Decompression of High-Risk Odontogenic Cysts: A Case Series with a Rare Bilateral Dentigerous Cyst

This descriptive case series reports three adult patients with odontogenic cystic lesions, including two cases of radicular cysts and a rare occurrence of bilateral dentigerous cysts in a non-syndromic individual. The present study explores the application of decompression as a management approach for odontogenic cysts, highlighting its role in cases characterized by heightened anatomical risk. Treatment decisions were determined according to lesion dimensions and their anatomical relationship to adjacent neurovascular structures. Primary enucleation was performed in cases where the lesions were limited in size and amenable to safe surgical access, whereas a staged approach consisting of decompression followed by secondary enucleation was selected for extensive cysts demonstrating close anatomical proximity to the inferior alveolar nerve to reduce the likelihood of neurosensory complications. In patients treated with decompression, follow-up evaluations demonstrated a substantial decrease in cystic dimensions along with gradual osseous regeneration, enabling subsequent surgical intervention to be performed under safer conditions. During a prolonged period of clinical and radiographic monitoring exceeding 12 months, neither cyst recurrence nor evidence of neurosensory impairment was identified. Histopathological analysis confirmed the diagnosis across all evaluated specimens. These findings indicate that, when applied under appropriate indications, decompression constitutes a reliable and conservative approach for large and high-risk odontogenic cysts.