Management of upper central incisor with large periapical inflammatory cyst and persistent fistula: Case report

Authors

DOI:

https://doi.org/10.33448/rsd-v10i8.17332

Keywords:

Tooth injuries; Infection control, dental; Radicular cyst.

Abstract

The objective of this case report was to describe the retreatment of an immature upper right central incisor in a 20-year-old female patient after unsuccessful endodontic treatment, who had probable clinical-radiographic diagnosis of a large periapical inflammatory cyst and persistent fistula. After removing the root canal filling material, disinfection of the root canal system, and successive intracanal medication changes over 60 days, the fistula remained active. Therefore, parendodontic surgery was performed. The root canal system was obturated, the periapical cyst was surgically enucleated, and retro-obturation with mineral trioxide aggregate was performed. We used the guided tissue regeneration technique with a xenograft and resorbable membrane. On histopathological examination, we observed bacterial colonies present in the lumen of the cystic lesion. Clinical evaluation, periapical radiograph, and cone-beam tomography confirmed complete healing of the periapical area of the affected tooth. The treatment success was verified by periapical healing over a follow-up period of 21 months.

References

Andreasen, J., Anthony, D., & Cols. (2012). Dental Trauma Guidelines. International Association of Dental Traumatology, 75(4). https://doi.org/10.1038/sj.onc.1202583

Atabek, D., Alacam, A., Aydintug, I., & Baldag, İ. (2017). Pulp prognosis of crown-related fractures, in relation to presence of luxation injury and root development stage. Journal of Oral Health and Dental Management, 16(1), 1–5.

Ekanayake, L., & Perera, M. (2008). Pattern of traumatic dental injuries in children attending the University Dental Hospital, Sri Lanka. Dental Traumatology, 24(4), 471–474. https://doi.org/10.1111/j.1600-9657.2008.00611.x

Güngör, H. C. (2014). Management of crown-related fractures in children: An update review. Dent Traumatol, 30(2), 88–99. https://doi.org/10.1111/edt.12079

Hecova, H., Tzigkounakis, V., Merglova, V., & Netolicky, J. (2010). A retrospective study of 889 injured permanent teeth. Dental Traumatology, 26(6), 466–475. https://doi.org/10.1111/j.1600-9657.2010.00924.x

Lin, L., Chen, M. Y. H., Ricucci, D., & Rosenberg, P. A. (2010). Guided tissue regeneration in periapical surgery. Journal of Endodontics, 36(4), 618–625. https://doi.org/10.1016/j.joen.2009.12.012

Lin, L. M., Gaengler, P., & Langeland, K. (1996). Periradicular curettage. International Endodontic Journal, 29(4), 220–227. https://doi.org/10.1111/j.1365-2591.1996.tb01373.x

Lin, S., Pilosof, N., Karawani, M., Wigler, R., Kaufman, A. Y., & Teich, S. T. (2016). Occurrence and timing of complications following traumatic dental injuries: A retrospective study in a dental trauma department. Journal of Clinical and Experimental Dentistry, 18(4), 429–436. https://doi.org/10.4317/jced.53022

Mohammadi, Z. (2011). Strategies to manage permanent non-vital teeth with open apices: A clinical update. International Dental Journal, 61(1), 25–30. https://doi.org/10.1111/j.1875-595X.2011.00005.x

Nagendrababu, V., Chong, B. S., McCabe, P., Shah, P. K., Priya, E., Jayaraman, J., Pulikkotil, S. J., & Dummer, P. M. H. (2019). Guidelines for reporting the quality of clinical case reports in Endodontics: a development protocol. International Endodontic Journal, 52(6), 775–778. https://doi.org/10.1111/iej.13067

Nair, P. N. R. (2004). Pathogenesis of apical periodontitis and the causes of endodontic failures. Critical Reviews in Oral Biology & Medicine., 15(6), 348–381.

Nair, P. N. R. (2006). On the causes of persistent apical periodontitis: a review. International Endodontic Journal, 39(4), 249–281. https://doi.org/10.1111/j.1365-2591.2006.01099.x

Natkin, E., Oswald, R. J., & Carnes, L. I. (1984). The relationship of lesion size to diagnosis, incidence, and treatment of periapical cysts and granulomas. Oral Surgery, Oral Medicine, Oral Pathology, 57(1), 82–94. https://doi.org/10.1016/0030-4220(84)90267-6

Ricucci, D., Siqueira, J. F., Lopes, W. S. P., Vieira, A. R., & Rôças, I. N. (2015). Extraradicular infection as the cause of persistent symptoms: A case series. Journal of Endodontics, 41(2), 265–273. https://doi.org/10.1016/j.joen.2014.08.020

