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Radicular Cyst — ORE Part 1 MCQ

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ModerateOral SurgeryRadicular CystORE Part 1

A 20-year-old patient has a large, well-defined periapical radiolucency associated with a non-vital upper central incisor. Root canal treatment of the central incisor has been completed adequately, but the lesion persists. Incisional biopsy confirms a radicular cyst. The adjacent lateral incisor responds normally to sensibility testing. Which is the most appropriate definitive management?

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Correct answer: A — Enucleate the cyst and retain the treated central incisor

**A is correct.** A persistent, biopsy-confirmed radicular cyst associated with an adequately treated, retainable tooth requires definitive surgical management; enucleation removes the cyst while preserving the central incisor when it is restorable. UK oral-surgery training guidance specifically includes cyst enucleation in peri-radicular surgery. Marsupialisation is mainly a conservative or staged option for selected large lesions, rather than the routine definitive choice in this scenario. Extraction alone does not remove the cyst lining or provide histological clearance. The lateral incisor has a normal sensibility response, so extension of the lesion does not justify automatic root canal treatment. Incision and drainage is appropriate for an acute abscess, not a chronic radicular cyst requiring definitive removal.

Reference: Royal College of Surgeons of England, Faculty of Dental Surgery. Oral Surgery Specialty Training Curriculum, 2023 (cyst management including enucleation; surgical management of peri-radicular lesions): https://www.rcseng.ac.uk/-/media/files/rcs/fds/dental-curricula/oral-surgery-specialty-training-curriculum-2023_a.pdf