A Short Case Study: Is It a Cyst?

Rico D. Short, DMD


A patient came in with pain in the upper right side of her face. She thought she had a sinus problem. Upon radiographic examination, she had a large radiolucent area associated with teeth Nos. 7 and 8. Many clinicians would have thought it could have been be a cyst due to its large size, bone destruction, and well circumscribed borders—possibly a globulomaxillary cyst, which is common in this area.

Figure 1: This pre-op image shows a large lesion associated with teeth Nos. 7 and 8. Figure 2: This pre-op image shows a large lesion circumscribed in red.
Figure 3: This post-op image shows completion of endodontic treatment on tooth No. 7 with warm vertical condensation. Figure 4: The 2-year recall shows nice healing of the lesion and tooth No. 8 still vital and asymptomatic.

Pulp testing with Endo Ice concluded tooth No. 7 was necrotic and tooth 8 was vital. The diagnosis was a necrotic pulp on tooth No. 7 with chronic apical periodontitis. Endodontic treatment was performed on tooth No. 7 only in 2 visits using calcium hydroxide and warm vertical condensation. A 2-year recall showed nice healing of the large lesion without surgery or CBCT. Tooth No. 8 remained asymptomatic and vital.

The lesson? Diagnose properly, treat properly, and the body will heal properly.

What are your thoughts? Please share them with me at dr.short@yahoo.com, or visit our related post on Facebook at facebook.com/DentistryToday/ or facebook.com/@rootcanaldoc.

Rico D. Short, DMD, attended the Medical College of Georgia (MCG) School of Dentistry to attain a Doctor of Dental Medicine degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry and assistant clinical professor at the Dental College of Georgia in Augusta. Dr. Short also has published articles in several magazines and peer-reviewed journals including Dentistry Today, Inside Dentistry, Rolling Out Magazine, Upscale Magazine, and the Journal of Endodontics. He has lectured throughout the United States and the Caribbean. Dr. Short is endorsed by the American Association of Endodontists speakers bureau, and his private practice, Apex Endodontics PC, is located in Smryna, Ga. Dr. Short also has authored a book, Getting to the Root of Your Problem: 365 Days of Inspirational Thinking.

Other Short Case Studies

A Maxillary First Molar with Two Palatal Canals

The Necrotic No. 2 Tooth

A Root Canal Trifecta

Relax, Don’t Extract!

Is It Periapical Cemental Dysplasia?