Abstract
Large periapical lesions in the anterior mandible present significant diagnostic and therapeutic challenges due to their proximity to vital structures and the potential for extensive alveolar bone loss. This case report describes the management of a 58-year-old African American female with a large radicular cyst associated with tooth #26. Utilizing Cone Beam Computed Tomography and histopathological biopsy, a definitive diagnosis was established while ruling out more aggressive neoplastic entities. The treatment involved the extraction of the non-vital tooth #26 and tooth #30, while successfully preserving the vitality of the adjacent tooth #27 through periodontal regenerative therapy and Guided Bone Regeneration. A 6-month follow-up revealed significant bone fill and stabilization of the anterior segment. This case underscores the "team approach" between referring and treating clinicians in prioritizing biological preservation over aggressive extraction and dental implant placement.