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Background: Periapical cysts are common odontogenic lesions resulting from chronic inflammation and are often difficult to manage when large. Conservative root canal therapy (RCT) is typically the first-line treatment, but in cases of large, persistent cysts, surgical intervention may be required. This study investigates the combined effectiveness of endodontic treatment and apical surgery in managing large periapical cysts.
Objectives: To evaluate the clinical success, radiographic healing, recurrence, and patient satisfaction following combined endodontic treatment and apical surgery for large periapical cysts.
Materials and Methods: This clinical trial involved 40 patients divided into two groups (20 cases per group). Group 1 received endodontic treatment alone, while Group 2 underwent a combination of endodontic treatment and apical surgery. Follow-up was conducted at 1, 3, 6, and 12 months, with assessments including clinical success, radiographic healing, recurrence rates, and patient satisfaction.
Results: Group 1 exhibited a decrease in clinical success from 80% at 1 month to 68% at 12 months. In contrast, Group 2 maintained a high success rate of 90% at 1 month and 85% at 12 months. Radiographic healing was more pronounced in Group 2, with 80% healing at 6 months and 78% at 12 months, compared to 60% and 58%, respectively, in Group 1.
The recurrence rate was significantly lower in Group 2 (2 recurrences at 3 months) compared to Group 1 (5 recurrences at 3 months). Group 2 also reported higher patient satisfaction across all measures.
Conclusions: Combining endodontic treatment with apical surgery for managing large periapical cysts demonstrated superior clinical and radiographic outcomes, reduced recurrence, and higher patient satisfaction compared to endodontic treatment alone. This dual approach may be considered more effective for complex cases involving large cystic lesions.