Management of radicular cyst involving four teeth

Abstract

c AXE EIISTORL’.-W. W., male, aged 32 years, presented himself Nov. 18, 1940, for routine dental examination and prophylaxis. He complained of no pain or discomfort. We insisted on an x-ray series. Clinical examination showed that both upper central incisors were badly discolored, the right lateral incisor and cuspid were. vital, but the vitality tests indicated that pulp degeneration was already present. A small fistula was seen over the upper right central incisor with its opening just below the mucobuccal fold. The paCent revealed that both upper central incisors were treated twelve years ago in Vienna. He thought that the fistulous opening into the mouth was of no special concern, since it came and disappeared at intervals and was not of any special discomfort to him. At no time was any great amount of swelling present. Radiographic examination revealed a radiolucent area involving both upper central incisors, the right lateral incisor and cuspid. Diagnosis of radicular cyst was made (Fig. 1). Plan of Treatment.-The retention of the involved teeth was decided on but the patient was advised of the risk involved, and of the possibility of failure to secure a successful result. Root canal therapy was performed on both upper central incisors, the upper right lateral incisor and cuspid, followed by removal of the cystic sac and its contents, and amputation of the four apices involved. Detailed treatment and case management was as follows : Nov. 25, 1940.-Rubber dam was applied for the upper right central incisor. The tooth and area were swabbed with iodine followed by alcohol. The upper right central incisor was opened lingually and adequately so as to expose the entire pulp chamber of the crown, and to remove the decomposed remnants of organic tissue contained therein. A barbed broach was introduced into the canal proper, whereupon a copious discharge of straw-colored fluid ensued. The canal was dried as well as possible with cotton points and the pulp chamber was then closed with base plate gutta-percha leaving a small opening for drainage. Dec. 2, 1940.-The rubber dam’ was applied to the upper left central incisor. The area and tooth was swabbed with iodine, followed by alcohol. The tooth was similarly opened and the old root canal filling removed. There was no discharge of pus. The root canal was irrigated with a 2 per cent chlorazene solution, dried with sterile cotton points, after which a formocresol dressing was inserted. The canal was then sealed with two layers of base plate gutta-percha, each layer being swabbed with chloroform to seal the margins of the cavity. The upper right central incisor was still draining and no change in treatment was instituted at this time.