Marsupialization of Juvenile Paradental Cyst: A Case Report

Paradental cysts are rare cystic lesions that develop on buccal, distal and rarely mesial side of the mandibular permanent molars in the period of their eruption. They belong to the group of inflammatory cysts and constitute less than 5% of all odontogenic cysts [1]. Most often they are associated with recurrent pericoronitis of semi-impacted wisdom teeth (61.4%) at the time of their eruption, between age 17 and 25. When localized on the buccal side of first and second mandibular molars (35.9%), they manifest at age 6-12 years [1]. Then, they are named juvenile paradental cysts (JPC) [2]. Very rarely, this cyst can develop on other teeth [3, 4]. Etiology and pathogenesis of these cysts have not been fully clarified. It is believed that inflammation of superficial periodontal tissue during eruption is initial factor that stimulates proliferation of odontogenic epithelium responsible for the development of cystic lesions [1, 5]. This theory is supported by the fact that the time of cyst appearance coincides with the time of tooth eruption. The origin of proliferating epithelium is not yet known: it might be derived from reduced enamel epithelium, junctional epithelium, epithelial remnants of dental lamina or epithelial rests of Malassez [1, 6, 7]. Histopathological finding of juvenile paradental cyst is not specific because it corresponds to radicular cysts [1, 5, 8]. It is characterized by hyperplastic non-keratinized stratified squamous epithelium and a layer of connective tissue with presence of inflammatory infiltrate [1, 5, 6, 7, 9]. Therefore, diagnosis is primarily established on the basis of clinical and radiographic findings. Differential diagnosis will consider lateral radicular cyst, lateral periodontal cyst and keratocystic odontogenic tumor. Different therapeutic procedures could be used: enucleation, enucleation with tooth extraction or marsupialization. For mandibular wisdom teeth enucleation with tooth extraction is recommended, while for JPC there is no established protocol, but conservative treatment has priority due to the importance of first and second molars and patient age. This case report describes conservative surgical approach in the treatment of bilateral juvenile paradental cysts attached on the first lower permanent molars.