The management of large periradicular lesions has been somewhat limited in contemporary endodontics to non-surgical or surgical treatment, treatment revision in some cases, and immediate extraction in favour of implant prostheses. Within these choices there are both advantages and disadvantages. With the intent to establish removal of the aetiology and elicit a positive osseous, regenerative response, the use of decompression or marsupialisation techniques afford the patient clinician the opportunity to achieve the ultimate goal of tooth retention within a sound and stable environment. This paper will address the many facets, considerations, ramifications and techniques of using this minimally invasive procedure, in addition to addressing new technologies that purport to enhance the kinetics of periradicular tissue healing when larger periradicular lesions are present. Schlagwörter: decompression, marsupialisation, necrotic pulps, non-surgical and surgical root canal treatment, treatment revision, osseous healing