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surgical endodontic management of

radicular cyst

A CASE REPORT

- Presented by

Dr. Roshan Kurian., PG Student.,

VMSDC Salem.

- Guided By

Prof. Dr. Joseph Paul., HOD

Prof. Dr. Sathish Kumar

Dr. Chokkalingam., Reader

Dr. Prasad., Senior Lecturer

Dr. Naveen ., Senior Lecturer


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INTRODUCTION

The radicular cyst is an inflammatory cyst which resultsbecause of the extrusion of infection from pulp into thesurrounding periapical tissue.

Radicular cyst is a pathological cavity completely linedby stratified squamous epithelium in an apicalperidontal lesion.

Prevelance rate ranges from 15 20%


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CASE REPORT

Patient aged 21/Mreported todepartment ofconservative dentistryand endodontics withthe complaint of painintra oral swelling pusdischarge in relation to11,12.

Patient had an historyof trauma 2years back


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On clinical examination it was a well circumscribedcystic lesion, fluctuant on palpation.

On aspiration yellowish creamy fluid was found,provisionally diagnosied as periapical abscess or anycystic lesion


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Preoperative radiograph shows 1*2 cm ovalradiolucency in relation to 11,12


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Root Canal therapy was done on 11,12


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After Root Canal therapy, apical curitage

and periapical surgery was done.


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The excised cystic mass was sent for histo

pathological examination which confirms thediagnosis radicular cyst.


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Postoperative radiograph after 4 months showing

healing of periapical pathology


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DISCUSSION

Radicular cyst is unique because no cyst in the

body have similar pathogenesis.

It is believed that radicular cyst is formed by the

inflammatory proliferation of epithelial cell rest in

the inflamed periodontal ligament.

A radicular cyst can be a pocket cyst (attached to

apical foramen) or a true cyst (no attachment toroot structure), but it cannot form by itself.


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ETIOLOGY

Caries

Irritation effect of restorative materials

Trauma

Pulpal death due to developmental defects

CLINICAL FEATURES

Cyst is frequently asymptomatic Incidence male are affected more than females.

As cyst enlarges the covering bone become thin in size and

exhibit springiness due to fluctuation

Involved tooth usually found to be non-vital, discoloured , fractured

or failed root canal

RADIOGRAPHIC FEATURES

Appears as rounded, pear or ovoid shaped radiolucency

outlined by a narrow radiopaque margin


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TREATMENT

Different options for management of

radicular cyst are:

Endodontic treatment

Apicetomy

Extraction( severe bone loss)

Eneculation with primary closure

Marsupulization (in case of large cyst)


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PERIAPICAL WOUND HEALING AFTERSURGICAL ENDODONTIC THERAPY

In surgical endodontic therapy the surgeon performs

removal of irritants such as necrotic cells, tissue

debries and bacteria in perapical lesion, called as

surgical debrident

In non-surgical endodontic therapy activated

macrophages performs bacterial killing and clean up

periapical lesion called biological debridement

Surgical debridement is very effective and quite

rapid while biological debridement takes time


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CONCLUSION

The mechanism of Periapical wound

healing after surgical and non-surgical

endodontical therapy is similar but the

kinetics of wound healing after surgicalendodontic therapy is much faster

However endodontic surgery is more

invasive and proper case selection is moreimportant in endodontic surgery.


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