Surgical Management of Large Radicular Cyst in Mandible

The Radicular cyst is the most common cyst occurring in the head and neck region. It is also called as root end cyst, periapical cyst and apical periodontal cyst. The causative factor of the radicular cyst is a non vital tooth. The radicular cyst is an odontogenic cyst formed due to the stimulation of cell rest of Malassez derived from the Hertwig epithelial root sheath. Similar to all odontogenic cysts it expands by hydrostatic theory and osmotic pressure theory. Smaller radicular cysts remain asymptomatic until they get infected. The large radicular cysts cause bone resorption, tooth displacement and if the inferior alveolar nerve is involved it causes paraesthesia. The management of radicular cyst is by conservative management or marsupialisation alone or enucleation alone or marsupialisation followed by enucleation. If the teeth involved in the cysts are salvageable, root canal treatment, apicoectomy and retrograde filling are done in order to salvage the teeth involved. To select an appropriate treatment plan from above the extent of the cystic lesion is an important factor. Thus it is clear that the selected diagnostic imaging modality should provide adequate information regarding the bony and soft tissue extent. Here we report a case of large radicular cyst of mandible involving all the six lower anterior teeth of the jaw successfully managed by enucleation followed by apicoectomy and retrograde MTA restoration of the six lower anterior teeth along with comments on diagnostic imaging.