Decision-Making in Endodontics Prior to the Surgical Removal of Large Cysts Involving Vital Teeth

Introduction Maintaining pulp vitality is crucial; however, treatment options for large lesions may hinder the vitality of the teeth involved within the lesion. Some clinicians are not updated about the diagnostic terminology of the American Association of Endodontists (AAE) which may affect their decision-making. In the literature, there was no absolute treatment to manage such cases. The purpose of this study is to explore different opinions, identify the evidence of practice and treatment options to help in decision-making and assess if clinicians are acknowledged by the AAE guidelines.  Materials and methods This cross-sectional study was conducted through a qualitative survey designed to interview randomly selected endodontists, oral maxillofacial surgeons, oral medicine specialists, oral pathologists, and general partitioners to record their decisions and management about a structured case scenario. A total of 120 participants were included in the study. The interviews were conducted by a single investigator, and the answers were recorded by another investigator. Finally, the responses of the interviewees were collected using Google Forms (Google, Mountain View, California). Results We found that there are dissimilarities between the different groups in decision-making concerning the management of teeth involved in large cystic lesions. Regarding the AEE guidelines, almost all the endodontics and general dentists were aware of the guidelines when compared with the other groups.  Conclusion The management of teeth involved in large cystic lesions is controversial. Furthermore, the AEE guidelines are not a common language between the different disciplines. Randomized clinical trials are needed to investigate the prognosis and management of teeth associated with large cystic lesions.