ABSTRACT Background Periapical cysts are the most common inflammatory odontogenic cysts and are typically managed through root canal therapy (RCT), with/without surgical intervention. However, when a vital tooth is involved, retrograde/conservative/biologically guided alternatives may be considered in carefully selected cases. Case Presentation A 41‐year‐old female presented with an asymptomatic, well‐defined radiolucent lesion involving the apices of the maxillary right first and second premolars. Cone‐beam computed tomography revealed a large cystic lesion extending toward the maxillary sinus. The first premolar had an acceptable previous RCT, while the second premolar responded positively to pulp vitality tests and showed no clinical signs/symptoms. Surgical enucleation of the lesion was performed using a conservative flap design. Root‐end resection and root‐end filling/sealing with calcium‐enriched mixture (CEM) cement were completed for both teeth. The second premolar was not endodontically treated, as its apex was exposed during surgery. Histopathologic examination confirmed a radicular cyst. Radiographic follow‐ups at 1 and 7 years demonstrated complete healing and long‐term periapical stability. Conclusion This case suggests that periapical healing may occur in an intact vital tooth following root‐end filling/sealing with a bioactive material without conventional RCT_ when the lesion is thoroughly enucleated and apical sealing is achieved. The 7‐year follow‐up underscores the potential durability of this conservative approach. However, such management requires meticulous case selection, acknowledgment of diagnostic limitations, and long‐term monitoring. Further clinical investigations are warranted to determine the broader applicability/safety of this approach.
Saeed Asgary (Mon,) studied this question.