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Panoramic radiograph for a patient with a large periapical lesion around the left maxillary central incisor.
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A large maxillary cyst was treated for 3 months with marsupialization and decompression, followed by surgical endodontic therapy of the affected teeth and cystectomy. Although small cystic lesions will typically heal with nonsurgical endodontic therapy, larger lesions may need additional treatment. Surgical enucleation of a large cystic lesion may...
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Context 1
... healthy 15-year-old male was referred to the dental clinic of the faculty of dentistry of Sevilla (Spain) for treatment of a large periapical lesion around the left maxillary central incisor. The tooth was discoloured and had undergone previous filling of the root because of irreversible pulpitis following a traumatic injury. Orthopantomography (Fig. 1) revealed a large periapical radiolucency, about 4 cm in the horizontal plane and 3 cm in the vertical plane, associated with teeth 21, 22, 23, 24 and possibly 25. Clinical examination revealed labial swelling over these teeth, and the area was tender to palpation and percussion. Teeth 22, 23 and 24 did not respond to thermal and electrical pulp tests. The provisional diagnosis was radicular cyst. Computed tomography (CT) revealed a lesion about 4 cm wide in the anteroposterior plane affecting the entire right premaxilla and contacting the floor of the nose and the maxillary sinus (Fig. 2). Swelling, a buccal cortical break and expansion of the bone were obvious; these features indicated that the lesion was ...
Context 2
... week after the operation, the surgical sites showed good healing (Fig. 8). Clinical examinations at 1, 3 and 6 months showed no sensitivity to percussion or palpation, and the soft tissues were healthy. After 8 months, clinical healing and radiographic resolution of the maxillary radiolucency were complete ( Figs. 9 and ...
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Fifty four extracted single-rooted human teeth were used. The samples were randomly divided into 3 experimental groups. In group A and B, 4 mm of WMTA and...
Citations
... As Rezende et al. 6 cysts of inflammatory origin did not recite after proper treatment, and occasionally fibrous scars may occur instead of bone neoformation. In relation to the clinical case, the patient was in follow-up in the 18 postoperative months, with no signs of recurrence, having good bone repair, and can be verified and proven through imaging tests, such as CFC, corroborating with the studies by Vasconcelos et al. 14 and Torres-Lagares et al. 15 on the gold standard of radiographic diagnosis. ...
Periapical cysts of endodontic origin originate from an infection that affects the apical region, causing pulpal necrosis that stimulates an inflammatory response. Among many pathologies found on radiographs, one of them is the root cyst, considered to be a lesion frequently found in the maxilla and mandible, associated with the apex of a tooth with pulp necrosis. They present slow growth and are discovered in routine examinations because they are asymptomatic. Due to the chronic aggression, the lesion does not present painful symptoms in most cases, and grows slowly, thus being able to reach large extensions, with the presence of swelling and sensitivity, as well as slight mobility in the affected tooth and adjacent ones. The objective of this study was to report a clinical case of swelling in the anterior region of the mandible, which was diagnosed as a periapical cyst, in this way the treatments performed and the final result after 18 months of follow-up will be reported. However, to achieve good results during periapical cyst treatment, it is necessary to make a correct diagnosis, followed by adequate planning, always performing clinical and radiographic follow-up, in addition to the patient's cooperation, so that good results can be achieved during the treatment. It can be observed that a well-performed endodontic treatment, associated with a elaborated surgical technique, in addition to anatomopathological evidence and radiographic follow-up, make the therapeutic success to be obtained in cases of large periapical cysts. Keywords: Radicular Cyst. Root Canal Therapy. Surgery, Oral. ResumoOs cistos periapicais de origem endodôntica, originam-se a partir de uma infecção que acomete em região apical, ocasionando uma necrose pulpar que estimula uma resposta inflamatória. Das várias patologias encontradas radiograficamente, o cisto radicular tem sido o mais frequente encontrado, tanto em maxila, quanto em mandíbula, associado ao ápice de um dente com necrose pulpar. Apresentam crescimento lento e são descobertos nos exames de rotina, por serem assintomáticos. Devido a agressão crônica, a lesão não apresenta sintomatologia dolorosa, na maioria dos casos, tendo seu crescimento lento, desta maneira podendo atingir grandes extenções, com presença de tumefação e sensibilidade, além de leve mobilidade no dente acometido e nos adjacentes. O objetivo deste estudo foi relatar um caso clínico de tumefação na região anterior de mandíbula, o qual foi diagnosticado como cisto periapical, desta forma serão relatados os tratamentos realizados e o resultado final após 18 meses de acompanhamento. Contudo, para que sejam alcançados bons resultados durante o tratamento do cisto periapical é necessário realizar um correto diagnóstico, seguido por um planejamento adequado, realizando sempre o acompanhamento clínico e radiográfico, além da colaboração do paciente, para que possam ser atingidos bons resultados durante o tratamento. Pode-se observar que um tratamento endodôntico bem realizado, associado à uma técnica cirúrgica bem elaborada, além de comprovação anatomo-patológica e acompanhamento radiográfico, fazem com que o sucesso terapêutico seja obtido para os casos de cistos periapicais de grande proporção. Palavras-chave: Cisto Radicular. Tratamento do Canal Radicular. Cirurgia Bucal
... Since the lateral wall of the maxilla is generally thinner than the lingual side, radicular cysts are frequently swollen toward the buccal side, resulting in buccal bone resorption. Because of buccal bone defects, large radicular cysts often cause collapsed lip deformities after cystectomy in the maxillary aesthetic area, and guided bone regeneration is the most used bone repair treatment modality [9][10][11]. ...
