Management of cysts Flashcards
General approach to managing a cyst (4)
Enucleation
-removal in entirety without cutting
Currettage (if it falls to bits)
-removal of tissue by scraping or scooping (in portions)
Resection
-removal of part of an organ
-takes pathology and margin of normal tissue
Marsupialisation
-creation of a pouch by suturing cyst lining to external surface
Which cysts are important with regards to undergrad exams? (5)
Potentially manageable in dental practice -radicular -dentigerous Recurrence -odontogenic keratocyst Common MOS -mucocele -sebaceous (epidermoid) cyst)
Management of radicular cysts (5)
- RCT?
- Extract causative tooth (cyst likely to come with it or resolve if small)
- Extract causative tooth then enucleate cyst (if large or retained)
- Rarely, marsupialise +/- further therapy (if exceedingly large)
- Apicect
- anterior tooth (mainly)
- acceptable orthograde RCT
- patient accepts risks (e.g. recession)
- consider implant first
Indications for apicectomy (2)
- Persistent symptoms/pathology in a non-vital
tooth - (re)RCT is an unfeasible solution
Persistent symptoms/ pathology *(5)
Apical cyst Swelling Discharge Mobility -grade I II or II Pain
When is (re)RCT unfeasible? (9)
Cyst Adequate re-RCT has failed Sclerotic canal, cannot instrument Canal morphology: curvature, accessory canals Post crown, cannot be removed Complex crown/ bridge, likely perforation rather than instrumentation Irretrievable snapped instrument Root perforation Fractured root
Relative contra-indications to (re)RCT (lots)
Previous apicectomy Molars Poor OH Active caries Sinus disease (recurrent sinusitis) Implant Unwilling to have LA High mobility index Advanced perio
Absolute contra-indications to (re)RCT (4)
Severe bleeding disorder
Endocarditis risk
Unrestorable
Post-crown retrievable
3 flap designs (3)
Mucoperisteal
Semilunar
Leubke-Oschenbein
Enucleation rules (4)
- Apical 3mm of root removed (apical delta)
- No need to remove to base of bone cavity
- 90o to long axis of tooth
- IRM Vs MTA as retrograde RCT
Why is semilunar flap design no longer used? (2)
- Scarring
2. Potential to leave margin of incision overlying cystic cavity – void
Leubke-Oschenbein flap design rules (6)
- 4mm below gingival margin, but in attached mucosa(!)
- As with semilunar, scarring
- Where is the gingival sulcus?
- Where is the crestal bone on a tooth that is non-vital and infected?
- Where are you going to stitch this flap?
- What do you think of the blood supply to the marginal gingivae?
Mucoperiosteal fap design - why is it good? (3)
- Best access
- Minimal scarring
- Gingival recession
Component phases in MTA (6)
Tricalcium silicate Dicalcium silicate Tricalcium aluminate Tetracalcium aluminoferrite Gypsum Bismuth oxide
Component phases in portland cement (5)
Tricalcium silicate Dicalcium silicate Tricalcium aluminate Tetracalcium aluminoferrite Gypsum