surgical management of a persistent radicular cyst in a maxillary lateral incisor: a case report with a 6-year follow-up

Radicular cysts are the most common odontogenic cysts, typically resulting from chronic periapical infection. although most resolve with nonsurgical endodontic therapy, persistent or enlarging lesions may require surgical intervention. this report describes a rare case of a radicular cyst that progressed despite orthograde retreatment. a 38-year-old woman presented with an endodontically treated left maxillary lateral incisor (#22) associated with a well-defined periapical radiolucency (8×8 mm). following orthograde retreatment, the lesion enlarged to 11×11 mm over 8 months, although the tooth remained asymptomatic. surgical endodontic management with apical resection and root-end filling using calcium-enriched mixture cement was performed. at 44-month recall, radiographs and cone-beam computed tomography demonstrated complete bony regeneration and re-establishment of the periodontal ligament. clinical and radiographic assessments at 6 years confirmed stable periapical healing and functional retention of the tooth, despite a traumatic crown fracture at 64 months, which was successfully restored. surgical endodontic treatment using biocompatible materials can result in complete and durable healing of large radicular cysts, even in cases where orthograde endodontic retreatment is unsuccessful.