PMC9900147_01
A) Periapical Radiography showing an outsized periapical lesion, previously endodontically treated tooth #21, and seemingly intact tooth #22. Tooth #22 had undergone a cavity test and exhibited clinical sensitivity to the performed test; B) Preoperative cone-beam computed tomography (CBCT) image showing large bone destruction and site perforation around the roots of teeth #21 and #22; C-E) CBCT images of teeth #21 and #22 revealing the previous root canal treatment of tooth #21 and seemingly sound tooth #22, with large periradicular radiolucency that had destroyed the labial/palatal cortical plates; F) Excision of the lesion and aspiration of its components using a syringe; G) Postoperative radiograph showing root-end resection and filling/sealing with calcium-enriched mixture cement as the endodontic biomaterial; H-I) Histopathological findings showing a squamous epithelial lining accompanied by the infiltration of inflammatory cells, representing a periapical cyst; J) Six-month follow-up denoting the regression of lesion and incomplete bone healing; K) 4-year follow-up radiograph showing the complete bone healing. Moreover, tooth #22 responded positively to the pulp sensibility tests and had normal PDL
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Clinical examination showed regional swelling/redness/tenderness, and radiographic evaluation revealed a large periradicular lesion surrounding the roots of teeth #21 and #22; tooth #21 was endodontically-treated whereas the pulp of tooth #22 was intact (Figure 1A). Additionally, cone-beam computed tomography showed a huge lesion; perforating the labial and palatal cortical plates, surrounding the roots of teeth #21 and #22 (Figures 1B-E). After premedication with ibuprofen 400 mg, mouth-rinse with 0.2% chlorhexidine, and proper anaesthesia, a syringe aspiration was performed, and 1.5 mL pus/blood were extracted (Figure 1F). Then, a full mucoperiosteal flap was incised, reflected and the lesion was carefully excised (Figure 1F) except for the periapical region of tooth #22. Iran) cement as a suitable biomaterial used in similar cases (Figure 1G). The removed specimens were sent for histopathological examination, which showed a radicular cyst lined by stratified squamous lining epithelium. In addition, there were foci of hemorrhage and a severe lympho-plasma cell infiltration in the fibrous cystic wall (Figures 1H-I). In 6-month recall, the radiographic evaluation showed incomplete healing of the lesion, specifically around the apex of tooth #22 (Figure 1J); however, at 4 years, the recall radiography presented complete bone healing and normal PDL of both teeth (Figure 1K).