Surgical endodontic management of an Unusual Radicular Cyst with Extensive Calcifications: A Case Report

Surgical endodontic management of an Unusual Radicular Cyst with Extensive Calcifications: A Case Report

Rajan Alex, George Liza, Mathew Josey, Yacob Jeason Paul

Department of Conservative Dentistry and Endodontics, Annoor Dental College and Hospital, Muvattupuzha

Running title – Radicular cyst with calcifications

Received: 27-03-2023

Revised: 1-04-2023

Accepted: 11-04-2023

Address for correspondence: Dr Alex Rajan, Post graduate, Dept of Conservative dentistry and Endodontics. Annoor Dental College & Hospital, Muvattupuzha, 686673

Email ID: alexrajan315@gmail.com

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How to cite this article: Rajan A, George L, Mathew J, Yacob J P. Surgical endodontic management of an Unusual Radicular Cyst with Extensive Calcifications: A Case Report J Oral Biomed Sci 2023; 2:

 

A 22 years old male patient came to the department of Conservative Dentistry and Endodontics with a chief complaint of pain on upper front tooth region since 2 weeks. Patient had a history of trauma from road traffic accident and root canal treatment was initiated 5 years back.

On oral examination – Temporary restoration on 21 and 22 with tenderness on percussion. A sinus tract was present on labial gingival surface between 21 and 22.

Fig 1: IOPA radiograph showing radioopaque material inside root canal of 21, 22 suggestive of previously initiated Root canal treatment. Diffuse periapical well defined radiolucent lesion at the apex of 21,22 with pebbles of calcification.

Fig 2: CBCT image showing well defined hypodense lesion extending from the distal aspect of 11 to mesial aspect of 23 (size 11.9 x 19.8mm), with labial bone perforation and involvement of nasopalatine canal.

 

Differential diagnosis: Calcifying cystic odontogenic tumor, Ossifying fibroma and Adenomatoid odontogenic tumor.

Treatment plan: Completion of root canal treatment on 21, 22, 23 followed by root resection of 21, 22 and excisional biopsy of the periapical lesion

 

Fig 3:  Tooth 21, 22 access opening modified and access opening done on 23.  Fig 4: Working length X-Ray of 21, 22, 23

Fig 5: Post Obturation X-Ray 21, 22 and 23

Fig 6: Pre-surgical photograph

Fig 7: Full thickness flap reflected                     Fig 8: Trephination done

Fig 9: Cyst enucleation

Fig 10: Excised specimen showing reddish soft tissue with several yellowish granules with hard consistency.

 

Histopathology report: Radicular cyst with dystrophic calcification.

 

6 month follow-up radiograph showing healing lesion

3 month follow-up radiograph

1 month follow-up radiograph