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The aim of this article is to describe a large mandibular cyst treated with decompression followed by surgical enucleation. Furthermore, we described the utility of cyst volume measurements by using a 3D reconstruction on Cone Beam Computed Tomography (CBCT). The dentigerous cyst is the most common cyst type of epithelial origin, arising from remnants of odontogenic epithelium, asymptomatic and associated with the crown of an unerupted or partially or completely impacted tooth. However, after a long duration and extension of the cyst volume it may provoke significant bone resorption, cortical expansion, tooth displacement and the vitality of neighboring teeth may be affected. The regular treatment of this lesion is enucleation and extraction of the involved tooth. Marsupialization and decompression are proposed when the volume of the cyst is well developed to release the cystic pressure and allow the bone cavity to progressively decrease in volume with the gradual apposition of bone. This report presents a large dentigerous cyst related to impacted mandibular third molar of a 21-year-old male patient. The cyst was treated successfully by decompression and later by surgical enucleation with surgical extraction of the related molar. In conclusion, the combination of decompression and surgical approach showed on the three-dimensional CBCT investigation a significant correlation between the treatment and volume reduction of the cyst. The clinical case described allows us to observe bone formation after decompression and surgical enucleation was performed with less risk on vital anatomic elements.