(TC04) Treatment of Massive Infected Residual Cyst with Marsupialization, Decompression, Surgical Endodontic Therapy, and Enucleation: Case Report

Abstract: Odontogenic cysts rarely grow into extensively large lesions; when they do develop, they commonly arise from odontogenic keratocysts or dentigerous cysts. Residual cysts are often discovered during routine dental radiographs. They are typically asymptomatic unless infected. These cysts arise from the proliferation of epithelial cell rests of Malassez in the periodontal ligament that are stimulated by the ingress of inflammatory mediators originating from the necrotic pulp of the associated tooth. The development of residual cysts has been attributed to the continuation of this inflammatory process after the extraction of the associated tooth. Upon extraction, the majority of residual cysts regress; however, a small percentage of these lesions remain static or become infected and grow. Most odontogenic jaw cysts are found in the anterior maxillary area, followed by the lower premolar area. Though surgical enucleation is typically the recommended treatment for small cystic lesions, management of large cystic lesions in the anterior maxilla can pose a challenge due to the risk of damage to vital anatomical structures, devitalization of neighboring teeth, complicated surgical procedures, high chances of operative complications, and delayed post-operative healing, in addition to aesthetic considerations. Treatment of large lesions may require a treatment plan that is delivered in two stages: the first stage is marsupialization and decompression. The second stage is surgical endodontic treatment, accompanied by curettage and surgical enucleation. The purpose of this table clinic is to discuss the presentation, diagnosis, and the two-stage procedure for the management of a massive residual dental cyst in the anterior maxilla.