Patience can sometimes be the difference …
Jon Richards DDS MS
This case was referred for a potential surgery, as the appearance of the large periapical finding could be suggestive of a cyst. It really is a little to much to conclude simply from the appearance on a radiograph. If we looked at this 5 years ago, would it be a smaller “typical” radiolucency? Is time what turns an absess into a cyst? I think often we might stretch our interpretations a little more than is warranted.
Anyway, after access there was a little pus, but a lot of clear fluid that drained. Ca(OH)2 was placed and the patient was seen monthly for three months. At each visit, the apical medicament was washed out and the canal continued to drain. Eventually the periapical seepage stopped and the Ca(OH)2 persisted and the case was obturated and restored.
If you look closely, you can see early signs of bony regeneration at the interim visits. With each assessment, my confidence that this was going to heal without surgery increased. Finally a 3 year recall shows complete healing. Notice the difference in appearance with the now bone. This is not uncomon with a “through-and-through” bone loss pattern. A CBCT scan would be interesting to see here, but was not taken.