Restor Dent Endod.  2016 May;41(2):137-142. 10.5395/rde.2016.41.2.137.

Progression of periapical cystic lesion after incomplete endodontic treatment

• Huh JK
• Yang DK
• Jeon KJ
• Shin SJ

• KMID: 2163296
• DOI: http://doi.org/10.5395/rde.2016.41.2.137

Abstract

We report a case of large radicular cyst progression related to endodontic origin to emphasize proper intervention and follow-up for endodontic pathosis. A 25 yr old man presented with an endodontically treated molar with radiolucency. He denied any intervention because of a lack of discomfort. Five years later, the patient returned. The previous periapical lesion had drastically enlarged and involved two adjacent teeth. Cystic lesion removal and apicoectomy were performed on the tooth. Histopathological analysis revealed that the lesion was an inflammatory radicular cyst. The patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. Although the patient had been asymptomatic, close follow-ups are critical to determine if any periapical lesions persist after root canal treatment.

Keyword

Incomplete endodontic treatment; Radicular cyst; Surgical intervention

MeSH Terms

Apicoectomy
Dental Pulp Cavity
Follow-Up Studies
Humans
Molar
Radicular Cyst*
Tooth

Figure

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  Figure 1 Initial radiograph findings when the patient first visited in 2009. (a) A panoramic radiograph revealed a periapical lesion on the mesial root of the left mandibular first molar (tooth #36); (b and c) Periapical radiographs showed radiolucency around the mesial root of tooth #36, and a metallic obstruction was noticed in one mesial canal.

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  Figure 2 Radiographic findings in 2014. (a) A panoramic radiograph showed the progression of a cystic lesion around tooth #36, as compared to radiographs taken 5 years ago (Figure 1); (b and c) The computed tomography scan views demonstrated the thinning of the cortical plates on the buccal and lingual sides; (d) The coronal view showed a radiopaque material inside the lumen.

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  Figure 3 Clinical photos and a panoramic radiograph taken during the surgical procedure. (a) A bony window was prepared to save the cortical plate; (b) Pus-like turbid exudate from the lumen; (c) The cystic membrane was removed and sent for a biopsy; (d) A small, calcific material with a diameter of 3 mm was removed from the lumen; (e) An extruded endodontic file was observed in the mesial root; (f) Both roots were retrofilled with MTA. (g) The resected mesial root showed a metallic file in the mesiobuccal canal and leaked isthmus; (h) The resected distal root showed a filled canal with leakage; (i) Immediate postoperative panoramic radiograph.

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  Figure 4 Histology of the inflammatory radicular cyst. Hematoxylin and eosin stain. (a and b) Fibrous connective tissue lined with nonkeratinized epithelium (×40); (c) Cholesterol clefts (arrowheads) and inflammatory cells were found (×40).

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