We report the challenges faced in the treatment of a large cystic lesion in the anterior maxilla. A 32-year-old woman presented herself to the urgency service, complaining about discomfort in the region of nonvital tooth #22. Endodontic treatment was started and the patient reported to the oral medicine discipline of the authors’ institution. Imaging and clinical examination revealed a large cystic lesion involving the hard palate, nasal cavity, and the anterior portion of the maxillary sinus. A cystic decompression was performed along with an incisional biopsy that led to a histopathologic diagnosis of periapical cyst. A second surgical approach tried to enucleate the lesion but the ostium of decompression remained open, thereby impairing bone formation. A third approach was performed along with allogeneic particulate bone graft and reabsorbable membrane barrier positioning. Radiographic follow-up showed the graft integration and good recovery of the lesion after 4 months of follow-up care.
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