**5.5 Apicoectomy with a huge cystectomy in the maxilla**

This case (**Figure 14**) represents a huge radicular maxillary cyst encompassing three teeth (11, 21, and 22). The cyst has destroyed a part of the vestibular and palatine bone with its expansive growth. Once endodontic treatment of the affected teeth had been done, apicoectomy with cystectomy was performed. The bony defect was filled with a sticky bone, which was prepared with a xenograft (BioSS). This was covered with PRF membranes and a collagen membrane. The flap was repositioned and sutured. Three months after the surgery, the OPG X-Ray (**Figure 12L**) shows excellent signs of bone regeneration.

#### **Figure 13.**

*(A) Insufficient bone height due to maxillary sinus pneumatization. (B) Incision line. (C and D) Lateral window approach. (E) Three implants inserted after sinus lift. (F) PRF membranes placed over sinus membrane. (G) Sticky bone. (H) Collagene membrane. (I) Flap repositioned and sutured. (J) OPG immediately after implant placement. (K) Three screw-retained solo prosthetic crowns. (L) Intraoral view.*

#### **Figure 14.**

*Apicoectomy with large cystectomy in the maxilla. (A) Arrows pointing to large radiolucency in the maxilla. (B) Large radiolucency on CBCT image- axial view. (C) Clinical appearance. (D) Cyst destroyed vestibular cortical lamella. (E) Palatal flap raised. (F) Enucleated cyst. (G) Sticky bone. (H) Bone cavity filled with sticky bone. (I) PRF membranes. (J) Collagene membranes. (K) Flap repositioned and sutured. (L) OPG 3 months after the surgery.*
