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.

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.

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.

Lateral periodontal cyst

The lateral periodontal cyst (LPC) is a harmless developmental aberration derived from odontogenic epithelia lying between the roots of vital teeth. The exact histogenesis of LPC is a matter of debate but therapy is usually only required to maintain stable periodontal conditions and in case of evidence for growth of the cyst. We report on a case of LPC where successful surgical therapy had initialized osseous restoration. We further discuss the value of histological findings to substantiate a clinical and radiological diagnosis.

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.

[A radiolucency between the roots of 2 vital teeth]

An asymptomatic radiolucency between a vital 44 and 45 was detected in a 64-year-old woman. Treatment consisted of enucleation. Histopathologically, the features of a lateral periodontal cyst were observed. The lateral periodontal cyst is a rather rare developmental odontogenic cyst that has a tendency to recur after incomplete removal.

An unusual clinicoradiographic presentation of a lateral periodontal cyst--report of two cases

The lateral periodontal cyst and the botryoid odontogenic cyst are two rare nosological entities, who, despite their radiological and clinical presentation can only be diagnosed by their rather typical histopathological characteristics. The purpose of this article is to report two cases of radiolucent cystic lesions of the mandible, located in the premolar area, with a clinical and radiographic diagnosis of residual cyst, which showed histological features of a lateral periodontal cyst. Histopathologically, the lateral periodontal cyst lining is characterized by a thin cuboidal to stratified squamous non-keratinizing epithelium, ranging from one to five cell layers and presence of one or more epithelial thickenings or plaques. Furthermore, glycogen-rich clear cells encountered either in the epithelial plaques or in the superficial layer of the lining epithelium.

Histological Observations Of Periradicular Healing Following Root Canal Treatment

The purpose of this study was to observe histologically the sequence of events leading to resolution of periradicular tissues, with a view to advancing the perception of periapical healing. Our material consisted of periapical specimens obtained from 15 single-rooted, endodontically treated teeth of patients aged 25-40 years. All the teeth required extraction because of complicated crown-root fracture following trauma, iatrogenic aetiology (cervical root resorption following bleaching) or extensive carious lesions. The patients were informed that, based on their clinical condition, surgical procedures should be performed under flap reflection in order to extract the fractured root. Informed consent, which was necessary for the surgery, was obtained in all cases. A small block section containing the apical root tip and surrounding periapical tissues was removed prior to root extraction. The results of histological examination revealed osteoblastic activty and osteoid bone formation six days after the root canal instrumentation. Periapical tissue healing was observed despite the presence of overfilled material. The lining epithelium was infiltrated with chronic inflammatory cells and surrounded by collagen bundles and newly formed bone.

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.

[Inflammatory paradental cyst. Report of 6 cases]

BACKGROUND

The inflammatory paradental cyst has been described as an entity in the WHO classification of odontogenic tumors and cysts (1992). It is mainly located at mandibular molars, in particular third molars of the lower jaw. Radiologically, involved molars show a circumscribed, mostly half-moon shaped translucency distal or distobuccal to the involved tooth. Patients frequently report episodes of infection (pericoronitis). The histological findings are identical to those of inflammatory radicular cysts. The inflammatory paradental cyst has been described infrequently in the international literature. There are no reports available in German.

AIM OF THE STUDY AND CASES

The aim of the present study was to present six of our own cases of inflammatory paradental cysts. Five men and one woman with an average age of 29.5 years were affected. In two cases paradental cysts occurred bilaterally. Three patients reported recurrent previous infections (pericoronitis). Radiologically, the typical translucency with clear demarcation distal to the third molars was observed. All of the third molars were vertically retained. Histologically, the inflammatory paradental cysts showed features identical to those of radicular cysts. The inflammatory paradental cyst is a clear indication for osteotomy of lower wisdom teeth. Postoperative complications or recurrences of the inflammatory paradental cysts have not been described.

DISCUSSION

A correct clinical, radiological, and histopathological diagnosis of paradental cysts is mandatory, and more reports are needed in order to compile more information about relative frequency and pathogenesis of this cyst variant.

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.

