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Lateral Periodontal Cyst:Report of a Case witti 1 -Year Reentry

Jeffrey A. Meltzer, DMD'

The iaterai periodontai cyst is a reiativeiy rare cyst of the jaw (0.8%) ofunproven origin, it is most commoniy found in the mandible between theroots of canines ond premoiars. This article reports a case of a lateral peri-odontai cyst in a 73-year-old woman, documents its diagnosis and treat-ment and aiso presents a l-year reentry. No grafting or barrier techniqueswere used The result was compiete bpny regeneration of the defect afteri year (Int J Periodontics Restorative Dent 1999:19:299-303.)

•ClinicQl Assistant Professor, Stote University of New York HealthSoience Center; and Private Proctice ih Periodontics, Syrocuse,New York.

Reprint requests: Dr Jeffrey A. Meitzer. 516 East Genesee Street,Foyettevjile, New York l30óó,e-maii: GUMDOC45@aol.com

The ioterai periodonfoi oysf is oreiofively uncommon develop-mental odontogenio cyst. It isusuaiiy osymptomotic, moy ex-hibit swelling, and is most com-monly found in the mandibularcanine-premolar region. It oo-curs in the lateral periodontolregion ot vital teeth ond oon Peseen os o circumscribed radlo-luoenoy Petv^/een odjaoentroots.'

Histologioally the loteroiperiodontal cyst comprises ocystic oovity with o oonnectivetissue sao that is iined internallyby o thin, nonkeratinized epi-thelium. This lining vories from asingle, flof layer ot squomousoells fo a fhin lining of 2 to 3oells inferspersed wifh conspic-uous clear cells containinggiycogen,^

The pathogenesis ot the lat-eral periodontol cyst is not fullyknown, Angelopoulou and An-gelopoulos^ present 3 possibleorigins: the reduced enamelepithelium ot on erupting tooth:the rests of the dental iamina;and the rests ot Malassez,

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A distinction must often bemade between fhe Iaferai peri-odonfal cyst ond fhe gingivalcysf, which has similar histoiegicfeafures. Angelepouleu andAngelopeules-' believe the 2lesions to be disfincf enfities.The Iaterai periedenfal cystdeveieps within the alveelarbcne, breaking through thebuccoi plate, while the gingivalcyst stays within the gingivaand oniy slightly enters inte thebone. An excellent example ofboth a Iaferai periedenfal cysfand gingivai cyst appearing infhe same pafienf was shown byTcison ef al.'̂ When the cerficalplate is slighfly invaded andshows a rodioiucency, if is diffi-cuit if net impessibie to teli thedifference between the 2 fypesof cysf. Lerhaupt ef ai^ recentlyshowed a Iaferai periodonfalcyst thof perforated fhe buccaland linguai plofes, creating athrough-and-fhrough iesicn.Surgical excision is the recom-mended freatment whetherperforation of beth piotes haseocurred or net. Some cases ofrecurrence have been re-perfed buf fhey appear to be

Case report

A 73-year-eid white woman pre-sented with a firm, nedulorswelling lecafed on fhe buccaiospect befween the mandibu-iar righf first and secend preme-iars. The lesion was paipated

and appeared to be a hardmass approximafely 6 mm indiamefer (Fig 1). if appeared tobe exesfetic, alfhcugh it wasscmewhat tender tc touch. Thepatient recalled that the swel-ling firsf appeared 3 monfhsprior tc the appoinfmenf andthot it had gotten larger andmore tender during that period.

A radiograph was taken,and it shewed a reund radielu-cency between the mandibu-lar ieft first and secend preme-lars below fhe crest ef thealveolar bone (Fig 2). The mar-ginoi gingiva wos probed withno break in fhe epitheiiai cuff.Ne exúdate er bleeding wasnoted and the tissue appearedpink and healthy.

With a preliminary diagnosisof Iateroi periodonfoi oysf, fhepatienf was injecfed wifh ap-proximately 1.5 mL et 2% iide-oaine wifh 1:100,000 epineph-rine, and a buocai flap wasdrawn reveaiing o round, cir-cumscribed, whitish lesion oboutä encapsulated inte the alveo-lar bone (Fig 3). The lesion wasoompleteiy enucieated using asurgical curefte. ieaving o well-defined, circumscribed benycrypt (Fig 4). Both tooth rootswere fenesfrafed wifhin fhe ie-sion buf were nof scaled. Thefiap wos closed using # 3-0 siiksufures. No dressing cr anfibiotiocoverage was used postopera-fiveiy Examination 1 week iatershowed unevenffui heaiing. Theiesien was senf for histeiogioexaminafion, which oonfirmed

the diagnosis ef lateral peri-odontol cysf (Fig 5).

The patient returned to theauthor's office 1 year later. Aradiograph was taken, and itappeared te shew completeheaiing (Fig 6). The patient wasasked if she would allow a reen-try ot the area for an examina-tion of the heoiing and for cphofegraph. She graciouslyagreed end Fig 7 shews fheresulf. Compiefe ciinicoi healinginciuding regeneraticn of thecerfical piafe can be seen.

