The paradental cyst: a clinicopathologic study of 50 cases

Dentigerous cysts suspected the other odontogenic lesions on panoramic radiography and CT

Dentigerous cysts are known as the second most common type of cyst in the jaws. The cyst is one of the lesions occurred frequently in the posterior body of the mandible and is often related to the unerupted third molar and forms around the crown of the unerupted tooth attaching at the cementoenamel junction. Such characteristic appearances are the diagnostic points differentiating from ameloblastoma or odontogenic keratocyst. However, it would be hard for us to diagnose it as a dentigerous cyst if the lesion does not show its typical appearance. We experienced two cases of dentigerous cysts which did not form around the crown of the unerupted tooth on radiologically. Both cysts were relatively large and resorbed adjacent teeth roots. Therefore, an ameloblastoma or an odontogenic keratocyst was suspected rather than a dentigerous cyst as the imaging diagnosis. The biopsy revealed that the lesion was a "dentigerous cyst" in one of the cases and "developmental cyst with inflammation" in another case. After the excision, the histopathological diagnosis was a dentigerous cyst with inflammation in both cases. This report shows the two cases of dentigerous cysts focusing on panoramic radiography and CT images. Also, we discuss the differential diagnosis by reconsidering those diagnostic points.

Current Perspectives on Paradental Cyst: A Literature Review

Paradental cyst (PC) is an uncommon type of odontogenic cyst of inflammatory origin, which develops near the cervical margin of the outside of the root of a vital tooth. The category of paradental cyst includes the buccal bifurcation cyst, which is found in the buccal area adjacent to the mandibular first or second molars in children. A conclusive diagnosis of a PC needs to correlate the surgical, radiographic, and histologic findings. When strict diagnosis is neglected, they can be easily misdiagnosed and mistreated. PCs associated with mandibular first and second molars and those associated with the mandibular third molar may have slightly different clinical manifestations but have almost completely different treatment principles due to the distinction in location. For the third molars, removal of both the tooth and the cyst is preferred. However, when the first or second molars are affected, it may be advisable to perform enucleation of the lesion while preserving the associated tooth. There are also more conservative methods to retain vital permanent teeth within the mandibular arch. Additionally, the cyst wall primarily consisted of granulation tissue firmly attached to the periodontal ligament space. The exact origin of these cysts was a subject of ongoing debate, but they were believed to primarily arise from either the reduced enamel epithelium or the inflammatory proliferation of junctional/sulcular epithelium, which originate from the superficial mucosa during tooth eruption. The aim of the present review was to update information on clinical manifestations, diagnosis and treatment strategies of cysts and discuss their pathogenic mechanisms. Raising familiarity with the distinctive features is beneficial for accurately diagnosing these lesions and effectively caring for the patients.

Actinomycosis of periodontium, mimicking gingival enlargement - A case report and its management

Gingival abscess is a localized, acute inflammatory lesion which is caused by various factors that include microbial plaque infection, foreign body impaction, and trauma. Management includes a simple incision and draining of the purulent exudate along with systemic antibiotics in most of the cases. This article reports a case of a 16-year-old female patient, with a chief complaint of painful and swollen gums in her lower right front tooth region of the jaw along with fever for the past 5 days. Emergency treatment of abscess drainage was done on day 1. On 5th day of review, the case presented with persistent signs of gingival inflammation in relation to 43 to 41. Considering the provisional diagnosis as dentigerous cyst with persistent gingival abscess, definitive treatment was performed by transalveolar extraction of the impacted canine and debridement of the osseous lesion. The histologic analysis of the lesion exhibited foci of eosinophilic coagulum-like areas with epicentric and radiating filamentous appearance at the periphery, which is suggestive of an inflamed dentigerous cyst with actinomycosis infection of periodontium.

Volumetric reduction in large cystic jaw lesions postoperative enucleation: a longitudinal clinical study

BACKGROUND

Enucleation, a surgical procedure, is commonly used to treat large jaw cysts, unicystic ameloblastomas and keratocysts. However, it remains unclear to what extent the jaw bone regenerates after enucleation. We aimed to evaluate the percentage and the survival analysis of jaw bone regeneration, in terms of cavity volume residual (CVR), in patients who underwent enucleation of large jaw cysts, unicystic ameloblastomas and keratocysts.

