Endodontic Workflow in Gorlin-Goltz Syndrome: Diagnostic and Treatment Challenges in a Case Report

Basal cell nevus syndrome (BCNS) is an autosomal-dominant syndrome characterised by the development of multiple keratocystic odontogenic tumours (KCOTs) in the jaws with a high recurrence rate. Only a limited number of clinical reports have documented the difficulties of its orthodontic, prosthetic or surgical treatment, and none of them focus primarily on the challenges involving the endodontic area. The purpose of this study is to summarise the anomalies and complexities encountered during endodontic treatment, detailing the diagnostic process and sequencing of interventions in parallel with maxillofacial management of KCOTs. This paper reports the case of a 35-year-old man with BCNS who required endodontic treatment of multiple maxillary teeth due to necrosis possibly related to recurrent keratocysts and respective surgeries over more than 20 years. Three-dimensional (3D) radiographic examination revealed pathological processes such as internal resorptions, apical resorption and partial canal obliterations. Moreover, some intraoperative complications were linked to anaesthetic efficacy and infectious processes. Based on the challenges described, an endodontic workflow is proposed, focused on performing routine sensitivity tests on teeth adjacent to keratocysts, with exhaustive evaluation of cortical thickness and atypical healing patterns through 3D evaluation, and adaptation of the anaesthesia strategy and root canal filling.