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ePaper created 2018-05-16, 11:45:19 | version 1.38.0
TREATMENT OF AN INFLAM- MATORY PERIAPICAL CYST OF ENDODONTIC ORIGIN — with surgical endodontic therapy Dr. Mehmet Kalcay, Turkey — Dr. Mehmet Kalcay Introduction Periapical cysts are defined as inflamma- tory and non-neoplastic lesions of the jaw. Approximately 15–20% of periapical le- sions are diagnosed as periapical cysts.1 The localized inflammatory proliferation of epithelial cell rests in the periodontal ligament results in the formation of peri- apical cysts.2, 3 These lesions are usually seen in the maxillary anterior region. These pathologies are generally asymp- tomatic and are diagnosed during routine radiographic examinations.4 Periapical cysts are generally seen in patients aged between 30 and 40 and predominantly in men.5 The purpose of this case report is to present the diagnosis, treatment and postoperative findings of previously treat- ed maxillary anterior teeth affected by an inflammatory periapical cyst. Case report A 25-year-old male patient presented to the Department of Endodontics, Gazi University, Faculty of Dentistry, Ankara, Turkey, with a swelling at the palatal mu- cosa of the maxillary anterior region. A detailed dental history revealed that the swelling had also occurred four months ago and was left untreated, with a pre- scription of antibiotics. Extraction had been advised by the previous general dentist. A dental panoramic tomogram was taken for initial radiographic exam- ination. A large radiolucent periapical lesion was observed associated with teeth #21 and 22 (Fig. 1). Clinical examination found a swelling at the palatal mucosa that was painful on palpation. Cone beam com- puted tomography (CBCT) images were used to gather more information on the size and association of the lesion with the surrounding anatomical structures (Fig. 2). CBCT images were taken of the maxillary anterior region axially and coronally with 1 mm spaces between the slices. These images showed a radiolucent lesion associated with the roots of teeth #21 and 22 that was lytic and of 11 × 16 mm in size and had a regular border. The lesion had perforated the palatal cortex and was in close proximity to the nasal cavity and the incisive canal. The preliminary radio- graphic diagnosis was an inflammatory periapical cyst. Root canal therapy was initiated for teeth #21 and 22 to relieve the patient of acute symptoms. During the retreatment of tooth #21, an open apex led to the ex- trusion of some gutta-percha into the periapical lesion. Pus and exudate drainage was achieved via the root canals. The root canals were vigorously irrigated with physiological saline until the drainage stopped. The cavities were then tempo- rarily restored with glass ionomer cement. The patient was prescribed antibiotics and nonsteroidal anti-inflammatory drugs and was recalled the next day. Acute symptoms had been alleviated by the time of the recall. The temporary res- torations were removed and the root ca- nals were irrigated with 5% sodium hypo- chlorite. There was no drainage of exudate; therefore, calcium hydroxide was intro- duced into the root canals after prepara- tion. Another appointment was set up 68 — issue 2018 Meet the Clinical Masters Article