METHODS

We collected data longitudinally from 75 patients who underwent jaw cystic lesions enucleation at the Stomatological Hospital of Xi'an Jiaotong University, between January 2015 and June 2021. All patients had both preoperative and postoperative cone-beam computed tomography (CBCT) imaging data. CBCT images were analyzed using Image J. Changes in the CVR were assessed at various follow-up time points, and the Kaplan-Meier method was utilized to evaluate the CVR over time.

RESULTS

The patients had a mean age of 31.7 years (range: 5.5-72 years) with 58.66% of them being male. The postoperative CVR was 32.20% at three months, 21.10% at six months, 15.90% at 12 months, and 5.60% at 24 months. The percentage of CVR during follow-up periods for the initial size Quartile (Q)1 (212.54-1569.60 mm3) was substantially lower than those of Q2 and Q3 at and after seven months of follow-up and became statistically significant at the 12-month mark.

CONCLUSION

This study demonstrates that spontaneous bone regeneration can occur after enucleation of large jaw cysts, unicystic ameloblastomas and keratocysts, even without the use of filler materials. The initial size of the lesion had a significant impact on the outcome of cystic lesion enucleation over time. To minimize the risks associated with radiation exposure and expenses, we recommend reducing the frequency of CT imaging follow-ups for patients with small initial cavity sizes (ranging from 212.54 to 1569.60 mm3).

Frequency and Demographic Profile of Odontogenic Cysts in Riyadh, Saudi Arabia: Retrospective Multicenter Study

Odontogenic cysts (OCs) are etiologically diverse conditions with a shared origin in the jaws. Unfortunately, there is a scarcity of published data regarding OC frequency, treatment, and follow-up information in Saudi Arabia, especially from tertiary centers.

OBJECTIVES

The study aims to assess the relative frequency, clinicopathological features, treatment, and follow-up of OCs in three tertiary medical centers.

METHODS AND MATERIAL

OCs were identified from King Abdulaziz Medical City, King Fahad Medical City, and Prince Sultan Military Medical City from January 2010 to December 2021.

RESULTS

Three hundred and seventy-two cases of OCs were identified from the archive of three medical centers in Riyadh; one hundred and forty-nine (40%) cases were retrieved from Prince Sultan Military Medical City. The mean age of all OCs was 32 years (range 2-90), with 225 (60.4%) cases occurring in males. There was an almost equal distribution of OCs between the maxilla (47.0%) and the mandible (53.0%). The apical radicular cyst (ARC) accounted for half of the cases, followed by dentigerous cyst (DC) (29.3%) and odontogenic keratocyst (OKC) (14.2%). Enucleation was the most common treatment modality (52.8%), followed by excision (35.0%). Thirteen cases showed recurrence: one ARC, four DCs, and eight OKCs.

CONCLUSION

This is the first large multicenter study of OCs in Riyadh, Saudi Arabia. All three centers showed that ARC was the most common, followed by DC and OKC.

Success in Conservative Treatment of an Inflammatory Follicular Cyst: A 5-year Follow-up

The inflammatory follicular cysts are cystic lesions associated with non-erupted permanent teeth and involve devitalized deciduous teeth. Products resulting from the necrotic pulp of deciduous teeth stimulate crown hood growth of successor permanent tooth radiographically shown as a unilocular, radiolucent area, associated with an impacted permanent crown. Treatment based on cyst decompression and maintenance of the deciduous tooth is a conservative approach to space maintenance. This case report describes the diagnosis, treatment, and post-surgery follow-up after 5 years of an extensive inflammatory follicular cyst in the mandible, in the region of tooth 75, with marsupialization being the method of treatment and emphasizing the importance of clinical and radiographic follow-up. How to cite this article: de Oliveira GAA, Limongi MC, Garcia HS, et al. Success in Conservative Treatment of an Inflammatory Follicular Cyst: A 5-year Follow-up. Int J Clin Pediatr Dent 2021;14(2):327-330.

