Odontogenic Cysts: Contemporary Diagnostic Principles, Radiographic Assessment, and Evidence-Based Surgical–Pathologic Management in Dental Practice

Background: Odontogenic cysts are epithelial-lined cavities arising from odontogenic tissues, commonly detected incidentally during routine dental imaging. Their clinical significance lies in diagnostic overlap with aggressive odontogenic tumors, necessitating accurate identification and management. Aim: To review contemporary diagnostic principles, radiographic assessment, and evidence-based surgical–pathologic management of odontogenic cysts in dental practice. Methods: A comprehensive literature synthesis was performed, integrating epidemiologic data, pathophysiologic mechanisms, histopathologic features, and clinical evaluation strategies. Emphasis was placed on classification (inflammatory vs. developmental), imaging characteristics, and treatment modalities supported by outcome data. Results: Periapical cysts represent the most prevalent subtype (≈60%), followed by dentigerous cysts (≈20%). Radiographically, most cysts appear as well-demarcated radiolucencies, but imaging alone cannot reliably distinguish subtypes. Histopathology remains the gold standard for definitive diagnosis. Management strategies vary: inflammatory cysts respond to endodontic therapy or enucleation, while developmental cysts often require extraction of associated teeth with curettage. High-recurrence entities such as odontogenic keratocysts and glandular odontogenic cysts demand aggressive surgical approaches and long-term surveillance. Conclusion: Accurate diagnosis of odontogenic cysts requires integrated clinical, radiographic, and histopathologic evaluation. Tailored management—ranging from conservative endodontic therapy to surgical excision—optimizes outcomes and minimizes recurrence risk. Long-term follow-up is essential for high-risk lesions.