Mandibular Radiolucency - Diagnosis & Treatment

Learning Objectives

In this case we will review the clinical and radiographic evaluation of a radiolucent lesion in the mandible. You will learn differential diagnosis for radiolucent lesions in the mandible and what clinical tests you need to perform to assist you with making a definitive diagnosis. You will gain an understanding of how such lesions are managed and how this may impact on other dental treatment such as orthodontics.

Dental History

  • Patient LD, female 23 years old, consult 21/5/10
  • Referral for orthognathic surgery and removal of cyst in the anterior mandible
  • A 1x1.5cm radiolucency between the apices of teeth 42 and 43 
  • OPG radiograph and cone beam (17/5/10) present at consult
  • Presenting complaint
  • Patient receiving presurgical orthodontics when radiolucent area noted interdentally between the 42,43

Clinical Examination

  • No pocketing around the 4th quadrant
  • Oral hygiene- fair to good
  • Caries- nil
  • No clinical mobility 42,43
  • No intraoral swellings noted around the 43,42 site, no tenderness to palpation
  • Tooth 43 and 42 tested positive to cold vitality testing, no tenderness to precussion
  • Patient reports no symptoms from the 4th quadrant
  • No swelling noted on palpation of the buccal and lingual aspect of the mandible below the mucogingival junction

Radiographic Examination

  • Panoramic xray reveals large well defined radiolucent lesion
  • The radiolucency has well defined boarders it involves the apex of the 43
  • Roots of the 43,42 have been displaced by the lesion, intact PDL noted around the 43 and 42 roots

Treatment plan

Patient was having orthognathic surgery under GA and enucleation of the cyst at the same time

Labial incision below the mucogingival junction, currettage of the cyst cavity, no cystic lining was present.