Patient demographics 45-year-old female
Chief complaint Persistent pain in left mandibular region
Dental history Tooth 36 previously treated with root canal and prosthetic crown
Clinical examination Tenderness to percussion; crown intact; normal periodontal probing
Radiographic assessment Orthopantomogram reveals cyst-like radiolucency
Advanced imaging CBCT confirms lesion adjacent to inferior alveolar nerve
Diagnosis Large periapical cystic lesion adjacent to inferior alveolar nerve
Informed consent Patient consented for publication and procedure
Surgical planning Preoperative strategy considering proximity to nerve
Surgical procedure - Full-thickness flap;
- Osteotomy and root-end resection;
- Removal of separated instrument;
- Cystectomy/enucleation;
- Ultrasonic root-end preparation;
- Retrograde obturation with calcium silicate material;
- Flap closure
Histological evaluation Confirmation of radicular cyst
Follow-up - Three-month clinical and radiographic assessment;
- No pain or neurosensory disturbance;
- Evidence of bone healing
Outcome and conclusions Successful healing, no nerve impairment