Ritwik, P., Massey, C., & Hagan, J. (2015). Epidemiology and outcomes of dental trauma cases from an urban pediatric emergency department. Dental Traumatology, 31(2), 97–102. https://doi.org/10.1111/edt.12148

Saoud, T. M. A., Huang, G. T. J., Gibbs, J. L., Sigurdsson, A., & Lin, L. M. (2015). Management of teeth with persistent apical periodontitis after root canal treatment using regenerative endodontic therapy. Journal of Endodontics, 41(10), 1743–1748. https://doi.org/10.1016/j.joen.2015.07.004

Sayre, J. W., Toklu, H. Z., Ye, F., Mazza, J., & Yale, S. (2017). Case Reports, Case Series-From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education. Cureus, 9(8), e1546. https://doi.org/10.7759/cureus.1546

Signoretti, F. G. C., Endo, M. S., Gomes, B. P. F. A., Montagner, F., Tosello, F. B., & Jacinto, R. C. (2011). Persistent extraradicular infection in root-filled asymptomatic human tooth: Scanning electron microscopic analysis and microbial investigation after apical microsurgery. Journal of Endodontics, 37(12), 1696–1700. https://doi.org/10.1016/j.joen.2011.09.018

Silvestrin, T., Torabinejad, M., Handysides, R., & Shabahang, S. (2016). Effect of apex size on the leakage of gutta-percha and sealer-filled root canals. Quintessence International, 47(5), 373–378. https://doi.org/10.3290/j.qi.a35525

Siqueira, J. F. (2001). Aetiology of root canal treatment failure: why well-treated teeth can fail. International Endodontic Journal, 34(1), 1–10. https://doi.org/10.1046/j.1365-2591.2001.00396.x

Susan Chi, C., Andrade, D. B., Kim, S. G., & Solomon, C. S. (2015). Guided tissue regeneration in endodontic surgery by using a bioactive resorbable membrane. Journal of Endodontics, 41(4), 559–562. https://doi.org/10.1016/j.joen.2014.10.018

Taschieri, S., Del Fabbro, M., Testori, T., Saita, M., & Weinstein, R. (2008). Efficacy of guided tissue regeneration in the management of through-and-through lesions following surgical endodontics: a preliminary study. The International Journal of Periodontics & Restorative Dentistry, 28(3), 265–271. https://doi.org/10.11607/prd.00.0806

Torabinejad, M., Parirokh, M., & Dummer, P. M. H. (2018). Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part II: other clinical applications and complications. International Endodontic Journal, 51(3), 284–317. https://doi.org/10.1111/iej.12843

Trope, M. (2006). Treatment of immature teeth with non-vital pulps and apical periodontitis. Endodontic Topics, 14(1), 51–59. https://doi.org/10.1111/j.1601-1546.2008.00223.x

Tsesis, I., Rosen, E., Tamse, A., Taschieri, S., & Del Fabbro, M. (2011). Effect of guided tissue regeneration on the outcome of surgical endodontic treatment: A systematic review and meta-analysis. Journal of Endodontics, 37(8), 1039–1045. https://doi.org/10.1016/j.joen.2011.05.016

Viduskalne, I., & Care, R. (2010). Analysis of the crown fractures and factors affecting pulp survival due to dental trauma. Stomatologija, Baltic Dental and Maxillofacial Journal, 12(4), 109–115.

von Arx, T., Jensen, S. S., Janner, S. F. M., Hänni, S., & Bornstein, M. M. (2019). A 10-year follow-up study of 119 teeth treated with apical surgery and root-end filling with mineral trioxide aggregate. Journal of Endodontics, 45(4), 394–401. https://doi.org/10.1016/j.joen.2018.12.015

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Published

10/07/2021

How to Cite

SOUZA, S. de F. C.; COSTA, S. A.; CAVALCANTE, A. H. M. .; CARNEIRO, A. L. F. C. .; SAUÁIA, T. S.; LEITE, S. A. M.; PEREIRA, Érika M. .; RABELO-JUNIOR, P. M. S. Management of upper central incisor with large periapical inflammatory cyst and persistent fistula: Case report . Research, Society and Development, [S. l.], v. 10, n. 8, p. e19410817332, 2021. DOI: 10.33448/rsd-v10i8.17332. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/17332. Acesso em: 18 nov. 2024.

Issue

Vol. 10 No. 8

Section

Health Sciences

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Copyright (c) 2021 Soraia de Fátima Carvalho Souza; Susilena Arouche Costa; Arianna Helena Marques Cavalcante; Aretha Lorena Fonseca Cantanhede Carneiro; Tetis Serejo Sauáia; Sandra Augusta Moura Leite; Érika Martins Pereira; Paulo Maria Santos Rabelo-Junior

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