implants - international magazine of oral implantology

I case report Fig. 1_Panoramic radiogram. Fig. 2_Frontal CT. Fig. 3_(a) Horizontal and (b) lateral CT. _Introduction Radicular cysts appear as a result of pulp necro- sis caused by inflammation, trauma or improper dental treatment. They are cavities enclosed by a wall of connective tissue with an inner epithelial layer, usually filled with fluid or pulp. Radicular cysts cause few clinical symptoms and are painless in many cases. Mobility of adjacent teeth may be noted,aswellasswellingofthebone.Ifthecortical bone is thinned or destroyed by the growing cyst, crackingunderpalpationmaybenoticed.Although radicular cysts are benign, they grow slowly but steadily and may lead to complications, depending on their size and location. Large cysts in the mandible may cause pathological fractures.1 Thetreatmentofmaxillaryandmandibularcysts is common in oral and maxillofacial surgery. The mostwidespreadtreatmentmethodsarecurettage and radical enucleation of the cyst (cystectomy).2, 3 In cases of very large cysts, or if cystectomy is con- tra-indicatedowingtotheriskofdamagingnearby anatomical structures, cystostomy is recom- mended. In cystostomy, the cystic lumen is opened in order to reduce the pressure inside the cyst. The cyst’s volume is reduced subsequently by bony ap- positiononthecystwallsuntilitreachesasizethat allows its safe removal by cystectomy.2, 4 The removal of a cyst evidently results in a bone defect.Dependingonitssizeandlocation,thebony lesion has to be treated with regard to functional and aesthetic aspects using autogenous grafts or bone substitutes.5 The authors present the treat- mentofaradicularcystinamalepatientinthiscase report. The lesion probably occurred as a conse- quence of earlier trauma in the frontal section of the mandible. The cyst was asymptomatic and an incidental finding. After endodontic treatment, cystectomy and bone augmentation were per- formed. _Case report A 27-year-old male patient visited the dentist for a routine visit. In the dental panoramic tomo- gramandsubsequentCTscan,apathologicalradi- olucent lesion of about 30 x 20 x 25 mm was ob- served in the alveolar bone of the mandible (Figs. 1–3). In the clinical examination, teeth 41 and 42 showed mobility but were painless. A pulp vitality Treatment of a mandibular cyst with synthetic bone graft substitute Authors_Dr Damian Dudek, Katarzyna Sołtykiewicz, Krzysztof Helewski, Grzegorz Wyrobiec, Marzena Harabin-Slowinska, Grażyna Kowalczyk-Ziomek & Romuald Wojnicz, Poland 34 I implants1_2013 Fig. 3aFig. 2 Fig. 1 Fig. 3b