Mandibular dentigerous cyst: Enucleation and bone reconstruction – Case report

Abstract

Purpose: The dentigerous cyst is the second most common odontogenic cyst in the jaws. These lesions are observed in routine examinations. The third molars and maxillary canines are the most affected teeth. Definition of marsupialization and enucleation techniques as well as consideration of important objective criteria for the treatment plan like cyst size, age, and proximity to anatomical structures, clinical importance of the tooth or teeth associated with the lesion and risk of bone fracture. This paper will present a case report treated by maneuver of decompression followed by enucleation and bone reconstruction. Case report: A 43-year-old female patient, Caucasian, attended the Oral-Maxillofacial Surgery consultation at Clitrofa - Centro Médico, Dentário e Cirúrgico, in Trofa - Portugal, to assess extraction of 3.8 and 4.8. On intraoral physical examination, a slight bulging of the cortical bone was noted in the region of the left external oblique line. Aspiration puncture was performed and a small amount of light-yellow liquid confirmed the cystic nature of the lesion. In a second stage, osteotomy through piezoelectric surgery was performed. The cystic capsule was excised together with the extraction of tooth 3.8 included and tooth 3.7. Bone regeneration was performed. The material obtained from the cystic cavity was sent for pathological examination, confirming the diagnosis of dentigerous cyst. During observation of the patient for twelve months, no hypoesthesia or any sign of recurrence of the lesion was observed. Conclusion: The technique preserved the neurosensory function and was effective for the enucleation and reconstruction of the lesion. Despite the clinical peculiarities of each case and the chosen treatment method, the prognosis of these lesions is favourable when appropriate therapy is used.

Técnica de janela óssea na enucleação de cisto mandibular com piezoelétrico: Relato de caso

“…A osteotomia foi realizada por meio da piezocirurgia, a qual apresenta um controle tridimensional das microvibrações ultrassónicas, permitindo um corte seletivo das estruturas ósseas de interesse, que resulta em danos mínimos aos tecidos moles e estruturas nervosas, além de possibilitar a enucleação precisa das lesões císticas, bem como uma melhora na visão da loca cirúrgica. 7,8 A técnica janela óssea apresenta como vantagem a redução da perda óssea, a qual propicia a regeneração óssea guiada, por meio do reposicionamento do fragmento ósseo, reduzindo as dimensões do defeito e criando uma barreira rica em osteoblastos que inibe a infiltração de células epiteliais para dentro da loca cirúrgica. 9,10 A espessura do fragmento é de fundamental importância para o sucesso da técnica, devendo ser confecionada com uma espessura adequada (> 1 mm), orientando a osteotomia com o propósito de delimitar um chanfrado interno mais longo que facilita no reposicionamento do fragmento em sua posição original.…”