Treatment of vital teeth involved in the extension of inflammatory radicular cysts: a systematic review.

An inflammatory radicular cyst (IRC) is an odontogenic cyst associated to a non-vital tooth, which may affect sound teeth. There is lack of consensus on whether to perform endodontic treatment on teeth involved in the extension of the lesion prior to surgical treatment.

Aim: To identify and quantify the therapies most often used on teeth with positive response to pulp tests that are involved in the extension of an IRC, and analyze the criteria upon which different authors based their decisions. Identify and evaluate the reliability of the dental pulp tests used for evaluation and deciding on treatment.

Materials and method: A review was performed of articles indexed in four databases from 2011 to 2023. The review included studies describing diagnosis and treatment of teeth involved in the extension of an inflammatory cyst.

Results: Fifteen articles were included in the review: nine case reports, five literature reviews and one comment to the editor. The case reports address 10 cystic lesions, directly associated with a total 21 sound teeth. Three of them report loss of tooth sensitivity, three report preemptive endodontic treatment of teeth with preserved sensitivity, two report recovery of previously lost sensitivity, and one reports preservation of sensitivity after surgical treatment. One of the literature reviews addresses the issue of treating teeth adjacent to a cystic lesion, while the other four, and the comment to the editor, discuss the methods for detecting sensitivity and vitality.

Conclusion: Clinical studies with long-term follow-up are needed in order to reach a consensus regarding treatment. Better understanding of pulp status is essential in order to select the treatment best suited to each clinical case.