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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

INTRODUCTION
The radicular cyst is an inflammatory cyst which results because of the extrusion of infection from pulp into the surrounding periapical tissue.

Radicular cyst is a pathological cavity completely lined by stratified squamous epithelium in an apical peridontal lesion. Prevelance rate ranges from 15 20%

CASE REPORT
Patient aged 21/M reported to department of conservative dentistry and endodontics with the complaint of pain intra oral swelling pus discharge in relation to 11,12. Patient had an history of trauma 2years back

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

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

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

Root Canal therapy was done on 11,12

After Root Canal therapy, apical curitage


and periapical surgery was done.

The excised cystic mass was sent for histo pathological examination which confirms the diagnosis radicular cyst.

Postoperative radiograph after 4 months showing healing of periapical pathology

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 to root structure), but it cannot form by itself.

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

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)

PERIAPICAL WOUND HEALING AFTER SURGICAL 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

CONCLUSION
The mechanism of Periapical wound healing after surgical and non-surgical endodontical therapy is similar but the kinetics of wound healing after surgical endodontic therapy is much faster However endodontic surgery is more invasive and proper case selection is more important in endodontic surgery.