Dentigerous CYST versus paradental CYST versus eruption pocket CYST

Abstract

When the oral surgeon observes a crescent or hemispherical radiolucency distal to the crown of a partially impacted mandibular third molar, he or she usually provides a clinical diagnosis of “dentigerous cyst.” I suspect that many of the dentigerous cysts in the recent report by Curran and colleagues (J Oral Maxillofac Surg 60:613-617, 2002) 1 Curran AE Damm DD Drummond JF Pathologically significant pericoronal lesions in adults: Histologic evaluation. J Oral Maxillofac Surg. 2002; 60: 613 Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar had this rather common presentation. Some investigators (Ackermann et al 2 Ackermann G Cohen MA Altini M The paradental cyst: A clinicopathologic study of 50 cases. Oral Surg Oral Med Oral Pathol. 1987; 64: 308 Abstract Full Text PDF PubMed Scopus (49) Google Scholar and Colgan et al 3 Colgan CM Henry SS Napier SS et al. Paradental cysts: A role for food impaction in the pathogenesis? A review of cases from Northern Ireland. Br J Oral Maxillofac Surg. 2002; 40: 163 Abstract Full Text PDF PubMed Scopus (20) Google Scholar ) call such lesions “paradental cysts.” I agree with Ackermann and Colgan that these are not dentigerous cysts, especially when the radiolucent lesion extends distal to a retained narrow follicular space (a positive Colgan sign 3 Colgan CM Henry SS Napier SS et al. Paradental cysts: A role for food impaction in the pathogenesis? A review of cases from Northern Ireland. Br J Oral Maxillofac Surg. 2002; 40: 163 Abstract Full Text PDF PubMed Scopus (20) Google Scholar ). However, as several investigators (Craig 4 Craig GT The paradental cyst. A specific inflammatory odontogenic cyst. Br Dent J. 1976; 141: 9 Crossref PubMed Scopus (60) Google Scholar and Brannon and Fowler 5 Fowler CB Brannon RB The paradental cyst: A clinicopathologic study of six new cases and a review of the literature. J Oral Maxillofac Surg. 1989; 47: 243 Abstract Full Text PDF PubMed Scopus (31) Google Scholar , 6 Brannon RB Fowler CB Diagnosing the paradental cyst [Letter]. J Oral Maxillofac Surg. 1990; 48: 100 Abstract Full Text PDF Google Scholar ) have pointed out, the paradental cyst occurs principally buccal and/or distal to the root (not the crown) of the erupting third molar. If neither term is entirely appropriate, then maybe we need a new designation. Perhaps the appellation “eruption pocket cyst” or “pericoronitis-associated eruption pocket cyst” could be suggested. This lesion appears to represent a ballooned periodontal pocket associated with an erupting tooth (developing after follicular reduced enamel epithelium fuses with gingival epithelium), a mechanism suggested and beautifully illustrated by Ackermann et al. 2 Ackermann G Cohen MA Altini M The paradental cyst: A clinicopathologic study of 50 cases. Oral Surg Oral Med Oral Pathol. 1987; 64: 308 Abstract Full Text PDF PubMed Scopus (49) Google Scholar Parenthetically, I believe the proliferation of granulation tissue associated with pericoronitis can result in a positive Colgan sign in the absence of cyst formation. Pathologically significant pericoronal lesions in adults: Histopathologic evaluationJournal of Oral and Maxillofacial SurgeryVol. 60Issue 6PreviewPurpose: Oral and maxillofacial surgeons devote a large portion of their practice to the removal of impacted teeth. Many of these teeth have associated soft tissue that is submitted along with or without the tooth for histopathologic examination. This study reports the histopathologic diagnoses of a large series of pericoronal lesions in adults submitted to an oral and maxillofacial pathology biopsy service. Materials and Methods: Two thousand six hundred forty-six pericoronal lesions received during a 6-year period were reviewed for location, age, and histopathologic diagnosis. Full-Text PDF