implant Placement using C-arm CT Real Time Imaging System: A Case Report. The Journal of Indian Prosthodontic Society, 14(1), 308-312.

Silva, Y. S., Stoelinga, P. J., & da Graça Naclério-Homem, M. (2019). Recurrence of nonsyndromic odontogenic keratocyst after marsupialization and delayed enucleation vs. enucleation alone: a systematic review and meta-analysis. Oral and maxillofacial surgery, 23(1), 1-11.

Santos Sanches, N., Silva, M. C., da Silva, W. P. P., Cervantes, L. C. C., de Lima Neto, T. J., Souza, F. A., Júnior, I. R. G., & Faverani, L. P. (2021). Auxílio do intensificador de imagem na remoção de agulha gengival curta. Research, Society and Development, 10(1), e41210111889-e41210111889.

Schueler, B. A. (2000). The AAPM/RSNA physics tutorial for residents: general overview of fluoroscopic imaging. Radiographics, 20(4), 1115-1126.

Shear, M. (2003). Odontogenic keratocysts: clinical features. Oral and maxillofacial Surgery Clinics, 15(3), 335-345.

Sri-Pathmanathan, R. (1990). The mobile X-ray image intensifier unit in maxillofacial surgery. British Journal of Oral and Maxillofacial Surgery, 28(3), 203-206.

Tabrizi, R., MsCD, M. R. H. K., & Jafarian, M. (2019). Decompression or Marsupialization; Which Conservative Treatment is Associated with Low Recurrence Rate in Keratocystic Odontogenic Tumors? A Systematic Review. Journal of Dentistry, 20(3), 145.

Takahashi, H., Takaku, Y., Kozakai, A., Otsuru, H., Murata, Y., & Myers, M. W. (2020). Primary intraosseous squamous cell carcinoma arising from a dentigerous cyst of the maxillary wisdom tooth. Case Reports in Oncology, 13(2), 611-616.

Tsamis, C., Rodiou, S., Stratos, A., & Gkantidis, N. (2018). Removal of a severely impacted mandibular third molar minimizing the risks of compromised periodontium, nerve injury, and mandibular fracture. Quintessence international, 49(1).

Tümer, C., Eset, A. E., & Atabek, A. (2002). Ectopic impacted mandibular third molar in the subcondylar region associated with a dentigerous cyst: A case report. Quintessence international, 33(3).

Valentin, J. (2000). Avoidance of radiation injuries from medical interventional procedures, ICRP Publication 85. Annals of the ICRP, 30(2), 7-7.

Vigneswaran, A., & Shilpa, S. (2015). The incidence of cysts and tumors associated with impacted third molars. Journal of pharmacy & bioallied sciences, 7(Suppl 1), S251.



How to Cite

GONÇALVES, K. W.-D. .; WASTNER, B. da F. .; EINSFELD, V. .; SILVA, W. P. P. da .; CAMPOS, L. G. .; FAVERANI, L. .; PIANOVSKI, M. A. D. .; ZANFERRARI, F. L. .; SASSI, L. M. . The use of the trans operative image intensifier in the removal of an unerupted tooth due to an extensive cystic lesion: Clinical case report . Research, Society and Development, [S. l.], v. 10, n. 10, p. e71101018517, 2021. DOI: 10.33448/rsd-v10i10.18517. Disponível em: Acesso em: 2 mar. 2024.



Health Sciences