Lateral Periodontal Cyst Treated with Enucleation and Guided Bone Regeneration: A Report of a Case and a Review of Pertinent Literature

Radiolucent lesions that may resemble inflammatory periapical lesions: A review article

Non-endodontic lesions (NEL) closely resemble lesions of endodontic origin. Its etiology can be odontogenic, non-odontogenic, neoplastic, or anatomic variations that can resemble inflammatory periapical lesions in the periapical area. Inflammatory periapical lesions are caused by pulpal pathoses and require endodontic treatment. Since numerous NEL may resemble inflammatory periapical lesions, they can lead to misdiagnosis and inappropriate management. Thus, a detailed review of the patients' medical and dental histories with clinical examination, including radiographic findings, is essential for the proper assessment of periapical lesions. Numerous cases of misdiagnoses of NEL have been reported in literature. Thus, this review aimed to strengthen the awareness of clinicians on periapical radiolucency, which may resemble inflammatory periapical lesions.

Usage of Guided Bone Regeneration in the Case of Lateral Periodontal Cyst in the Maxilla with Buccal Cortical Expansion

A lateral periodontal cyst (LPC) is a rare finding. Patients diagnosed with LPC younger than 40 years of age are not that common. Mostly asymptomatic LPCs can be discovered on routine radiographs as an oval radiolucency between two mandibular premolar teeth roots and can vary in shape and size. Most cases are treated with enucleation, bone curettage, or a combination of both, greatly depending on the surgeon’s preference. Because most LPCs are quite small, lesions do not require any regenerative procedures. In the presented case, because of cortical expansion of the lesion and loss of vital bone bridge surrounding two adjacent maxillary teeth, a guided bone regenerative procedure (GBR) with xenograft bone substitute was used. Despite that small lesions can heal on their own, nowadays the approach of full-mouth therapy (FMT), including direct soft or hard tissue reconstruction in the oral cavity, seems to be a wise treatment. The presented paper presents and describes an unusual LPC case with cortical bone expansion in a very rare maxillary canine–premolar region.

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.

Lateral Periodontal Cyst - A diagnostic dilemma: Report of a rare case with CBCT and histological findings

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Lateral periodontal cyst [LPC] is a rare developmental odontogenic cyst.

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It is difficult to differentiate a LPC from a cyst of endodontic origin by clinical and radiographic methods. Histopathological evaluation is the only method to confirm diagnosis.

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Usually seen in association of a vital tooth, but in this case it was seen in a non-vital tooth.

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LPC is usually seen within bone, but in this case besides Intrabony component there was a gingival presentation as a swelling.

Introduction

Lateral Periodontal Cyst (LPC) is considered as a rare developmental odontogenic cyst. It is often diagnosed as an incidental radiographic finding, presenting as a circumscribed round radiolucent area between the roots of vital teeth. LPC usually does not present any clinical features. Differentiating the origin of the lesion from an endodontic or periodontal perspective presents as clinical challenge.

Presentation of case

A female patient presented with an asymptomatic gingival swelling in the lingual aspect of mandibular anterior region. The associated tooth (#34) was endodontically treated 3 years back. A periapical radiograph showed a well-defined round radiolucency on the tooth. Cone beam computed tomography (CBCT) revealed extensive bone destruction. The lesion was surgically excised and histological examination confirmed the diagnosis of LPC. The site healed satisfactorily post-operatively. The case was followed up for a year without any recurrence seen.

Discussion

LPC is a very rare clinical entity, the diagnosis of which requires a detailed case history taking, clinical and radiographic examination are essential to get proper assessment of the pathology. It is said to originate from either the remnants of dental lamina, reduced enamel epithelium or rests of Malassez. LPC presents with a typical histological picture which ensures the confirmatory diagnosis. Surgical enucleation with thorough curettage is the treatment of choice.

Conclusion

By reporting this rare case, we would like to stress to clinicians that there are a wide range of cysts and anatomic structures are present in the canine-premolar region of mandible of which LPC is a rare possibility.

Massive Radicular Cyst in the Maxillary Sinus as a Result of Deciduous Molar Tooth Pulp Necrosis

The article describes a rare case of radicular cyst associated with deciduous right upper molars in a 5 y.o. male patient. The cyst developed asymptomatically in the maxillary sinus, thus causing considerable displacement of both premolar germs. Due to the severity of surgery, the patient was treated under general anesthesia in a one-day surgery system with use of the enucleation method. The extent of the lesion results in necessity of removal of the second premolar germ. Early diagnosis of the lesion would have resulted in a more conservative treatment plan. The purpose of this article is to lay emphasis on the pedodontist's role in early diagnosis of such lesions.