what should be the best surgical method for a large infected dentigerous cyst with two impacted teeth.. will perform surgery tomorrow morning.. want some suggestions about the surgical procedure.. please advice, what should be the best method and how to proceed.. oral surgeons will be very keen to watch the opg.. boy aged 18yrs..@Dr. Adit Mehta @Dr. Arpit Vashistha @Dr. Disha Gupta @Dr. Tarun Garg @Dr. Tarun Garg @Dr. Parthasarathy R @Dr. Anuj Chaturvedi @ and all oral surgeons and endodontists.. 1. shall I go for extraction of all teeth involved, 2. shall I go for marsupialisation or complete excision.. 3. what shall I fill in the cavity..gel foam or gauge dressing.. 4. if dressing what should be the medicaments..shall I use EC.. 5. what shall be done for the naked nerves and vessels.. please help me out..

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Dr.. Are u a oral surgeon? First of all u shud not do this case. Extraction shud not done. This is not at all Dc. I think it is keratocyst. Kindly refer it to oral surgeon. Whr u r working. Mandible lower border is involved. Full prosthesis needed. Plz refer to hospital
Please don't discourage.. I have everything in my mind, but needed some better suggestions, if anyone can give.. I m asking to oral surgeons if they can advice me something about the whole surgery.. I will post pictures of surgery after performing..
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Hello doc, This is not a dc This is an okc As dc surrounds the crown of an unerupted tooth and as we can see in opg the two tooth are fully erupted. So dc is ruled out. Well, if you really want to proceed with this case, consult an oral surgeon as the cyst is so large. Also go for biopsy to confirm the lesion. The first thing we're taught in bds is that refer the complicated cases to the hospital or you need to consult specialist. In this case, oral surgeon. Also, mind you that OKC is the highest recurrent cyst although various treatment modalities of okc are known but still it's the most recurrent cyst.
Biopsy will rule out
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What did you get on FNAC?As there is no resorption of teeth..they are only been displaced..ameloblastoma can be ruled out.can you provide an intraoral picture of patient..just want to see the expansion of lesion..most likely OKC..advised marsupilization and give a piece of lining for biopsy..and continue with idoform gauze dressings regularly..as patient is only 18 years old..excision is not at all advised..when cavity shrinks go for enucleation and chemical cauterization (carnoy's)..you can save teeth if not very mobile presently and go for RCT for all of them.(treatment suggested for OKC only)
Done exactly what you said.. Same line of treatment.. Posted the pics, please go through..
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I will answer u all tomorrow after performing the surgery..u people don't think that I've never done these kind of surgeries.. I just asked u in this way that I don't know anything as the new dentists may get interested.. Don't worry u all, I m prepared.. Fnac is already done 5days back.. I m only worried about the bleeding and nothing else.. I got many suggestions, and I m pleased.. Thank u all.. Please wish me luck.. Will tell you about the surgery tomorrow..
Though I agree with all others...I have strong belief too, that,....you are not incapable & definitely not a "kachakhiladi"--with certain past case handling... I wish you all the best in handling the case Skilfully@Dr. Arvind Khatri
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It can be dc, Okc, ameloblastoma.. final diagnosis can be made with excisional biopsy.. whatever it may come to the preferred treatment will be complete resection followed by recon plate or bone graft... the pathology is crossing midline, involving lower border and is quite massive.. I will not recommend marsupilization as it won't reduce the cavity and there are risks such as infection, breach and involvement of soft tissue..
I didn't wrote ameloblastoma as in ameloblastoma knife edge resorption of roots is seen. So, ameloblastoma is ruled out.
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As the cyst is large and the lower border is thin..To prevent pathological fracture go for marsupilization followed by iodoform gauze dressings after the cavity shrinks go for complete enucleation and apprehension about nerves and vessels they r usually pushed by cystic pressure but careful when enucleate
U can go for careful extraction before also
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I will advice you 1. Do all needed investigation before proceeding ( CBC count, biopsy etc) 2. If you had done these type of cases then do independently otherwise under experienced oral surgeon.........or.....refer to higher center.
Did the surgery, took 3 hrs.. Removed both the impacted teeth and also 73,74,35.. Debrided the lesion curdy pus mixed with blood..dressed with gauge.. Send for biopsy.. Fnac already done..
Sir, please do share intraoral pic's of the case ,if possible
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DC surrounds the unerupted tooth so its finally not dat....its an okc which actuly has highest recurrence....so do the management well acc to it...as there are chances to recur
Only biopsy will prove it.....u can't get idea radiographically much
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I appreciate you. Dr.Arvind ... Before surgery plz go for proper investigations n diagnosis.... Regards
Thanks.. Did the surgery.. Please go through my recent posts..
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