The canine furcation cyst, a newly defined odontogenic cyst in dogs: 20 cases (2013-2017)

OBJECTIVE

To characterize clinical, radiographic, and histologic features of canine furcation cysts (CFCs) in dogs and to propose possible mechanisms of CFC development.

ANIMALS

20 client-owned dogs with CFCs biopsied between January 1, 2013, and December 31, 2017.

PROCEDURES

Medical records of the Center for Comparative Oral and Maxillofacial Pathology at the University of Wisconsin-Madison were retrospectively searched to identify records of dogs that had surgical biopsy specimens of mandibular or maxillary cavitary lesions diagnosed as odontogenic cysts and that met additional inclusion criteria. Biopsy sample submission records, medical records, clinical and radiographic images, and histologic samples were reviewed. Clinical, radiographic, and histologic features were evaluated.

RESULTS

Mean body weight and age of affected dogs were 23.5 kg (51.7 lb) and 8.2 years, respectively. All 20 dogs had a unilateral cyst, with the right (n = 13) or left (7) maxillary fourth premolar tooth affected and viable in all dogs. A predominant clinical sign was a fluctuant swelling of the buccal gingiva and mucosa overlying the CFC, and enucleation of the cyst lining, with or without extraction of the affected tooth, resolved the lesion in most dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Our findings indicated that CFC is an odontogenic cyst of uncertain etiopathogenesis and that complete evaluation of the clinical, radiographic, and histologic features of the lesion in affected patients is necessary to distinguish a CFC from other odontogenic cysts and tumors in dogs. Defining CFCs in terms of characteristic features permits accurate diagnosis and appropriate treatment of these previously unclassifiable odontogenic cysts in dogs.

Bilateral mandibular buccal bifurcation cyst: a case report emphasizing the role of imaging examination in the diagnosis

A mandibular buccal bifurcation cyst is an inflammatory cyst that usually occurs on the buccal aspect of the permanent mandibular first molar of children. This lesion is diagnosed by an association of radiographic, clinical, and histological features. We report a bilateral case of mandibular buccal bifurcation cyst and discuss the main findings of this entity. A 7-year-old girl presented pain and delayed dental eruption in the posterior mandibular region. A cone beam computed tomography was performed and revealed hypodense lesions involving the crown and root of the mandibular first molars, with expansion of the buccal cortical and lingual tilting of the molar roots. A biopsy was carried out, and the common features of an inflammatory odontogenic cyst were histologically observed. The final diagnosis was bilateral mandibular buccal bifurcation cyst. Clinicians need to be aware of this diagnostic possibility in cases of mandibular cysts in children—especially when bilateral—to perform the correct treatment, which should not involve the extraction of the affected tooth.

Cysts and Pseudocysts of the Oral Cavity: Revision of the Literature and a New Proposed Classification

This article includes a comprehensive and up-to-date review on the cysts of the oral cavity. Several classifications of odontogenic (OC) and non-odontogenic (non-OC) oral cysts and the surrounding regions have been proposed. We suggest a new critical classification based on an established relationship between anatomical area, histological origin and clinical behavior (frequency, rate of recurrence, malignant potential). Moreover, the differential cytokeratin (CKs) expression of the various cysts is reported as epithelium-specific markers of differential diagnosis. Finally, issues related to differential diagnosis and therapeutic approaches of the cysts included in the two groups are described.

Role of cone-beam computed tomography in the evaluation of a paradental cyst related to the fusion of a wisdom tooth with a paramolar: A rare case report

Fusion is an abnormality of tooth development defined as the union of two developing dental germs, resulting in a single large dental structure. This irregular tooth morphology is associated with a high predisposition to dental caries and periodontal diseases. As a result of recurring inflammatory periodontal processes, disorders such as periodontal pocket, pericoronitis, and paradental cysts may develop. A rare mandibular anatomic variation is the retromolar canal, which is very significant for surgical procedures. The fusion of a paramolar and mandibular third molar associated with a paradental cyst co-occurring with the presence of a retromolar canal is rare, and the aim of the present study is to describe the evaluation of this anatomical configuration using cone-beam computed tomography.

