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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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