RESUMEN
OBJECTIVE: The limitations of spontaneous bone healing underscore the necessity for exploring alternative strategies to enhance bone regeneration in maxillary radicular cyst cases. This retrospective study aimed to assess the impact of a bone substitute material (i.e., Bio-Oss) on bone volume regeneration following maxillary radicular cyst enucleation using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Seventy-three patients with maxillary radicular cysts were divided into two groups: one undergoing guided bone regeneration (GBR) with Bio-Oss and absorbable collagen membrane (n = 35), and the other receiving cyst excision alone (n = 38). Volumetric measurements using Amira software on CBCT scans evaluated bone regeneration, with cystic lesion shrinkage rates calculated. Intergroup comparisons utilized independent sample t-tests (P < 0.05), and linear regression analysis assessed the influence of preoperative cyst volume and group on bone healing. RESULTS: Both groups showed similar success rates in bone formation at the 12-month follow-up, with no significant differences between them (mean (SD), control: 75.16 (19.17) vs. GBR: 82 (20.22), P > 0.05). Linear regression analysis revealed a negative correlation between preoperative cyst volume and bone regeneration in both groups (P < 0.05). CONCLUSION: Bio-Oss may not significantly enhance bone augmentation in maxillary radicular cysts. In addition, preoperative cyst volume negatively affected the shrinkage rate of cystic lesions. CLINICAL RELEVANCE: Clinicians should consider patient-specific factors such as anatomy and lesion size when determining the need for bone substitute materials. Future research could focus on optimizing treatment protocols and alternative regenerative strategies to improve patient outcomes in maxillary cyst cases.
Asunto(s)
Sustitutos de Huesos , Minerales , Quiste Radicular , Humanos , Trasplante Óseo/métodos , Estudios Retrospectivos , Quiste Radicular/cirugía , Sustitutos de Huesos/uso terapéutico , Regeneración ÓseaRESUMEN
AIM: Periapical cysts of primary teeth are pathologic entities which are seldom encountered in the clinical practice. Most frequently, these lesions arise in correspondence with primary teeth presenting previous pulp therapy, severe carious lesions, or a history of previous trauma. The aim of the present study is to systematically review the treatment modalities of periapical cysts of the deciduous, along with the reporting of a clinical case. MATERIALS: A case of periapical cyst treated with marsupialization occurring in an 11-year-old patient is described. A literature search was devised to retrieve studies reporting the treatment of periapical cysts, and involved papers published in the Cochrane Oral Health Group specialist trials, MEDLINE via PubMed, and EMBASE up to March 2023. A total of 39 articles were retrieved. Following title and abstract analysis, 27 articles were selected for full-text analysis, with the final inclusion of 24 articles. CONCLUSION: Periapical cysts of primary teeth present an overall good prognosis irrespective of the treatment option adopted. The performance of a prompt diagnosis appears of utmost importance, as the extraction of the primary teeth involved implies the management of the residual space for the correct positioning of the corresponding permanent teeth.
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Quiste Radicular , Diente Primario , Humanos , Niño , Quiste Radicular/terapia , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/cirugía , MasculinoRESUMEN
AIM: To evaluate the indication of the endodontic treatment for vital intact teeth with the root apex involved in large radicular cystic lesions of endodontic origin. METHODOLOGY: This prospective cohort study enrolled healthy participants with radicular cysts of endodontic origin and with the root apex of vital intact teeth involved in the bone defect, as determined by cone beam computed tomography (CBCT). Thirty-two sound vital teeth were analysed by thermal (TPT) and electric pulp tests (EPT) before surgery (T0) and 1 week (T1), 2 weeks (T2), 3 months (T3) and 6 months (T4) post-surgery. Student's t-test (p < .05) was used to compare the EPT values at baseline and T4. anova (p < .05) was used to analyse the EPT variations for all maxillary and mandibular teeth. McNemar test (p < .05) was used to compare the results according to variation in EPT values gathering by variation, no variation and no response. RESULTS: At T1, 75 and 65.7% of teeth responded positively whilst 25 and 34.3% did not respond to EPT and TPT, respectively. The variation of the EPT values between T0 and T1 was observed for 50.0% of teeth, whilst no variation was noticed in 25.0% of teeth. At T4, 90.6 and 87.5% of teeth responded positively whilst 9.4 and 12.5% did not respond to EPT and TPT, respectively. At T4, variation of the EPT values between T0 and T4 was observed for 28.1%, whilst no variation was noticed in 62.5% of teeth. There were no statistical differences in EPT results between T0 and T4 (p > .05), but significant differences were observed for EPT values between T1 and T4 (p < .05), and between mandibular and maxillary teeth. The pulp sensibility of maxillary teeth worsened after surgery, before reverting progressively to T0 values, whilst no statistically significant differences were observed for mandibular teeth at the different time points. CONCLUSIONS: These data support the inconsistence of the prophylactic endodontic treatment in healthy vital teeth with apex involvement in large cystic lesions of endodontic origin. Post-surgery follow-up with TPT and EPT is recommended to assess pulp status.