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Cementum is an adaptable component of the periodontium which can respond to functional changes throughout its development, with its formation being characterized by apposition during the final stage of the tooth's life. In some cases, this formation occurs in excess, giving rise to hypercementosis, or other lesions (e.g., cementoblastoma) often presenting similar clinical and imaging features, but they are actually distinct entities requiring different approaches. The objective of the present study is to demonstrate the clinical and imaging characteristics of a case based on a differential diagnosis of these entities. Accurate diagnosis through detailed examination and adequate interpretation of imaging characteristics is essential for appropriate and successful therapy.

Paradental cyst is an inflammatory odontogenic cyst linked with mandibular molars. The occurrence rate of the lesion ranges from 0.9 to 4.7% suggesting its infrequency. The histopathologic findings in hematoxylin and eosin routine staining are not pathognomonic, and the correlation with clinical and imaging characteristics is essential to establish the final diagnosis. The periapical radiographs show a unilocular radiolucency on the distal or disto/buccal aspect of the involved tooth, however, the lesion can superimpose over the roots and mimic periapical pathology. We report the imaging features of a rare bilateral paradental cyst with an emphasis on magnetic resonance imaging and cone beam computed tomography to help a correct identification and characterization of the cyst and to reliably establish the diagnosis.