Benign cysts and tumors of the paranasal sinuses

To thoroughly understand the biology of any lesion and render the appropriate management, clear and accurate definitions are paramount. For benign cysts and tumors of the oral maxillofacial region, an accurate depiction of these lesions needs to be elucidated to provide both the treating surgeon and the patient with a clear understanding of the course of treatment and the outcome.

Paradental (mandibular inflammatory buccal) cyst

The paradental cyst is commonly misinterpreted when associated with atypical clinical and radiographic characteristics, in turn causing diagnostic problems. For this reason, the study of the differential diagnosis of this lesion has become extremely important. In addition, the correlation of clinical, histologic, and radiographic findings are also of great value in obtaining accurate diagnoses. The minor variations in the clinical appearance of paradental cysts make it feasible to consider the two main groups of cysts separately: those associated with 1st and 2nd permanent molars of the mandible and those associated with the 3rd mandibular molar. Moreover, this distinction in localization may well dictate the necessary treatment. Bearing in mind the minor clinical variations, the present article aims to discuss the differential diagnosis of this lesion and its different possible treatments by presenting a case report to illustrate the findings.

Pathology Associated With Impacted Mandibular Third Molars in a Group of Jordanians

PURPOSE

The aim of this study was to determine the frequency and type of a group of radiographically detectable pathologic conditions around impacted mandibular third molars in Jordanians.

PATIENTS AND METHODS

A retrospective study of patients referred to the Oral and Maxillofacial Surgery unit for surgical removal of impacted mandibular molars. The analysis outcome measures were the patients' age and gender, and any radiographic lesions associated with the impacted mandibular third molars. The following radiographic lesions were recorded in relation to the impacted third molar: caries, pericoronal radiolucent areas, and periapical radiolucent areas, in addition to odontomes, caries in the adjacent second molars, and external resorption of the roots of adjacent mandibular second molars. Bony radiolucent areas were all verified histopathologically.

RESULTS

Impacted mandibular third molars (N = 2,432) from 1,398 patients were examined; 46.4% of third molars showed associated radiographically detected lesions. The most common lesion seen on panoramic radiographs was dental caries. Others included pericoronal radiolucent and periapical radiolucent areas. The majority of periapical radiolucent areas were histologically proven to be chronic periapical inflammation. All pericoronal radiolucent areas were histologically found to be either cysts or tumors. The most common cyst was dentigerous cyst; the most common tumor was ameloblastoma.

CONCLUSION

A high ratio of impacted mandibular third molars in this group of Jordanians had an associated pathologic lesion.

Paradental cyst: report of two cases

BACKGROUND

The paradental cyst is an odontogenic lesion of inflammatory origin that has few clinical signs and symptoms apart from recurring acute episodes. A well-defined radiolucency associated with the roots or distal to the crown may be seen radiographically. The purpose of this article is to report on different aspects of two cases involving paradental cysts. In the first case, the patient complained about recurring pericoronitis. A semilunar-shaped radiolucency on the distal aspect of the mandibular third molar was noted on the periapical radiograph. In the second case, the patient's main complaint was chronic trauma of the overlying mucosa. Radiographs revealed an enlarged pericoronal space.

METHODS

In both cases, the mandibular third molar was extracted due to a lack of space. Lesional samples were sent for histopathologic analysis.

RESULTS

In the first case, the drainage of cystic fluid and a regular concavity were found during tooth removal. In the second case, a nodular lesion was found adhering to the disto-buccal surface of the tooth arising from the distal wall of a periodontal pocket. The histopathologic analysis revealed a hyperplastic stratified squamous epithelium with arcading lining a fibrous capsule with inflammatory infiltrate, resulting in a final diagnosis of a paradental cyst.

CONCLUSIONS

The presence of a paradental cyst should be considered when recurrent inflammatory periodontal processes are associated with partially erupted vital teeth, even when characteristic radiographic findings are absent. Definitive diagnosis requires a clinicopathologic correlation incorporating surgical, radiographic, and histologic findings.