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Quiste Radicular , Humanos , Estudios Prospectivos , Femenino , Masculino , Adulto , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/cirugía , Resultado del Tratamiento , Prueba de la Pulpa Dental , Tratamiento del Conducto Radicular/métodos , Adulto Joven , Ápice del Diente/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
The radicular cyst is the most common odontogenic cyst and is caused by inflammation. It can become atypically large, although the size of the radiographic osteolysis says nothing about the entity of the lesion. This case shows an unusually large multilocular radicular cyst expanding buccally from tooth 46 in a patient with severe autism who can only be treated under general anesthesia. The clinical and radiological picture as well as the intraoperative situation was more indicative of an aggressive cyst or benign tumor. The lesion was surgically completely removed and the teeth 46, 47 and 48 were extracted because of poor compliance and prognosis. Histopathology revealed a radicular cyst. There were no postoperative complications. After eight months, the lesions had almost completely reossified.
Asunto(s)
Quistes Odontogénicos , Quiste Radicular , Humanos , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/cirugía , Quistes Odontogénicos/diagnóstico por imagen , Quistes Odontogénicos/cirugía , Quistes Odontogénicos/patología , Mandíbula/patología , Radiografía , Cabeza/patologíaRESUMEN
Squamous cell carcinomas (SCCs) are common malignant tumors in the oral and maxillofacial region. However, SCCs secondary to marsupialization of odontogenic radicular cysts are extremely rare. The authors report an unusual case of a 43-year-old male presented with dull pain in the right molar region of the mandible without numbness of lower lips, who had a long history of smoking, alcohol consumption, and betel nut chewing. Computerized tomography revealed a round well-defined unilocular radiolucent at the apex of lower right premolars, 2 nonvital teeth. The clinical diagnosis was the radicular cyst of the right mandible. The patient was initially treated with root canal therapy of the teeth followed by marsupialization with a mandibular vestibular groove incision. While the patient did not follow the instruction of irrigation of the cyst and had no regular follow-up. The reexamination of computerized tomography indicated a round well-defined unilocular radiolucent at the apex of lower right premolars and filled with a soft tissue without clear boundary with buccal muscles at 31 months follow-up. There were no masses or ulcer around the mandibular vestibular groove incision and the patient had no sign of numbness of lower lips. The clinical diagnosis was the radicular cyst of right mandible with infection. A curettage was performed. However, the pathologic diagnosis was well-differentiated SCC. An extended radical surgical resection including segmental resection of the right mandible was performed. The histopathology was well-differentiated SCC without the cyst epithelium and invasion of bone, which can be distinguished from primary intraosseous SCC. The case indicates that marsupialization performed in patients with a history of smoking, alcohol consumption, and betel nut chewing, has a risk of suffering from oral SCC.
Asunto(s)
Carcinoma de Células Escamosas , Quistes Odontogénicos , Quiste Radicular , Masculino , Humanos , Adulto , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/cirugía , Mucosa Bucal/patología , Hipoestesia , Quistes Odontogénicos/cirugía , Mandíbula/cirugía , Carcinoma de Células Escamosas/cirugía , Carcinoma de Células Escamosas/patología , EpitelioRESUMEN
In addition to pathogenic teeth associated with cysts, the roots of adjacent teeth are often included in the cystic cavity. Whether these teeth require elective endodontic treatment followed by cystic enucleation remains unclear. In the case presented herein, we aimed to preserve the pulp of the teeth included in the cystic lesion. Unfortunately, the sensibility of the included teeth was negative after endodontic surgery, including cystic enucleation. However, the sensibility recovered after 1 year and was maintained throughout a 4.5-year follow-up. Therefore, we suggest that elective endodontic treatment of the included teeth should be avoided, and further research should be conducted regarding this issue. (EEJ-2022-05-063).
