Background. A radicular cyst is the most common odontogenic cyst of inflammatory origin. Radiographically, it commonly\ndemonstrates clear unilocular radiolucency; radicular cysts with multilocular radiolucency are quite rare. Case Presentation. A\n64-year-old Japanese man who presented with a bilocular radiolucent lesion in his left mandible was referred by a dental clinic\nto our oral and maxillofacial surgery department. He had no particular subjective symptoms. Orthopantomography and\ncomputed tomography (CT) revealed an 18mm*15mm lesion with well-defined bilocular radiolucency in the left mandible\nexpanding from the distal side of a canine tooth to the bottom of the 2nd premolar. The lesion included the roots of the 1st and\n2nd premolars. The root of the 2nd premolar showed knife-edge resorption. Although the 1st premolar was nonvital, the 2nd\npremolar was a vital tooth. As differential diagnoses, a radicular cyst, ameloblastoma, odontogenic keratocyst, pseudocyst, and\nothers might be considered. We performed a total resection of the bilocular lesion and diagnosed the lesion as a radicular cyst\nwith tooth structure components inside. The tooth structure components represented lamellar structures of cementum; they\nwere located only in the proximal part (under the 1st premolar) of the lesion. The distal part of the lesion presented distinctive\ninflammation without tooth structure components. Conclusion. We encountered a rare case of a bilocular radicular cyst with\ntooth structure components inside.
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