Crown root fracture imaging on Cone Beam Computed Tomography

Objectives: This case report is aimed to describe the features of CBCT in assessing tooth fracture. Case Report: A 50-year-old man came with complaints of discomfort in the right lower jaw area, especially when used for chewing. The results of the percussion test were positive. CBCT examination showed that there was a radiolucent image of the enamel in the middle of the crown root to the 1/3 apical of the mesial and distal roots of tooth 47 which resembled a fracture line. The fracture line also appears to have reached the pulp. In addition, there is a well-defined radiolucent appearance with an irregular shape along the root from the buccal to lingual alveolar crest and accompanied by a decrease in the alveolar crest. The fracture that occurred in this case was from the enamel to the apical and involved the pulp, thus the radiodiagnosis on tooth 47 was a complicated crown root fracture with lateral periodontal cyst. Conclusion: CBCT can be used to help identify tooth fractures by obtaining a more accurate and useful value in differentiating conditions associated with fractures. CBCT provides data on the size and length of the fracture line and the size of the lesion.

Cisto periodontal lateral e cisto odontogênico botrióide

Cystic jaw bone lesions have been largely studied and discussed since the beginning of their recognition. Although many of them have already been well-defined, some of them go on generating divergent opinions, such as the lateral periodontal cyst (LP C) and the botryoid odontogenic cyst (BOC). The objective of this article is to report two cases of unusual characteristics, one of them is about a lateral periodontal cyst and the other one is about a botryoid odontogenic cyst, presenting considerations as to their clinical, radiographic and histological aspects.

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 CASE REPORT AND LITERATURE REVIEW

Background: Lateral periodontal cyst (LPC) is a rare example of a developmental odontogenic cyst. LPC may clinically be diagnosed as a radicular cyst, keratocyst, ameloblastoma, odontogenic fibroma, odontogenic myxoma or as other types of odontogenic cysts and tumours. Purpose: The aim is to present an unusual two clinical cases of LPC of the upper and lower jaw. Material and methods: We present two cases with histologically proved LPC. The X-ray revealed radiolucent well-defined, circular in shape homogeneous formation around the root of the affected tooth. Results: The treatment of choice was surgery- enucleation of cyst formation. The complete removal of the cysts was successfully performed. The result of the pathophysiological examination of both cases showed LPC. Since after the operation regular follow up was perform and till now there was not any signs of recurrence. Conclusion: LPC is a rare odontogenic cyst of developmental origin, which should be timely diagnosed and surgically removed.

Botryoid Odontogenic Cyst

A 70-year-old man consulted for a mass of unspecified duration in the anterior area of the mandible. Radiologic information was not provided. An incision biopsy was performed by the dentistry service. The specimen received at the laboratory was labeled “cystic lining” and consisted of two light-gray to dark brown, irregularly shaped tissue fragments measuring 0.3 cm and 0.4 cm in diameters. Histological sections show biloculated cyst wall segments composed of fibrocollagenous tissue lined by an epithelial lining of varying thickness. (Figure 1) The latter consists of a thin layer of non-keratinizing epithelium with plaque-like thickenings that are composed of cells with a whorled pattern and variably clear cytoplasm. (Figures 2 & 3) Based on these microscopic features we signed the case out as a botryoid odontogenic cyst. Botryoid odontogenic cyst (BOC) is a developmental, non-inflammatory odontogenic cyst derived from residual odontogenic epithelium such as the dental lamina.1,2 It occurs between the roots of erupted teeth and is typically multilocular. It represents less than 1% of odontogenic cysts. Most cases occur in the sixth and seventh decades of life and a slight preponderance of males has been observed.1 Other studies report an equal distribution between sexes.2 It most often occurs in the mandible anterior to the molars, particularly the incisive/canine and premolar regions.1,2 Most BOCs are asymptomatic and discovered incidentally on radiographs although occasionally bone expansion is observed.1 Radiologically, BOCs often present with a multilocular radiological appearance.2 This multilocular feature has been likened to a “bunch of grapes” (botryoid: from the Greek botrys – bunch of grapes, and oeides – in the shape of).3 Microscopically, the cyst locules are lined by a one-to-two cell thick non-keratinizing epithelium with plaque-like thickenings of cells in a whorled arrangement and connective tissue septa.1,3 Cytoplasmic clearing may be observed because of glycogen.1 The differential diagnosis includes a lateral periodontal cyst (LPC) and a gingival cyst (GC). Although their histological features are largely identical, a LPC is unilocular while a GC occurs in the alveolar ridge of infants.1-3 A BOC is often considered a multilocular variant of lateral periodontal cyst.2,3 Making this distinction however is more than just of morphologic interest but is important as BOCs are reported to give rise to recurrences unlike LPCs and GCs.2,3 An ameloblastoma may be considered because of the multilocular appearance although the microscopic features are sufficiently distinct to rule out this entity. An adenomatoid odontogenic tumor (AOT) may be considered because of the nodular thickenings with a whorled pattern. However, AOT is a solid tumor characterized in addition by the presence of rosette- or duct-like spaces with dentinoid matrix. The recommended treatment is by enucleation.1 Successful conservative management with Carnoy’s solution has also been described.4 Peripheral ostectomy has also been recommended – a more aggressive approach being proposed as appropriate to extirpate any residual lesion.3 Recurrence has been stated to be between 15 to 30% which is largely ascribed to the multilocular characteristic of BOCs and consequent difficulty of complete removal, or of larger lesions.1-3 Thus, appropriate follow-up of cases or adjunctive therapy after enucleation might be warranted.2,3 To the author’s awareness, this is the first locally reported case of BOC after a search of local health research databases.