Esthetic and morphofunctional rehabilitation of pacients with radicular cyst

Abstract

Introduction. Surgical treatment of patients with radicular cysts often lead to poor offer of soft and hard tissues after healing which may jeopardize further implant-prosthetic rehabilitation. In such cases, the implant treatment planning should be performed even before the cystectomy and teeth extractions. Aim of the study. Evaluation of aesthetic risk factor and obtained aesthetic and functional results in patients rehabilitated with implants after cystectomy and teeth extractions. Materials and methods. The study focuses on 5 patients with odontogenic radicular cyst (mean age 38.45±2.67 years). The dimensions of cysts varied between 1.5 -2.5 cm. The following procedures were performed: teeth extractions and cystectomy with augmentation using collagen and PRF (4 cases), delayed bone grafting with bone block from ramus and xenograft (1 case). The insertion of implants was performed after the healing period. The aesthetic risk factor was evaluated for all patients before the implant placement. On the fifth day after the implantation, the wound surface was assessed by the Early Wound Healing Index (EHI). The obtained results were appreciated using Furhauser’s scale Pink Aesthetic Score (PES). Results. The restauration of implants installed in posterior regions were easy to predict, as no major problems occurred regarding esthetical results. However, in the cases with defects in anterior region, the results showed a smaller risk aesthetic factor (≤2) and a good PES (close to 10) only for single unit implants. The defects restoration of two nearby teeth or more in anterior region are difficult to predict and showed a higher aesthetic risk (>2) and lower PES values (7), which are considered at the limit of success/failure. The bone defects and the lack of periodontal ligaments affected the maintaining of soft tissues between implants and decreased the esthetic results. Conclusions. The surgical treatment of radicular cysts and GBR for further implant prosthetic rehabilitation can lead to good predictable results with high PES values in case of single tooth defects. The two- teeth defects may jeopardize the esthetic results due to papilla maintaining between implants. This risk became emphasized for defects in anterior region of jaws.