## 5 Case Report  
A nine-year-old male patient was referred for treatment to the Department of Orthodontics of the Central Teaching Hospital, Institute of Dentistry, Medical University of Lodz. Apart from an allergy to tree and grass pollen, the patient did not report any other relevant general disorders from an orthodontic perspective. Starting with an extraoral examination, facial asymmetry was revealed, visible as painless swelling that deformed the nasolabial sulcus (Figure 1). The submandibular lymph nodes on the right side were enlarged, hard, painless and movable relative to the skin and surrounding tissues. A functional assessment of the masticatory system did not reveal any kinematic jaw alteration. The movements of the mandible were symmetric, and their range was normal. Intraorally, mixed dentition was present with increased overjet and bilateral 1/2 cusp angle class II malocclusion. The oral vestibular, in the area of the upper right primary canine (53) and first molar (54), was deformed due to alveolar bone expansion, and the overlying mucosa was red and swollen (Figure 2). The patient was referred for a radiological examination, as well as for a consultation at the Department of Oral Surgery. A preliminary investigation with a panoramic radiogram was ordered to disclose the presence of erupted and unerupted teeth with their possible developmental or positional abnormalities, as well as to assess the condition of surrounding maxillofacial structures. The radiolucent, unilocular area with a diameter of approximately 3 cm, extending in the area above Teeth 53 and 54, was observed (Figure 3). \begin{table}
\begin{tabular}{c c c c c c} \hline
**Year** & **Author** & **Unerupted Teeth** & **Patient Age** & **Treatment Method** & **Treatment Time** \\ \hline
2018 &
\begin{tabular}{c} [PERSON] et al. \\ [19] \\ \end{tabular} & 35 (open apex) & 13 y & M + Se & 6 months after surgery \\  & 33 (inclined distally), & & & & tooth fully erupted \\
2017 & [PERSON] et al. [27] & 34 displaced with & 12 y & M + OTr and FA & 2 y 11 m \\  & 27 & 35 inclined mesially & & & \\
2017 & [PERSON] et al. [28] & 35 (open apex) & 7 y & Decompression + Se & 9 months after surgery, start of eruption; 4-year follow-up tooth totally erupted \\
2016 & [PERSON] et al. [29] & 33–34 (open apex) & 11 y & M + Se & 9 months after surgery, start of eruption \\ \hline  & \multicolumn{4}{c}{Legend: M—marsupialization, OTr—orthodontic traction, En—enucleation, FA—fixed appliance, TADs— temporary anchorage device, Se—spontaneous eruption.} \\ \end{tabular}
\end{table} 
Table 3: _Cont._Figure 1: Extraoral photographs before treatment. Figure 2: Intraoral photographs before treatment. Figure 5: CBCT before treatment—axial view. Figure 6: CBCT before treatment—coronal view. A hypodense focus representing a loss of osseous tissue surrounded the crown of the displaced upper right permanent canine. The unerupted first and second premolars were dislocated and rotated, and Tooth 12 also presented mesiorotation and mesioinclination. The teeth involved in the lesion had open apices and no sign of root resorption. The alveolar bone was deformed, especially in the vestibulopalatal dimension, with a noticeable displacement of the medial interior wall of the right maxillary sinus. The extended diagnostic process also included a blood test with the level of thyroid hormones (TSH, fT3, fT4), and it did not reveal any deviation from standard. A microscopic verification by means of aspiration cytological biopsy was also performed. The result confirmed the cystic character of the pathology and denied the presence of a neoplastic lesion. An interdisciplinary treatment plan was established to achieve the best therapeutic result and reduce the risk of complications. The first surgical step included a minimally invasive approach, and marsupialization was the method of choice. After the procedure, an alginate impression was taken, and an acrylic obturator was made. The aim was to maintain communication between the cyst and the oral cavity and reduce intracystic pressure.