The diagnosis and therapeutic approach to periapical cysts is an extremely controversial concern for dentists. Furthermore, as this complaint represents the most frequent cystic lesion of the maxilla, together with the fact that its differential diagnosis with chronic apical periodontitis presents special difficulty, the question takes on even greater importance. The purpose of this article is to assess the validity of the various diagnostic techniques used to differentiate between both pathologies and make a critical analysis of the controversy surrounding the therapeutic approach to suspected periapical cysts through non-surgical and follow-up treatment, or surgical enucleation and histopathological analysis.