(TC70) The Management of Large Periapical Odontogenic Lesions

Abstract: The aim of this case report is to discuss the management strategies of large periapical odontogenic lesions, which can be challenging and less predictable. This report presents two cases of very large, aggressively expanding lesions diagnosed as radicular cysts following incisional biopsies. The first case involved the temporary retention of severely compromised teeth to enhance bone graft stability after cyst enucleation. The patient sought a second opinion for managing a 2.5x2cm lesion spanning teeth #7-11. The treatment plan included extracting previously treated immature maxillary incisors with unfavorable endodontic prognoses. The management approach utilized temporary retention of the compromised teeth to provide stability and minimize maxillary bone loss following cyst enucleation. Root canal therapy of all teeth involved in the lesion was completed using mineral trioxide aggregate, and resections were performed in conjunction with cyst removal at a subsequent appointment. The second case employed a six-week-long decompression before surgical enucleation. The patient was referred for the management of a 2.4x16.5cm lesion in the anterior mandible. A customized impression syringe tip was sutured in place, and the patient was instructed to irrigate the lesion daily. The decompression technique aimed to reduce the size of the periapical lesion, minimizing the invasiveness of endodontic microsurgery, and preventing the devitalization of adjacent teeth during cyst enucleation. These cases demonstrate potential conservative treatment options aimed at reducing morbidity that should be considered when treatment planning for large periapical odontogenic lesions.