Infected paradental cysts in children: A clinicopathological study of 15 cases

We report the clinical, radiographic and histological features of 15 paradental cysts of the first and second molars and recommend conservative surgical treatment. Twelve young patients were operated on for 15 paradental cysts of the first and second molars, and had conservative operations with partial preservation of the mandibular cortical bone. After 2 years there had been no recurrences. The differential diagnosis of paradental cyst was fundamental to allow the correct treatment and the early diagnosis of lesions on the opposite side. The maintenance of periodontal hygiene in the immediate and late postoperative periods was an aid to ensure complete remission of the lesions.

Inflammatory paradental cyst (IPC) in the mandibular premolar region in children

OBJECTIVES

We investigated the occurrence of inflammatory paradental cysts (IPC) in the mandibular premolar, and demonstrated the points of difference with regard to diagnostic features between IPC and dentigerous cysts (DC).

MATERIAL AND METHODS

We analyzed the radiographs and histology of 60 cases with a cystic lesion associated with inflammation in the mandibular premolar region based on diagnostic criteria as IPC.

RESULTS

In 4 out of 60 cases, we diagnosed the 4 cysts as IPCs in the mandibular premolar region, and recognized that one form of IPC was similar to a mandibular infected buccal cyst. The other 56 non-IPC cases were diagnosed as DC. On the IPCs, the permanent tooth normally erupted in all 4 cases after treatment, but in one case, the IPC recurred.

CONCLUSIONS

The present investigation suggested that we might have misdiagnosed IPCs in the mandibular premolar region as DC to date. It is important to consider the differences between IPC and DC with regard to the causes of recurrence during treatment of IPC.

Diagnosis and management of unusual dental abscesses in children

Although the majority of dental abscesses in children originate from dental caries or trauma, a few are associated with unusual conditions which challenge diagnosis and management. Recent research findings have shed light on these unusual entities and greatly improved understanding of their clinical implications. These conditions include developmental abnormalities such as dens invaginatus in which there is an invagination of dental tissues into the pulp chamber and dens evaginatus in which a tubercle containing pulp is found on the external surface of a tooth crown. In addition, inherited conditions which show abnormal dentine such as dentine dysplasia, dentinogenesis imperfecta, and osteogenesis imperfecta predispose the dentition to abscess formation. Furthermore, 'spontaneous' dental abscesses are frequently encountered in familial hypophosphataemia, also known as vitamin D-resistant rickets, in which there is hypomineralization of dentine and enlargement of the pulp. In addition to developmental conditions, there are also acquired conditions which may cause unusual dental abscesses. These include pre-eruptive intracoronal resorption which was previously known as 'pre-eruptive caries' or the 'fluoride bomb'. In addition, some undiagnosed infections associated with developing teeth are now thought to be the mandibular infected buccal cysts which originate from infection of the developing dental follicles. In the present paper, these relatively unknown entities which cause unusual abscesses in children are reviewed with the aim of updating the general practitioner in their diagnosis and management.

Paradental cyst mimicking a radicular cyst on the adjacent tooth: case report and review of terminology

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 an additional case of a paradental cyst in the buccal and mesial aspects of a mandibular second molar involving the apical area of a mandibular first molar. The difficulty of diagnosis, treatment, and controversies regarding terminology are also discussed.

Paradental cysts: a role for food impaction in the pathogenesis? A review of cases from Northern Ireland

We present the clinical, radiographic and histological findings of 15 paradental cysts. These were the second most common type of cyst associated with mandibular third molars, comprising 25% of all lesions at this site. Ten patients were aged 30 years or younger and 13 gave a history of pericoronitis. There was a close relationship between the site of the cyst and the angle of the impacted tooth; the cyst lay mesially to two mesioangularly impacted teeth, buccal to two vertically impacted teeth and distal/distobuccal to the remainder, all but one of which were distoangular in impaction. The pericoronal follicular space was preserved in nine cases, a useful diagnostic sign. Most cysts were lined with epithelium that resembled that seen in radicular cysts, although the lining of three cysts resembled that of unicystic ameloblastoma, a potential diagnostic pitfall. We propose that the relation between location of cyst and angle of impaction points to a role for food impaction in the pathogenesis of paradental cysts.

