Decompression and Enucleation of a Mandibular Radicular Cyst, Followed by Bone Regeneration and Implant-Supported Dental Restoration

Abstract

Odontogenic cysts are usually treated by enucleation (cystectomy). Limited cysts (less than 5 cm) are usually managed by primary excision (total cystectomy), whereas larger ones (exceeding 5 cm) are often decompressed or marsupialized. Because it consists only of opening a much smaller surgical window, decompression is regarded as a more conservative method of treatment: this method associates the creation of an opening (window) into the cystic cavity with the suturing of a decompressing device (plastic tube or stent) at the periphery of the cyst. Apart from releasing intraluminal pressure in the pathological cavity, this procedure helps the lesion to progressively decrease in volume “with a gradual increase in bone apposition” and preserves pulp vitality and periodontal integrity of the adjacent teeth. We are reporting a case of a mandibular radicular cyst that was treated by decompression, followed by enucleation, bone reconstruction, and restoration with two osseointegrated dental implants. The cystic cavity progressively decreased in volume and increased in bone density.

Salvage of Dental Implant Located in Mandibular Odontogenic Cyst. A Conservative Surgical Treatment Proposal

“…The relation between dental implants and cysts has been analyzed in the literature both preliminarily on implant insertion and late cyst development in the fixture insertion area. Researchers have also focused on post-cystectomy surgical timing and implant insertion in post-extractive infected sites [11][12][13][14][15][16][17][18]. Furthermore, studies have been made on implant periapical lesion and radiolucent lesions that could derive from epithelium inclusion in particular situations such as dental implant fixation following sinus augmentation [7][8][9][10].…”

“…The cases focused on radiolucent lesions related to implant periapical lesions or derived from epithelium inclusion caused by sinus surgery and implant placement near the nasopalatine duct [7][8][9][10]. Other studies have considered surgical timing, outcome, and implant insertion in infected sites [11][12][13][14][15][16][17][18]. The common treatment plan in implant failure usually follows three steps: explantation of the implant, bone regeneration, and reimplantation.…”

Abordagem Conservadora e Cirúrgica para Tratamento de Cisto Periapical: Um Relato de Caso / Conservative and Surgical Approach for Periapical Cyst Treatment: A Case Report

“…O cisto radicular resulta em áreas associadas a dente cariado, sem vitalidade, que provoca a inflamação da polpa levando a uma necrose pulpar que se manifestará no espaço perirradicular (ABOULHOSN et al, 2019, MENDONÇA et al, 2017. Deve-se planejar uma terapêutica adequada prevenindo sua progressão e danos maiores a saúde bucal do paciente.…”

Tunnel’ radicular cyst and its management with root canal treatment and periapical surgery: A case report

“…Conventional orthograde root canal treatment is the regular approach for the management of the cyst. However, marsupialization, decompression, and surgical enucleation may be required for the cyst with a large and extensive size 2 . This case report describes a tunnel radicular cyst (through‐and‐through cyst) of the anterior maxilla with clinical presentation of a labial mucosa swelling which was successfully treated by conventional root canal treatment, cyst enucleation, and placement of bone graft at the surrounding bone defect.…”