Abstract:
Periapical diseases ranges from mild granulomatous lesions to large cystic ones, with the treatments corresponding to their respective pre-operative diagnoses. However, the determination of cause of periapical radiolucency is impossible on pre-operative clinical and radiographic examinations. We present a case highlighting the difficulties encountered in treating a periapical cyst using the current evidence in literature. It demonstrates the uncertainty involved in treating such lesions, owing to the impossible nature of determining the histopathological nature of the cyst, i.e., being either true cysts or pocket cysts. This case includes orthograde re-treatment; decompression of the cystic lesion, followed by peri-apical surgery of two teeth over a course of three years; and the uncertain outcomes encountered after each phase of the treatment. 'Pocket cysts' are in continuity with the infected root canal, making these cysts manageable by endodontic intervention.1,2 Contrarily, 'true cysts' are so called due to their ability to persist independently of the initiating endodontic infection.1,2 These are self-sustaining lesions, with no openings to the root canal and require surgical intervention disrupting the epithelial lining to ensure healing.1,2 Since both cysts are fundamentally indistinguishable on radiographs pre-operatively, their treatment presents a dilemma for clinicians. In the following narrative we present a case of large 'radicular cyst' that had challenged the current evidence due to the oversimplified nature of classicfiation of cysts and the prescribed treatment options.
Keywords:
Granuloma
,
periapical surgery
,
periradicular lesion
,
apical cyst
,
nonsurgical retreatment