A contribution to the diagnosis of the small dentigerous cyst or the paradental cyst

The aim of this study was to verify the relationship between the radiographically measured width of the pericoronal space (PS) and the microscopic features of the follicle in order to contribute to the diagnosis of small dentigerous cysts and paradental cysts. One hundred and thirty unerupted teeth (UT) and thirty-five partially erupted teeth (PET) were radiographed and extracted. The radiographic analysis consisted of measuring the width of the PS. The results of the radiographic analysis were compared with those of the histopathologic examination of the dental follicle. The width of the PS ranged from 0.1 to 5.6 mm. The most frequently observed lining of the follicles was a reduced enamel epithelium (REE) (68.4%) in UT and a hyperplastic stratified squamous epithelium (HSSE) (68.5%) in PET. Inflammation was present in 36.1% of the UT and in 82.8% of the PET. There was a statistically significant association between the presence of stratified squamous epithelium (SSE) and PS enlargement for UT (p < 0.05). There was a tendency of association between inflammation and PS enlargements in PET and, possibly, in UT, despite the absence of statistical significance. Surgically, we did not detect bone cavitation or luminal cystic contents in pericoronal spaces smaller than 5.6 mm. We suggest that the first radiographic diagnosis for a PS enlargement, in most of the routine clinical cases, should be of "inflammation of the follicle". The hypothesis of "dentigerous cyst" or "paradental cyst" is suggested as a second diagnosis. The final differential diagnosis between a small dentigerous or a paradental cyst and a pericoronal follicle depends on clinical and/or surgical findings, such as the presence of bone cavitation and cystic content.

The buccal bifurcation cyst: a prospective study of treatment outcomes in 44 sites

OBJECTIVE

The clinical, radiographic, and histologic features of the mandibular buccal bifurcation cyst were studied to further define this lesion. The treatment and outcomes were also analyzed.

STUDY DESIGN

This prospective study, which spanned 3 years, included 32 patients. Their ages ranged from 5.5 to 11 years (mean of 7.5). A total of 44 buccal bifurcation cysts were treated solely with enucleation, and patients were followed up for 2.5 to 3 years.

RESULTS

All lesions were located at the buccal bifurcation of the mandibular first molar. Tilting of the buccal cusps, causing prominence of the lingual cusps, occurred in 75% of the cases. The lesion extended from the buccal bifurcation to the tooth apex in 81.2%, and a periosteal reaction on the lateral surface of the mandible adjacent to the cyst was noted in 68.8% of the cases. All of the 44 histologic reports were nonspecific, but showed a cyst lining of stratified squamous epithelium with chronic inflammation. Microbiology consisted of mixed oral flora. Complete radiographic healing in all sites without recurrence was noted in 2.5-year follow-up. The periodontal pocket depth around all the involved teeth was normalized. No loss of the mandibular first molars occurred.

CONCLUSIONS

The mandibular buccal bifurcation cyst is a distinct site-specific and age-specific clinical entity treatable by enucleation without tooth extraction.

Dentigerous cysts of inflammatory origin. A clinicopathologic study

The exact histogenesis of dentigerous cysts remains unknown, but most authors favor a developmental origin from the tooth follicle. The aim of this article is to report a series of 15 dentigerous cysts that we believe to be of inflammatory origin. These inflammatory dentigerous cysts occurred in the first and early part of the second decades of life. Males were affected more frequently, and there did not appear to be any racial predilection. All of the cases involved permanent teeth: premolars in nine cases, canines in four cases, and second molars in two cases. The mandible was affected twice as frequently as the maxilla. In 13 cases, nonvital grossly carious or heavily restored deciduous teeth were associated with the cysts. Some of these teeth had been extracted before the cysts were diagnosed. In the remaining two cases, both of which involved the second permanent molars, there were no nonvital deciduous teeth, however both had concomitant proliferative periostitis. All of the cysts were moderately or intensely inflamed and were lined predominantly or entirely by nonkeratinized stratified squamous epithelium that in some cases was markedly hyperplastic and exhibited anastomosing rete ridges mimicking radicular cysts. In the majority of cases, parts of the cysts were lined with a 2 to 3 cell layer thick cuboidal epithelium that we believe was derived from reduced enamel epithelium. Rests of odontogenic epithelium frequently were evident in the cyst walls. We suggest that these cysts arose as a result of periapical inflammation from any source but usually from a nonvital deciduous tooth and spreading to involve the follicles of the unerupted permanent successors. The inflammatory exudate causes separation of the reduced enamel epithelium from the enamel with resultant cyst formation. This study proposes the existence of two types of dentigerous cysts: one developmental and the other inflammatory in nature.