Asunto(s)
Quistes , Quiste Radicular , Humanos , Quiste Radicular/cirugía , Estudios de Seguimiento , Pulpa DentalRESUMEN
BACKGROUND: Radicular cysts arising from primary teeth are rare. Enucleation and marsupialization or decompression are treatment approach to odontogenic cysts. Decompression known to achieve good results in various cysts is widely used in clinic. This study aims to evaluate the efficiency of decompression in reducing radicular cysts associated with primary teeth in children. METHODS: Cases of radicular cysts associated with primary teeth treated by decompression were reviewed in the present study. Clinical information and radiologic data of pre and post decompression were measured and analyzed. RESULTS: Twenty-three patients treated for 25 cysts were included. All lesions with mean initial area 3.66 ± 2.00 cm2 were reduced after decompression time ranging 2 to 10 months. Mean rate of reduction was 0.77 ± 0.44 cm2/mo and large lesions (> 3.5 cm2) had a significantly higher reduction rate compared to smaller ones (< 3.5 cm2) (P < 0.00). All effected succedaneous teeth erupted after treatment at follow-up while 12 (46%) of them had root development problems. CONCLUSIONS: Decompression represents superiority as an effective and less invasive treatment in radicular cysts associated with primary teeth. TRIAL REGISTRATION: This study was retrospectively registered in the Ethics Committee of Ninth People's Hospital Affiliated with Shanghai JiaoTong University School of Medicine (No.SH9H-2022-T158-1).
Asunto(s)
Quistes Odontogénicos , Quiste Radicular , Niño , Humanos , Quiste Radicular/cirugía , Estudios Retrospectivos , China , Quistes Odontogénicos/complicaciones , Quistes Odontogénicos/cirugía , Descompresión , Diente PrimarioRESUMEN
O cisto radicular é uma lesão inflamatória associada à necrose pulpar que ocorre frequentemente em maxila. Objetivo: Descrever um caso cirúrgico detalhado de Cisto Periapical Abscedado. Relato de Caso: paciente gênero feminino, 40 anos, hipertensa, diabética Tipo II, compareceu à clínica queixando-se de dor ao ingerir alimentos frios e quentes na região da maxila, lado esquerdo. Ao exame físico, observou-se destruição coronária e presença de fístula na região do elemento dentário 23. Ao exame radiográfico, observou-se uma área radiolúcida ovalada bem circunscrita com halo radiopaco envolvendo a região apical do elemento dentário 23. Frente ao aspecto clínico e radiográfico, foram sugeridas as hipóteses diagnósticas de abscesso periapical crônico, granuloma periapical ou cisto apical abscedado. Foi realizada a exodontia do elemento 23 seguida de enucleação cística. O diagnóstico histopatológico final foi de cisto abscedado. Após 5 meses de evolução observa-se mucosa íntegra e reparo ósseo alveolar. Conclusão: É imprescindível um exame clínico cuidadoso associado ao exame radiográfico e histopatológico para analisar minuciosamente o caso a fim de oferecer ao paciente melhores condutas de tratamento. O diagnóstico de lesões intraósseas associado ao correto tratamento interrompe a evolução do processo patológico, evita danos maiores e restabelece a condição de saúde dos pacientes... (AU)
The radicular cyst is an inflammatory lesion associated with pulp necrosis that often occurs in the maxilla. Objective: To describe a detailed surgical case of Abscessed Periapical Cyst. Case Report: female patient, 40 years old, hypertensive, type II diabetic, came to the clinic complaining of pain when ingesting cold and hot foods in the left side of the maxilla. On physical examination, coronary destruction and the presence of a fistula in the region of the tooth 23 were observed. The radiographic examination showed a well-circumscribed oval radiolucent area with a radiopaque halo involving the apical region of the tooth 23. In view of the clinical and radiography, the diagnostic hypotheses of chronic periapical abscess, periapical granuloma or abscessed apical cyst were suggested. Element 23 extraction was performed followed by cystic enucleation. The final histopathological diagnosis was an abscessed cyst. After 5 months of evolution, intact mucosa and alveolar bone repair are observed. Conclusion: A careful clinical examination associated with radiographic and histopathological data is essential to systematically analyze the case in order to offer the patient better treatment. The diagnosis of intraosseous lesions associated with the correct treatment interrupts the evolution of the pathological process, avoids further damage and restores the patients' health condition... (AU)