[Microcystic lateral parodontal cyst. Report of a case]

The lateral periodontal cyst (LPC) is an odontogenetic lesion of the maxillary bone representing about 0.8% of maxillary cystic lesions. It starts in the lateral periodontal area of a vital erupted tooth. Clinical symptoms are generally absent. Its diagnosis usually can be made on the basis of an occasional radiographic examination which shows an osteolytic monoloculate lesion with defined outlines. The botryoid cyst is a variation of LPC and is radiographically different and more aggressive than the common LPC. A clinical case of LPC which allows to make histopathological and clinical considerations on these cystic lesions is described.

Unusual surgical approach in a bilateral case of mandibular buccal infected cyst

In the new edition of WHO's "Histological typing of odontogenic tumors", the mandibular infected buccal cyst, that is associated with the lower first or second permanent molars, is considered a paradental cyst as well as the inflammatory collateral cyst, which is usually related to the lower third molar. The lesion occurs on the buccal and lateral aspects of the roots of mandibular molars with vital pulp, at the eruption time, in children aged between 6 and 10 years. The inflammation is always present in these cysts and may have an important role in their pathogenesis because it stimulates hyperplasia and cystic change of the reduced enamel epithelium or the epithelial cell rests of Malassez. The authors report the case of a 7-year-old girl, in whom both first mandibular molars were affected by an infected buccal cyst. A different surgical approach was performed with marsupialization on the left side and cystectomy on the right side. The case reported here seems to be interesting because it is the second well documented case of bilateral mandibular infected cyst associated with unerupted molars and because the adopted treatment differs from the therapeutical approach suggested in the literature. A 6-year follow-up demonstrates a correct dental and bone evolution on both mandibular molar sides.

Clinicopathologic features of 54 cases of paradental cyst

OBJECTIVE

The aim of the study was to evaluate the clinicopathologic features of 54 paradental cysts.

METHOD AND MATERIALS

The cases were retrieved from the files of the Department of Oral Pathology of the University of São Paulo, in Brazil. Only case files that included complete data, radiographs, and clinical history were used for the study.

RESULTS

Most of the cysts were adjacent to a partially erupted mandibular third molar; only two cysts were adjacent to mandibular second molars, and one cyst was adjacent to a first molar. Women were affected more often than were men (33:21), and most of the patients were in their second or third decades. In most cases, the affected tooth had a history of one or more episodes of pericoronitis. Histologically, these cysts presented the typical features of an inflammatory cyst, having a lining epithelium, which apparently resulted from a union between reduced enamel epithelium and oral epithelium.

CONCLUSION

Development of the paradental cyst could be avoided if episodes of pericoronitis were properly treated, because the cyst is usually related to pericoronitis.

Long-term follow-up on keratocysts treated according to a defined protocol

A prospective study was conducted on 82 odontogenic keratocysts (OKCs) diagnosed in 80 patients over a 25 year period. The clinical and radiographic data were correlated, which resulted in an accurate picture of the clinical presentation, relationship with teeth and incidence of lingual perforations in mandibular OKCs. In 40% of the cysts no suspicion had arisen before surgery, in 60% the diagnosis was secured before surgery. This last group of patients was treated according to a defined protocol, with the exception of the maxillary OKCs, which entailed excision of the attached, overlying mucosa and enucleation of the cyst after which the defect was treated with Carnoy's solution. The other patients underwent just enucleation of the cysts. For the first 5 years the patients were seen every year, thereafter every 2 years if possible. Recurrences (9/82) were mainly found in the patients in which the cyst had just been enucleated. Only three cysts recurred in the group treated according to the above mentioned protocol. Most recurrences presented within 5 years, but late recurrences did occur even after 25 years. The aetiology and pathogenesis of OKCs is briefly discussed in the light of the present findings. It is concluded that the suggested treatment protocol and follow-up schedule provides a safe means to manage a lesion that is known to recur and may even give rise to life threatening situations.

