I have gum cysts near my upper teeth. What treatment works best?

Question

Hello doctor,

I have two cysts in relation to upper right canine and premolar. Since I did not know anything about it, I ignored it. But last year I got an OPG, and I saw the cysts in it.

I do not have pain or swelling, but whenever I touch the root of the upper teeth on the gums, I feel a sensation. Can an oral and maxillofacial surgeon extract the two concerned teeth and then remove the cysts?

I am scared of an enucleation surgery. I am attaching the OPG.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

The OPG (attachment removed to protect patient identity) shows a cystic lesion extending from your upper right canine to the last molar.

The maxillary sinus floor is also involved. Enucleation is a surgical procedure to remove the cystic lesion, depending on the cyst size and location. It can be done under local anesthesia or general anesthesia.

The treatment of a cyst involves the following steps.

Teeth in the cystic area will be checked for tooth vitality and mobility.
If the teeth are not grossly decayed, then root canal treatment will be done for the concerned teeth.
If multiple teeth are involved (in your case, canine to molar is in the cystic area), splinting will be done to stabilize your teeth during surgery. Then, cyst enucleation is done.
There are different methods available now for filling the bone cavity after cyst enucleation to improve and accelerate healing.

OPG (orthopantomogram) is not conclusive for a maxillary posterior region pathology.

CBCT (cone beam computed tomography) of the maxilla gives the best picture regarding the size, location, association with adjacent structures, bone quality, and tooth prognosis.

Due to the thickness and curvature of the lower jaw, OPG will not give a clear picture. For that, you have to take an intraoral periapical radiograph (IOPA).

I hope this helps you.

Take care.

Answer 2

Hello,

Welcome back to icliniq.com.

You are always welcome. Do not hesitate to get back.

For more information, consult a maxillofacial prosthodontist online.

Take care.

Answer 3

Hello,

Welcome back to icliniq.com.

The OPG radiograph that you have send before was not taken in the proper method. According to that I suspected cystic growth in upper posterior region. The maxillary sinus was overlapped over the tooth extensively due to improper positioning of the x-ray tube or x-ray film or patient angulation, which gave an impression of a large cyst in maxilla.

The CBCT image that you have sent now gives a clear picture. According to this, no cystic growth is present in the maxilla. Instead, periapical (below the root) infection is present with respect to the upper right first premolar and the upper left second molar. You must get root canal treatment for the upper right first premolar (14). The upper left second molar is grossly decayed, involving root bifurcation.

So, RCT cannot be effective, and extraction of the tooth is the best option. Upper right central incisor (11), lateral incisor (12), and canine(13) are root stumps. It cannot be saved. So, extraction of 11, 12, and 13 has to be done. Maxillary sinus wall thickening is due to periapical pathology. So, after RCT of 14 and extraction of 27, that will subside. Get the treatment done as early as possible. If delayed, it can progress to a cyst and further complications.

Take care.