Sixteen patients treated in our department were selected between September 2015 an October 2016, including 11 males and five females. The age of the included patients with jaw cyst in our study ranged from 21 to 49 years. In total, 54 involved teeth from 16 patients were included in this study. Inclusion criteria consisted of:
① A jaw cystic lesion involved at least two teeth (Fig. 1).
② Clinical examinations such as a preoperative clinical exam, dental radiograph, or cone beam computed tomography (CBCT) identified the pathogenic teeth and affected teeth.
③ The pathogenic teeth had had completed root canal filling before surgery.
④ The involved teeth did not have an enlarged apical foramen, showed no root resorption on X-ray film or CBCT, and reacted normally or insensitively in a pulp vitality test.
⑤ Written informed consent was obtained from each patient. If a patient had any postoperative discomfort, root canal therapy would be given.
⑥ During the operation, the roots of the involved teeth were reconfirmed to have exposed roots in the cystic cavity.
Panoramic tomography, cone beam computed tomography, Neosono Co-Pilot Pulp Vitality Tester, conventional surgical instruments for maxillofacial surgery.
First, the involved tooth should be diagnosed by X-ray (Fig. 2-3), CBCT, and a pulp vitality test before surgery. After considering pathological scope and location, jaw cystic lesion resection should be conducted under local or general anesthesia (Fig. 4). Next, a routine trapezoidal or angular incision should be performed on the labial mucosa to expose the labial lesions. If the labial bone plate is in the process of resorption, a complete removal of cystic lesions should be done. First, the cystic lesion area should be stripped to keep it away from the teeth. It must be removed carefully under direct vision around the area of the involved tooth. Performing a complete removal of the fiber lining is not suggested, so as not to pose an impact on the blood supply and nerve fibers of the involved teeth. Finally, treatment for the involved tooth should be carried out thoroughly around its roots.
A high-frequency electrotome is used to scratch and burn adhesion of the capsule wall and then the root tips are removed 3 mm by round burs while the involved tooth is well protected. If the labial bone plate exists, chisel the apical alveolar bone 5 mm above the root tip of the involved tooth to remove any intact jaw cystic lesion. Treatments for the root apex of both pathogenic teeth and involved teeth are as previously described. After that, we irrigated the chamber with sterile saline solution, ensuring sterile conditions and non-inflammatory factors in the cystic space. The root tip should be covered with a gelatin sponge. If the size of the cavity is less than three tooth positions, suture it after debridement. If it is larger than four teeth positions, fill the hole with iodoform gauze and then suture wound.
Patients whose preoperative diagnosis tended to be of a non-odontogenic cyst were treated the same as those with an odontogenic cyst. In this circumstance, if the root apex of the involved tooth was not exposed in the cavity, only the cyst itself would be completely removed during the operation. On the contrary, if there was only an adjacent relationship between the walls and the involved teeth, the capsule wall would be stripped and the roots of the involved tooth would require no treatment.
Radicular cyst in five cases; periapical granulomas in five cases; dentigerous cyst in four cases; odontogenic squamous intraepithelial lesion in two cases.
Postoperative follow-up was conducted for 12 to 36 months. The patients underwent a pulp vitality test at one week, one month, three months, six months, and 12 months postoperatively and underwent X-ray radiography at three months, six months, and 12 months after surgery (Fig. 5). The criteria for protecting the pulp of the involved tooth successfully were as follows.
① The incision has healed well and there is no inflammation in the surgical area.
② The occlusion of the involved teeth is functioning well without any discomfort.
③ The pulp vitality of the involved teeth has returned to normal after the operation.
④ The scope of the lesion has gradually narrowed and the bone density has gradually increased.
If any of the following symptoms appeared within one year after surgery, preservation of the involved tooth was considered a failure.
① The patient experiencing toothache or any discomfort should be given root canal therapy.
② The mucosa of the surgical area showed redness, swelling, and pus. After root canal therapy, inflammatory reaction disappeared.
③ There was no cystic space reduction or enlargement around the involved tooth in an X-ray.