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JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Oct - Dec 2012 | Issue 4 | Vol 30 | 343
Borgonovo, et al.: Bilateral paradental cyst of the first molar
episodes, this cyst presents only a few signs and mild and then enucleated trough the access previously
symptoms, including discomfort, tenderness, moderate created[Figure 5]. Having done an irrigation with
pain, and in some cases, suppuration through the sterile saline, the suture was carried out with silk 4/0.
periodontal sulcus.[810]
Histologically, the cyst capsule was lined by a
The aim of this work is to present a rare case of bilateral proliferating, nonkeratinized, stratified squamous
paradental cyst in a young patient affecting the buccal epithelium, showing as arcading. The cystic wall
aspect of lower first molars, discussing diagnosis, consisted of a dense, mature fibrous connective tissue,
treatment, and radiographic findings of the case. with an intense chronic inflammatory reaction mainly
near the epithelium[Figure6].
Case Report
An 8yearold boy was referred to Oral Surgery
Department, Dental Clinic, IRCCS Fondazione
Ospedale Maggiore Policlinico, University of Milan,
Italy, with the complaint of swelling over the buccal
gingiva of his unerupted lower left first molar. Clinically,
there was mild edema in the overlaying mucosa distal
to the second deciduous molar, showing a bluish
color [Figure1]. The evaluation of the panoramic
radiography[Figure2] disclosed a welldefined
semilunarshaped radiolucency, demarcated by a fine
radiopaque line, on the buccal aspect of the unerupted Figure1: Intraoral preoperative viewleft side
lower left first molar[Figure3]. Observing closely the
radiograph, a second lesion was evident on the buccal
aspect of the partially erupted right lower first molar,
but less defined than the previous.
344 JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Oct - Dec 2012 | Issue 4 | Vol 30 |
Borgonovo, et al.: Bilateral paradental cyst of the first molar
The histopathology associated with macroscopic and about 1year after surgery, evidence the complete
radiographic examinations permitted the definitive regression of the lesion and the correct eruption
diagnosis of a paradental cyst on the mandibular left of the mandibular permanent left and right first
and right first molars. molars[Figures78].
Figures4: Computed tomography shows that the margins of Figure7: Panoramic radiograph 1 year after surgery, indicating a
radiolucent lesion were delimited by a thin layer of denser bone on complete regression of the two lesions and the correct eruption of the
the buccal aspect mandibular left and right first molars
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Oct - Dec 2012 | Issue 4 | Vol 30 | 345
Borgonovo, et al.: Bilateral paradental cyst of the first molar
346 JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Oct - Dec 2012 | Issue 4 | Vol 30 |
Borgonovo, et al.: Bilateral paradental cyst of the first molar
the cyst. The cortical expansion of the bone is not pulp test is a diagnostic criterion for paradental cyst.
so frequent like in the forms previously described, The diagnosis would be a lateral radicular cyst if the
and the majority of lesions do not exceed 15mm of associated tooth is nonvital.[21]
diameter.[18]
The initial diagnosis of paradental cyst was made
The etiology of paradental cysts is of an inflammatory considering the anamnestic, clinical, and radiological
nature, as shown by the histological findings of features. Only the enucleation of cyst without
odontogenic epithelium proliferation, presence of extraction of the adjacent tooth was done in both
an inflammatory infiltrate, and occasional hyaline the cysts. Most reports[5,11,2022] show that if the tooth
changes in blood vessel walls.[4,13,1517] However, there involved is the first or the second molar, the treatment
are controversies surrounding the origin of the lining of choice is enucleation of the cyst without the
epithelium. According to Souza etal.,[15] most cases of extraction of the tooth, whereas surgical removal of
paradental cysts stem from the proliferation of reduced the tooth and the paradental cyst has been considered
epithelium of the enamel organ, probably caused by the best case solution when the involved tooth is
inflammatory stimuli originating from the junction of a third molar. [8,9,21] Pompura et al. [23] presented
the epithelium of the cystic capsule with the gingival 44cases treated by enucleation without extraction.
epithelium. Colgan etal.[4] and Lim and Peck[17] also Packota et al.[11] successfully treated five cases of
believe that this cyst arises from reduced epithelium of paradental cyst involving the mandibular first molar
the enamel organ. The epithelial remnants of Malassez with enucleation of the cyst without extraction. In Wolf
seem to be the most unlikely origin, although they may and Hietanens report,[20] of all the cases of mandibular
unreasonably explain cysts located near the roots.[15] infected buccal cyst(paradental) associated with the
first molar(three cases) and the second molar(three
In this article, the authors present a case of bilateral cases), four were treated without extraction. In Vedtofte
paradental cyst involving both the left and right and Praetoriuss[21] series involving the mandibular
mandibular first molar. In both cases, the radiographic first and second molars, 11 of the 13cases treated
image of these lesions revealed a welldefined with preservation of the involved tooth had successful
radiolucency associated with the roots on their buccal outcome. In all cases, recurrence is rare, provided that
aspect. the lesion has been completely removed.[6,21,2325]
The differential diagnosis included the radicular cyst, The histopathological features of the paradental cyst
odontogenic keratocyst, lateral periodontal cyst, are identical to the radicular cyst and to those of
gingival cyst, dental follicles, and the dentigerous cyst. other inflammatory odontogenic cysts; microscopic
examination shows a fibrous connective tissue capsule
The most recent literature shows the rarity of the invaded by a lymphocytic inflammatory infiltrate, lined
paradental cyst occurring with bilateral localization; by a hyperplastic, nonkeratinized, stratified squamous
some authors[17] report only seven cases of bilateral epithelium; in the case that we described, both the cysts
involvement, including lesions occurring on first, capsule were lined by a proliferating, nonkeratinized,
second, and third molars; a more detailed analysis on stratified squamous epithelium, showing as arcading.
342cases carried out by Philipsen etal.[9] reveals only The cystic wall consisted of a dense, mature fibrous
23.6% of bilateral occurrence for paradental cysts on connective tissue, with an intense chronic inflammatory
first and second mandibular molars and 4.1% for those reaction mainly near the epithelium, supporting a
involving third molars. Considering the low prevalence definitive diagnosis of a paradental cyst.
of the paradental cyst (35% of all odontogenic cysts),
we can assert that the bilateral occurrence is very rare. The paradental cyst can present variable clinical and
radiographic signs,[2] in addition to being confounded
In our case, the second lesion on the right side with the radicular cyst at the microscopic level; for
was noted on radiographs(and confirmed only by these reasons, it is mandatory to correlate all clinical,
computed tomography); for this reason, it is generally radiographic, and histological data to obtain a definitive
recommended that the contralateral tooth should be diagnosis. Surgical findings, such as bony cavitation,
carefully evaluated for a second lesion. cystic content, and location of lesion adherence,
can give some important clues. Enucleation of the
Most studies[5,6,10,19,20] report that a positive electric lesion with the maintenance of the associated tooth
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Oct - Dec 2012 | Issue 4 | Vol 30 | 347
Borgonovo, et al.: Bilateral paradental cyst of the first molar
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involved.[8,9,11,19,26] 15. de SousaSO, Corra L, DeboniMC, de Arajo VC.
Clinicopathologic features of 54cases of paradental cyst.
Quintessence Int 2001;32:73741.
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