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Peri apical cyst - Courtesy ROOTS

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The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Carlos Heilborn, Reggio Emilia - ROOTS

From: Carlos Heilborn
Sent: Saturday, January 05, 2008 12:15 AM
Subject: [roots] Opinions and suggestions welcome

First very difficult situation of the year
I have received this case last week, for me it is a peri apical cyst, but considering the size and that is very productive
( I have drained it through root canal twice in a week) I would like to know how do you think this case should be
Conventional RTC and monitoring
Surgical Approach
Any other dx tools prior deciding? - Carlos Heilborn

I would use 2 ca(oh)2 appointments, from 3 to 3 months, rx reevaluation, and apical plug of mta, most cases heal just fine. - Sergiu Nicola Hi Carlos, Difficult case indeed. Dens invaginatus type II, associated with a very large lesion. I would try to remove the whole dens tract, which can be difficult, due to the enamel lining. When the canal keeps weeping, you could consider to do a marsupialization or decompression, because the lesion is huge. When it has decreased in size, you can fill the canal with MTA, whether or not in conjunction with surgery. Good luck! - Marga Hi Marga, Thank you very much for your suggestions, I will try to do my best!! - Carlos In my opinion this is a case of "dens invaginatus". I treated three or four cases with conventional RTC. I removed the anomalous structure in the coronal part and in the coronal third of the root then I performed the treatment in one visit only. In your case I suggest the use of MTA to seal the wide apex. You'lI find here enclosed a similar case that I treated with thermoplastic guttapercha and cement only. Prof. Emanuele Ambu - University of Modena - Reggio Emilia (Italy)

Dear Prof. Ambu Thank you very much for your answer and suggestions. Thank you for the case you posted, is quiet similar to the one I have to treat. Best regards from Asunción, Paraguay - Carlos Heilborn Hi Carlos, I always prefer the conventional RTC and follow-up before surgical approach. I believe that sometimes we can have an agreeable surprise. In this specifically case, I would do a MTA apical plug because of the wide-open apex. Please attached find a case report of mine in which I have used Portland cement for research purposes. Of course, that your case is more complex considering the cyst size. However, using a MTA apical plug you still have a promise of healing; see the attached case of the competent group of Florence University. I hope that this can help you a little. - Gustavo
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