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Persisting endodontic lesion- compound odontomes and residual cyst: clinical case report; |Dr vineet vinayak

ABSTRACT
Odontomas and residual cysts are the most common type of persisting lesions encountered and generally are asymptomatic. This paper describes cases of compound odontomas and residual cysts. in both cases, the surgical excision of the lesions was performed. The results achieved indicate that the early diagnosis of these persisting lesions allows the adoption of a less complex and expensive treatment and ensures better prognosis.

INTRODUCTION
The periapical cyst is a common sequela of periapical granuloma originating as a result of bacterial infection and necrosis of dental pulp. The majorities of cases of periapical cyst are asymptomatic and present no clinical evidence of their presence. The tooth is seldom painful or even sensitive to percussion. This type of cyst is infrequently of such size that it destroys much bone, and even rarely produces expansion of cortical plates. But if neglected for long time may undergo acute exacerbation of inflammatory process and may develop into large residual cyst or an odontoma. A residual dental (or radicular) cyst arises from epithelial remnants stimulated to proliferate by an inflammatory process originating from pulpal necrosis of a non-vital tooth that is no longer present. The natural history begins with a non-vital tooth which remains in situ long enough to develop chronic periapical pathosis such as a dental (radicular) cyst. Eventually the tooth is extracted with little regard to the periapical pathosis which remains within the jaw bone as a residual dental cyst. Over the years, the cyst may regress, remain static or grow in size. Odontomas are considered to be developmental anomalies resulting from the growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts. These tumors are basically formed of enamel and dentin but they can also have variable amounts of cementum and pulp tissue. During the development of the tumor, enamel and dentin can be deposited in such a way that the resulting structures show an anatomic similarity to normal teeth, in which case the lesion is classified as a compound odontoma. However, when the dental tissues form a simple irregular mass occurring in a disorderly pattern, it is described as a complex odontoma. Compound odontomas appear more frequently than complex odontomas.This paper discusses two case reports for management of persisting lesions.

CASE REPORT 1
A 28 year old female was referred to the department of endodontics by a general practitioner. The patient came with a big swelling on the palatal aspect. (Fig A) Patient had trauma 4 years back and had undergone acrylic crown placement for discolored tooth 21.

Preoperative photo showing large palatal swelling

Fig A: Preoperative photo showing large palatal swelling

Preoperative OPGPeriapical radiolucency was observed to be extending from 21 to 25. Pulp vitality tests using an electric pulp tester were done irt #21, 22, 23, 24, 25. All the teeth were non vital. Routine endodontic procedure was done from 21 to 25.

Fig B: Preoperative OPG

Fig B: Preoperative OPG

Purulent exudate was coming out only from 21 and dramatically swelling subsided after access opening in relation to 21, subsequently swelling developed after obturation. Surgery was performed after endodontic procedure. During surgery under local anesthesia flap reflection was performed. The lesion was found to be extending well enough on labial side that was not diagnosed initially. Biopsy report confirmed the diagnosis of residual cyst.

Fig C: Extent Of Lesion

Fig C: Extent Of Lesion

The granulation tissue was removed using curettes (API). Removal of cystic lesion was done.(Fig D) The flap was repositioned and sutured using sling suture technique. Patient reported back asymptomatic after 3 months.

Fig D: Residual Cyst RemovedFig D: Residual Cyst Removed

Fig D: Residual Cyst Removed

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