Paradental cyst: Misdiagnosed or underdiagnosed

Paradental cysts (PDCs) are odontogenic cysts having inflammatory origin contributing to 3%–5% of all odontogenic cysts. They arise either on the buccal, distal, or mesial aspects of partially erupted mandibular third molars. It has been previously known by various terms such as collateral inflammatory cyst, inflammatory lateral periodontal cyst, or mandibular infected buccal cyst. PDC is most commonly associated with recurrent history of pericoronitis and is attached to the cementoenamel junction and coronal third of the roots. While there is little doubt that it develops as a response to chronic inflammatory stimulus triggering proliferation of the crevicular and/or odontogenic epithelium, considerably same as other inflammatory odontogenic cysts, the exact histogenesis remains unclear. The PDC is commonly misinterpreted when it is associated with atypical characteristics clinically and radiographically, in turn causing diagnostic problems, leading to misdiagnosis as other inflammatory cysts including the dentigerous cyst of inflammatory origin. In this present case series, two cases with a history of pericoronitis are discussed showing overlapping clinical, radiographic, and histological features with other odontogenic cysts creating diagnostic dilemma. A combined correlation of all relevant findings helped to attain a final diagnosis of PDC.