Medical Science: Updates and Prospects Vol. 8

Background: Radicular cysts are the most common inflammatory odontogenic cysts arising from epithelial rests of Malassez secondary to pulpal necrosis and chronic periapical inflammation. Clinically, they are often asymptomatic and frequently detected incidentally on routine radiographs. When symptoms are present, they may manifest as swelling, mild discomfort, or cortical plate expansion, depending on lesion size. These lesions are commonly associated with non-vital teeth in the anterior maxillary region and may cause progressive bone destruction if left untreated.

Objective: The objective of this study is to present a multidisciplinary management approach for a large periapical lesion in the anterior maxilla, emphasizing surgical enucleation, endodontic therapy, and prosthetic rehabilitation, along with one-year clinical and radiographic follow-up to evaluate treatment outcomes.

Case Presentation: A 28-year-old female patient presented with mild swelling and pain in the anterior maxillary region with a history of trauma three months earlier. Extraoral examination revealed no facial asymmetry or lymphadenopathy. Intraoral examination showed localised swelling in the labial vestibular region corresponding to teeth 21, 22, and 23. Radiographic evaluation revealed a well-defined unilocular radiolucent lesion measuring approximately 2.5 × 3 cm involving teeth 21, 22, and 23. All involved teeth were non-vital with expansion of the labial cortical plate. Considering the size of the lesion and the associated cortical plate expansion, a multidisciplinary treatment plan was implemented, involving surgical enucleation and curettage, followed by root canal therapy and prosthetic rehabilitation to restore function and aesthetics. Surgical enucleation was performed under local anaesthesia, followed by curettage of the surrounding bone. The excised tissue was submitted for histopathological examination.

Results: Histopathological examination demonstrated fibrocellular connective tissue with chronic inflammatory infiltrate, vascular proliferation, and cholesterol clefts without epithelial lining, confirming the diagnosis of periapical granuloma. Postoperative healing was uneventful, and radiographic evaluation at six months demonstrated significant bone regeneration. Endodontic therapy was subsequently completed for teeth 21, 22, and 23, followed by prosthetic rehabilitation using zirconia crowns. At one-year follow-up, restorations remained stable, gingival tissues were healthy, and no recurrence was observed.

Conclusion: This case emphasises the importance of correlating clinical, radiographic, and histopathological findings in the diagnosis of periapical lesions. Although the lesion initially mimicked a radicular cyst radiographically, histopathological examination confirmed the diagnosis of periapical granuloma. Successful management was achieved via a multidisciplinary approach, and long-term follow-up demonstrated satisfactory healing, functional restoration, and stability.