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Fig I Firm swelling presents suPmarginaliy between the firstand second mandibular premolars.

Fig 2 Preoperotive radiograph of loterol periodontoi cyst

Fig 3 Appearonce of laterat periodontal cyst on flapexposure.

Fig 4 Lateral periodontal cyst is enucleated, leaving a well-defiried. circumscribed crypt of bone.

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Fig 5 (-íi.í.'L'iL'Lfic section o< ine lateral penodontai cysl showsepithelidi lining wifh ciear ceils and facal thickening (Originaimagnification x 60: hemqtaxyiin-eosin stain )

Figo O':-' ,•'. I: : : ".i-.'perafive radiograph The detecfappears to be compietely filled with bone.

Fig 7 Oria-y^at leenny Ihe liil is hard and appears corticated. Fig 8 Localized buccai bony exosfasis. ¡he dinicai appear-ance is identical to the lateral peribdohtai cyst, indicating theneed for a radiograph.

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Discussion

This cose is interesting from sev-erai standpoints. First, fhe iateraiperiodontoi cyst, oithough ex-tensiveiy written about in the iit-erature. is nevertheiess quiterore. Angeiopouiou and Angei-opoulos^ reported that in 1990,152 well-documented coseswere reported in the Engiish-lan-guoge literature. Altini andSheor̂ reported thot the ioteraiperiodontai cyst comprised0.8% of aii jow cysts seen in theiroiinic. A periodontai ciinicianmoy see very few in a coreen

The iiterature recommendsenucleation of the cyst as thetreotment of choice. Many offhe orticies suggest that fheresuif of enucleation is com-piefe or neor-complefe regen-erofion of bone. iHowever. mostof them offer littie postoperotiveevidence. Angeiopouiou ondAngeiopouios-' showed o 1-yeorpostoperotive rodiograph withalmost oompiefe fill. In iight ofthe modern presence of de-mineralized freeze-dried bone,bone subsfifutes. borrier tech-noiogy, and guided boneregeneration, fhe outhor consid-ered the piocement of o groftond/or membrone on the ex-posed defect during the sur-gery. This technique had beenused successfuiiy by the authorin fiiiing o lorge defect creotedby on odenomafoid odonto-genic tumor.^ Lerhaupf et oi^recenfiy used deminerolizedtreeze-dried bone to ciose a

through-ond-through defectcreoted by o ioteroi periodon-toi cyst. A 30-month radiographwos offered os evidence ofheoiing.5 However, the presenfiesion wos over '/f circumscribedby bone onO it wos feif fhot fillwould occur wifhout o groft orborrier membrane. Fortunately itdid, as evidenced by the 1-yeorpostoperotive photogroph ondrodiogroph. The oufhor couidfind no ofher such ciinicoi docu-mentation in the iiteroture.

Finally, the reported lesionappeared to be exostotic at firstgionce. An exompie of o simiiar-oppeoring exostosis was re-centiy noted by the oufhor (Fig8). Hod a radiogroph not beentaken, the diagnosis oouid hovebeen missed in fhe presentcose; it was forfunote thof fhepatient experienced someminor tenderness on poipofionthat ied her to seek ossisfonceond ied uitimateiy to the diog-nosis of loferai periodontal cyst.

Acknowiedgment

The autf ior wishes to thank EileenNowak for graciousiy and generousiyailowing him to reenter a healthy oreafcr the purpose of documentation.

References

1. Shafer WG. Hine MK. Levy BM. ATextbook of Oral Pathoiogy. ed 4.Philadelphio: WB Sounders. 1983:265-268.

2. Shear M. Pondborg JJ. Microscopicfeatures of lateral periadontai oyst.Scand J Dent Res 1975;83:103.

3. Angeiopouiou E. Angelopouios APLatera i periodontal cyst' Review ofthe iiteroture ond review cf a case. JPeriondontol 199O;Ó1:125-I31.

4. Toison GE. Czuszok CA. Bilimon MA.Lewis DM. Report of a iateroi peri-odantal oyst and gingival oyst occur-ring in the same patient. J Periodontoi199o;67:54l-54il

5. Lerhoupt NB. Brcwnstein CN. DecseyMJ. Osseous repair of a lotero I peri-odonfai cyst. J Periodontoi !997;ó8.608-611.

6. Phelan JA. Kritchman D. Fusco-Ramer M. Freedman PD, LimermanH. Recurrent boytroid cyst (iateraiper icdontol cyst). Oroi Surg OrolMed Orai Pothoi Orol Radiol Endad1988:60:345-340.

7. Altini M, Shear M. The Iateroi peri-odonta i cyst: An upda te . J OralPathal Med 1992:21C6):245-250.

8. Vitkus R. Meltzer JA. Repair ot odefeot following the removai of omaxillary adenomatoid cdontogenictumor using guided tissue regenero-tion. A case report. J Periodontoi1996.-67 40-50.

Volume 19, Number 3.1999