Large radicular cyst with both buccal and palatal cortical bones perforation secondary to vital pulp therapy failure

Radicular cyst as the most common odontogenic cyst usually arises from residual epithelial cells stimulated by inflammatory factors initiating by pulpal necrosis of a non-vital tooth. Radicular cyst is commonly asymptomatic, slow grower, and rarely invade near bony structures. Many treatment approaches are presented for a radicular cyst like surgical endodontic treatment, tooth extraction, enucleation, and marsupialization. In this case treatment plan compromised with root canal therapy and surgical enucleation of cystic lesion. This case report presents a large radicular cyst in a vital maxillary first molar with only one necrotic root canal secondary to direct pulp capping with mineral trioxide aggregate with buccal and palatal cortical bone perforation.