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Lateral Periodontal Cyst

A lateral periodontal cyst is a nonkeratinized developmental cyst occurring adjacent or lateral to the root of a tooth. The origin of this cyst is believed to be related to proliferation of rests of dental lamina.

 The lateral periodontal cyst has been pathogenetically linked to the gingival cyst of the adult; the former is believed to arise from dental lamina remnants within bone, and the latter from dental lamina remnants in soft tissue between the oral epithelium and the periosteum (rests of Serres) and it represents the intrabony counterpart of the gingival cyst of the adult. The close relationship between the two entities is further supported by their similar distribution in sites containing a higher concentration of dental lamina rests, and their identical histology.

Clinical features

Around 75% to 80% of cases occur in the Maxillary  and mandibular premolar-canine-lateral incisor area. Also  most gingival cysts of the adult occur in the mandibular premolar and cuspid regions and occasionally in the incisor area.

 A distinct male predilection has been noted for lateral periodontal cysts, with a greater than 2:1 distribution.

 The median age for both types of cysts is between the fifth and sixth decades of life, with a range of 20 to 85 years for lateral periodontal cysts, and 40 to 75 years for gingival cysts of the adult.

Radiographic Features

The cyst usually appears as a well-circumscribed unilocular radiolucent area located laterally to the root or roots of vital teeth. Most such cysts are less than 1.0 cm in greatest diameter.

 Lateral periodontal cysts with Polycystic appearance  with Multifocal or multilocular radiolucency, which is rare have been termed as  botryoid odontogenic cysts. They show a grapelike cluster of small individual cysts. This is a variant of the lateral periodontal cyst, possibly the result of cystic degeneration and subsequent fusion of adjacent foci of dental lamina rests

In addition, some examples can develop in edentulous sites.

  

 Multifocal Lateral periodontal cyst/botryoid odontogenic cysts

  

Clinical photograph and radiographs showing (a) circumscribed swelling in the attached gingiva in between the left mandibular canine (33) and premolar (34); (b) three-dimensional reconstructed cone beam computed tomography image of left mandible showing cystic lesion between roots of teeth 33 and 34, along with loss of buccal and lingual cortices; and (c) orthopantomograph showing well-circumscribed radiolucency with a sclerotic border in between roots of teeth 33 and 34, along with displacement of the roots.

 

Differential diagnosis

The lateral periodontal cyst must be distinguished from a cyst resulting from

an inflammatory stimulus through lateral root canal of a nonvital tooth (a lateral radicular cyst)

 an odontogenic keratocyst along the lateral root surface,

 and radiolucent odontogenic tumors.

 A differential diagnosis for the gingival cyst would include gingival mucocele, Fordyce’s granules, parulis, and possibly a peripheral odontogenic tumor.

Lateral Periodontal Cyst

Origin from rests of the dental lamina in bone

Occurs along lateral surface of tooth root

Associated with a vital tooth

Most found in mandibular canine-premolar area

Males affected more than females

Treated by cystectomy; multilocular variant has recurrence potential

Dental lamina rests in soft tissue give rise to gingival cysts of adult

 

 

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