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Khalifa C, Garma M, Mabrouk R, Slim A, Bouguezzi A, Selmi J. Conservative management of dentigerous cyst in children: Report of two clinical cases. Clin Case Rep 2023; 11:e7051. [PMID: 37064731 PMCID: PMC10090943 DOI: 10.1002/ccr3.7051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 04/18/2023] Open
Abstract
The dentigerous cyst is the second most common odontogenic. The prevalence rates ranging from 0.8% to 3.6% in the general population. It affects people especially at the second and third decade of life with a male predilection. It presents a preference for the mandibular region particularly for the second lower premolar. Surgical marsupialization or decompression are the most conservative treatment modalities as it prevents the risks of cyst removal as nerve injuries and preserves the unerupted tooth. Two clinical cases of two young patients presenting a dentigerous cyst involving impacted teeth, which were successfully treated by decompression will be reported in order to highlight the benefits and limits of cyst decompression as well as detailing its operating protocol and its instructions.
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Affiliation(s)
- Chaima Khalifa
- Department of Oral medicine and Oral SurgeryDental Clinic of MonastirMonastirTunisia
- Faculty of Dental Medicine, Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11)University of MonastirMonastirTunisia
| | - Maroua Garma
- Department of Oral medicine and Oral SurgeryDental Clinic of MonastirMonastirTunisia
- Faculty of Dental Medicine, Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11)University of MonastirMonastirTunisia
| | - Rihab Mabrouk
- Department of Pediatric and Preventive DentistryDental Clinic of MonastirMonastirTunisia
| | - Afef Slim
- Department of Oral medicine and Oral SurgeryDental Clinic of MonastirMonastirTunisia
- Faculty of Dental Medicine, Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11)University of MonastirMonastirTunisia
| | - Adel Bouguezzi
- Department of Oral medicine and Oral SurgeryDental Clinic of MonastirMonastirTunisia
- Faculty of Dental Medicine, Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11)University of MonastirMonastirTunisia
| | - Jamil Selmi
- Department of Oral medicine and Oral SurgeryDental Clinic of MonastirMonastirTunisia
- Faculty of Dental Medicine, Laboratory of Oral Health and Maxillofacial Rehabilitation (LR12ES11)University of MonastirMonastirTunisia
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Kivovics M, Pénzes D, Moldvai J, Mijiritsky E, Németh O. A custom-made removable appliance for the decompression of odontogenic cysts fabricated using a digital workflow. J Dent 2022; 126:104295. [PMID: 36116543 DOI: 10.1016/j.jdent.2022.104295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/29/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This case series aimed to assess the feasibility of a custom-made decompression appliance fabricated using a digital workflow to decompress odontogenic cysts. Additionally, the treated cysts were assessed for volumetric changes. METHODS A three-dimensional (3D) reconstruction software (CoDiagnostiX version 10.4) was used to obtain the master cast STL (Standard Tessellation Language) file by placing a customized virtual implant to create a recess for the tube of the decompression device. The decompression appliance was planned using Dental Wings Open Software (DWOS). Following rapid prototyping, the tube of the appliance was perforated using round burs. In cases where the appliances were designed to replace teeth, denture teeth were added using the conventional workflow. The appliances were delivered on the day of the cystostomy. Following decompression, cyst enucleation was performed. Cyst volume was assessed by manual segmentation of pre- and post-operative cone-beam computed tomography (CBCT) reconstructions using slice-by-slice boundary drawing with a scissors tool in the 3DSlicer 4.10.2 software. Percentage of volume reduction was calculated as follows: volume reduction/pre-operative volume × 100. RESULTS Six odontogenic cysts in six patients (5 male, 1 female; age 40 years, range: 15-49 years) with a pre- and post-operative cyst volume of 5597 ± 3983 mm3 and 2330 ± 1860 mm3 respectively (p < 0.05) were treated. Percentage of volume reduction was 58.84 ± 13.22 % following a 6-month-long decompression period. CONCLUSIONS The digital workflow described in this case series enables the delivery of decompression appliances at the time of cystostomy, thus effectively reducing the volume of odontogenic cysts. The resulting bone formation established a safe zone around the anatomical landmarks; therefore, during enucleation surgery, complications to these landmarks can be avoided.
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Affiliation(s)
- Márton Kivovics
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary.
| | - Dorottya Pénzes
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary.
| | - Júlia Moldvai
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary.
| | - Eitan Mijiritsky
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv 64239, Israel,; Goldschleger School of Dental Medicine, Sackler School of Medicine, Tel-Aviv University, Tel Aviv 39040, Israel.
| | - Orsolya Németh
- Department of Community Dentistry, Semmelweis University, Szentkirályi utca 40. 1088 Budapest, Hungary.
