Radicular Cyst of Jaw: A Case Report

A radicular cyst is an inflammatory cyst and it is one of the most common and significant types of cystic lesion affecting the jaw. It is a chronic inflammatory response to the epithelial rest of Malassez which occurs in the periodontium of affected teeth. It is usually symptomless and detected incidentally on plain OPG. Several treatment options are available for a radicular cyst such as surgical endodontic treatment, extraction of the offending tooth, enucleation with primary closure, or marsupialization followed by enucleation. We present a case of radicular cyst in a 61-years-old female patient and the treatment of this based on a review of the literature.


Introduction
The radicular cyst develops at the apex of a necrotic erupted tooth and is one of the most common and significant types of cystic lesion affecting the jaw accounting for about 52 %-68 % of all incidences Mandibular molars are the favoured site for the development of radicular cysts as they are frequently affected by caries [5,6]. Cortical bone in this region is thick; therefore, lesions may not drain readily through the sinus tract [7,8]. The cyst is believed to form by the proliferation of the epithelial cell rests of Malassezia in inflamed peri radicular tissues [9]. Its size rarely exceeds 1 cm and is usually associated with carious, non-vital, discoloured, or fractured teeth [10,11]. The radicular cyst is usually symptomless and detected incidentally on plain OPG while investigating for other diseases; radiographically, the radicular cyst appears as a well-defined round or oval unilocular radiolucency with a radiopaque sclerotic margin in the periapical region of involved tooth [12].
The vitality test is essential for the diagnosis: the vitality of the tooth involved would rule out the presence of a radicular cyst.
Radicular cysts are generally considered to be the direct consequence of a periapical granuloma, but less than 20 % of granulomas have this type of evolution.
Several treatment options are available for a radicular cyst such as surgical endodontic treatment, extraction of the offending tooth, enucleation with primary closure, and marsupialization followed by enucleation [11].
The purposes of this paper were to report the case of a 61-year-old female patient with a radicular cyst in mandibular molar teeth and the treatment of this based on a review of the literature. The patient refers to a previous history of melanoma (1998), and at present the daily intake of escitalopram and delorazepam.

Case Report
The orthopantomography, carried out at the diagnostic radiology service, shows a large radiolucent with a sclerotic radiopaque margin involving the root apexes of elements 36 and 37 and the crown of The second level radiographic examination (CT cone beam) confirms the reports of the radiolucent lesion with the apexes of the elements.

Abstract
A radicular cyst is an inflammatory cyst and it is one of the most common and significant types of cystic lesion affecting the jaw.
It is a chronic inflammatory response to the epithelial rest of Malassez which occurs in the periodontium of affected teeth. It is usually symptomless and detected incidentally on plain OPG.
Several treatment options are available for a radicular cyst such as surgical endodontic treatment, extraction of the offending tooth, enucleation with primary closure, or marsupialization followed by enucleation.
We present a case of radicular cyst in a 61-years-old female patient and the treatment of this based on a review of the literature.   On clinical examination there was a voluminous swelling at the fornix of elements 3.6 and 3.7; the opening of the mouth is limited. Elements 3.6 and 3.7 were subjected to periodontal probing, which was negative, and the absence of viability was confirmed through a viability test with cryospray and electrical.
Clinical, radiographic examination, and excisional biopsy reports were suggestive of a radicular cyst associated with mandibular left molars.
The histopathological examination confirmed the provisional diagnosis of a radicular cyst.
It showed the presence of stratified squamous epithelium with subadjacent granular tissue and inflammatory infiltration.

Procedure
The patient was informed about the treatments she must undergo and signed informed consent.
The patient first underwent root canal therapy of elements 36 and 37.
During the first session, the endodontic treatments of elements 3.6 and 3.7 were performed.
The treatment, despite the total absence of vitality, was conducted with an inferior alveolar nerve block (IANB) with mepivacaine without a vasoconstrictor.
In both elements, 3 root canals were found. The osteotomy followed the fenestration caused by the injury and was performed with a "rosette" bur, used on a low-speed handpiece. The odontology was performed with piezosurgery.
After the odontology procedure, the crown and roots of dental element 3.8 were extracted in two steps.
The lesion was detached from the surrounding bone and enucleated in its entirety. [ Figure 6-7-8] The cavity was washed with a physiological solution and the flap was closed with a vicryl 4/0 resorbable suture.
The surgical piece was sent for histopathological examination to the pathological anatomy service of the Mauriziano Hospital.
The postoperative indications were given and a 10-day checkup was performed, simultaneously with the removal of the suture. [ Figure 9-

10]
One month after the surgery, the final restorations were made in private dental practice. [ Figure 11] The patient undergoes quarterly follow-ups.
An intraoral radiograph was taken during the 6-month follow-up.