Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, 35516, Egypt.
Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, 03722, Republic of Korea.
BMC Oral Health. 2021 Aug 3;21(1):382. doi: 10.1186/s12903-021-01738-2.
Radicular cysts may enlarge considerably, cause extensive bone destruction, and jeopardize the integrity of the associated vital teeth. The different treatment approaches are aimed mainly at eliminating the cystic epithelial membrane while reducing the risk of injury to vital structures. Contrary to other treatment modalities, preapical surgery offers an unequivocal single occasion resolution for the patient. However, it has been associated with higher risk of collateral damages.
A patient presented with a large radicular cyst originating from a maxillary lateral incisor. The adjacent central and canine teeth initially failed to exhibit responses to sensibility tests but showed signs of vitality. Microsurgical management was aimed at enucleating the cystic membrane while maintaining adjacent teeth vitality. Upon careful and controlled cyst enucleation under the dental operating microscope, the neurovascular bundle of one of the involved teeth was visualized and its integrity was maintained throughout the procedure.
The procedure was successful and follow up recalls revealed recovery of normal sensibility of tooth 11 and 13 with complete bone regeneration around their apices.
Within the limitation of the present case report, we demonstrated that complete excision of large periapical cyst can be performed without sacrificing the vitality of the adjacent teeth, by preserving the integrity of their neurovascular supply through controlled microsurgical enucleation, and by a potential apical vascular repair ensuing unintended injury. Diagnosing the pulp vitality of non-offending teeth whose apices protrude into the cystic lumen is a complex process and can be misleading. Pressure from the growing cyst can inhibit vital teeth responses to neural-based sensibility tests leading to false negative results. Thus, in such cases, the use of blood perfusion-based vitality testing is recommended for correct initial diagnosis.
根囊肿可能会显著增大，导致广泛的骨破坏，并危及相关恒牙的完整性。不同的治疗方法主要旨在消除囊状上皮膜，同时降低对重要结构损伤的风险。与其他治疗方式不同，根尖前手术为患者提供了明确的单次解决方法。然而，它与更高的并发症风险相关。
一位患者出现了一个起源于上颌侧切牙的大型根囊肿。相邻的中切牙和犬牙最初对感觉测试没有反应，但显示出活力迹象。微创手术管理旨在通过切除囊状膜来维持相邻牙齿的活力。在牙科手术显微镜下仔细和控制地进行囊状切除后，其中一颗受累牙齿的神经血管束被可视化，其完整性在整个过程中得以维持。
手术成功，随访显示 11 号和 13 号牙齿的正常感觉恢复，其根尖周围完全再生骨。
在本病例报告的限制范围内，我们证明通过保护其神经血管供应的完整性，通过控制的微创手术切除，可以在不牺牲相邻牙齿活力的情况下，对大型根尖周囊肿进行完全切除，并通过潜在的根尖血管修复来避免意外损伤。诊断根尖突入囊腔的非受影响牙齿的牙髓活力是一个复杂的过程，可能会产生误导。生长的囊肿的压力会抑制恒牙对基于神经的感觉测试的反应，导致假阴性结果。因此，在这种情况下，建议使用基于血液灌注的活力测试进行正确的初始诊断。