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Vizuete–Bolaños MX, Salgado–Chavarría F, Cruz–Tapia RO. Quiste dentígero. Revisión de la literatura y reporte de caso. ACTA ODONTOLÓGICA COLOMBIANA 2022. [DOI: 10.15446/aoc.v12n1.98021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción: el quiste dentígero, también conocido como quiste folicular, es la segunda forma más habitual de los quistes de la región maxilar después del quiste radicular. Tiene una incidencia del 20% con respecto a todos los quistes odontogénicos y se encuentra más en el género masculino entre los 20-40 años. El manejo conservador en lesiones quísticas de gran tamaño es indispensable para evitar defectos óseos o daño a estructuras vecinas. Sin embargo, en lesiones de menor tamaño, la enucleación continúa siendo el tratamiento de elección. Objetivo: presentar un caso clínico de un quiste dentígero y hacer una revisión de la literatura actualizada. Caso clínico: paciente masculino de 23 años que presentó aumento de volumen en zona geniana derecha y, además, en su ortopantomografía se observó una lesión en el sector de los incisivos superiores. Se realizó enucleación de la lesión, cuyo diagnóstico histológico previo fue quiste dentígero y posteriormente se obtiene una correcta regeneración ósea tras un año de seguimiento Conclusión: el manejo del quiste dentígero es variado: puede ir desde la enucleación quirúrgica hasta la descompresión y marsupialización del mismo. No obstante, todos los tratamientos actuales se basan en contrarrestar los factores de expansión quística que permiten a esta lesión alcanzar grandes tamaños intraóseos y poder causar desde rizolisis de dientes adyacentes hasta una asimetría facial como sucedió en este caso clínico.
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Umer F, Javed F. Decompression strategy for critical-sized lesions: A case series and literature review. AUST ENDOD J 2021; 47:731-740. [PMID: 34145932 DOI: 10.1111/aej.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/23/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Critical-sized lesions are defined as the smallest sized intraosseous wound in a particular bone that will not heal spontaneously during the lifetime of that animal. These critical-sized entities pose a unique challenge in endodontics, where these lesions are most likely cystic, with dimensions extending over 10 mm. This paper describes a structured methodology to treat such cases whilst also highlighting inconsistencies and variability between practitioners regarding management of critical-sized lesions. The case series demonstrates that non-surgical root canal therapy followed by surgical decompression may be the treatment of choice for such pathosis. A 16 gauge nasogastric tube was used as a decompression device and sutured to surrounding mucosa. Healing was evaluated using both two- and three-dimensional radiographs. Decompression of critical-sized lesions would appear to be a reliable, conservative and an altogether complete procedure that may not warrant second-stage surgery.
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Affiliation(s)
- Fahad Umer
- Operative Dentistry, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Faizan Javed
- Operative Dentistry, Department of Surgery, Aga Khan University, Karachi, Pakistan
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Salvage of Dental Implant Located in Mandibular Odontogenic Cyst. A Conservative Surgical Treatment Proposal. Dent J (Basel) 2020; 8:dj8020049. [PMID: 32403226 PMCID: PMC7344506 DOI: 10.3390/dj8020049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/21/2022] Open
Abstract
The aim of this case report was to evaluate the use of Partsch I cystotomy in order to preserve a dental implant located in an odontogenic cyst extended from 3.2 to 4.4. A 50 year-old woman showed a circular, well-defined unilocular radiolucent area, Ø2.5 cm, in the right mandibular region with an oral implant intruding inside it. The overdenture in the mandibular right site showed no clinical mobility. The authors decided to perform a surgical treatment aimed to preserve the implant. The patient underwent Partsch I surgery followed by iodoform gauze insertion replaced weekly for one month, revision of the previous orthograde endodontic treatments, and an acrylic resin obturator prosthesis application for the following two months. The twelve month follow-up showed no clinical mobility of the right lateral mandibular implant prostheses. Radiographical analysis revealed cystic lesion healing and perimplant bone regeneration. This report highlights the opportunity to apply cystotomy when the cyst involves a dental implant and undermines its stability. This possibility is offered by the peculiar clinical scenario where the implant was stabilized by the presence of a previous prosthetic fixation. Our study led to the application of an operative protocol that allowed for the preservation of the implant.
