A 55-year-old male patient presented with moderate pain and discomfort during food consumption for approximately 3 months.
The patient did not report any relevant systemic history.
Intraoral examination revealed 14 individual metal-ceramic crowns at the dental organ level, as well as redness and inflammation of adhered gum.
Percussion and consolidation manifested sensitivity.
Radiographic examination with periapical radiograph of dental organ (OD) 14 to 17 showed radiopacity corresponding to filling material in the RE 14 and bonded nucleus in both root roots.
At the level of this RE, space of the enlarged periodontal ligament was evidenced, as well as the presence of a unilocular radiolucent image in the shape of a pears of approximately 8 mm, well defined.
Taking into account the clinical and radiographic findings described, the initial differential diagnosis of this lesion included residual cyst, or another developing cyst or odontogenic tumor.
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The patient was informed about the complications and adverse effects of the procedure, as well as the anonymity and confidentiality of their personal data.
After authorization and signing of the informed consent, surgery was performed under local anesthesia with 2% lidocaine. A flap was designed with preservation of the papillae, total thickness flap dissection, followed by osteotomy with round burr number 4.
Debridement of pathological tissue was carried out, which had an anatomical size greater than estimated with the initial radiograph, and was later carried out histopathological study.
Apicoectomy of approximately 3 mm was performed, scraping and polishing of the periapical process and using gauze and aspirator to dry the cavity.
Regrading obturation was performed with mineral trioxide aggregate (MTA) and cleaning and irrigation with saline solution, then the edges of the flap were repositioned with simple points isolated with Nylon 5-0.
After the surgical intervention, the patient was prescribed: Amoxicillin, 500 mg capsules for 7 days; Nimesulide, 100 mg tablets for 5 days and 0.12% rinse with chlorhexidine for 7 days.
Finally, immediate radiographic control was performed, which showed the actual amount of bone loss, which was not identified prior to surgery.
The sutures were removed after 7 days.
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The histopathological study diagnosed a radicular cyst wall; this study showed stratified squamous epithelium not keratinized with underlying connective tissue fibrous, dense, well vascularized and inflammatory infiltrate.
Three months after the removal of the lesion's wall, as well as appropriate apical formation, the patient came to postoperative control of painful organ seal, as well as sensitivity to establish a vertical lesion or periapical lesion per seal.
