Beyond the Scalpel: Conservative Resolution of a Radicular Cyst

Radicular cysts are one of the most common types of odontogenic cysts and are typically associated with chronic periapical infections. There is increasing interest in non-surgical alternatives that provide similar outcomes while preserving the tooth structure. Mineral Trioxide Aggregate (MTA), a practical option for non-surgical treatment of periapical lesions, including radicular cysts. This case report discusses the successful non-surgical management of a radicular cyst in a 17-year-old male patient. The patient presented with a history of persistent pain and swelling in the maxillary anterior region. Clinical and radiographic examination revealed a well-defined radiolucent lesion at the apex of a non-vital tooth, suggestive of a radicular cyst. After initial root canal therapy, the infected tissue was carefully debrided, and the cystic cavity was filled with MTA to promote healing. The biocompatible nature of MTA, combined with its ability to form a tight seal, was believed to have contributed to the resolution of the cyst without the need for surgical intervention. Follow-up radiographs taken at 6 months post-treatment demonstrated significant healing of the periapical region. The patient remained asymptomatic, with no clinical complications. These findings suggest that MTA can be an effective and viable option for non-surgical treatment of radicular cysts. In conclusion, using MTA in the non-surgical management of radicular cysts may offer a promising approach to preserving the natural dentition while ensuring satisfactory clinical outcomes. Further long-term studies and clinical trials are needed to better understand the efficacy and limitations of MTA in the treatment of periapical cystic lesions.

1. Lin YT, Lin YTJ. Success rates of mineral trioxide aggregate, ferric sulfate, and sodium hypochlorite pulpotomies: A prospective 24-month study. J Formos Med Assoc. 2020 ; 119(6):1080-5.

2. Liu Y, Liu XM, Bi J, Yu S, Yang N, Song B, et al. Cell migration and osteo/odontogenesis stimulation of iRoot FS as a potential apical barrier material in apexification. Int Endodontic J. 2020;53(4):467-77.

3. Lopes MB, Soares VCG, Fagundes FHR, Gonini-Junior A, Kaneshima RH, Guiraldo RD, et al. Analysis of molecular changes induced by mineral trioxide aggregate on sPLA2. Braz Dent J. 2019;30(5):453-8.

4. Serin Kalay T. Effects of intracoronal bleaching agents on the surface properties of mineral trioxide aggregate. Odontology. 2019;107(4):465-72.

5. Tu MG, Sun KT, Wang TH, He YZ, Hsia SM, Tsai BH, et al. Effects of mineral trioxide aggregate and bioceramics on macrophage differentiation and polarization in vitro. J Formos Med Assoc. 2019;118(10):1458–65.

6. Cervino G, Fiorillo L, Spagnuolo G, Bramanti E, Laino L, Lauritano F, et al. Interface between MTA and dental bonding agents: scanning electron microscope evaluation. J Int Soc Prev Community Dent. 2017;7(1):64-8.

7. Lapinska B, Klimek L, Sokolowski J, Lukomska-Szymanska M. Dentine surface morphology after chlorhexidine application—SEM study. Polymers. 2018;10(8):905.

8. Hurley MM, Abreu C, Gronowicz G, Kawaguchi H, Lorenzo J. Expression and regulation of basic fibroblast growth factor mRNA levels in mouse osteoblastic MC3T3-E1 cells. J Biol Chem. 1994;269(12):9392-6.

9. Higuchi C, Myoui A, Hashimoto N, Kuriyama K, Yoshioka K, Yoshikawa H, et al. Continuous inhibition of MAPK signaling promotes the early osteoblastic differentiation and mineralization of the extracellular matrix. J Bone Miner Res.

2002;17(10):1785-94.

10. Hiraki Y, Inoue H, Shigeno C, Sanma Y, Bentz H, Rosen DM, et al. Bone morphogenetic proteins (BMP-2 and BMP-3) promote growth and expression of the differentiated phenotype of rabbit chondrocytes and osteoblastic MC3T3-E1 cells in vitro. J Bone Miner Res. 1991;6(12):1373-85.

11. Ghasemi N, Rahimi S, Lotfi M, Solaimanirad J, Shahi S, Shafaie H, et al. Effect of Mineral trioxide aggregate, calcium-enriched mixture cement and mineral trioxide aggregate with disodium hydrogen phosphate on BMP-2 production.

Iran Endod J. 2014;9(3):220-4.

12. Nowicka A, Wilk G, Lipski M, Kołecki J, Buczkowska-Radlińska J. Tomographic evaluation of reparative dentin formation after direct pulp capping with Ca(OH)2, MTA, biodentine, and dentin bonding system in human teeth. J Endod. 2015;41(8):1234 40.

13. Bonte E, Beslot A, Boukpessi T, Lasfargues JJ. MTA versusCa(OH)2 in apexification of non-vital immature permanent teeth: a randomized clinical trial comparison. Clin Oral Invest. 2015;19(6):1381-8.

14. Bernabé PFE, Gomes-Filho JE, Bernabé DG, Nery MJ, Otoboni-Filho JA, Dezan-Jr E, et al. Sealing ability of mta used as a root end filling material: effect of the sonic and ultrasonic condensation. Braz Dent J. 2013;24(2):107-10.

15. Sönmez IS, Oba AA, Sönmez D, Almaz ME. In vitro evaluation of apical microleakage of a new MTA-based sealer. Eur Arch Paediatr Dent. 2012;13(5):252-5.

16. Leye Benoist F, Gaye Ndiaye F, Kane AW, Benoist HM, Farge P. Evaluation of mineral trioxide aggregate (MTA) versus calcium hydroxide cement (Dycal®) in the formation of a dentine bridge: a randomised controlled trial. Int Dent J.

2012;62(1):33-9.