The lateral periodontal cyst: aetiology, clinical significance and diagnosis

The lateral periodontal cyst (LPC) is a relatively uncommon but widely recognized odontogenic cyst of developmental origin. It is found mostly in adults and has no sex predilection. LPC is usually discovered during routine radiographic examination, is located mainly between the roots of vital mandibular canines and premolars, and seldom causes pain or other clinical symptoms. The defect appears on radiographs as a round or teardrop-shaped, well circumscribed radiolucency. Due to its location it can easily be misdiagnosed as a lesion of endodontic origin. In this paper, two cases of lateral periodontal cysts are presented. In the first case, the patient (woman, 62 years old) complained of an asymptomatic gingival swelling in the region between the right maxillary canine and premolar. The radiographic examination revealed a well circumscribed radiolucency with a radiopaque margin between the roots of the canine and premolar. The adjacent teeth had vital pulp. Surgical enucleation of the lesion was performed and the histological examination revealed that the lesion was a "lateral periodontal cyst of developmental origin". In the second case, the patient (women, 44 years old) complained of a swelling in the area of tooth 32. During radiographic examination a well circumscribed radiolucency between the roots of the lateral incisor and the canine was discovered. Surgical enucleation of the lesion was performed and the histological examination revealed that the lesion was a "lateral periodontal cyst of developmental origin".

Lateral periodontal cyst: report of a case with 1-year reentry

The lateral periodontal cyst is a relatively rare cyst of the jaw (0.8%) of unproven origin. It is most commonly found in the mandible between the roots of canines and premolars. This article reports a case of a lateral periodontal cyst in a 73-year-old woman, documents its diagnosis and treatment, and also presents a 1-year reentry. No grafting or barrier techniques were used. The result was complete bony regeneration of the defect after 1 year.

Rapid cystic involvement of a lower third molar

Cystic change can occur in association with partially and unerupted lower third molars. This case report describes an inflammatory paradental cyst which developed over a relatively short period of time and presented with acute symptoms.

The buccal bifurcation cyst: in non-surgical treatment an option?

The mandibular buccal bifurcation cyst (BBC) was first described by Stoneman and Worth in 1983. It is a lesion with a specific location, classically the buccal surface of the mandibular first molar and less frequently the mandibular second molar. There have been numerous reports in the literature describing the BBC and its treatment. Treatment advocated thus far includes extraction of the involved first molar, marsupialization and enucleation of the cyst. In their most recent article, Pompura, Sándor and Stoneman reported on the successful treatment of 44 cysts with enucleation without tooth extraction. This article will describe the diagnostic features of the BBC and present three cases with a total of five cysts, which were treated non-surgically and ultimately resolved. The authors, therefore, propose that a more conservative non-surgical approach to these lesions may be considered.

Lateral periodontal cyst: a case report and review of the literature

A polycystic lateral periodontal cyst was observed over a period of 25 months. The case history, a description of the natural history of this lesion and its diagnostic characteristics, and a review of the literature are presented.

[Computerized presentation of densitometry values of the size of bone defects]

On the basis of experimental knowledge, this investigation intended to give its contribution to knowledge of the process of bone reparation and regeneration of alveolar extension cyst's. The results have shown that the denzinometrics, as a possible way of reparational and regenerational processes verification, has its full X-ray and clinical justification as it enables not only the observation of the reparational process but also mutual comparison.

Case #7. Residual cyst

A 26-year-old male visited a general dentist for his annual check-up. Radiographic examination revealed a small radiolucent lesions in the anterior mandible.

Lateral periodontal cyst. Multifactorial analysis of a previously unreported series

The objective of the present study was to review a series of 23 lateral periodontal cysts and 2 botryoid odontogenic cysts retrieved from the files of the State University of New York at Buffalo (SUNY) Oral Pathology Biopsy Service for epidemiologic characteristics as well as radiographic findings, clinical presentation, histopathologic features, and management. This study corroborated some previously established characteristics of the lesion but also revealed some surprising aberrations. A significant difference in the age range and mean age by gender was detected with the Student's t test within this population at the 0.05 level. The classic presentation of a lateral periodontal cyst seems to be that of an asymptomatic, small, ovoid, well-corticated radiolucency that occurs in an interradicular locus in the mandibular premolar segment of a middle-aged man. However, lateral periodontal cysts may manifest with pain and cause cortical perforation, may present as large expansile radiolucencies, may arise in the maxillary molar segment, and may develop in young females. Because of the tendency for aggressiveness of other lesions that may present with a similar picture, it is important to establish the final diagnosis of lateral periodontal cyst on a histologic basis in conjunction with the clinical and radiographic findings.

