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

Abstract

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.

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

“…In most cases, a fully erupted tooth is related to LPC, with typical location in the anterior mandible, incisor, or premolar area [20]. An atypical case of LPC associated with impacted teeth was described by Buchholzer et al [21]. Since most case are unilocular, rarely multiple or multifocal LPC cyst presentation can also occur, similar to in Siponen et al's case [23].…”

“…Since LPC has a low re-occurrence rate that requires in most cases simple cyst removal, with or without additional curettage, no other special approaches are needed [7,16,17]. Curettage itself is used to avoid remaining any cyst remnants and improve surgical quality [17][18][19][20][21]. On the other hand, cases of bigger, expansive LPC forms, along with GOC and BOC forms of LPS, which are rare, require a more radical approach because of a big possible re-occurrence rate around 22-35% in total [18,19,22].…”

“…If GBR procedures are not used, a spontaneous healing method can also be used. The mentioned method should be indicated for small lesions, inflammated tissues, presence of good adequate volume of cortical bone and adequate bony ridge height and shape, and others [5,8,14,21,22].…”

Diversity of an Odontogenic cyst of Jaws – A case report with literature review

“…4,5 Additionally, abnormal LPC cases have been discovered in connection with unerupted teeth. 6 LPCs are found to occur less frequently than 1% of the time, and they account for just 0.8% of central maxillary bone cysts. 2 It is one of the developmental odontogenic cysts with a lower incidence.…”

Lateral periodontal cyst: A rare clinicopathological presentation mimicking a residual cyst

“…When presenting the typical clinical and radiological features, the main differential diagnosis for LPC include lateral periapical cyst, odontogenic keratocyst and other uncommon odontogenic tumors (such as squamous odontogenic tumor) ( 2 , 15 ). Some LPC, however, can present as multilocular radiolucencies (in a multicystic pattern so-called “botrioid odontogenic cyst”) ( 2 , 7 ), close to a periapical location ( 16 , 17 ), mimicking a dentigerous cyst ( 18 ), or resembling periodontal defects ( 19 ), and in these specific situations differential diagnosis can be broader. Although the clinical and radiological features of typical LPC are very suggestive, final diagnosis depend upon histological analysis of the surgical specimen ( 2 , 10 , 15 ).…”