# Root Dilaceration and Dentigerous Cyst--A Cause-Effect Relationship?--\"Case-Series Study\"
## 2 Materials and Methods
The panoramic X-ray revealed on the right side a DC, associated with the second premolar, and on the left side both premolars are included in another DC, which was binocular (Figure 4a). The first left premolar was in a horizontal position with the crown facing labially and root lingually (Figure 4b). The eruption of the left lateral incisor and canine was blocked by the lack of space, due to a supernumerary erupted mandibular incisor. A lingual arch was placed to maintain the position of the first mandibular molars. Extraction of deciduous mandibular molars and the marsupialization of the cysts were performed. After surgery, all impacted teeth started their eruption in an appropriate position. Although the left first premolar changed its position to a normal one, there was not enough space for its eruption in addition to having a root DL (Figure 4c). The left lateral incisors and canine also had small degrees of root DL. As was stated previously, the cause of the DCs could be the pulp infection of the deciduous molars, but there were differences between the two DCs and local conditions. The right DC was of  
Figure 4: (**a**) Initial panoramic X-ray revealed large DCs on both sides of the mandible. (**b**) CBCT image showing the labiolingual orientation of the lower left first and second premolars. (**c**) CBCT showing root DL of the left first premolar. inflammatory origins, and after the marsupialization, the premolar started to erupt in its normal position. On the left side, the cyst is bilocular, and the inflammatory origin could not be the only etiological factor. There are also other dental anomalies, supernumerary teeth, and the different degrees of root DL affect not only the tooth associated with the DC but also other teeth from that area. This clinical case is a DAP case. **Case 4**  
A 9-year-old boy came for orthodontic treatment because of the protrusion of his upper incisors. A trainer was recommended for him, but he could not manage it. The patient had a class II div 1 Angle malocclusion, mixed dentition with a delayed eruption of the permanent teeth, and the absence of the first mandibular molars. On the panoramic X-ray, it was noted that the rest of the permanent teeth on the right side (including the third molars), the first and second mandibular molars were impacted and associated with a sizeable DC, with the development of the roots delayed, and the first molar was dilacerated. On the left side, the situation was almost the same, with both the first and second molars being impacted and associated with DC. The roots of the molars were in an early stage of development, uncorrelated with the patient's age (Figure 5a). As in all previous cases, the treatment objective regarding the DC-associated impacted teeth was to try to preserve the teeth. Therefore, the cyst's marsupialization was done, followed by monitoring of the patients. Six months later, although the first permanent molars started to erupt slowly, orthodontic traction from a bonded attachment was applied to bring the teeth intraorally (Figure 5b). The DC of the left second molar continued to grow, blocking the molar's eruption and the development of its roots. On the right side, the second molar became more horizontally positioned in the bone under the crown of the first molar. We decided on another marsupialization of the cyst-associated second left molar and extraction of both mandibular third molars. After four months, the left second molar was erupting in an optimal vertical position. The right second molar was still almost horizontally impacted, without any bony defect, due to DC (Figure 5c). At that moment, both first mandibular molars were in the oral cavity, well aligned in the lower arch, but not in the appropriate one, because of the roots DL. There was also a slight root flexion of the right mandibular canine. The aforementioned is a rare case of bilateral mandibular DC-associated first and second molars, impaction, and root DL of the first molar.