The lateral periodontal cyst: an update

Lateral periodontal cysts account for 0.8% of all jaw cysts seen in our department. Published reports have indicated that they occur most frequently in the 5th to 7th decades, that there is a male preponderance and that they are located mainly in the mandibular canine-premolar region. In our own series of 20 cases, 10 were found in the anterior maxilla. We have distinguished unicystic and multicystic (including botryoid) varieties. They were lined predominantly or exclusively by thin reduced enamel epithelium-like tissue which contained many clear cells and epithelial thickenings referred to as plaques. Glycogen was present in the epithelium of two-thirds of our cases although not exclusively in the clear cells, many of which showed no positivity. Two of our examples of the botryoid variety were different histologically, being lined predominantly by non-keratinizing stratified squamous epithelium with crowded and pyknotic nuclei and no clear cells. One case contained melanin while another showed epithelial crypt formation and superficial palisaded low columnar cells as seen in the glandular odontogenic cyst. This raised the question of whether the latter may form part of the clinicopathologic spectrum of lateral periodontal cyst. The histogenesis of lateral periodontal cysts is uncertain but we favour origin from reduced enamel epithelium.

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.

Paradental cysts on mandibular first molars in children: report of five cases

Five cases of paradental cyst are reported which were found to arise buccal to a mandibular first permanent molar in children under the age of 10 years. The justification for calling these lesions paradental cysts is discussed. Since the histopathological findings of this lesion are non-specific, the clinical and radiographic features are of prime importance in diagnosis when the lesion occurs in this site in patients of this age. Buccal swelling adjacent to a mandibular first molar which is partially erupted or which has a soft tissue cover is a common clinical finding. Occlusal projections generally give the best presurgical diagnostic information, demonstrating the presence of a radiolucent lesion with a periosteal bone reaction buccal to the involved tooth and displacement of the roots to the lingual. The cyst can be successfully treated by simple enucleation without disturbing the associated tooth.

[Odontogenic botryoid cyst]

The clinical and histopathological features of two cases of botryoid odontogenic cyst are reported. The lesion is an uncommon variant of the lateral periodontal cyst and differs from this with regard to the histopathological features and the biological behaviour.

Lateral periodontal cysts. Clinical, radiographical and histopathological findings

21 lesions, clinically and radiographically diagnosed as lateral periodontal cysts (LPC), were retrospectively studied. The majority of the lesions were symptomless and were located in the premolar-canine-incisor region and predominantly in the mandible. 15 cases had the typical lining consistent with the diagnosis LPC. Three lesions were odontogenic keratocysts and 3 were inflammatory cysts. It was concluded that cysts in a lateral periodontal position are usually LPC but the diagnoses of keratocyst and inflammatory cyst must be considered.

A radiolucent lesion adjacent to the roots of the mandibular right first and second premolars

A distinct odontogenic cyst of developmental origin, the lateral periodontal cyst has characteristic clinical, radiographic, and histopathologic findings. In addition to inflammatory lesions, lateral periodontal cysts may appear similar radiographically to an ameloblastoma or odontogenic keratocyst in its early stage; therefore, clinical and histologic correlations are necessary to establish the diagnosis and ensure proper treatment.

The lateral periodontal cyst. A report of 37 cases

The lateral periodontal cyst is a developmental cyst of odontogenic origin which is located along the lateral aspect of a tooth root. Thirty-seven previously unreported lateral periodontal cysts ( LPCs ) are presented. Clinical, roentgenographic and histologic features of the LPC are reviewed. Further, the importance of distinguishing the developmental LPC from laterally positioned inflammatory cysts of pulpal or periodontal disease origin and laterally occurring odontogenic keratocysts is stressed.