El quiste radicular es una lesión inflamatoria asociada a necrosis pulpar que frecuentemente se presenta en el maxilar. Objetivo: Describir un caso quirúrgico detallado de Quiste Periapical Absceso. Caso Clínico: paciente femenina, de 40 años, hipertensa, diabética tipo II, acudió a la consulta quejándose de dolor al ingerir alimentos fríos y calientes en el lado izquierdo del maxilar. Al examen físico se observó destrucción coronaria y la presencia de una fístula en la región del diente 23. El examen radiográfico mostró un área radiolúcida oval bien delimitada con un halo radiopaco que involucraba la región apical del diente 23. En vista de la clínico y radiográfico, se sugirieron las hipótesis diagnósticas de absceso periapical crónico, granuloma periapical o quiste apical abscesificado. Se realizó la extracción del elemento 23 seguida de enucleación quística. El diagnóstico histopatológico final fue de quiste abscesificado. A los 5 meses de evolución se observa mucosa intacta y reparación del hueso alveolar. Conclusión: Un examen clínico cuidadoso asociado con el examen radiográfico e histopatológico es fundamental para analizar a fondo el caso con el fin de ofrecer al paciente mejores enfoques de tratamiento. El diagnóstico de lesiones intraóseas asociado al correcto tratamiento interrumpe la evolución del proceso patológico, previene mayores daños y restablece el estado de salud de los pacientes... (AU)
Asunto(s)
Humanos , Femenino , Adulto , Quiste Radicular/cirugía , Quiste Radicular/diagnóstico por imagen , Procedimientos Quirúrgicos Orales , Quiste Radicular/patología , Resultado del TratamientoRESUMEN
Radicular cyst is the most common type of odontogenic cyst associated with the apex of non-vital teeth. The lining of the radicular cyst usually arises from the epithelial rests of Malassez. These cyst usually persists even after the elimination of microbial load from the root canals. Surgical removal is deemed necessary for the management. For larger lesions extending to the facial or palatal cortical plates, additional regenerative procedures such as bone grafting along with collagen membrane are warranted. This case report describes the surgical and prosthetic management of a giant radicular cyst that was perforating the cortical plates in the anterior maxilla.
Asunto(s)
Quiste Radicular , Humanos , Maxilar/patología , Maxilar/cirugía , Prostodoncia , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/patología , Quiste Radicular/cirugíaRESUMEN
Radicular cysts are most common odontogenic cysts seen in the orofacial region, but not commonly detected in paediatric cases. This case report describes the accidental detection of radicular cyst and its surgical management in an 8-year-old boy in lower left back region of the jaw. The article also gives an insight about radicular cyst from its aetiology to the various other treatment modalities.
Asunto(s)
Quistes Odontogénicos , Quiste Radicular , Niño , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Diente Molar/cirugía , Quistes Odontogénicos/diagnóstico , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/cirugíaRESUMEN
One of the most frequent pathologies of jaw bone is a bacteria-induced inflammation at the apices of teeth with subsequent bone resorption that typically presents as a radiolucency in radiographs. Usually, corresponding clinical and radiographic findings correlate and allow for an accurate diagnosis. However, occasionally an unexpected and completely different diagnosis presents as documented in this case report. In a 55-year-old female patient, a radicular cyst was suspected in her right maxillary bone. The treatment plan included a cystectomy as well as apical surgery of the adjacent and root-canal filled teeth 15 and 16. However, the intraoperative finding absolutely did not fit a radicular cyst but rather a mucous retention cyst, as could be confirmed subsequently by histopathology. The diagnosis of a mucous retention cyst within the jaw bone is extraordinary and as such has never been described before in the literature.
