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Fluid samples from the lesions contained cholesterol crystals, which were identified by light microscopy. After adequate draining, the teeth were treated endodontically using calcium hydroxide as the intracanal medicament. All cases were followed up for a period of 2\u201310\u2003years. Complete healing was observed in 73.8% and incomplete healing in a further 9.5% of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key learning points<\/jats:title><jats:p>\u2022\u2002Root canal treatment using calcium hydroxide as an antibacterial dressing was successful in healing large cyst\u2010like periapical lesions.<\/jats:p><jats:p>\u2022\u2002This study suggests that the size of a periapical lesion is not a major determining factor in the decision to perform conventional root canal treatment or surgical removal of the lesion. 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