Diseases and lesions associated with third molars. Review of 1001 cases

This study reports on a retrospective survey of 1001 panoramic radiographs in a dental school population of persons with impacted third molars. The objective was to determine the association between pathologic conditions visible on radiographs and third molar teeth. In the series 2872 impacted third molars were examined. The most common problem seen radiolucencies. Other than caries, occurrence rates were low. Statistically significant differences in occurrences rates were seen within and between jaws for various pathologic conditions. The low rates did not offer support for the likely presence of pathologic conditions to be an indication for third molar removal.

The mandibular infected buccal cyst (paradental cyst). A radiographic and histological study

Mandibular infected buccal cysts occur on the buccal and distal aspects of the roots of partly or fully erupted mandibular molars with vital pulps. In the present investigation six cases associated with mandibular first and second molars were studied. The cysts were lined with a non-keratinised squamous epithelium with a mixed inflammatory cell infiltrate in the connective tissue. The clinical and microscopic features were similar to those of previously reported paradental cysts. The inflammation always present in these cysts may have an important role in their pathogenesis. It may induce periodontal pocketing, which may lead to hyperplasia and cyst formation in adjacent odontogenic epithelium, which may be either remnants of the reduced enamel epithelium or cell rests of Malassez.

Unusual jaw-bone cysts

Four cases of unusual types of jaw-bone cysts (paradental, lateral periodontal/botryoid type, sialo-odontogenic, and intraosseous dermoid cyst) are reported. Radiographic and histopathologic features are described. Current literature is reviewed with special attention given to radiographic, histogenetic, and histopathologic aspects of these entities.

The inflammatory paradental cyst

The inflammatory paradental cyst has previously been described as the collateral inflammatory cyst, the inflammatory lateral periodontal cyst, the paradental cyst, or the mandibular infected buccal cyst. Clinical, radiographic, and histologic features of 29 inflammatory paradental cysts diagnosed over a 5-year period were studied. The cysts occurred in relation to a partly or fully erupted tooth with a vital pulp. Twenty-seven of the cysts were located in the mandible and the remaining two in the maxilla. The mandibular cysts were in all cases associated with a molar. The observation that the cysts are diagnosed within a few years after tooth eruption and the demonstration of a statistically significant difference (p = 0.001) in age distribution and in the type of tooth involved suggest that eruption is important for the development of the cysts. The consistent finding of a hyperplastic, nonkeratinized stratified squamous epithelium with an intense inflammation in the connective tissue is in accordance with the hypothesis that inflammation is important for the development of these cysts.

The paradental cyst: a clinicopathologic study of six new cases and review of the literature

The paradental cyst is an inflammatory odontogenic cyst arising in conjunction with partially erupted vital teeth associated with pericoronitis. In this study of six cases, these cysts were found primarily adjacent to the buccal root surface of mandibular third molars. Radiographically, they presented as well-defined radiolucencies superimposed over the roots of the affected teeth. Where extracted teeth were available for examination, these cysts were usually associated with a developmental enamel projection or ridge extending into the buccal bifurcation. These developmental anomalies may be instrumental in the pathogenesis of paradental cysts. Although the paradental cyst may represent a distinct entity, a variant of the dentigerous cyst, or an occluded periodontal pocket, it is a useful descriptive term to explain the unique clinical, radiographic, and gross characteristics of this lesion.