Asunto(s)
Quiste Radicular , Femenino , Humanos , Maxilar , Persona de Mediana Edad , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/cirugía , Tratamiento del Conducto RadicularRESUMEN
INTRODUCTION: Endodontic-periodontal combined lesions pose a treatment challenge for clinicians, especially when the lesion is persistent and does not show signs of healing after initial endodontic treatment. This case report describes interdisciplinary management of a non-healing combined endodontic-periodontal lesion related to a peri-apical cyst, through a combined approach of apicoectomy and guided tissue regeneration (GTR) with enamel matrix derivative (EMD). Most documented cases have been treated in a sequential manner, with minimal literature present on the effects of a combined approach utilizing EMD for the treatment of these lesions. CASE PRESENTATION: A 72-year-old male patient presented with an endodontic-periodontal lesion at tooth #31 initially treated with nonsurgical root canal therapy. The lesion was not responsive to initial endodontic treatment. The patient was informed of questionable prognosis, however wished to save the tooth. Tooth #31 was treated via a combination approach of apicoectomy with bioceramic putty retrograde filling, followed by GTR of the defect using allograft, EMD, and resorbable barrier membrane. The lesion was biopsied and diagnosed as a periapical cyst. Clinical and radiographic examination at 1 year showed resolution of lesion, reduction in probing depths, and good bone fill of the defect. CONCLUSION: Traditionally, endodontic-periodontal lesions, which were not responsive to initial therapy, would be given a questionable prognosis and be extracted. This case demonstrates that non-healing, peri-apical lesions may be cystic in nature and effectively managed utilizing a combined approach, with apicoectomy and GTR with EMD, to produce a stable outcome.
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Apicectomía , Quiste Radicular , Anciano , Regeneración Tisular Guiada Periodontal , Humanos , Masculino , Quiste Radicular/cirugía , Tratamiento del Conducto RadicularRESUMEN
Los quistes periapicales o radiculares representan una de las patologías periapicales más frecuentes dentro del grupo de las lesiones quísticas de los maxilares. Son el resultado de la extensión de proce- sos inflamatorios-infecciosos. Su diagnóstico sigue siendo un desafío para el profesional odontológico, quien debe diferenciarlo de otros procesos inflama- torios periapicales. El objetivo del presente artículo es presentar, apoyado en una revisión de la literatura, el caso clínico de un paciente masculino de 38 años de edad que se presentó a la consulta por leve tume- facción indolora en zona anterosuperior del maxilar. A la inspección se observó borramiento de la región del surco vestibular a nivel de piezas dentarias 1.1, 1.2 y 1.3, de color rojizo con crepitación de la tabla ósea vestibular a la palpación. La tomografía de haz cónico mostró lesión osteolítica, extendida desde zona apical de la pieza dentaria 1.4 hasta zona del elemento dentario 1.1. Se realizó la extirpación de la lesión y api- cectomía. El estudio histológico corroboró el diagnós- tico presuntivo de quiste periapical. Los controles a distancia mostraron buena evolución del tratamiento. Se concluyó en la importancia de realizar un correcto diagnóstico clínico e imagenológico para la selección de un adecuado tratamiento según el caso (AU)
Periapical or radicular cysts represent one of the most frequent periapical pathologies within the group of cystic lesions of the jaws. They are the result of the spread of inflammatory-infectious processes. Its diagnosis continues to be a challenge for the dentist, who must differentiate it from other periapical inflammatory processes. The objective of this article is to present, supported by a review of the literature, the clinical case of a 38-year-old male patient who presented to the consultation due to mild painless swelling in the anterosuperior maxilla. Upon inspection, effacement of the vestibular sulcus region was observed at the level of teeth 1.1, 1.2 and 1.3, reddish in color with crepitation of the buccal bone table on palpation. Cone beam tomography showed an osteolytic lesion that extended from the apical area of tooth 1.4 to area of tooth 1.1. Excision of the lesion and apicoectomy were performed. The histological study corroborated the presumptive diagnosis of periapical cyst. Remote controls showed a good evolution of the treatment. It was concluded on the importance of carrying out a correct clinical and imaging diagnosis for the selection of an adequate treatment according to the case (AU)
