Atypical presentation of lateral periodontal cyst associated with impacted teeth: two case reports.

BACKGROUND: Lateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst. LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region. Histopathological analysis allows LPC to be diagnosed based on its characteristic features such as a thin cuboidal to stratified squamous non-keratinizing epithelium containing epithelial plaques and glycogen-rich clear cells. The aim of this article was to report two cases of atypical LPC associated either with an impacted lower left canine (tooth #33) or with a lower right third molar (tooth #48). CASE PRESENTATION: Case 1: A 56-year-old man was referred to us for an oro-dental assessment. Panoramic radiography revealed an impacted lower left permanent canine (tooth #33) with well-defined radiolucency on its upper cervical margin. A CT scan revealed a pericoronal radiolucency of 5 mm at its widest diameter around the impacted tooth #33. The pericoronal tissue was removed and sent for histopathological examination. The results revealed a lateral periodontal cyst. Satisfactory postoperative healing was achieved at the site. Follow-up at 12 months indicated no recurrence of the lesion. Case 2: A 54-year-old woman consulted with the main issue being pain on the lower right side of the face. Intra-oral examination revealed a vestibular swelling involving the region of the second molar (tooth #47), with obliteration of buccal sulcus. Pocket depth was determined to be 9 mm at the distal of #47. A diagnosis of gingival abscess resulting from chronic periodontitis was made. Panoramic radiography revealed a radiolucent cystic lesion associated with an impacted horizontal lower right third molar (tooth #48), suggestive of a dentigerous cyst. X-rays also revealed alveolar bone resorption on the molar (tooth #47). The cyst was removed along with the third molar and submitted for histopathological diagnosis. The diagnosis was LPC. Follow-up at 18 months indicated no recurrence of the lesion. CONCLUSION: These cases represent atypical presentations of LPC. They provide examples of the differential diagnosis of pericoronal radiolucencies involving an impacted tooth and our observations provide insights regarding the pathogenesis of LPC.

Suspected Lateral Periodontal Cyst Presenting Concurrently with Canine Acanthomatous Ameloblastoma in a 2-Year-Old Standard Poodle.

Lateral periodontal cysts (LPCs) are odontogenic epithelial cysts composed of nonkeratinized epithelial cells that are in the category of developmental cysts, rather than inflammatory cysts. Lateral periodontal cysts are rare both in people and domestic animals; they are associated with vital teeth and located lateral to a tooth root. Lateral periodontal cysts are typically asymptomatic lesions that are characterized radiographically as a unilocular lucency with well-defined corticated borders. Canine acanthomatous ameloblastoma (CAA) is the most common odontogenic neoplasm in dogs and rarely presents as a cystic lesion. This case report describes the diagnosis and treatment of a cyst that occurred as a swelling apical to a gingival mass that was diagnosed histologically as CAA. Surgical management by conservative gingivectomy, cyst enucleation, and bone grafting was an effective treatment in this patient.

Inflammatory Paradental Cyst in the Mandibular Region: A Report of Two Cases.

A distinctive form of paradental cyst can occur on the buccal and apical aspects of erupted mandibular molars. This cyst has peculiar clinical and radiographic features, although the microscopic findings are the same as those of odontogenic inflammatory cysts. Diagnostic and therapeutic problems can occur when this lesion is misinterpreted as a radicular cyst. The purpose of this paper is to present two additional cases of a paradental cyst in the buccal and mesial aspects of a mandibular first molar involving the apical area. The difficulty of diagnosis, treatment, and controversies regarding terminology are also discussed.

A clinicoradiographic and pathological study of pericoronal follicles associated to mandibular third molars.

BACKGROUND: Third molar surgery is considered the most frequently performed procedure in oral surgery. Although there are some indications for the removal of this tooth, such as the possibility of cystic degeneration or a tumor of the adjacent pericoronal follicle, there is no consensus in the literature about their prophylactic removal. OBJECTIVES: The aims of this study were to investigate the pathological alterations related to mandibular third molar dental follicles and to perform a narrative literature review. METHODS: A prospective clinical, radiographic, and histopathologic study was conducted with pericoronal follicles of third molars. After histopathologic evaluation and establishment of diagnosis, 2 groups were defined: G1 (pericoronal tissues with pathological alterations based on histopathologic analysis) and G2 (pericoronal tissues without pathological alterations based on histopathologic analysis). In addition, a systematic review of the literature was performed. RESULTS: One hundred thirteen specimens were analyzed. G1 was the most prevalent (P = 0.0004). Lesions were found in patients between 20 and 25 years of age (P < 0.004). The most prevalent histological diagnosis was the paradental cyst (47.7%; P < 0.0001). The narrative literature review showed that the majority of cases were mainly dentigerous cysts (P < 0.05). CONCLUSIONS: The mandibular third molars in young adults showed a direct relationship with age and a statistical propensity for the development of these cystic alterations, notably paradental cysts.

