{"title":"Post-traumatic radicular cyst involving multiple anterior Teeth: Open apex management and surgical enucleation – A case report","authors":"B. Doumari, S. Dhoum, Z. EL Hajjioui, M. Jabri","doi":"10.1016/j.adoms.2025.100558","DOIUrl":null,"url":null,"abstract":"<div><div>Radicular cysts are the most common inflammatory odontogenic cysts, typically arising from chronic periapical infection following pulp necrosis. Post-traumatic radicular cysts involving immature teeth with open apices are uncommon and present unique clinical challenges due to incomplete root formation. This case report describes the management of a large post-traumatic radicular cyst affecting multiple maxillary anterior teeth (teeth 11, 12, and 13) in a 27-year-old patient, discovered incidentally during routine radiographic examination.</div><div>Clinical examination revealed pulp necrosis and an open apex on tooth 11, with teeth 12 and 13 also non-vital. Radiographs and CBCT confirmed a well-demarcated radiolucent lesion with buccopalatal expansion and cortical bone resorption, consistent with a radicular cyst. Treatment included conventional root canal therapy for teeth 12 and 13, and apexification with Biodentine for tooth 11. Surgical enucleation of the cyst was performed via a full-thickness mucoperiosteal flap, achieving complete removal of the lesion.</div><div>Biodentine, a bioactive calcium silicate-based material, was used to create an apical plug, promoting hard tissue formation and providing a reliable apical barrier, thus facilitating root canal obturation in the immature tooth. Histopathology confirmed an inflammatory radicular cyst. At 13-month follow-up, the patient was asymptomatic, with radiographic evidence of significant bone regeneration, although a residual bony defect remained. Long-term follow-up was recommended to monitor complete healing and prevent recurrence.</div><div>This case highlights the importance of early diagnosis and a multidisciplinary approach combining modern endodontic materials and surgical intervention in managing post-traumatic radicular cysts involving open apex teeth, ultimately preserving tooth structure and function.</div></div>","PeriodicalId":100051,"journal":{"name":"Advances in Oral and Maxillofacial Surgery","volume":"19 ","pages":"Article 100558"},"PeriodicalIF":0.0000,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in Oral and Maxillofacial Surgery","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2667147625000445","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Radicular cysts are the most common inflammatory odontogenic cysts, typically arising from chronic periapical infection following pulp necrosis. Post-traumatic radicular cysts involving immature teeth with open apices are uncommon and present unique clinical challenges due to incomplete root formation. This case report describes the management of a large post-traumatic radicular cyst affecting multiple maxillary anterior teeth (teeth 11, 12, and 13) in a 27-year-old patient, discovered incidentally during routine radiographic examination.
Clinical examination revealed pulp necrosis and an open apex on tooth 11, with teeth 12 and 13 also non-vital. Radiographs and CBCT confirmed a well-demarcated radiolucent lesion with buccopalatal expansion and cortical bone resorption, consistent with a radicular cyst. Treatment included conventional root canal therapy for teeth 12 and 13, and apexification with Biodentine for tooth 11. Surgical enucleation of the cyst was performed via a full-thickness mucoperiosteal flap, achieving complete removal of the lesion.
Biodentine, a bioactive calcium silicate-based material, was used to create an apical plug, promoting hard tissue formation and providing a reliable apical barrier, thus facilitating root canal obturation in the immature tooth. Histopathology confirmed an inflammatory radicular cyst. At 13-month follow-up, the patient was asymptomatic, with radiographic evidence of significant bone regeneration, although a residual bony defect remained. Long-term follow-up was recommended to monitor complete healing and prevent recurrence.
This case highlights the importance of early diagnosis and a multidisciplinary approach combining modern endodontic materials and surgical intervention in managing post-traumatic radicular cysts involving open apex teeth, ultimately preserving tooth structure and function.