Asunto(s)
Humanos , Femenino , Adulto , Quiste Radicular/cirugía , Quiste Radicular/diagnóstico por imagen , Apicectomía/métodos , Biopsia/métodos , Procedimientos Quirúrgicos Orales , Tomografía Computarizada de Haz CónicoRESUMEN
Introdução: os cistos radiculares são as lesões císticas mais comuns nos maxilares. Eles surgem dos Restos Epiteliais de Malassez, presos no ligamento periodontal e podem ser ativados por um processo inflamatório na região pulpar. Geralmente são descobertos em exames radiográficos de rotina, apresentando-se como uma imagem radiolúcida, bem delimitada, envolvendo o periápice de um ou mais dentes. Objetivo: apresentar o tratamento de um extenso cisto radicular, em região de maxila, com acompanhamento de 18 meses. Relato do caso: Paciente do sexo feminino, 49 anos, foi encaminhada para avaliação e tratamento na Clínica Odontológica da Faculdade Sete Lagoas (FACSETE), apresentando lesão extensa em região maxilar anterior direita ao exame radiográfico. Ao exame clínico, observou-se leve assimetria facial e ausência de sintomas dolorosos. Tomografia computadorizada, punção aspirativa e biópsia incisional foram utilizadas para se chegar ao diagnóstico compatível com cisto radicular. Optou-se por uma técnica conservadora, em que foi realizada a descompressão da lesão. Após 05 meses de tratamento, um novo procedimento cirúrgico foi realizado para enuclear o restante da patologia. Conclusão: a descompressão, com utilização de cânula, é um tratamento auxiliar fácil, conservador, eficaz e reduz a morbidade causada por diferentes cistos odontogênicos(AU)
Introduction: root cysts are the most common cystic lesions in the jaw. They arise from the Epithelial Remains of Malassez, trapped in the periodontal ligament and can be activated by an inflammatory process in the pulp region. They are usually discovered in routine radiographic examinations, presenting as a well-defined radiolucent image involving the periapex of one or more teeth. Objective: to present the treatment of an extensive root cyst, in the maxillary region, with a follow-up of 18 months. Case report: A 49-year-old female patient was referred for evaluation and treatment at the Dental Clinic of Faculdade Sete Lagoas (FACSETE), with an extensive lesion in the right anterior maxillary region on radiographic examination. On clinical examination, mild facial asymmetry and absence of painful symptoms were observed. Computed tomography, aspiration puncture and incisional biopsy were used to reach a diagnosis compatible with radicular cyst. We opted for a conservative technique, in which the lesion was decompressed. After 05 months of treatment, a new surgical procedure was performed to enucleate the rest of the pathology. Conclusion: decompression, using a cannula, is an easy, conservative, effective auxiliary treatment and reduces the morbidity caused by different odontogenic cysts.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Quiste Radicular , Descompresión , Ligamento Periodontal , Quistes Odontogénicos , Quiste Radicular/cirugía , Quiste Radicular/diagnóstico , Quiste Radicular/terapia , Quiste Radicular/diagnóstico por imagenRESUMEN
Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect of previous root canal treatment on the clinical presentation of large maxillary radicular cysts. Materials and Methods: All cases of radicular cysts treated at the Oral and Maxillofacial Surgery Department of a tertiary public hospital over a period of six years (2012-2018) were evaluated. Histologically confirmed radicular cysts of the maxilla with a maximal dimension of over 15 mm were included. Demographic data of the patients, clinical presentation and radiographic features of the lesions were analyzed. Results: A total of 211 inflammatory cysts were treated in the study period, of these 54 histologically diagnosed radicular cysts in the maxilla were found to have a maximal dimension of over 15 mm. The mean age of patients with large maxillary radicular cysts was 43.3 years, 57.6% of which were male and 42.4% female. The lateral incisor was the most common tooth affected (46.3%). The mean size of the large radicular cysts was 25 mm. Then, 83.8% of the cysts were observed in teeth with previous endodontic treatment. Teeth without endodontic treatment presented clinically with significantly fewer acute symptoms in comparison to teeth with previous endodontic treatment. Conclusions: the vast majority (83.8%) of large maxillary radicular cysts were associated with endodontically treated teeth. Previous endodontic treatment was correlated to increased frequency of clinical symptoms.