Background: Radicular cysts are the most frequent inflammatory odontogenic cysts of the jaw. Cystectomy of larger radicular cysts in the maxillary aesthetic area often results in collapsed lip deformities. BonMaker® ATB has been investigated and demonstrated excellent autogenous bone graft candidacy. The aim of this study is to share a single team’s experience in repairing osseous defects after cystectomy in the maxillary aesthetic area by using autogenous tooth sticky bone grafts prepared with extracted third molars.
Method: A total of 12 patients with radicular cysts and impacted third molars were enrolled in this retrospective clinical study. The whole procedure was performed under general anesthesia. First, the impacted third molars were extracted, and autogenous tooth sticky bone grafts were prepared by mixing autogenous fibrin glue. Subsequently, cystectomy and grafting were performed and covered with concentrated growth factors. The patients were followed up at four months.
Results: The 12 patients included seven males and five females with a median age of 26 years. Primary wound healing of the graft donor and receiving site was achieved in all patients without complications. Osseous defects of radicular cysts demonstrated satisfactory ossification without bone resorption during the postsurgical follow-up after four months.
Conclusion: Autogenous tooth sticky bone grafts show promising alveolar bone repair quality.
... In veterinary dentistry, the current treatment method of choice for odontogenic cysts is the surgical exposure of the cyst and complete extirpation of the cyst lining through the use of curettage (5). This technique has been proven to be an effective treatment method for odontogenic cysts with little or no chance of recurrence (1,6,7). However, this method is invasive and in larger cysts, may require creation of a large surgical incision, extraction of multiple teeth and placement of a bone graft. ...
... The stoma allows drainage of fluid from within the cyst which facilitates regrowth of surrounding bone and reduction in the size of the bony deficit created by the cyst (4,8). This method is useful for large cysts or in cases where extirpation of the cyst may damage vital structures (6). It is also useful when the cyst is multilocular and there may be a higher risk of incomplete extirpation. ...
... Appropriate oral home care was then demonstrated at discharge. The post-operative protocol used for each of the cases in this study was a 2 week duration of twice-daily lavage of the marsupialisation sites with 0.12% chlorhexidine solution, which was based on previous reports in humans (6,9,19,20). Other solutions have been used postoperatively including distilled water (21) and normal saline (9,22). ...
Marsupialisation of odontogenic cysts is a minimally invasive treatment method used in human dentistry. Marsupialisation decompresses the cyst and promotes remodeling of alveolar bone and shrinkage of the cyst. In this retrospective study we look at the effectiveness of marsupialisation at reducing the size of odontogenic cysts in dogs. The case series consists of six Boxer dogs with 12 odontogenic cysts. Each case underwent a high resolution CT scan prior to treatment and at follow-up. Each CT scan was reviewed, the volume of each cyst calculated using manual segmentation and the reduction in cyst volume calculated. There was a marked reduction in cystic volume of 66.6% over a mean of 138 days. This shows that the use of marsupialisation effective method of reducing cyst volume.
... Also, in cases of excessive bone loss, it is worth to consider a procedure of decompression before surgery. It can be a good solution, especially if the lesion is in the area of important neurological structures (19). ...
... The lesion becomes smaller in the radiographic image, and bone trabeculae with different radiopacities which fill the space of the lesion [46]. The majority of periapical lesion healing should be assessed at least between 6 [47] and 12-months [48] after the root canal treatment. Orstavik D. reported that half of cases present experienced advanced and complete healing at the 6-month visit, and after 12 months, 88% of these lesions were completely healed. ...
The study presents results of periapical lesion healing after one-visit root canal treatment (RCT) with Advanced Platelet Rich Fibrin plus (A-PRF+) application compared to a two-visit RCT with an inter-appointment calcium hydroxide filling. The comparison was made based on CBCT-Periapical Index (PAI) lesion volume changes and the occurrence of post endodontic pain. The results of 3D radiographic healing assessments based on volume reduction criteria were different from the CBCT-PAI. Based on volume changes, the healing assessment criteria-9 cases from the Study Group and six cases in the Control Group were defined as healed. Based on the CBCT-PAI healing assessment criteria, 8 cases from the Study Group and 9 cases from the Control Group were categorized as healed. The volumes of apical radiolucency were, on average, reduced by 85.93% in the Study Group and by 72.31% in the Control Group. Post-endodontic pain occurred more frequently in the Control than in the Study Group. The highest score of pain in the Study Group was five (moderate pain, n = 1), while in the Control Group, the highest score was eight (severe pain, n = 2). In the 6-month follow-up, CBCT scans showed a better healing tendency for patients in the Study Group.
