MANAGEMENT OF AN EXTENSIVELY SPREADING RADICULAR CYST OF THE MANDIBLE RADIOGRAPHICALLY MIMICKING AN ODONTOGENIC KERATOCYST: A CASE REPORT

Abstract

Radicular cysts are the most common inflammatory odontogenic cysts of the jaws, typically presenting as localized periapical radiolucencies associated with non-vital teeth. While their expansion usually occurs in a buccolingual direction, atypical horizontal/transverse mesiodistal expansion mimicking multilocular or extensive lesions like Odontogenic Keratocysts (OKCs) presents a diagnostic challenge. This case report describes a 48 year-old female presenting with pain and mild chin swelling caused by a large, well-defined radicular cyst extending from the left mandibular second premolar (35) across the midline to the right mandibular canine (43), associated with apical root resorption of involved teeth. The lesion originated from a non-vital, non-RCT treated tooth (35) beneath a PFM crown. Management involved endodontic therapy of teeth 35 to 42, surgical enucleation via a buccal window osteotomy, histopathological confirmation, and subsequent fixed prosthetic rehabilitation with a mandibular PFM bridge with bilateral distal extensions following the patient's refusal of implant and precision attachment options.