Peripheral lesions including radicular cysts are eliminated by body once the causative agents are removed. Majority of radicular cysts can undergo resolutions following Root Canal Treatment & don't require surgical intervenation. It is suggested that insertion of file or other root canal instrument beyond the apical foramen (for 1-2mm) produces transitory acute inflammation which may destroy epithelial lining of radicular cyst & convert it in to granuloma. Thus, leading to its resolutions.
2) Surgical Treatment:-
a) Enucleation- The affected tooth is extracted or preserved by root canal treatment with apicocetomy. A mucoperiosteal flap over cyst is raised & a window is opened in the bone to give adequate access. The cyst is carefully seperated from its bony wall. The entire cyst is removed intact. the edges of bony cavity are smoothened off, free bleeding is controlled and cavity is irrigated to remove debris. Mucoperiosteal flap is replaced back and sutured in place.
b) Marsupialisation- The cyst is opened essentially as for enucleation but the epithelial lining is sutured to mucous membrane at margins of opening. Yhe aim is to produce a self clensing cavity, which becomes an invagination of oral tissues. The cavity is initially packed with ribbon gauze & after margins are healed a plug or extension of denture is made to close the openings. The cavity usually closes by regrowth of surrounding tissues & restoration of normal contour of that part. However, there are always chances of closing the orifice & reformation of cyst. The main application is for temporary decompression of exceptionally large cyst where fracture of jaw is a risk factor. When enough new bone is formed, cyst can be enucleated.