Clinical and Radiographic Characteristics and Outcomes of Guided Apicoectomy With Retrograde Mineral Trioxide Aggregate Filling for Periapical Cysts

Patients with periapical cysts associated with premolar teeth often require apical surgery when conventional endodontic treatment cannot resolve the lesion. Guided apicoectomy using a three-dimensional surgical guide may improve surgical accuracy while minimizing bone removal and reducing the risk of damage to adjacent anatomical structures. This prospective single-arm interventional study aims to evaluate the clinical and radiographic characteristics of premolar teeth with periapical cysts and assess the treatment outcomes of guided apicoectomy with retrograde Mineral Trioxide Aggregate (MTA) filling. Forty-two participants will be treated and followed for six months. Clinical healing and radiographic bone healing will be evaluated one week, three months, and six months after surgery.

Sex

All

Minimum age

18 Years

Maximum age

70 Years

Inclusion Criteria:

* Adults diagnosed with a periapical cyst involving a premolar tooth.
* Diagnosis confirmed by clinical examination and CBCT.
* Histopathological confirmation of periapical cyst after surgery.
* Root canal treatment completed with acceptable obturation quality.
* Tooth considered restorable.
* No previous apicoectomy on the study tooth.
* Able to provide written informed consent.

Exclusion Criteria:

* Uncontrolled systemic diseases.
* Coagulation disorders.
* Uncontrolled diabetes mellitus.
* Active malignancy receiving radiotherapy.
* Severe cardiovascular disease contraindicating surgery.
* Vertical root fracture.
* Grade IV tooth mobility.
* Allergy to local anesthetics or study materials.
* Previous surgery for recurrent periapical cyst at the study site.
* Inability to comply with follow-up schedule.