title: Surgical management of the buccal bifurcation cyst: bone grafting as a treatment adjunct to enucleation and curettage.
abstract: 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.
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Levarek
authors.affiliation: Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Dentistry, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Mauricio J
authors.initials: MJ
authors.lastname: Wiltz
authors.affiliation: Assistant Professor, Departments of Dental Medicine and Pathology and Laboratory Medicine, NSLIJ Health System, New Hyde Park, NY, Attending, Departments of Dentistry and Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kelsch
authors.affiliation: Chairman, Department of Dentistry, Director, Oral and Maxillofacial Surgery Residency Program, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Electronic address: chrclark@montefiore.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kraut
mesh_terms: D020341:Absorbable Implants; D001857:Bone Matrix / Q000637:transplantation; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003475:Curettage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery*; D008567:Membranes, Artificial; D008963:Molar / Q000000981:diagnostic imaging / Q000473:pathology*; D010509:Periodontal Cyst / Q000601:surgery*; D011862:Radiography, Panoramic / Q000379:methods; D014092:Tooth Root / Q000000981:diagnostic imaging
chemical_list: D008567:Membranes, Artificial