Surgical Management of a Large Radicular Cyst in a Maxillary Incisor Following Failed Regenerative Endodontics and Apical Plug in an Adolescent: A Case Report
Saeed Asgary
TL;DR
A 14-year-old boy with a large tooth cyst failed nonsurgical treatments, so surgery was done when he turned 18, leading to full healing.
Contribution
Demonstrates the need for surgical intervention in large radicular cysts when nonsurgical methods fail in adolescents reaching skeletal maturity.
Findings
Nonsurgical treatments like REP and apical plug failed to heal the large radicular cyst over 44 months.
Surgical enucleation and CEM cement placement led to complete radiographic healing and bone regeneration within one year.
Histopathology confirmed the diagnosis of a radicular cyst, supporting the effectiveness of the surgical approach.
Abstract
This case report describes the surgical treatment of a large radicular cyst in a maxillary incisor of an adolescent, following an unsuccessful regenerative endodontic procedure (REP) and an apical plug. It highlights minimally invasive, age‐appropriate decision‐making. A 14‐year‐old boy presented with an acute abscess (pain, swelling, and fever) in the right maxilla. Tooth #11 was nonvital, with apical resorption, an open apex, and a huge radiolucent lesion involving Tooth #12, confirmed by CBCT. Initial treatment included incision/drainage, calcium hydroxide dressing, and antibiotics, which resolved symptoms. REP was performed 3 months after presentation (inducing a blood clot, placing biomaterial, and coronal sealing). Partial healing was noted at 8 months, but lesion recurrence occurred asymptomatically at 19 months. An apical plug using calcium‐enriched mixture (CEM) was inserted,…
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Taxonomy
TopicsOral and Maxillofacial Pathology · Endodontics and Root Canal Treatments · dental development and anomalies