Radicular dental cyst in patient with second skeletal class malocclusion. A case report

Objectives. The study shows how a skeletal second class malocclusion, combined with an overbite and muscular hypertonicity, can be a contributing factor to the development of an inflammatory radicular dental cyst. Materials and Methods. The case of a female patient is reported, with a radicular cyst caused by necrotic 4.1 e 3.1, which extended from 3.1 to 4.5. The first orthopantomograph showed an area of bone rarefaction at 3.4 and 3.5. At the physical examination, the patient presented with second class malocclusion, pronounced overbite and muscular hypertonia. Endodontic therapy of 3.1 and 4.1 was performed, followed by cystic enucleation. Electromyographic and kinesiographic examinations were subsequently carried out to assess the muscles status and a therapy with orthosis was implemented for 8 months. Several orthopantomographic examinations were performed to assess the prognosis: in the pre-surgery phase (T0), in the post-operative phase at one month (T1), after neuromuscular therapy at 8 months (T2). Finally, a follow-up at 10 years was carried out to assess the stability of results (T3). Results. At T1 and at T2, bone regeneration in both lesions was observed. At T3 the patient was in a stable condition. Conclusions. Malocclusion is responsible for necrosis and loss of periodontal bone support in the more affected teeth by occlusal trauma. In addition to surgical therapy, a correction of the freeway space and of the neuromuscular trajectory is necessary, in order to achieve bone regeneration in the traumatized sites.