Large buccal bifurcation cyst in a child: a case report and literature review.

BACKGROUND: WHO defines the mandibular buccal bifurcation cyst as a cyst occurring near the cervical margin of the lateral aspect of a root as a consequence of inflammatory process in a periodontal pocket. The pathogenesis of these cysts is still debated, but they are most likely originated from reduced enamel epithelium or from inflammatory proliferation of epithelial cell rests of Malassez that come from the superficial mucosa of a tooth in eruption. The aim of this article was to describe a case of large buccal bifurcation cyst of a permanent mandibular first molar. CASE REPORT: A 6-year-old boy was referred to Department of Oral Riabilitation of the Istituto Stomatologico Italiano, University of Milan, Italy, with the complaint of hard swelling over the buccal gingiva and a deep probing depth located on the buccal aspect. Radiograph revealed a well-defined semilunar-shaped radiolucency, marked by a fine radiopaque line on the buccal aspect of the partially-erupted lower right first molar and it was large enough to include a small part of the crown of the second right molar. As reported in the literature the treatment of choice is enucleation and curettage of the lesion without extraction of the vital involved tooth. This procedure has shown excellent results in both the short- and long-term. The definitive diagnosis of paradental cysts can be assessed by histopathologic analysis.

Observer strategy and radiographic classification of healing after grafting of cystic defects in maxilla: a radiological appraisal.

AIM: The aim is to radiographically quantify the bone density and relate the same with observer strategy in the bone healing. OBJECTIVES: To assess pattern of bone regeneration following grafting of defects with hydroxyapatite after apicoectomy/cystic enucleation. MATERIALS AND METHODS: An observer strategy involving trained and experienced examiners used in large series of cases, evaluated radiographically over a period of 1 year with intervals. The cases were grouped into different categories depending on (1) surgical site outline merging with material margin, (2) internal portion of surgical site (i.e. bone formation characteristics) and (3) density of surgical site. The radiographs examined by blind process and the findings were tabulated. Operating surgeon (oral surgeon) has done the interpretation of data to create observer strategy of grafting cases. OBSERVATIONS AND RESULTS: The outline of the defect was changed, partly reduced and completely absent along with remodeling, which showed ground glass, specular or trabecular pattern of bone over a time with increasing density correlating bone regeneration within a short duration. The applied strategy and classification are recommended for follow-up studies. In this study the characteristics of the new bone formation were also delineated. This strategy is helpful for follow-up studies; implant procedures and so; to know quality and condition of bone after treatment.

An evaluation of factors associated with persistent primary teeth.

The aim of the present study was to investigate the reasons for the persistence of primary teeth and also use panoramic radiography to determine the characteristics of persistence teeth. Four-hundred and twenty-six panoramic radiographies, which diagnosed one or more retained primary teeth, were selected from 100,577 panoramic radiographic image files from nine clinics and six different cities in Turkey. The selected radiographies were evaluated to determine the reasons for the persistence of primary teeth; furthermore, this study analyzed the characteristics of the retained primary teeth including tooth type, number, location, and root resorption, and whether, or not, the primary teeth showed evidence of pathological conditions, such as periodontal problems, caries, ankylosis, infra-occlusions, or tipping of the adjacent permanent teeth. Six hundred and seventy-seven retained primary teeth were determined in 426 patients (148 males and 278 females). Retained primary teeth were found most frequently in the mandible rather than the maxilla and the left side was more frequently affected than the right side. Level 1 was found as a most frequently encountered root resorption level. Within the limitation of the present study, the most common type of persistent primary teeth seen on the dental arch were mandibular primary second molars, followed by maxillary primary canines. The most frequent reason for the persistence was the congenital absence of successors to the primary teeth, followed by impaction of the successor teeth.

Odontogenic Keratocyst Is Frequently Misdiagnosed for a Lateral Periodontal Cyst in Premolar and Anterior Tooth-Bearing Areas.

INTRODUCTION: Radiolucent lesions with gingival swelling found in the premolar and intercanine region can elicit a different clinical diagnosis than one confirmed by histologic findings. The purpose of the study is to identify and present the frequency of the unexpected microscopic diagnosis of odontogenic keratocyst (OKC) in a location preoperatively favoring a lateral periodontal cyst (LPC) with similar clinical and radiographic appearance. METHODS: A retrospective analysis of biopsies received from 2011 and 2019 was performed, and the number of LPC and OKC cases was assessed. The alignment of clinical and radiographic diagnosis to histologic findings and anatomic location was analyzed, and the number of OKC cases preoperatively misdiagnosed as LPCs was identified. RESULTS: A total of 79,257 biopsies were received. Of those, 184 were diagnosed as LPCs and 742 as OKCs. For all preoperatively diagnosed LPCs, the clinical and histologic diagnosis aligned; however, 182 of 742 OKCs were submitted with a clinical misdiagnosis of LPCs. The location of these lesions with the unanticipated diagnosis overlapped with those for LPCs, specifically the maxillary and mandibular anterior and premolar regions. CONCLUSIONS: Radiolucent lesions with gingival swelling in the premolar and intercanine region are frequently clinically and radiographically misdiagnosed. A biopsy should be considered in all cases to establish the correct pathologic diagnosis and treatment course.

