Restorative Dentistry & Endodontics

Biological mechanisms underlying the inflammatory radicular cyst formation-focus on epithelial proliferation: a systematic review of experimental cell and tissue models: Néstor Ríos-Osorio, Sandra Briñez-Rodríguez, David Betancur-Calle, Marggie Grajales, Óscar Mauricio Jiménez-Peña, Mario Guerrero-Torres, Rafael Fernández-Grisales; Restor Dent Endod 2026;51(1):e7. Published online February 12, 2026; DOI: https://doi.org/10.5395/rde.2026.51.e7

Abstract PDF PubReader ePub: Objectives
This study aimed to assess the molecular and cellular mechanisms involved in the epithelial proliferation that leads to the transformation of periapical granulomas (PGs) into inflammatory radicular cysts (IRCs).
Methods
A comprehensive search was conducted in three databases. Experimental, observational, or descriptive studies using human or animal tissue samples, or epithelial cell cultures that assessed the molecular and/or cellular mechanisms driving the proliferation of epithelial rests of Malassez and their role in the transformation of PGs into IRCs were included. The risk of bias and applicability of the included studies were assessed using the QUADAS-2.
Results
Fourteen studies (including 399 samples) met the inclusion criteria for qualitative synthesis. The studies highlight the role of pro-inflammatory cytokines (IL-1β, IL-6), growth factors (EGF, KGF, TGF-β, and IGF), and signaling pathways (NF-κB, MAPK/ERK, PI3K/AKT, and Smad) in the progression of PG to IRC. Biomarkers of epithelial proliferation, such as Ki-67, PCNA, and CD34, are consistently associated with this process, while MMP-13 emerges as a key regulator of epithelial behavior and matrix remodeling.
Conclusions
IRC development arises from a transition from homeostatic to pathological signaling, in which pro-inflammatory mediator levels inside the periapical chronic inflammation override regulatory checkpoints.

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Endodontic micro-resurgery and guided tissue regeneration of a periapical cyst associated to recurrent root perforation: a case report: Fernando Córdova-Malca, Hernán Coaguila-Llerena, Lucía Garré-Arnillas, Jorge Rayo-Iparraguirre, Gisele Faria; Restor Dent Endod 2022;47(4):e35. Published online September 3, 2022; DOI: https://doi.org/10.5395/rde.2022.47.e35

Although the success rates of microsurgery and micro-resurgery are very high, the influence of a recurrent perforation combined with radicular cyst remains unclear. A 21-year-old white female patient had a history of root perforation in a previously treated right maxillary lateral incisor. Analysis using cone-beam computed tomography (CBCT) revealed an extensive and well-defined periapical radiolucency, involving the buccal and palatal bone plate. The perforation was sealed with bioceramic material (Biodentine) in the pre-surgical phase. In the surgical phase, guided tissue regeneration (GTR) was performed by combining xenograft (lyophilized bovine bone) and autologous platelet-rich fibrin applied to the bone defect. The root-end preparation was done using an ultrasonic tip. The retrograde filling was performed using a bioceramic material (Biodentine). Histopathological analysis confirmed a radicular cyst. The patient returned to her referring practitioner to continue the restorative procedures. CBCT analysis after 1-year recall revealed another perforation in the same place as the first intervention, ultimately treated by micro-resurgery using the same protocol with GTR, and a bioceramic material (MTA Angelus). The 2-year recall showed healing and bone neoformation. In conclusion, endodontic micro-resurgery with GTR showed long-term favorable results when a radicular cyst and a recurrent perforation compromised the success.

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Outcome of endodontic micro-resurgery: A systematic review
Faisal Alnassar, Riyadh Alroomy, Qamar Hashem, Abdullah Alqedairi, Nabeel Almotairy
Saudi Endodontic Journal.2025; 15(2): 112. CrossRef
Platelet-Rich Plasma and Platelet-Rich Fibrin in Endodontics: A Scoping Review
Simão Rebimbas Guerreiro, Carlos Miguel Marto, Anabela Paula, Joana Rita de Azevedo Pereira, Eunice Carrilho, Manuel Marques-Ferreira, Siri Vicente Paulo
International Journal of Molecular Sciences.2025; 26(12): 5479. CrossRef
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Beatrice Spaggiari, Paolo Vescovi, Silvia Pizzi, Roberta Iaria, Ilaria Giovannacci
Cureus.2025;[Epub] CrossRef
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Management of Apico-marginal Defects With Endodontic Microsurgery and Guided Tissue Regeneration: A Report of Thirteen Cases
Abayomi O. Baruwa, Jorge N.R. Martins, Mariana D. Pires, Beatriz Pereira, Pedro May Cruz, António Ginjeira
Journal of Endodontics.2023; 49(9): 1207. CrossRef

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Progression of periapical cystic lesion after incomplete endodontic treatment: Jong-Ki Huh, Dong-Kyu Yang, Kug-Jin Jeon, Su-Jung Shin; Restor Dent Endod 2016;41(2):137-142. Published online February 22, 2016; DOI: https://doi.org/10.5395/rde.2016.41.2.137

Abstract PDF PubReader ePub

We report a case of large radicular cyst progression related to endodontic origin to emphasize proper intervention and follow-up for endodontic pathosis. A 25 yr old man presented with an endodontically treated molar with radiolucency. He denied any intervention because of a lack of discomfort. Five years later, the patient returned. The previous periapical lesion had drastically enlarged and involved two adjacent teeth. Cystic lesion removal and apicoectomy were performed on the tooth. Histopathological analysis revealed that the lesion was an inflammatory radicular cyst. The patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. Although the patient had been asymptomatic, close follow-ups are critical to determine if any periapical lesions persist after root canal treatment.

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Khalid A. Merdad, Maha Shawky, Khalid A. Aljohani, Rawia Alghamdi, Saja Alzahrani, Omar R. Alkhattab, Abdulaziz Bakhsh
Dentistry Journal.2025; 13(2): 83. CrossRef
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The effectiveness of antibacterial treatment of the root canal in chronic apical periodontitis using an erbium-chromium laser
M. A. Postnikov, A. Yu. Rozenbaum, S. E. Chigarina, D. N. Kudryashov, M. B. Khaikin, I. V. Khramova, G. N. Belanov
Endodontics Today.2022; 20(2): 115. CrossRef
Factors Associated with Incomplete Endodontic Care
Carla Y. Falcon, Anthony R. Arena, Rebecca Hublall, Craig S. Hirschberg, Paul A. Falcon
Journal of Endodontics.2021; 47(9): 1398. CrossRef
Tratamento cirúrgico e conservador de cisto periapical de grande proporção: relato de caso
Maraísa Aparecida Pinto Resende, Neuza Maria Souza Picorelli Assis, Augusto César Sette-Dias, Evandro Guimarães de Aguiar, Bruno Salles Sotto-Maior
HU Revista.2018; 43(2): 191. CrossRef

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