Santé bucco-dentaire et gestion dentaire

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Large Periapical Cyst Regression by Endodontic Treatment

Ana Flávia Almeida Barbosa, Camila Soares Lopes, Leopoldo Cosme Silva, Idiberto José Zotarelli Filho, Naiana Viana Viola Nicolí

The periapical cyst is a frequently found maxillary lesion associated with the apex of a tooth presenting pulpal necrosis. Usually asymptomatic, the cysts grow slowly and may be discovered in routine radiograph examinations. This case report relates the regression of a large periapical cystic lesion by endodontic treatment and drug therapy. A 41 years old female patient, T.A.B., came to the Student Dental Clinic I of the UNIFAL-MG complaining about pain on apical palpation and vertical percussion on teeth 31 and 41, showing swelling around the mentolabial sulcus. Looking into the patient’s dental records, it was noticed that an endodontic treatment had been performed on these two teeth presenting periapical cystic lesion four years earlier. A new radiograph showed that the endodontic treatment was deficient and that the lesion itself had expanded. The teeth 31 and 41 were retreated; a foraminal debridement was performed during the instrumentation along with three Calen/PMCC (SS White, Rio de Janeiro, RJ, Brazil) dressing changes with 30 days intervals between them. By applying puncture aspiration to the lesion, it was observed that the collected contents were yellowish, viscous and bloody, characterizing it as cystic fluid. Ninety days later, another periapical radiograph showed a nearly complete regression of the lesion; clinically the edema and symptoms have disappeared. The endodontic treatment was then concluded and the teeth restored. We concluded that, in some cases, it is possible to obtain clinical success in the regression of large periapical cysts by endodontic treatment without the need for surgical removal.