Radicular Cyst Associated with Maxillary Anterior Teeth: A Case Report and Literature Review on Combined Surgical Enucleation and Endodontic Management with One-Year Follow-Up

Abstract

Background: Radicular cysts are the most common inflammatory odontogenic cysts arising from epithelial rests of Malassez secondary to pulpal necrosis and chronic periapical inflammation. They are frequently associated with non-vital teeth in the anterior maxillary region and may lead to progressive bone destruction if not managed appropriately. Objective: The present study reports a multidisciplinary management approach for a large periapical lesion in the anterior maxilla using surgical enucleation followed by endodontic therapy and prosthetic rehabilitation, along with one-year clinical and radiographic follow-up. Case Presentation: A 28-year-old female patient presented with mild swelling and pain in the anterior maxillary region with a history of trauma three months earlier. Clinical examination and radiographic evaluation revealed a well-defined unilocular radiolucent lesion measuring approximately 2.5 × 3 cm involving teeth 21, 22, and 23. All involved teeth were non-vital with expansion of the labial cortical plate. Surgical enucleation of the lesion was performed under local anaesthesia, followed by curettage of the surrounding bone. The excised tissue was submitted for histopathological examination. Results: Histopathological analysis revealed fibrocellular connective tissue with chronic inflammatory infiltrate and cholesterol clefts, consistent with a periapical granuloma rather than a true radicular cyst. Postoperative healing was uneventful, and radiographic evaluation at six months demonstrated significant bone regeneration. Endodontic therapy was subsequently completed for teeth 21, 22, and 23, followed by prosthetic rehabilitation using zirconia crowns. Conclusion: This case highlights the importance of a multidisciplinary approach combining surgical management, histopathological diagnosis, endodontic therapy, and prosthetic rehabilitation in the successful treatment of large periapical lesions. Long-term follow-up confirmed complete osseous healing and functional rehabilitation, emphasizing the importance of integrated treatment strategies in managing periapical pathology.