Prof. Gabi Chaushu

A 52-year-old male patient presented with severe swelling accompanied by purulent discharge from the anterior palate. Based on the clinical and radiographic findings, a preliminary clinical diagnosis of a radicular cyst associated with the maxillary incisors was established. The treatment plan was formulated to address both the pathological lesion and the resultant bony defect. The proposed treatment strategy involved a two-stage approach: initial marsupialization to reduce cyst size and promote bone formation, followed by cyst enucleation and GBR.

A marsupialization procedure was initially performed to manage a large odontogenic cyst, involving incision, drainage, suturing of the cyst lining to the mucosa, placement of a rubber drain for decompression, and a structured follow-up plan. After six months, clinical and radiographic evaluation confirmed cyst regression and improved bone density, allowing progression to the definitive treatment. This included surgical enucleation of the cyst via full-thickness flap elevation and careful curettage, followed by irrigation and histopathological confirmation.

Due to the large osseous defect and erosion of the palatal bone wall, bone graft stabilization was essential to prevent structural collapse and support regeneration. Thus, a NOVAMag^® membrane was positioned within the defect followed by the placement of cerabone^® for the bone augmentation. A second magnesium membrane was then positioned over the filled defect, serving as a barrier to prevent soft tissue ingrowth. Then, to improve soft tissue healing at the site where the marsupialization drain had been placed, a platelet-rich fibrin (PRF) membrane was prepared and applied. Subsequently, root canal treatment was performed.

The follow-up examinations at 2 and 16 months post-augmentation revealed favorable bone and soft tissue healing outcomes. At the 2-month follow-up, CBCT imaging demonstrated initial bone formation within the augmented site. By the 16-month mark, significant improvements in bone volume and density were observed. The palatal contour was restored to its proper anatomical form, with notable cortication of the palatal wall and no evidence of pathological recurrence around the treated teeth was reported. Clinical examination at 16 months post-augmentation revealed that the patient remained asymptomatic.

These findings indicate that a combined approach involving marsupialization, enucleation, and GBR with NOVAMag^® membrane and cerabone^® may be a promising strategy for managing large periapical cystic lesions, though further studies are needed to confirm its broader applicability.

The full case report and complete protocol have been published and are accessible at the following link: https://www.mdpi.com/2227-9032/13/9/1068

The „Case Of The Month“ highlights every month a clinical case, which distinguished itself by the clinical results or the treatment concept in combination with the applied botiss biomaterials. The selection of the case is based on content relevance and quality of the documentation.