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Nyimi BF, Yifang Z, Liu B. The Changing Landscape in Treatment of Cystic Lesions of the Jaws. J Int Soc Prev Community Dent 2019; 9:328-337. [PMID: 31516866 PMCID: PMC6714425 DOI: 10.4103/jispcd.jispcd_180_19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/06/2019] [Indexed: 11/11/2022] Open
Abstract
Objective: Cystic lesions of the jaw are common pathologies of chronic swelling of the jaw in oral and maxillofacial regions. Different treatment modalities have been described in the literature. However, the existence and proper treatment of these cysts remains a contentious topic. The aims of this review were to discuss the complexity of various surgical treatment and as factors with potential to influence outcome treatment. Finally, a practical and a rational clinical guideline for the management of such lesions have been suggested. Materials and Methods: A literature search without language limitation was performed in 2018 using MEDLINE, PubMed, Scopus, and Embase. Keywords for the search included the following terms: jaws cyst, cystic lesions, odontogenic cysts, cystic tumors, pseudocysts, treatments, therapy, wound healing, bone regeneration, and teeth involved cysts. Prospective or retrospective clinical studies with a sample size of n ≥ 5 were evaluated and included in this review. The exclusion criteria were studies with unclear reporting of the treatment applied or outcome, nonhuman studies, case reports, letters, preface, comments, and cystic lesions associated to syndrome. After the full reading, 30 articles were included in the quantitative synthesis for the review. No meta-analysis could be performed due to the heterogeneity of the studies included. Clinical radiographic images were presented to illustrate the principles of some surgical treatments. Conclusion: Conservative surgery with primary closure defect (less than 4 cm) remains an initial approach, which reduces the morbidity of aggressive surgeries and obtains the complete bone healing before 24 months of postoperative. Marsupialization is considered as the most common option for the treatment of large cystic lesions when cases are carefully selected. Evocyst is an attractive new technique of obtaining complete bone defect healing within <3 months.
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Affiliation(s)
- Bushabu Fidele Nyimi
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China, People's Republic of China.,Oral and Maxillo-Facial Surgery, Teaching Hospital of Kinshasa University, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Zhao Yifang
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China, People's Republic of China
| | - Bing Liu
- Department of Oral Maxillofacial Head and Neck Oncology Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China, People's Republic of China
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Tian FC, Bergeron BE, Kalathingal S, Morris M, Wang XY, Niu LN, Tay FR. Management of Large Radicular Lesions Using Decompression: A Case Series and Review of the Literature. J Endod 2019; 45:651-659. [DOI: 10.1016/j.joen.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/10/2018] [Accepted: 12/15/2018] [Indexed: 01/08/2023]
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Abstract
PURPOSE Recently, the terms sugosteogenesis and distraction sugosteogenesis have been introduced to the scientific literature. While the former describes a biologic phenomenon, the latter refers to the clinical technique which relies on the accelerated normal bone healing process that takes place at the osseous walls surrounding a cystic cavity when active negative pressure is applied. The purpose of this study is to provide the biologic bases and the therapeutic principles of this emerging technique. Employing well-stablished biologic principles, clinical evidence from analogous techniques, emerging experimental data, and circumstantial evidence, this study presents the possible mechanism of action of the evacuator for odontogenic cysts (Evocyst), a closed, vacuum-like drain system intended to treat cystic conditions using negative pressure. METHODS A review of the literature was done. Keywords for the Medline search were: marsupialization, decompression, odontogenic cysts, effects of negative pressure on bone, and negative pressure wound therapy. In addition, relevant publications from the reference list of the retrieved studies were considered. The matches were evaluated for relevance and analyzed accordingly. Clinical reports used to illustrate the concept of distraction sugosteogenesis were performed following the Declaration of Helsinki on medical protocol and ethics. RESULTS Currently, the standard of care to manage odontogenic cystic lesions includes marsupialization, enucleation and curettage, decompression, and surgical resection. However, there is a need for an alternative option in which the entity could be treated while promoting bone formation. With large odontogenic cystic conditions treated in a short period of time, distraction sugosteogenesis appears to be a choice. CONCLUSION The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promotes fluid flow, and enhances angiogenesis. All of them, combined, may explain sugosteogenesis. The clinical application of such parameters may explain the good clinical results obtained with the Evocyst.
