Paradental (mandibular inflammatory buccal) cyst

Clinical, Radiographic, and Histological Features of Buccal Bifurcation Cysts: A Systematic Review to Aid Accurate Diagnosis and Treatment Decisions

OBJECTIVE

This systematic review delves into the nuanced landscape of buccal bifurcation cysts (BBCs), emphasizing their clinical significance amid the diagnostic challenges in oral and maxillofacial pathology. We trace the evolution of BBC classification from historical perspectives to its current status in the World Health Organization's classification system, aiming to equip dental professionals with crucial insights for accurate diagnosis and effective management.

METHODS

This systematic review (PROSPERO: CRD42023405169) followed PRISMA guidelines to examine the epidemiological characteristics of BBCs. Observational studies were included, while reviews, meta-analyses, and experimental studies were excluded. A comprehensive search across five databases identified eligible studies. Two independent reviewers screened articles, resolving disagreements by consensus or a third reviewer. Data extraction included clinical, histological, and imaging findings. Risk of bias was assessed using Murad's framework for case reports/series and the Newcastle-Ottawa Scale for other study types, with studies rated as low, moderate, or high quality.

RESULTS

The information presented here is crucial for preventing past treatment errors associated with BBC. In addition, this review confirms that BBCs predominantly affect the posterior mandible of pediatric patients and exhibit consistent clinical and histopathological features, aiding in their differentiation from similar maxillofacial lesions. Thus, well-informed clinicians should be able to diagnose BBC and make a proper treatment choice after familiarizing themselves with this review, which will ultimately lead to a favorable prognostic outcome and reduced risk of lesion recurrence.

CONCLUSION

This study provides a comprehensive analysis of BBC, aiming to enhance clinical understanding and ultimately improve patient care.

Exploring mandibular buccal bifurcation cysts: a case series and a comprehensive literature review

OBJECTIVE

The objective of this study was to explore the clinical and microscopic findings of mandibular buccal bifurcation cysts (MBBCs) in an original case series and to perform a literature review of this lesion.

STUDY DESIGN

Paraffin-embedded tissue blocks from patients microscopically diagnosed with MBBCs were retrieved from 4 oral and maxillofacial pathology archives. Data, including clinical, radiographic, and microscopic characteristics, treatments used, and follow-up status, were collected from the pathology records.

RESULTS

A total of 23 cases were examined, consisting of 10 male subjects (43.47%) and 13 female subjects (56.52%). The mean age of the subjects was 10.52 years, with a range from 6 to 42 years. The majority involved the first molar, accounting for 19 cases (82.60%), whereas the second molar was affected in 4 cases (17.39%). Only 2 cases presented with bilateral lesions (8.69%), with the remaining 21 cases showing unilateral occurrence (91.30%). Treatment predominantly involved enucleation, utilized in 16 cases (69.56%). The average follow-up period was 6.5 months, ranging from 1 to 27 months.

CONCLUSIONS

This study highlights the diagnostic challenges and treatment considerations associated with MBBC, emphasizing the importance of a conservative approach, particularly in young patients, to preserve dental function and normal facial growth.

Inflammatory Paradental Cyst: A Case Report

Inflammatory paradental cysts (IPC) are frequently under-reported due to insufficient clinical details. Our case report describes a 45-year-old male with a complaint of discomfort in the right lower posterior region. Intra-oral examination revealed a partially erupted, mesioangularly impacted 48 without any dental caries. The radiograph revealed a well-circumscribed radiolucency around the distal root of the impacted mandibular third molar. Histopathology revealed odontogenic epithelium with an inflamed connective tissue wall. It was diagnosed as an IPC correlating the clinical and radiological findings. This case report describes the importance of clinical correlation to diagnose IPC.

A review of oral pathology in orthodontics. Part 2: Pathology of the jaw bones

For many patients, their first full jaw imagining will be requested and reported by an orthodontist. This may lead to the discovery of unexpected pathology in the jaws. In this review article, we discuss the clinical and radiological appearance as well as the pathologic features and treatment of the more common entities of the jaws. In addition, we will discuss the less common lesions which carry important consequences for the patient. Through the identification of these lesions, appropriate referral and management can be pursued.

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.

Incidental finding of paradental cyst in the maxillary anterior teeth during immediate implant placement

Paradental cyst is classified as an inflammatory cyst, and its occurrence in the anterior maxillary region is very rare. Several hypotheses have been put forward on the etiopathogenesis among which the formation of cyst secondary to inflammatory destruction of the periodontium and alveolar bone can be attributed to the present case. A 26-year-old male patient reported with loosened maxillary anterior teeth. After clinical and radiological examination, extraction of teeth #12, #11, #21, and #22 followed with immediate implant placement was planned. During extraction of #21, incidentally, a cyst was noted to be attached to the apices of #21 tooth. Implants were placed at #12, #11, and #22 sites, and socket of #21 was debrided thoroughly, followed by the placement of graft. A histopathological study of the cyst revealed it to be a paradental cyst. The patient was followed up for 6 months, and no recurrence of cystic lesion was noted. When immediate implant placement is being planned, considerations to the periodontal and periapical disease status of the teeth being extracted are crucial to achieve better treatment outcomes.

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.

The use of localised CBCT to image inflammatory collateral cysts: a retrospective case series demonstrating clinical and radiographic features

Introduction

Inflammatory collateral cysts are uncommon cysts primarily affecting first permanent molars during their eruption. There are diagnostic challenges that can be overcome with CBCT imaging. However, given the paediatric age group for this condition, there are patient cooperation and radiation dose factors to consider when justifying the scan. The aim of this case series study is to illustrate the value of CBCT in imaging and diagnosing inflammatory collateral cysts in paediatric patients, to highlight the need for a multidisciplinary approach for this uncommon pathological condition and to review the relevant literature.

Case series description and results

We present three patients aged between 6 and 11 years of age with inflammatory collateral cysts affecting their first or second permanent molars for which CBCT imaging was utilised. All patients underwent cyst enucleation with preservation or extraction of affected teeth under general anaesthesia.

Discussion

Inflammatory collateral cysts are likely to be under reported given their indistinct clinical features and radiological signs. Conventional planar radiographs may not reveal this lesions size and full extent. CBCT overcomes these limitations; however, careful assessment of patient cooperation is needed and a low-dose protocol should be used.

Conclusions

CBCT can provide useful imaging information which is difficult to obtain using conventional radiography, especially in cases where an inflammatory collateral cyst is suspected.

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.

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.

Odontogenic Cysts and Neoplasms

This article reviews a myriad of common and uncommon odontogenic cysts and tumors. The clinical presentation, gross and microscopic features, differential diagnosis, prognosis, and diagnostic pitfalls are addressed for inflammatory cysts (periapical cyst, mandibular infected buccal cyst/paradental cyst), developmental cysts (dentigerous, lateral periodontal, glandular odontogenic, orthokeratinized odontogenic cyst), benign tumors (keratocystic odontogenic tumor, ameloblastoma, adenomatoid odontogenic tumor, calcifying epithelial odontogenic tumor, ameloblastic fibroma and fibroodontoma, odontoma, squamous odontogenic tumor, calcifying cystic odontogenic tumor, primordial odontogenic tumor, central odontogenic fibroma, and odontogenic myxomas), and malignant tumors (clear cell odontogenic carcinoma, ameloblastic carcinoma, ameloblastic fibrosarcoma).