Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts

BACKGROUND The odontogenic jaw cyst is a cavity containing liquid,semifluid or gaseous components,with the development of the disease.In recent years,with the rapid development of oral materials and the transformation of treatment of jaw cysts,more options are available for treatment of postoperative bone defect of jaw cysts.Guided bone regeneration(GBR)places biomaterials in the bone defect,and then uses biofilm to separate the proliferative soft tissue and the slow-growing bone tissue to maintain the space for bone regeneration,which is widely used in the field of implantology.AIM To observe the clinical effect of GBR in repairing bone defect after enucleation of small and medium-sized odontogenic jaw cysts.METHODS From June 2018 to September 2020,13 patients(7 male,6 female)with odontogenic jaw cysts were treated in the Department of Oral Surgery,Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.Adults without hypertension,heart disease,diabetes or other systemic diseases were selected.The diagnosis was based on the final pathological results:11 cases were diagnosed as apical cysts,one as primordial cyst,and one as dentigerous cyst.The lesions were located in the maxilla in seven cases,and in the mandible in six cases.All cases were treated with the same method of enucleation combined with GBR.RESULTS Three to four months after the operation,the boundary between the implant site and the surrounding normal stroma was not obvious in patients with small-sized odontogenic jaw cysts.The patients with tooth defects were treated with implant after 6 mo.For the patients with medium-sized odontogenic jaw cysts,the density of the center of the implant area was close to the normal mass at 6 mo after surgery,and there was a clear boundary between the periphery of the implant area and the normal mass.The boundary between the periphery of the implant area and the normal mass was blurred at 8-9 mo after surgery.Patients with tooth defects were treated with implants at>6 mo after the operation.CONCLUSION Enucleation combined with guided bone regeneration in small and medium-sized odontogenic jaw cysts can shorten the time of osteogenesis,increase the amount of new bone formation,reduce complications,and improve quality of life.

Microsurgical management of radicular cyst using guided tissue regeneration technique:A case report

BACKGROUND Radicular cyst is a lesion of odontogenic origin that arises from epithelial remains due to periapical periodontitis caused by inflammatory reactions generated at the apex of affected teeth with infected or necrotic pulps.The therapeutic mana gement of radicular cysts is controversial.There is only one case report of enucleation of a radicular cyst managed with microsurgery and apicoectomy,but without the use of the guided tissue regeneration(GTR)technique in the same surgical procedure.The present clinical case describes the management of a radicular cyst with microsurgical approach,performance of an apicoectomy of the tooth associated with the entity,application of GTR technique,use of a resorbable membrane of type I bovine collagen,and bovine xenograft.CASE SUMMARY A 68-year-old patient presented with a radicular cyst from an upper lateral incisor.The microsurgical management used was aimed at enucleating the chemical membrane,performing apicoectomy of the tooth along with careful and precise retrograde filling,and implementing GTR technique using a resorbable collagen membrane and bovine xenograft.The diagnosis of radicular cyst was confirmed using histopathological analysis.The patient underwent follow-up evaluations at 10 and 30 d postoperatively.At 4 months postoperative evaluation,she remained asymptomatic,and radiographs showed significant periapical healing with adequate bone formation.CONCLUSION These results suggest that microsurgical management using the GTR technique with collagen membrane and xenograft,contributes to bone regeneration.

Calcifying Odontogenic Cyst of the Oral Cavity: A Clinical Case and Current Updates on the Ethiopathogenesis

Background: The calcifying odontogenic cyst (COC) is a rare pathological entity. It falls into a group of lesions with calcifications that present benign and sometime malignant tumor variants. Case Presentation: In the present study, we report on a case of intraosseous/intrasinusal COC with impacted maxillary canine and dentinoid structures odontoma-like. The clinical, radiographical, histopathological, and molecular characteristics of this pathological entity are discussed in relation also to the problems of differential diagnosis, treatment, and prognosis. Conclusion: The true COC is a rare entity in the oral cavity and represents about less than 1% of all odontogenic lesions. Careful clinical, instrumental and histological analysis must be performed for odontogenic cysts in order to accomplish the correct surgical act and to avoid recurrence.

