Tooth vitality preservation following odontogenic keratocyst enucleation: Systematic review and clinical implications

Odontogenic keratocysts are locally aggressive jaw lesions with a high recurrence rate, often involving the roots of adjacent teeth. The management of these teeth remains controversial, with no consensus on the necessity of prophylactic endodontic treatment prior to enucleation. Therefore, the purpose of this study was to assess the tooth vitality response of teeth involved in the cystic lumen of odontogenic keratocysts after enucleation and evaluate the suitability of prophylactic root canal therapy.

A comprehensive search was conducted in PubMed, Scopus, and Web of Science following PRISMA guidelines, along with a manual search for relevant clinical articles published up to January 2025. Inclusion criteria required explicit postoperative vitality assessment of teeth involved in odontogenic keratocysts treated by enucleation, with a follow-up period of at least 6 months.

Four studies met inclusion criteria, analyzing 19 teeth in 5 patients, with a mean follow-up of 50 months (range: 10-84). Overall, 87.5% of teeth retained positive pulp vitality after surgery. Vitality was assessed using cold and/or electric pulp testing. All studies used 3D imaging for lesion evaluation. Longer follow-up periods were significantly associated with reduced vitality retention.

Despite limited data, preserving pulp vitality in teeth adjacent to odontogenic keratocysts appears both viable and clinically beneficial. This conservative approach may help avoid unnecessary endodontic procedures, especially in the absence of definitive signs of necrosis. However, long-term follow-up remains essential to monitor vitality changes over time. Further high-quality studies are necessary to establish predictive success factors and standardized clinical protocols.