2020 Volume 63 Issue 4 Pages 332-337
Introduction: Apical periodontitis adjacent to the maxillary sinus may induce the formation of a thin hard tissue dome on the sinus floor. This reactive bone formation can be detected as a halo-like radiopaque lesion and is termed periapical osteoperiostitis (PAO). We herein report the successful surgical endodontic treatment of a radicular cyst accompanied with PAO in a maxillary first molar.
Case: A 47-year-old female was referred for endodontic treatment of her right maxillary first molar. Panoramic and periapical radiographs revealed a diffuse periapical radiolucency around the mesiobuccal and distobuccal roots and elevation of the floor of the right maxillary sinus with a radiopaque lesion. Cone-beam computed tomography (CBCT) demonstrated a well-defined radiolucency of about 8×8×10 mm encompassing the apices of the mesiobuccal and distobuccal roots of the right maxillary first molar, and elevation of the maxillary sinus floor adjacent to the radiolucent lesion with a dome-shaped radiopacity. A diagnosis of previously-treated root canals with symptomatic apical periodontitis accompanied with PAO was made, and root canal treatment was instituted according to the standard procedure. However, the mesiobuccal and second mesiobuccal canals presented persistent exudation, and thus apicoectomy and retrograde filling were performed on the buccal roots under a dental operating microscope. The removed tissue was histopathologically diagnosed as radicular cyst. One-year follow-up showed an increase of radiopacity in the periapical area of the buccal roots and a reduction of the mesiodistal width of the radiopacity on the floor of the maxillary sinus.
Conclusions: A case of radicular cyst accompanied with PAO in the maxillary first molar was successfully treated with surgical endodontic treatment. CBCT was useful for the diagnosis and treatment planning of this case.
