Apicoectomy and Enucleation on Maxillary Lateral Incisor with Radicular Cyst

Abstract

Introduction. A radicular cyst is an odontogenic cyst originated from residual epithelial cells (remnants of Malassez cells) of periodontal ligaments with the previous history of chronic inflammation. The radicular cyst usually results from traumatized pulp or necrotic pulp that is left untreated. This study aimed to treat the maxillary lateral incisor with necrotic pulp and radicular cyst by apicoectomy, retrograde closure using mineral trioxide aggregate, followed by enucleation and bone graft application. Case Report. A 28-year-old female patient who suffered from recurrence pain and swelling in the right maxillary incisor area came to Gadjah Mada University Dental. The patient had a history of trauma on her maxillary right incisor 12 years ago. Vitality test, percussion test and palpation test showed negative results. Cone beam computed tomography radiograph showed circular radiolucent lesions with a firm radiopaque border surrounding the apical of tooth resulted in a cortical bone loss on the labial aspect. The lateral maxillary incisor was diagnosed as necrotic pulp with the radicular cyst. Conventional endodontic treatment was performed in two visits using calcium hydroxide as intracanal medicament followed by class I composite resin restoration. Apicoectomy procedure was performed on the third visit using mineral trioxide aggregate as retrograde filling material followed by enucleation of radicular cysts and application of bone graft as bone regeneration material. Three months of control after treatment showed good bone tissue regeneration. Post-operative control in the third month showed functional bone tissue regeneration. Conclusion. Apicoectomy and retrograde closure using aggregate mineral trioxide followed by enucleation and bone graft application is a treatment of choice for pulp necrosis with the radicular cyst.