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[Lateral periodontal cysts].

The lateral periodontal cyst is a rather infrequently reported odontogenic cyst. The cyst seems to develop in direct contact to the periodontal membrane of an erupted vital tooth. This type of cyst should not be confused with a radicular cyst in a lateral position developing as a consequence of inflammation from an infected or necrotic branch of the pulp canal. Several authors do not differentiate between the lateral periodontal cyst and the gingival cyst, but it seems justified to consider the lateral periodontal cysts as a separate entity of odontogenic cysts. In this origin of the lateral periodontal cyst is reviewed and several possibilities are discussed. It is concluded that the epithelial lining of this type of cysts most probably originates from the cell rests of Malassez. Case report of one lateral periodontal cyst is presented.

Adult

Microscopic features of the lateral periodontal cyst.

The lateral periodontal cyst is of developmental odontogenic origin and must be differentiated from the gingival cyst of adults, a primordial cyst in a lateral periodontal position, and a cyst of inflammatory origin. This paper is based on a histologic study of five cases. Four were in the mandibular premolar region and one in the lateral incisor-canine region of the maxilla. The cysts are lined by a thin non-keratinized epithelium which resembles the reduced enamel epithelium. Many of them arecharacterized by the presence of localized plaque-like thickenings of their epithelial linings, consisting of fusiform or large swollen, edematous cells. These epithelial thickenings appear to result from a localized proiferation of basal cells. The lateral periodontal cyst may arise initially as a dentigerous cyst which develops by expansion of the follicle along the lateral surface of the crown and comes to lie on the lateral aspect of the root if tooth eruption is normal. Alternatively, it may arise from the cell rests of Malassez.

Epithelial Cells

Lateral periodontal cyst. An analysis of forty-six cases.

The clinical and histopathologic features of forty-six cases recorded as lateral periodontal cyst are reviewed. Three distinct types of epithelial lining were noted as well as varying degrees of inflammation. The data, although inconclusive, suggest that cysts arising in the lateral periodontal area may be of either an inflammatory or developmental odontogenic origin.

Adolescent

Squamous-cell carcinoma arising in a lateral periodontal cyst.

A rare case of well-differentiated squamous-cell carcinoma arising in the epithelial lining of a lateral periodontal cyst is reported. Submission of surgically removed tissues for histopathologic evaluation is emphasized. The surgical site has been reconstructed and functions well. Because of early diagnosis and treatment, the patient has no evidence of clinical disease 2 1/2 years postoperatively.

Adult

Odontogenic cystic lesions of the jaws.

In a period of ten years 64 patients with odontogenic cystic lesions were found in 80,408 patients attending the Dental Out-Patient Department, All India Institute of Medical Sciences Hospital, New Delhi. Two-thirds of the lesions were found in male patients and no neoplastic lesion was recorded in the maxilla. There were more periodontal cysts in the maxillary than in the mandibular incisor region. The majority of lesions were found in age groups 10-40 years.

Adolescent

Intracystic fluid pressure in non-keratinizing jaw cysts.

The technique for registration of fluid pressure in jaw cysts by means of pressure transducer and cannulation of the cyst cavity or cementation of a two-way valve into a tooth communicating with the cyst is described. Twenty-six closed cysts were subjected to registration of intracystic pressure. Subsequent histologic examination showed that all cysts were non-keratinized. Initial pressure values in apical periodontal cysts averaged +47 mmHg, in follicular cysts +44 mmHg, and in residual cysts +38 mmHg. A median palatine cyst exhibited a pressure of +81 mmHg. Most cysts showed intracystic pulsation corresponding to the number of heart beats on electrocardiograms obtained simultaneously. The intracystic pulsation disappeared when the intracystic pressure was experimentally increased and reappeared when it was lowered. In three cases in which registration of pressure was performed 7-14 days after the aspiration of the cyst fluid, an intracystic pressure in the same range as the initial one was found. The findings indicate deficient lymphatic drainage of non-keratinizing jaw cysts.

Bone Cysts

Odontogenic cyst growth and prostaglandin-induced bone resorption.

Forty-six odontogenic cysts produced significant quantities of bone-resorbing prostaglandins (PGs) in tissue culture. The follicular and periapical cysts released a mixture of PGEs and PGFs, while the keratocysts released only PGE2. There were also quantitative differences between the cyst types. Follicular cysts produced small quantities, as did keratocysts when allowance was made for their thin walls, whereas periodontal cysts are capable of relatively high activity. This prostaglandin activity can be related to the clinical behaviour of these lesions.

Bone Resorption

The histomorphologic spectrum of the gingival cyst in the adult.

Gingival cysts with clinical manifestations are relatively uncommon lesions. The present study adds thirty-three new cases to the literature and analyzes their clinical and histologic features. The mandibular cuspid and first premolar region was found to be the most common location. The epithelial lining of the cysts was of several types. The most common type was a thin, flattened lining with or without localized thickenings (buds). Other types included nonkeratinized stratified squamous epithelium, keratinized stratified squamous epithelium, and parakeratinized epithelium with palisading basal cells. Gingival cysts should be distinguished from lateral periodontal cysts on the basis of their origin in the gingiva rather than in bone. It appears that most gingival cysts with clinical manifestations are of odontogenic origin.

Adolescent

Hyalin material bounding dystrophic calcification in the epithelial lining of odontogenic cysts.

Areas of dystrophic calcification present in the epithelial lining of two apical periodontal cysts have been shown to exhibit an outer layer of hyalin material. Similar calcific areas in the connective tissue walls do not show hyalin boundaries. Hyalin material has been found around muscle fibers present in the epithelial lining of a residual dental cyst. It is believed that the hyalin material is secreted by the epithelial cells and these observations are considered to be supporting evidence that hyalin bodied arise as an epithelial secretion.

Calcinosis

Dental lesions causing abnormalities on skeletal scintigraphy.

The dental lesions of periodontitis, periodontal cysts, and tooth extraction were studied by Tc-99m phosphate scintigraphy of the jaws. Inflamed apical periodontal lesions caused a localized area of increased concentration of radiotracer regardless of the presence or absence of symptoms. Scintigrams may be positive up to eight months after dental extractions but tend to return to normal thereafter unless complications arise.

Diagnosis, Differential

Response of periapical pathosis to endodontic treatment in monkeys.

Response of induced periapical lesions in monkeys to a conventional endodontic technique was investigated at varying periods ranging from 15 to 365 days after treatment. The findings indicate that response to treatment is influenced by the extent of the root canal filling, the time lapse between treatment and death, and the presence or absence of bacteria in the apical portion of the canal.

Animals