Case #830: 41-year-old man seen for recall exam   
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Our appreciation is extended to Dr. Juan Yepes, Indiana University School of Dentistry Department of Pediatric Dentistry and Riley Hospital for Children, for contributing this case.

History: A 41-year-old man visited the dental office for a regular recall exam. The patient was asymptomatic. His last dental appointment was four years ago before COVID-19, because he did not want to see a dentist during the pandemic.

The patient’s past medical history was remarkable for hypertension, which was being treated with hydrochlorothiazide (50 mg daily).

The intraoral exam revealed moderate generalized gingival erythema. The presence of dental plaque was evident across the entire dentition.

The dentist ordered bitewing and periapical x-rays. The bitewing and periapicals were within normal limits except the maxillary right periapical showed a radiolucency associated with the canine. The dentist ordered a cone-beam computed tomography (CBCT) scan. Below in order is a sagittal, coronal, and axial view of the right maxilla. Click to enlarge the images.

What is the LEAST likely preliminary diagnosis?
Odontogenic keratocyst
Radicular cyst
Idiopathic bone cavity
Lateral periodontal cyst