Treatment
Non-Surgical: Root Canal Treatment
For small to medium cysts where the epithelial lining may regress after periapical healing
- • Complete root canal treatment of the causative tooth
- • Elimination of bacterial biofilm from the entire root canal system
- • Obturation with gutta-percha to seal the apex
- • Radiographic review at 6 and 12 months to assess resolution
- • Adequate root canal treatment resolves approximately 60-70% of periapical lesions regardless of their cystic or granulomatous nature
Surgical: Periapical Surgery
For cysts failing to resolve after root canal treatment or for large lesions
- • Apicectomy (root end resection): removal of the apical 3 mm of root to remove apical delta and lateral canals
- • Cyst enucleation: removal of the entire cystic lining from the bony cavity
- • Retrograde root-end filling with MTA or Biodentine after curettage
- • Histopathological examination of the specimen
- • Decompression: for very large cysts — a tube is placed to allow continuous drainage and cyst shrinkage before definitive surgery
Extraction with Cyst Enucleation
When the tooth is unrestorable
- • Extract the causative tooth
- • Remove the entire cystic lining from the socket under direct vision
- • Curettage and irrigation of the bony cavity
- • Primary closure with sutures
- • Submit specimen for histopathology