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ePaper created 2015-06-05, 15:15:11 | version 1.38.0
tion. After complete biomechanical preparation, 2percentchlorhexidinegluconatewasusedasanir- rigantandintracanalmedicament.Inthesubsequent visits, root canal treatment was completed. Persist- ent pus discharge was observed at three months af- ter endodontic treatment, and surgical enucleation was planned. The procedure was as follows: local anaesthesia was administered, crevicular incisions were given, and a full thickness mucoperiosteal flap from 41 to 43 and a split thickness flap in regio 31 and 32 were reflected. The area was degranulated revealing two small perforations of the buccal cortical plate in the regions of 41 to 43 of size 1 x 1 x 1 mm. The remain- ing buccal cortical covering was carefully removed with rotary and hand instruments to expose the rest ofthelesionsofsize3x3x2mm.Fragmentedpieces of the lesion were freed from the bone, and a com- pletecurettageofthecysticlesionswasdone(Fig.3). The cystic cavities were thoroughly irrigated, and a root biomodification of involved teeth was done us- ingtetracycline.DFDBAwasmixedwithsterilesaline solutionandgraftedinanattempttoclosethedefect via osteoconduction (Fig. 4). Autologous healthy pe- riosteumwasharvestedfromregio31–32(Fig.5),and PRF was prepared from the patient’s blood, as de- scribed by Choukroun et al.3 The lesion was covered withperiosteum,overwhichPRFwasplacedasasec- ond layer of barrier membrane covering the graft (Figs. 6 & 7). The flap was coronally advanced and closed with interrupted sutures using 3-0 black braided silk (Fig. 8).Aperiodontaldressingwasappliedatthesurgical site. The patient was prescribed amoxicillin 500mg TID and diclofenac sodium 50mg TID both for 5 days with 0.12 per cent chlorhexidine gluconate rinse BD for seven days. The patient was asked to report after a week for suture removal, and the curetted tissue was submitted for histopathological examination. The patient returned for the postoperative visit, and the healing was uneventful. Histopathology revealed the presence of a vary- ing thickness of epithelium with fibrocellular con- nective stroma. The epithelium was disrupted with infiltration of chronic inflammatory cells along with vacuolations within the epithelium. The connective tissue showed dense infiltration of lymphocytes and plasma cells with few macrophages (Fig. 9). A diag- nosisofradicularcystwasgiven.Thepatientwasfol- lowedupforninemonths.Aradiographatsixmonths shows a healing lesion (Fig. 10). A subsequent radi- ograph nine months after operation (Fig. 11) reveals increased radiopacity where the bone graft was placed, and no evidence of recurrence of the lesion was seen (Fig. 12). _Discussion A radicular cyst is an odontogenic cyst of inflam- matoryoriginprecededbyachronicperiapicalgran- ulomaandstimulationofcellrestsofMalassezfound in the periodontal membrane. The pathogenesis of radicular cysts comprises of three distinct phases: the phase of initiation, the phase of cyst formation, and the phase of enlargement.4 The initial swellings of these radicular cysts are usually bony hard, but as they increase in size, the covering bone may become very thin despite initial subperiosteal bone deposi- tion.Withprogressiveboneresorption,theswellings 22015 implants | | | Publish your expertise! AD