Category I cystectomy

Cystectomy is the complete removal of a cyst together with its lining. Category I cystectomy is surgery for a small cyst at a root tip when the tooth can be saved: the surgeon removes the cyst and performs an apicoectomy at the same time. At UKRMED Maxillofacial Surgery, the operation is performed by surgeon Anna Kravchenko after a CT scan and assessment of the causative tooth.

Where a tooth cyst comes from

Most often it is a radicular cyst — the result of chronic inflammation at the root. Infection from the root canal spreads into the bone, the body walls it off, and fluid builds up inside. The cyst grows slowly and can go unnoticed for years, often found by chance on an X-ray. But it destroys the surrounding bone, can involve neighbouring teeth and may flare up with swelling and pain.

What category I means

Category I is a relatively straightforward situation:

• a small cyst at the tip of one tooth;
• the tooth can be kept after root canal treatment;
• the cyst is not close to the maxillary sinus or the mandibular nerve;
• the bone defect does not need complex reconstruction.

More complex cases — large cysts, proximity to the sinus or nerve, several teeth — fall under category II cystectomy.

Can it be treated without surgery?

A small lesion at the root (granuloma) often heals after good microscope-assisted root canal treatment. A true cyst with a lining, however, rarely disappears with root treatment alone — tooth cyst removal is then needed.

The dental cystectomy procedure

1. Preparation. The root canals of the causative tooth are treated and filled beforehand or during surgery.
2. Anaesthesia. Local, or under sedation if preferred.
3. Access. A small gum incision and a window in the bone over the root tip.
4. Removal. The cyst is removed with its lining, and the root tip is cut off (apicoectomy).
5. Retrograde filling. The canal is sealed from the root tip.
6. Closure. The removed tissue is sent for histology if needed.

A meta-analysis of endodontic surgery found that modern microsurgical technique achieves 94% success versus 59% with traditional methods. That is why the surgeon works under magnification with modern retrograde filling materials — the standard for radicular cyst removal today.

Why CT matters

On an ordinary X-ray a cyst appears as a dark area, but only CT shows its exact borders, the distance to the sinus and nerve and the condition of the root. This decides whether category I applies or a larger procedure is needed.

Recovery

Mild swelling and discomfort for the first days. Stitches are removed after 7–10 days. Bone fills the cyst cavity gradually, visible on X-rays over several months. A follow-up X-ray is taken on the surgeon's schedule.

Category I cystectomy price at UKRMED

The surgeon gives the cost after the CT scan.

Sources

1. Setzer F. C., Shah S. B., Kohli M. R. et al. Outcome of endodontic surgery: a meta-analysis of the literature — part 1: Comparison of traditional root-end surgery and endodontic microsurgery. J Endod, 2010. https://doi.org/10.1016/j.joen.2010.08.007
2. Duncan H. F., Kirkevang L. L., Peters O. A. et al. Treatment of pulpal and apical disease: The European Society of Endodontology (ESE) S3-level clinical practice guideline. Int Endod J, 2023. https://doi.org/10.1111/iej.13974