PMC6487169_01
(a) Orthopantomography in the phase of mixed dentition. A normal rate of tooth eruption, without any radiolucent lesion, is seen in the area of the third quadrant. (b) Follow-up orthopantomography of the third molars after orthodontic treatment. The radiolucent lesion affecting the areas of 35, 36, and 37 is diagnosed.
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By chance, during a routine postorthodontic visit, an orthopantomography of the third molars identified a radiolucent image encompassing the periapical area of teeth 35 and 36 (Figures 1(a) and 1(b)).
Cone beam computerized tomography. A welldefined unilocular radiolucent lesion of 12.0 x 17.8 mm is observed, with preservation of both the root apex and the cortical bone. However, a marked thinning of the lingual cortical mandibular plate is seen.
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However, the lingual cortical plate was observed to be extremely thin, due to the compressive effect of the pseudocyst itself (Figure 2).
(a) Clinical image of the mucoperiosteal flap for accessing the buccal cortical plate and for performing trepanation to allow drainage of an amber-colored serohematic fluid. (b) Cannulation of the lesion via a microperforated Nelaton catheter.
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Finally, the bone cavity was cannulated through the end (3.5 cm) of a Nelaton-type catheter leaving a 1 cm section exposed which was fixed with silk 3/0 (Figures 3(a) and 3(b)).
Cone beam computerized tomography 2 months after surgery. A slight reduction in lesion size (11.1 x 15.9 mm) is seen. Note the incipient recovery of the cancellous bones in the radiolucent image. The drainage catheter placed in the area of the lesion can also be seen.
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After two months, a new CBCT was requested to inspect the area of the lesion, which indicated the incipient recovery of cancellous bone in the radiolucent image (Figure 4).
Control orthopantomography 5 months after surgery, showing a significant improvement in bone density at the level of the cavity.
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Five months after treatment, a control orthopantomography indicated improved bone density at the site of the lesion (Figure 5).
(a) Clinical image: excellent scarring of the area where the drainage catheter was placed. (b) Control orthopantomography 9 months after surgery. Significant reductions are seen in the size of the lesion and in the presence of cancellous bone.
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At nine months, a new orthopantomography showed a significant reduction in the size of the lesion and a significant increase in the cancellous bone inside (Figures 6(a) and 6(b)).
Cone beam computerized tomography within 18 months of canalization. Complete replacement of the radiolucent image is observed, with a density compatible with normal bone tissue in the process of calcification. The lingual cortical plate adjacent to the lesion in the area of teeth 35-37 presents normal thickness.
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Surprisingly, at 18 and 24 months after the surgical cannulation, the pathological image presented a bone density compatible with normal bone tissue in the process of calcification, and indeed, it was difficult to define the original lesion (Figures 7 and 8). In addition, the thickness of the lingual cortical plate adjacent to the lesion in the area of teeth 35-37 was normal (Figure 7).
Control orthopantomography 24 months after surgery. Note the complete recovery of the lesion.
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Surprisingly, at 18 and 24 months after the surgical cannulation, the pathological image presented a bone density compatible with normal bone tissue in the process of calcification, and indeed, it was difficult to define the original lesion (Figures 7 and 8).