Unusual Presentation of Lateral Periodontal Cyst in Molar Region of Elderly Patient

The case report was described in the Gerodontology Journal by John K. Brooks, Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, Maryland, USA, and colleagues.

LPC is a developmental odontogenic cyst that typically occurs along the lateral roots of mandibular canines and premolars. However, its presence in the molar region is highly uncommon, and reports of such cases in geriatric patients are even rarer. This case sheds light on an unusual location of LPC and reinforces the importance of considering it in differential diagnoses for cystic lesions in the posterior mandible.

The lesion was incidentally detected during routine extraoral and intraoral radiographic examinations. Initially, the researchers suspected it to be an infected odontogenic keratocyst or unicystic ameloblastoma due to its radiographic features. Given the potential for more aggressive pathologies, further investigation was necessary to determine the exact nature of the lesion.

Histopathological analysis of the excised specimen confirmed the diagnosis of an LPC, revealing a thin cuboidal epithelial lining with focal nodular thickenings and an underlying fibrovascular connective tissue wall. The patient underwent surgical removal of the lesion, and follow-up at six months showed no recurrence, with evidence of radiographic bone regeneration.

This case highlights the importance of considering LPC in the differential diagnosis of odontogenic cysts, even in atypical locations such as the inter-molar region. Preoperative cone beam computed tomography (CBCT) can be a valuable tool in optimizing surgical planning by providing detailed imaging of the lesion’s extent and relationship with surrounding structures.

Early identification and excision of cystic lesions, particularly in older patients, prevent complications such as infection, bone loss, or potential malignancy. The case emphasizes the need for dental professionals to remain vigilant when evaluating radiolucent lesions in geriatric patients, ensuring timely intervention to reduce postoperative complications and promote better outcomes.

"LPC should be considered in the differential diagnosis of developmental odontogenic cysts in the inter-molar region. A preoperative cone beam computed tomography scan can aid in optimizing the surgical approach," the researchers wrote.

"Early removal of suspected cystic lesions, especially in older patients with infection, may help minimize postoperative complications and exclude the possibility of malignancy," they concluded.

Reference:

Brooks, J. K., Portillo, N., Bhatti, A. K., Parsa, A., & Basile, J. R. (2025). Lateral periodontal cyst in an interdental molar site: Novel presentation in a geriatric patient. Gerodontology, 42(1), 124-128. https://doi.org/10.1111/ger.12759