... (4) Conservative approach as marsupialization can be preferred instead of excessive bone removal in cases of the large radicular cysts. [5] Furthermore, clinical and radiographic assessment of the effectiveness of decompression as a conservative treatment in decreasing the size of a pediatric radicular mandibular cysts and the correlation between cyst decompression and several variables such as impacted tooth angulation, cusp tip depth and cyst size on related impacted tooth eruption. ...
... Lesions that fail to resolve with such therapy may be successfully managed by extraction of the associated non-vital teeth and curettage of the epithelium in the apical zone [18]. The other options suggested are surgical decompression to reduce the size of the lesion before marsupialisation or complete enucleation is planned, to reduce the chances of damage to other teeth or anatomic structures [20]. Conservative treatment approaches have proved to be effective for the treatment of radicular cysts in primary teeth [18]. ...
... In extensive lesions, treatment consists of marsupialization, followed by cystic enucleation and endodontic treatment of the involved teeth. [9,[13][14][15] Regardless of the diameter or therapeutic approach, after treatment, clinical and radiographic follow-up is necessary to assess tissue repair, observe the bone neoformation process and the absence of symptoms. [13] Generally, inflammatory cysts do not recur after adequate treatment, and occasionally fibrous scars may occur, instead of bone neoformation, however, without necessity for intervention, [16] with long-term follow-up. ...
... Such conditions were confirmed in the patient's follow-up. [15] ...
Background: Radicular cyst is the most prevalent inflammatory odontogenic cyst and it has small dimensions. The
objective of this work is to report a case, approaching conservative therapeutic intervention, using marsupialization
and cystic enucleation associated with endodontic therapy, for the treatment of a large radicular cyst in the maxilla.
Case report: A young female patient with pain and swelling in region of the sulcus and palate in the left side from
maxilla and movimentation of teeth 22 and 23. Panoramic radiography showed unilocular radiolucent image,
extending from 21 to 25, approximately 4cm at its largest diameter. The histopathological result of the biopsys
revealed an odontogenic cyst of inflammatory origin. The therapeutic approach was the endodontic treatment of 21
and 23 and endodontic retreatment of 22 with its apicetomy, decompression and total enucleation of the cystic
lesion. Conclusion: The endodontic therapy of the involved teeth associated with marsupialization, which allowed a
reduction of the lesion and the possibility of cystic enucleation, avoided the possible involvement of adjacent
structures, such as the maxillary sinus, with regression of signs and symptoms, achieving the restoration of
patients’oral homeostasis.
... healing has not achieved at the end of this period, surgery should be considered [13]. However, some authors suggest complete enucleation of cystic lesions smaller than 3 cm, together with epithelium and marsupialization for lesions larger than 3 cm [14]. ...
Objective
The aim of this case report is to present a multidisciplinary treatment administered to a patient with a cystic lesion in the jawbone, in the root region of the incisors, caused by trauma. The report also emphasizes the effect of accurate diagnosis and treatment planning on the prognosis of cyst-associated teeth in the presence of large cystic lesions.
Case report
A 12-year-old male patient with the maxillary central teeth broken as a result of trauma experienced 3 years ago. In radiographic examination, a round and wide radiolucent area with smooth and distinct borders was observed which included the root of tooth number 11. As a result of the clinical and radiographic examination, it was decided to resect the cyst after consultation with oral and maxillofacial surgery specialists. According to the one-year follow-up results, no pain was felt in the area of the tooth.
... Fenestration decompression, also known as fenestration drainage or marsupialization, is a conservative treatment for cysts which has been widely used in recent years (9)(10)(11). It mainly involves fenestration surgery to form an opening on the surface of the mouth close to the cyst. ...
Background:
In order to improve the postoperative decompression and drainage of large mandibular cysts after fenestration decompression, a new drainage plug was designed and its feasibility for clinical application was explored.
Methods:
A total of 74 patients with large mandibular cysts requiring fenestration decompression were included and randomly divided into the control group (n=34) and model group (n=40). Patients in the control group were given a conventional plug, while patients in the model group were given the new silicone drainage plug. The drainage plug mold was printed using 3D printing technology. Subsequently, the mold was filled with silicone material and the drainage tube was placed into the mold to make a drainage plug. The clinical effect of the new drainage plug was assessed, and the postoperative recovery time was compared between the 2 groups.
Results:
In the model group, the average wear time of the new drainage plug was approximately 13 months. Compared with the control group, the course of treatment in the model group was shortened by approximately 5 months, with a better fit, less food debris, and easier installation and removal.
Conclusions:
The new drainage plug provides more convenience and better prognosis for patients after fenestration decompression, and holds great promise for clinical application.
