Juvenile paradental cyst: presentation of a rare case involving second molar.

The aim of this article was to describe a rare case of paradental cyst of the permanent mandibular second molar. A 14-year-old girl was referred to Oral Surgery Department, Dental Clinic, IRCSS Fondazione Ca' Granda, University of Milan, Italy, for the evaluation of the deep probing located on the buccal aspect of her erupted mandibular left second molar. Clinical signs of inflammation were absent and the mucosa around the second molar appeared clinically normal. Pulp tests for the second molar were positive. The evaluation of the panoramic radiograph did not revealed radiolucency. The Cone-beam tomography showed a well-defined semilunar-shaped radiolucency demarcated by a fine radiopaque line. The cyst was enucleated. The histopathologic analisys revealed the presence of hyperplastic, non-keratinized squamous epithelium with heavy, dense inflammatory cell infiltrate in the epitelium and connective tissue wall. This analysis associated with macroscopic, clinical and radiografic examination confirmed the diagnosis of paradental cyst. A clinic-pathologic correlation, incorporating the surgical, radiographic and histologic findings, is required to obtain the final diagnosis of paradental cyst. Today, the treatment of choice is simple enucleation and thorough curettage of the cyst without extraction of the involved tooth, but if CT demonstrates erosions in the buccal or lingual cortices, marsupialization should be the treatment of choice.

Hard and soft tissue augmentation in implant surgery: a case report.

Correct pre- and postimplant hard and soft tissue management is prerequisite to achieving optimal esthetic and functional outcomes after implant-prosthesis treatment. Various different methods for preimplant hard tissue augmentation in alveolus maxillary atrophy are described. In some cases, non-resorbable titanium-reinforced membranes are employed for vertical augmentation of the edentulous crest. Also well documented is soft tissue management through mucus-gingival surgery techniques that increase the thickness of peri-implant keratinized gingiva, enhancing soft tissue esthetic and health. These methods also include the use of epithelial-connectival grafts collected from the palate. Here we present a clinical case of severe bone vertical resorption in edentulous areas treated with two vertical ridge augmentations by means of non-resorbable membranes in the retromandibular area and deferred insertion of six implants. Peri-implant plastic surgery techniques to improve the quantity of keratinized mucosa during the second surgery phase are also discussed. Combination of the two techniques resulted in harmonic tissue architecture and adequate presence of keratinized gingiva.