Preserving the vitality of adjacent teeth by microsurgical enucleation of a large radicular cyst: A case report with 4-year follow-up

Background: Radicular cysts may enlarge considerably, cause extensive bone destruction, and jeopardize the integrity of the associated vital teeth. The different treatment approaches are aimed mainly at eliminating the cystic epithelial membrane while reducing the risk of injury to vital structures. Contrary to other treatment modalities, preapical surgery offers an unequivocal single occasion resolution for the patient. However, it has been associated with higher risk of collateral damages. Case presentation: When a patient presented with a large radicular cyst originating from a maxillary lateral incisor, the adjacent central and canine teeth initially failed to exhibit responses to sensibility tests but showed signs of vitality. Microsurgical management was aimed at enucleating the cystic membrane while maintaining adjacent teeth vitality by preserving their apical vascular supply. Upon careful and controlled cyst enucleation under the dental operating microscope, the neurovascular bundle of one of the involved teeth was visualized and its integrity was maintained throughout the procedure. Results: : The procedure was successful and follow up recalls revealed recovery of normal sensibility of tooth 11 and 13 with complete bone regeneration around their apices. Conclusions: : The findings of this report demonstrate that teeth adjacent to radicular cysts albeit vital, may fail to respond to sensibility tests and that their vitality can be successfully preserved by utilizing the appropriate microsurgical techniques for direct cyst enucleation.