Paradental cyst of the first molar: a report of two cases.

OBJECTIVE: The paradental cyst is an uncommon lesion associated with the permanent mandibular first or second molar in children just prior to tooth eruption. The purpose of this article is to present two cases of paradental cyst affecting the buccal aspect of permanent mandibular first molar of both young patients. We also discuss diagnosis, treatment and radiographic findings of the cases. PATIENTS AND METHODS: In both cases was made only the enucleation of cyst without extraction of the adjacent tooth. Lesional samples were sent for histopathologic analysis. RESULTS: The histopathologic analysis of both cases, revealed a lining of hyperplastic, nonkeratinized squamous epithelium with heavy, dense inflammatory cell infiltrate in the epithelium and connective tissue wall. The histopathology associated with macroscopic and radiographic examination permitted the definitive diagnosis of a paradental cyst on the mandibular left first molar. A follow-up of 1 year was carried out in both cases and no recurrences was noted; in the first case was observed the correct eruption of the mandibular permanent left first molar. CONCLUSIONS: A clinicopathologic correlation, incorporating the surgical, radiographic, and histological finding, is required to obtain the final diagnosis of paradental cyst. Today, the treatment of choice is simple enucleation and thorough curettage of the cyst without extraction of the involved tooth.

Buccal bifurcation cyst (paradental cyst) defined by ultrasonography and cone-beam computed tomography.

Buccal bifurcation cyst (BBC) is an uncommon inflammatory odontogenic cyst that generally occurs at the buccal region of the permanent mandibular first molars in children aged 6-8 years. The diagnosis of BBC cannot be made from the histopathologic features; therefore, diagnosis is primarily based on specific clinical and radiographic findings. In this case report, we present the clinical and radiological findings, including ultrasonography (USG) and cone-beam computed tomography (CBCT) images, of a 10-year-old boy who was referred with a complaint of swelling on the lower right jaw. According to the radiographic and clinical findings, the differential diagnosis of this lesion included lateral radicular cyst, lateral periodontal cyst, dentigerous cyst, eruption cyst, and others. Recently, in addition to classical radiographies and CBCT, USG has been considered important for diagnosis. In particular, if a cyst produces a perforation in the cortical bone, it is helpful to make a pre-diagnosis with USG.

Guided Bone Regeneration in the Treatment of a Lateral Periodontal Cyst: 2-Year Clinical and Radiologic Follow-up.

Lateral periodontal cysts (LPCs) are rare odontogenic cysts of developmental origin. A 52-year-old man presented with an asymptomatic gingival swelling located between the mandibular left canine and first premolar, both of which were vital. Radiography showed a well-circumscribed radiolucent area and loss of the lamina dura around the tooth socket in contact with the lesion and of the interproximal buccal bone. The lesion was enucleated. The defect was immediately grafted with a 1:1 mixed autologous and heterologous bone graft covered with a collagen membrane. Histology confirmed the diagnosis of LPC. At 12- and 24-month clinical and radiologic follow-up, complete bone and periodontal healing was found, with no sign of recurrence.

A Rare Case of Gingival Cyst in a Child.

Gingival cysts, which are more frequently reported as gingival cysts of adults (GCA), are soft tissue cystic lesions of odontogenic origin that are infrequently seen, especially in children. These lesions usually appear as localized firm elevations on the facial gingiva in the anterior segment of the mandible. The purpose of this paper is to present a rare case of a gingival cyst discovered on the palatal aspect of the posterior maxilla in a four-year-old child. The lesion was treated with excisional biopsy.

Managing a Lateral Periodontal Cyst With Bone Graft: A Computed Tomography Assessment 18 Months Postoperatively.

The lateral periodontal cyst is a rare benign lesion that is generally asymptomatic and commonly discovered by routine intraoral radiography. Reports on proper management of this lesion are readily available. However, the literature is sparse regarding the long-term outcomes following surgery. A traditional radiographic technique does not provide an adequate image of the healing, and a patient may resist the prospect of a reentry procedure. The current report is the first to utilize a cone-beam computed tomography scan to evaluate the healing potential of a freeze-dried bone allograft approximately 18 months postoperatively.