Surgical symphony: Tackling large periapical cysts with precision

This case report details the comprehensive treatment of a large radicular cyst in a 48-year-old male with a five-year history of swelling and pus discharge in the upper anterior jaw. Clinical and radiographic examinations, including CBCT, revealed a significant periapical lesion involving multiple teeth. The multidimensional treatment began with meticulous endodontic therapy for teeth 12, 11, 21, and 22, followed by platelet-rich fibrin (PRF) application to enhance healing. Surgical cystic enucleation was performed under local anesthesia, involving flap elevation and cyst removal, confirmed by biopsy as a radicular cyst. Apicoectomy and retrograde filling with mineral trioxide aggregate (MTA) were executed. A nanocrystalline hydroxyapatite (NCHA) bone graft was placed in the cystic cavity to promote bone regeneration. Six-month follow-up radiographs showed significant bone regeneration, validating the success of this tailored, evidence-based approach, and contributing valuable insights into periapical cyst management.