Solitary intraosseous neurofibroma in the mandible mimicking a cystic lesion:A case report and review of literature

BACKGROUND Neurofibromas are benign tumors of a neurogenic origin.If these tumors occur without any other signs of neurofibromatosis,they are classified as isolated neurofibromas.Neurofibromas in the oral cavity mostly occur within soft tissues,indicating that solitary intraosseous neurofibromas in the mandible are rare.Due to the absence of specific clinical manifestations,early diagnosis and treatment of these tumors are difficult to achieve.CASE SUMMARY A 37-year-old female patient visited our hospital due to numbness and swelling of the gums in the right lower molar area that had persisted for half a month.The patient’s overall condition and intraoral examination revealed no significant abnormalities.She was initially diagnosed with a cystic lesion in the right mandible.However,after a more thorough examination,the final pathological diagnosis was confirmed to be neurofibroma.Complete tumor resection and partial removal of the right inferior alveolar nerve were performed.As of writing this report,there have been no signs of tumor recurrence for nine months following the surgery.CONCLUSION This case report discusses the key features that are useful for differentiating solitary intraosseous neurofibromas from other cystic lesions.

Efficacy of bone grafts in jaw cystic lesions:A systematic review

BACKGROUND Bone grafts have been applied for many years in orthopedic surgery to assist with bone repair for defects or bone discontinuity caused by trauma and tumors as well as periodontal defects.Jaw cysts are another common benign disease of the maxillofacial region which may lead to pathological bone fracture,loss of teeth,and infection.However,whether bone grafts are beneficial for bone regeneration in jaw cystic lesions and when bone grafts should be used remains unclear.AIM To study the efficacy of bone grafts compared to spontaneous healing in the treatment of jaw cystic lesions.METHODS A literature search was performed in Medline,Cochrane Library and Embase to identify related articles published in English in the last ten years.The following key words and Me SH terms were used:“jaw cyst”,“cystic lesion”,“odontogenic cyst”,“periapical cyst”,“dentigerous cyst”,“follicular cyst”,“keratocyst”,“treatment”,“surgery”,“bone graft”,“enucleation”,“cystectomy”,and“bone regeneration”.Case reports,clinical trials,clinical studies,observational studies and randomized controlled trials were included.Study quality was evaluated.RESULTS Ten studies(n=10)met the inclusion criteria.Five studies reported spontaneous bone healing after enucleation,three studies investigated the efficacy of various bone grafts,and two randomized comparative studies focused on the comparison between spontaneous healing and bone grafting.Over 90%of bone regeneration occurred within 6 mo after bone grafting.The bone regeneration rate after cystectomy showed great variation,ranging from 50%to 100%after 6 mo,but reaching over 90%after 12 mo.CONCLUSION While the long-term superiority of bone grafting compared with spontaneous healing after cystectomy is unclear,bone grafts accelerate the process of healing and significantly increase bone quality.

Central mucoepidermoid carcinoma of the jaws:report of two cases

Central mucoepidermoid carcinoma of the jaws (CMCJ) is an extremely rare neoplasm. The clinical manifestation of CMCJ is nonspecific, which includes swelling, pain, mobile teeth and bleeding, etc. To develop the diagnosis and treatment of CMCJ. this article presents 2 cases of CMCJ treated in our hospital. Their clinical data, treatment and prognosis were analyzed retrospectively.

Mandibular Buccal Bifurcation Cyst:Report of Two Cases

Mandibular buccal bifurcation cyst is a rare inflammatory odontogenic cyst.We reported two cases who complained of painful swelling of extraoral soft tissue.Intraoral examination revealed the partially erupted mandibular first molar.Cone beam computed tomography showed a well-defined cystic lesion surrounding the first molar.Histopathologic images showed the cyst wall was infiltrated by a large number of plasma cells,neutrophils and eosinophils,and lined with a thin layer of non-keratinized stratified squamous epithelium.Finally,the two patients were diagnosed as mandibular buccal bifurcation cyst and treated with cyst enucleation and curettage.