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Sun Y, Zhang J, Qian N, Sima G, Zhang J, Zhong J, Guo Z, Chen Y, Dong W. Comparison of the osteogenic differentiation of orofacial bone marrow stromal cells prior to and following marsupialization in patients with odontogenic cyst. Mol Med Rep 2017; 17:988-994. [PMID: 29115541 PMCID: PMC5780180 DOI: 10.3892/mmr.2017.7949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 10/18/2017] [Indexed: 12/26/2022] Open
Abstract
Decompression has been considered a valuable tool for odontogenic cystic lesions to minimize cyst size with low morbidity and recurrence. However, whether decompression has a role in regulating stem cell properties of orofacial bone marrow stromal cells (BMSCs) around the cysts has not been fully investigated. The present study compared the stem cell marker profile and osteogenic differentiation potential of orofacial BMSCs prior to and following marsupialization (pre-BMSCs vs. post-BMSCs) in the same individuals. The results demonstrated that post-BMSCs proliferated significantly faster, displayed higher colony-forming unit-fibroblast capacity and demonstrated higher expression of octamer binding protein 4, Nanog and SRY-related HMG box 2 when compared with the pre-BMSCs. Notably, the osteogenic potential was greater in the post-BMSCs compared with in pre-BMSCs, by demonstrating that the protein and mRNA expression levels of osteopontin, runt-related transcription factor 2, osteocalcin, alkaline phosphatase and osterix were upregulated in pre-BMSCs. Furthermore, the phosphorylated levels of extracellular signal-regulated kinase and c-Jun N-terminal kinase were enhanced in post-BMSCs. In conclusion, the study indicated that decompression influences the stem cell properties of orofacial BMSCs, and further studies are needed to verify the findings.
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Affiliation(s)
- Yao Sun
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
| | - Juan Zhang
- Department of Stomatology, Zhenjiang Stomatological Hospital, Zhenjiang, Jiangsu 212000, P.R. China
| | - Naiying Qian
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
| | - Guoqi Sima
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
| | - Jianming Zhang
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
| | - Jiayong Zhong
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
| | - Zhiqin Guo
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
| | - Yawen Chen
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
| | - Weijie Dong
- Department of Stomatology, The First Hospital of Jiaxing, Jiaxing, Zhejiang 314000, P.R. China
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Decompression of an extensive Keratocystic Odontogenic Tumor in an elderly patient. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2017. [DOI: 10.1016/j.ajoms.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sheikh J, Cohen MD, Ramer N, Payami A. Ghost Cell Tumors. J Oral Maxillofac Surg 2016; 75:750-758. [PMID: 27865804 DOI: 10.1016/j.joms.2016.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/27/2022]
Abstract
Ghost cell tumors are a family of lesions that range in presentation from cyst to solid neoplasm and in behavior from benign to locally aggressive or metastatic. All are characterized by the presence of ameloblastic epithelium, ghost cells, and calcifications. This report presents the cases of a 14-year-old girl with a calcifying cystic odontogenic tumor (CCOT) and a 65-year-old woman with a peripheral dentinogenic ghost cell tumor (DGCT) with dysplastic changes, a rare locally invasive tumor of odontogenic epithelium. The first patient presented with a 1-year history of slowly progressing pain and swelling at the left body of the mandible. Initial panoramic radiograph displayed a mixed radiolucent and radiopaque lesion. An incisional biopsy yielded a diagnosis of CCOT. Decompression of the mass was completed; after 3 months, it was enucleated and immediately grafted with bone harvested from the anterior iliac crest. The second patient presented with a 3-month history of slowly progressing pain and swelling at the left body of the mandible. Initial panoramic radiograph depicted a mixed radiolucent and radiopaque lesion with saucerization of the buccal mandibular cortex. An incisional biopsy examination suggested a diagnosis of DGCT because of the presence of ghost cells, dentinoid, and islands of ameloblastic epithelium. Excision of the mass with peripheral ostectomy was completed. At 6 and 12 months of follow-up, no evidence of recurrence was noted.
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Affiliation(s)
- Jason Sheikh
- Former Resident, Mount Sinai Medical Center, New York, NY; Fellow, Cleft and Craniomaxillofacial Surgery, Charleston Area Medical Center, Charleston, WV.
| | - Molly D Cohen
- Chief Resident, Department of Oral and Maxillofacial Pathology, Mount Sinai Medical Center, New York, NY
| | - Naomi Ramer
- Director, Oral and Maxillofacial Pathology Residency Program, Mount Sinai Medical Center, New York, NY
| | - Ali Payami
- Attending, Department of Oral and Maxillofacial Surgery, Mount Sinai Medical Center, New York, NY
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