Surgical management of the buccal bifurcation cyst: bone grafting as a treatment adjunct to enucleation and curettage. 2014

Rachel E Levarek, and Mauricio J Wiltz, and Robert D Kelsch, and Richard A Kraut
Resident, Division of Oral and Maxillofacial Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.

The buccal bifurcation cyst (BBC) is a rare inflammatory odontogenic cyst of unknown etiology. It typically develops on the buccal aspect of the permanent mandibular first molar and occasionally on the permanent mandibular second molar in children 4 to 14 years old. Distinct clinical findings of the BBC include involvement of a vital partially or fully erupted mandibular first or second molar, swelling in the affected mandibular molar region, delayed or altered eruption pattern of the involved tooth, and an increase in periodontal pocket depth when the affected tooth is partially erupted. Specific radiographic features include a radiolucent lesion on the buccal aspect of the tooth involving the roots to a variable extent, tilting of the involved molar so that the root apices are toward the lingual cortical plate, an intact periodontal ligament space and lamina dura, a periosteal reaction on the buccal surface, and an intact inferior border of the mandible. The histopathology of the lesion has been described as similar to a radicular or inflammatory odontogenic cyst. Most of the current literature supports simple enucleation and curettage of the cyst without extraction of the involved tooth as the treatment of choice. This report presents 3 cases of BBCs that were treated with enucleation and curettage without extraction of the involved tooth, in addition to a bone graft placed primarily or secondarily as an adjunctive treatment approach to the current therapies.

UI MeSH Term Description Entries
D008297 Male Males
D008336 Mandibular Diseases Diseases involving the MANDIBLE. Disease, Mandibular,Diseases, Mandibular,Mandibular Disease
D008567 Membranes, Artificial Artificially produced membranes, such as semipermeable membranes used in artificial kidney dialysis (RENAL DIALYSIS), monomolecular and bimolecular membranes used as models to simulate biological CELL MEMBRANES. These membranes are also used in the process of GUIDED TISSUE REGENERATION. Artificial Membranes,Artificial Membrane,Membrane, Artificial
D008963 Molar The most posterior teeth on either side of the jaw, totaling eight in the deciduous dentition (2 on each side, upper and lower), and usually 12 in the permanent dentition (three on each side, upper and lower). They are grinding teeth, having large crowns and broad chewing surfaces. (Jablonski, Dictionary of Dentistry, 1992, p821) Molars
D010509 Periodontal Cyst An epithelium-lined sac containing fluid; usually found at the apex of a pulp-involved tooth. The lateral type occurs less frequently along the side of the root. Dentoalveolar Cyst,Lateral Cyst,Cyst, Dental Root,Cysts, Dental Root,Dental Root Cyst,Dental Root Cysts,Root Cyst, Dental,Root Cysts, Dental,Cyst, Dentoalveolar,Cyst, Lateral,Cyst, Periodontal,Cysts, Dentoalveolar,Cysts, Lateral,Cysts, Periodontal,Dentoalveolar Cysts,Lateral Cysts,Periodontal Cysts
D011862 Radiography, Panoramic Extraoral body-section radiography depicting an entire maxilla, or both maxilla and mandible, on a single film. Orthopantomography,Panoramic Radiography,Pantomography,Orthopantomographies,Panoramic Radiographies,Pantomographies,Radiographies, Panoramic
D001857 Bone Matrix Extracellular substance of bone tissue consisting of COLLAGEN fibers, ground substance, and inorganic crystalline minerals and salts. Bone Matrices,Matrices, Bone,Matrix, Bone
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D003475 Curettage A scraping, usually of the interior of a cavity or tract, for removal of new growth or other abnormal tissue, or to obtain material for tissue diagnosis. It is performed with a curet (curette), a spoon-shaped instrument designed for that purpose. (From Stedman, 25th ed & Dorland, 27th ed) Curettages
D005260 Female Females

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