A Novel Approach for Treatment of an Unusual Presentation of Radicular Cysts Using Autologous Periosteum and Platelet-Rich Fibrin in Combination with Demineralized Freeze-Dried Bone Allograft

Radicular cysts are the most common cystic lesions affecting the jaws. They are most commonly found at the apices of the involved teeth. This condition is usually asymptomatic but can result in a slow-growth tumefaction in the affected region. The following case report presents the successful treatment of radicular cysts using autologous periosteum and platelet-rich fibrin with demineralized freeze-dried bone allograft. 1. Introduction Radicular cysts are the most common (52%–68%) cystic lesions affecting the jaw [1]. They are commonly found at the apices of involved teeth and sometimes lateral to accessory root canals. They are a direct sequel of chronic periapical infection [1]. Most of them are asymptomatic and are discovered when periapical radiographs are taken of teeth with nonvital pulps. Patient often complains of slowly enlarging swellings. Radiographically, most radicular cysts appear as round or pear shaped unilocular radiolucent lesions in the periapical region. The cyst may displace adjacent teeth or cause mild root resorption [2]. The following case report presents the successful treatment of radicular cysts using autologous periosteum and platelet-rich fibrin (PRF) with demineralized freeze-dried bone allograft (DFDBA). 2. Case Report A 17-year-old female patient reported to the Department of Periodontics, HKES’s S.Nijalingappa Institute of Dental Sciences and Research, Gulbarga, India, with a chief complaint of pain, swelling ongoing and pus discharge in the lower anterior region since two months. Past history revealed trauma in the lower anterior region 5 years ago with recurrent swelling and pus discharge. On intraoral examination, inflamed and swollen gingiva was seen in relation to 41, 42, and 43 (FDI notation). A draining fistula was seen on the labial aspect in relation to 41 (Figure 1). 42 had grade I mobility, whereas no mobility was noticed with 31, 41, and 43. Pulp vitality test was negative with 41, 42, and 43, while adjacent teeth showed normal response. Periodontal probing depth was ≤3？mm for concerned teeth, and no clinical attachment loss was seen. They were also painless on vertical percussion. On radiographic examination, two radiolucent areas of size approximately ？mm were seen in relation to 41, 42, and 43 (Figure 2). No root resorption was seen. Figure 1: Preoperative view of the lesion. Figure 2: Preoperative radiograph. The treatment plan comprised of endodontic treatment of nonvital teeth followed by surgical enucleation of cystic lesions if necessary. Treatment plan was explained to the patient, and a written