17. Hansen SW, Marshall JG, Sedgley CM. Comparison of intracanal endosequence root repair material and ProRoot MTA to induce pH changes in simulated root resorption defects over 4 weeks in matched pairs of human teeth. J Endod. 2011;37(4):502-6.

18. Yildirim T, Taşdemir T, Orucoglu H. The evaluation of the influence of using MTA in teeth with post indication on the apical sealing ability. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(3):471-4.

19. Culp DJ, Robinson B, Parkkila S, Pan P wen, Cash MN, Truong HN, et al. Oral colonization by Streptococcus mutans and caries development is reduced upon deletion of carbonic anhydrase VI expression in saliva. Biochim Biophys Acta. 2011;1812(12):1567-76.

20. Gibbins HL, Yakubov GE, Proctor GB, Wilson S, Carpenter GH. What interactions drive the salivary mucosal pellicle formation?. Colloids Surf B Biointerfaces. 2014;120(100):184-92.

21. Heller D, Helmerhorst EJ, Oppenheim FG. Saliva and serum protein exchange at the tooth enamel surface. J Dent Res. 2017;96(4):437-43.

22. Hannig M, Hannig C. Nanomaterials in preventive dentistry. Nat Nanotechnol. 2010;5(8):565-9.

23. Huq N, Myroforidis H, Cross K, Stanton D, Veith P, Ward B, et al. The Interactions of CPP–ACP with Saliva. Int J Mol Sci. 2016;17(6):915.

24. Kanaparthy R, Kanaparthy R. The changing face of dentistry: nanotechnology. Int J Nanomedicine. 2011;6:2799-804.

25. Karan NB, Aricioğlu B. Assessment of bone healing after mineral trioxide aggregate and platelet-rich fibrin application in periapical lesions using cone-beam computed tomographic imaging. Clin Oral Invest. 2020;24(2):1065-72.

26. Christiansen R, Kirkevang LL, Hørsted-Bindslev P, Wenzel A. Randomized clinical trial of root-end resection followed by root-end filling with mineral trioxide aggregate or smoothing of the orthograde gutta-percha root filling– 1-year follow-up. Int Endod J. 2009;42(2):105-14.

27. Torabinejad DrM, editor. Mineral Trioxide Aggregate: Properties and Clinical Applications [Internet]. 1st ed. Wiley; 2014 [cited 2024 Dec 26]. Available from: https://onlinelibrary.wiley.com/doi/book/10.1002/9...

28. Chong BS, Pitt Ford TR, Hudson MB. A prospective clinical study of mineral trioxide aggregate and IRM when used as root-end filling materials in endodontic surgery. Int Endod J. 2003;36(8):520-6.

29. Lindeboom JAH, Frenken JWFH, Kroon FHM, Van Den Akker HP. A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(4):495-500.

30. Kogan P, He J, Glickman GN, Watanabe I. The effects of various additives on setting properties of MTA. J Endod. 2006;32(6):569-72.

31. Bhojwani P, Ikhar A, Patel A, Chandak M, Bhopatkar J, Manik K, et al. Rooted in metal: a philosophical reflection on preservation. Multidiscip Sci J. 2024;7(6):2025298.

32. Bhojwani P, Ikhar A, Patel A, Chandak M, Bhopatkar J, Manik K, et al. Recent advances in antimicrobial and biosynthesis properties of bioglass and nanoparticles: a narrative review. Multidiscip Rev. 2024;7(12):2024286.

33. Bhojwani P, Ikhar A, Patel A, Chandak M, Sedani S, Bhoptakar J, et al. Optimizing cosmetic results in dental fluorosis: a case report of bleaching and microabrasion techniques. Case Rep Dent. 2025;2025(1):9972925.

34. Bhojwani PR, Ikhar A, Patel A, Chandak M, Sedani S. Microabrasion as an Effective Treatment for Severe Dental Fluorosis: Images in Medicine. JCDR [Internet]. 2025 Jul 1 [cited 2025 Aug 12]; Available from: https://www.jcdr.net/ article_fulltext.asp?issn=0973-709x&year=2025&month=-July&volume=19&issue=7&page=ZJ01-ZJ02&id=21206

Bhojwani P, Ikhar A, Patel A, Chandak M, Sedani S. Beyond the Scalpel: Conservative Resolution of a Radicular Cyst: A case reports/series. Oral Sci Rep [Internet]. 2025 Sep 19 [cited 2025 Oct 23];46(3):285-290. Available from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=524

Bhojwani, P., Ikhar, A., Patel, A., Chandak, M. & Sedani, S. (2025). Beyond the Scalpel: Conservative Resolution of a Radicular Cyst. Oral Sci Rep, 46(3), 285-290. Retrieved from: https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=524

Bhojwani, P., Anuja Ikhar,Aditya Patel,Manoj Chandak and Shweta Sedani. 2025. "Beyond the Scalpel: Conservative Resolution of a Radicular Cyst." Oral Sci Rep, 46(3), 285-290. https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=524

Bhojwani, P. et al. 2025. 'Beyond the Scalpel: Conservative Resolution of a Radicular Cyst', Oral Sci Rep, 46(3), 285-290. Retrieved from https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=524

Bhojwani, P., Ikhar, A., Patel, A., Chandak, M. and Sedani, S. "Beyond the Scalpel: Conservative Resolution of a Radicular Cyst", Oral Sci Rep, vol.46, no. 3, pp. 285-290, Sep. 2025.

Bhojwani, P., Ikhar, A., Patel, A., et al. "Beyond the Scalpel: Conservative Resolution of a Radicular Cyst." Oral Sci Rep, vol.46, no. 3, Sep. 2025, pp. 285-290, https://www.dent.cmu.ac.th/cmdj/frontend/web/?r=site/viewarticle&id=524