The evaluation of the effect of performing guided lid surgery with enucleation of a cystic lesion; a case report

INTRODUCTION AND IMPORTANCE: Dentigerous cysts are benign odontogenic cysts of developmental origin. Enucleation and marsupialization are still considered the blueprint of cystic lesion treatment. CASE PRESENTATION: A 23-year-old male patient presented complaining of a minimal swelling in his upper jaw with slight tenderness in his upper anterior teeth. Cone Beam Computed Tomography (CBCT) on the maxilla was requested. The cystic lesion was found to be minimally expansile with intact cortical plates of the maxilla in the affected area. The CBCT was used to fabricate a cutting guide to determine the exact location of the bony window to fully access the lesion. Root canal treatment was done for the affected non-vital teeth. The cuts were done using a piezo-electric device. Complete enucleation was done for the lesion followed by fixation of the cortical bone lid using micro-plates and screws. The case was followed up after 6 months for new bone deposition using CBCT and 1 week, 1 month, and 6 months postoperatively for postoperative pain using the Visual Analogue Scale (VAS). CLINICAL DISCUSSION: Piezo-electric surgery was used due to the selective cutting merit to cut through bone while preserving the cystic lining intact. Lid surgery aims to maximize the volume of bone deposited in place of the defect by converting the cavity of the cystic lesion into a contained defect. CONCLUSION: Guided lid surgery using a piezo-electric device could be a useful technique for cystic enucleation regarding the new bone formation and pain level.