Asunto(s)
Quiste Radicular , Diente no Vital , Adulto , Femenino , Humanos , Incisivo , Masculino , Maxilar/diagnóstico por imagen , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/epidemiología , Quiste Radicular/cirugía , Tratamiento del Conducto Radicular/efectos adversos , Diente no Vital/diagnóstico por imagen , Diente no Vital/epidemiologíaRESUMEN
BACKGROUND: Radicular cysts may enlarge considerably, cause extensive bone destruction, and jeopardize the integrity of the associated vital teeth. The different treatment approaches are aimed mainly at eliminating the cystic epithelial membrane while reducing the risk of injury to vital structures. Contrary to other treatment modalities, preapical surgery offers an unequivocal single occasion resolution for the patient. However, it has been associated with higher risk of collateral damages. CASE PRESENTATION: A patient presented with a large radicular cyst originating from a maxillary lateral incisor. The adjacent central and canine teeth initially failed to exhibit responses to sensibility tests but showed signs of vitality. Microsurgical management was aimed at enucleating the cystic membrane while maintaining adjacent teeth vitality. Upon careful and controlled cyst enucleation under the dental operating microscope, the neurovascular bundle of one of the involved teeth was visualized and its integrity was maintained throughout the procedure. RESULTS: The procedure was successful and follow up recalls revealed recovery of normal sensibility of tooth 11 and 13 with complete bone regeneration around their apices. CONCLUSION: Within the limitation of the present case report, we demonstrated that complete excision of large periapical cyst can be performed without sacrificing the vitality of the adjacent teeth, by preserving the integrity of their neurovascular supply through controlled microsurgical enucleation, and by a potential apical vascular repair ensuing unintended injury. Diagnosing the pulp vitality of non-offending teeth whose apices protrude into the cystic lumen is a complex process and can be misleading. Pressure from the growing cyst can inhibit vital teeth responses to neural-based sensibility tests leading to false negative results. Thus, in such cases, the use of blood perfusion-based vitality testing is recommended for correct initial diagnosis.
Asunto(s)
Quiste Radicular , Diente Canino , Estudios de Seguimiento , Humanos , Incisivo , Microcirugia , Quiste Radicular/cirugíaRESUMEN
Background and Objectives: Periapical cystic lesions are a pathology frequently addressed to endodontic specialists. Although their therapy is still not standardized, the treatment should be as conservative as possible and by endodontic means, as they are lesions of endodontic origin. The present case report describes two cases of upper central incisors with large cyst-like periapical lesions, and their one-year follow up. Materials and Methods: Endodontic orthograde treatment was performed under copious irrigation with sodium hypochlorite, in association with calcium hydroxide as an intra-canal medication for both teeth. Root canal filling was achieved in a separate appointment using the continuous wave of condensation technique. A decompression procedure was used in association with endodontic therapy in the second case to reduce the pressure inside the cystic lesion and to allow its drainage, and only because the root canal could not be dried three weeks after medication. Initial cone beam computed tomography (CBCT) investigations, as well as at the one-year follow up, were used to compare the evolution of the lesion. Results: Both cases had a favorable outcome. New bone formation in the periapical region and complete resolution of the lesion was observed at the one-year control in the first case. In the second case, although the lesion was still not completely healed at 12 months, a significant reduction in its size could be observed, showing active signs of healing. Conclusions: Endodontic treatment is the first choice option in the management of teeth with pulpal necrosis and large periapical cystic-like lesions. Decompression is the only surgical procedure recommended when the canals cannot be dried and obturated. Large surgical interventions are unnecessary in cases where endodontic treatment can be performed.
Asunto(s)
Periodontitis Periapical , Quiste Radicular , Hidróxido de Calcio/uso terapéutico , Humanos , Incisivo , Quiste Radicular/diagnóstico por imagen , Quiste Radicular/cirugía , Tratamiento del Conducto RadicularRESUMEN
Cistos Periapicais são proliferações dos restos epiteliais de Malassez em decorrência do processo desenvolvimento ou inflamatório devido necrose pulpar. Apresenta-se no início de forma assintomática, e dependendo da sua evolução pode levar a expansão da corticais e reabsorção óssea. Ao exame de imagem se apresentam como uma área radiotransparente bem delimitada, circunscrita por halo radiopaco geralmente associado a região apical de uma ou mais unidades dentárias. O objetivo desse trabalho é relatar abordagem cirúrgica de enucleação e curetagem de um cisto periapical em região maxilar(AU)
Periapical cysts are proliferations of the epithelial remains of Malassez due to the development or inflammatory process due to pulp necrosis. It presents at the beginning asymptomatic, and depending on its evolution may lead to cortical expansion and bone resorption. Imaging studies present as a well-defined radiotransparent area, circumscribed by a radiopaque halo generally associated with the apical region of one or more dental units. The objective of this study is to report a surgical approach of enucleation and curettage of a periapical cyst in the maxillary region(AU)