Management of a periapical cyst in an 8-year-old patient with challenging etiology: a case report with three-year follow-up

Abstract

The success of pulp therapy in primary teeth depends on accurate diagnosis and effective treatment. Periapical inflammation due to bacterial infection or pulpal necrosis can result in granulation tissue and may activate epithelial rests of Malassez, leading to a periapical cyst. In large cysts, especially in children, marsupialization is preferred to preserve developing teeth and minimize damage to surrounding structures. This case report describes an 8-year-old presenting with spontaneous pain in the lower right jaw. Radiographic examination revealed a round, well-defined radiolucency over 1 cm around tooth #84 with root canal treatment and #85 with pulpotomy, with dental bud displacement. The preliminary diagnosis was in favor of a periapical cyst due to pulp therapy failure. Teeth #84 and #85 were extracted, and marsupialization was performed. Over three years, the cyst resolved completely, and teeth #44 and #45 erupted naturally in proper alignment.