Odontogenic cysts

Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review

OBJECTIVE

This systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm.

STUDY DESIGN

A literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included.

RESULTS

Of 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk.

CONCLUSION

This study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.

Bone Trabecular Pattern Analysis in Odontogenic Cysts Using Cone Beam Computed Tomography: A Clinical Retrospective Study

Introduction The cysts of the maxillofacial region account for one of the most common pathologies of the head and neck region after the mucosal pathologies. Radiography provides an essential clue in early diagnosis and triaging, but it continues further as it is used to evaluate the post-treatment outcome. However, manual analysis is prone to errors. In this scenario, fractal analysis (FA) in radiographs uses mathematical methods to analyse the changes in grey scales in a given radiographic image. FA in odontogenic cysts is used to characterise their complexity, uncover hidden patterns, monitor treatment response, and potentially provide prognostic information. This paper aimed to assess the fractal characteristics of the radicular cyst (RC), dentigerous cyst (DC), and odontogenic keratocyst (OKC) using cone beam computed tomography (CBCT). The objective was to calculate fractal dimension (FD) values expressed in each of these cysts, which could prove to be a radiological adjunct in diagnosing the above cysts. Materials and methods As this is a retrospective study, the archives of CBCT images from June 2021 to December 2023 were obtained from patients diagnosed and confirmed with a histopathological diagnosis with RC, DC, and OKC. The FA was performed using Image J Software (Ver 1.51, National Institute of Health Bethesda, Fiji). The cortical and cancellous bones were segmented using thresholding techniques and converted to binary images. The mean FD of the three planes was then compared to establish the distinctive fractal characteristic for the specific odontogenic cysts. A one-way ANOVA was performed using the Statistical Product and Service Solutions (SPSS) (version 23.0; IBM SPSS Statistics for Windows, Armonk, NY) to determine the difference between FD values of RC, DC, and OKC with a significance level less than 0.05. Results The FD values of DC, RC, and OKC were 1.33 ± 0.17, 1.08 ± 0.16, and 1.65 ± 0.12, respectively. The results indicated that OKC had higher FD values than DC and RC, which means that OKC had lesser bone destruction compared to DC and RC. Inferential statistics showed that the one-way ANOVA was used to compare the means of the three groups of FD data. When calculated for the three groups, the F-statistic value was at 7.29, which yielded a P value of 0.03, making it statistically significant for a 95% confidence interval (p<0.05). Conclusion Our CBCT study on bone trabecular pattern analysis using FD and FA in odontogenic cysts reveals distinct alterations in bone parameters among different cyst types. The probability of higher FD values in OKC is because of lesser cortical bone destruction in OKC compared to the other cyst types. These findings have potential implications for diagnosing, treating, and prognosticating odontogenic cysts.

A review of oral pathology in orthodontics. Part 2: Pathology of the jaw bones

For many patients, their first full jaw imagining will be requested and reported by an orthodontist. This may lead to the discovery of unexpected pathology in the jaws. In this review article, we discuss the clinical and radiological appearance as well as the pathologic features and treatment of the more common entities of the jaws. In addition, we will discuss the less common lesions which carry important consequences for the patient. Through the identification of these lesions, appropriate referral and management can be pursued.

Factors affecting the reduction rate of odontogenic cysts after decompression based on 3-dimensional volumetric analysis

Purpose

This study aimed to investigate the potential factors that could affect the reduction rate of odontogenic cysts following decompression using cone-beam computed tomography (CBCT) for 3-dimensional volumetric analysis.

Materials and Methods

The study sample consisted of CBCT images of 41 individuals who underwent decompression of odontogenic cysts at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, between 2010 and 2022. Preoperative and postoperative CBCT results were collected, and a volumetric analysis was conducted to evaluate the differences in the reduction rate and the percentage of volume reduction of cystic lesions based on different parameters. Correlations between these parameters were analyzed to determine associations.

Results

In this study, the average time of decompression for odontogenic cysts was 316 days. Males demonstrated a higher reduction rate than females (P<0.05). The reduction rate was directly proportional to initial cyst volume, with higher reduction rates for cysts with large initial volume than those with small initial volume (P<0.05). Spearman's rank correlation coefficient indicated a weak positive correlation between the initial cyst volume and the duration of decompression. Additionally, a strong positive correlation was observed between the initial volume and the reduction rate.

Conclusion

Knowledge of the reduction rate of odontogenic cysts is vital for surgeons to evaluate the duration of decompression before enucleation and to determine a definitive treatment plan. Sex and initial lesion volume had significant effects on the reduction rate.

The differences in mitochondrial function, mitochondrial dynamics, and cell death between odontogenic cysts/tumors and normal dental follicles

We aimed to compare mitochondrial function, mitochondrial dynamics, apoptosis, and necroptosis between odontogenic cysts/tumors, including radicular cysts, dentigerous cysts, ameloblastoma, vs. dental follicles as control. We demonstrated that mitochondrial dysregulation and imbalanced mitochondrial dynamics were observed in ameloblastoma. Apoptosis was increased in dentigerous cysts, and ameloblastoma, while necroptosis was suppressed in ameloblastoma. Necroptosis in radicular cysts was higher than that of control, suggesting that the inflammation-associated cell death occurred in radicular cysts. Our findings suggest ameloblastoma exhibited mitochondrial dysfunction, decreased mitochondrial fusion, and potential apoptosis. Therefore, alleviating mitochondrial dysregulation and apoptosis may be novel-targeted therapy for odontogenic cysts and tumors.

Florid Cemento-Osseous Dysplasia with a Concurrent Glandular Odontogenic Cyst

The presence of non-odontogenic cysts associated with benign fibro-osseous lesions of the jaws has been well documented. However, literature is scant when describing benign fibro-osseous lesions with associated odontogenic cysts. This case report highlights the presence of a concurrent developmental odontogenic cyst, glandular odontogenic cyst with extensive squamous metaplasia, in a patient with florid cemento-osseous dysplasia (COD). The postulated pathogenesis of these synchronous lesions is discussed along with a review of current literature. Surgical treatment is discouraged for florid COD, however, radiological follow-up is recommended, especially in lesions with associated cysts.

Diagnóstico de quiste dentígero en sacos foliculares de terceros molares incluídos

Objetivo: establecer el tipo de patología más frecuente asociada a terceros molares incluidos, extraídos en las clínicas de cirugía oral de la Facultad de Odontología de la Universidad Nacional de Colombia y la frecuencia de aparición de quistes dentígeros, rango de edad, sexo y la región anatómica en que predominan. Métodos: se revisaron 17 sacos foliculares de 11 pacientes atendidos en las clínicas de cirugía oral entre agosto del 2018 y febrero 2019. Resultados: se recolectaron 7 biopsias de 5 pacientes masculinos  y 10 de 7 pacientes femeninos, con edades comprendidas entre los 17 a 24 años (media: 20.40), se realizó estudio histopatológico con hematoxilina-eosina, los datos obtenidos se analizaron para determinar frecuencia, edad, sexo y patología asociada. Se encontraron 15 casos que mostraron cambios quísticos diagnosticados como quistes dentígeros y  2 casos diagnosticados como saco folicular. Conclusiones: aunque la muestra es pequeña, este estudio da indicios que los sacos foliculares asociados a terceros molares incluídos están  altamente implicados en la formación de quistes dentígeros.

Evaluación radiográfica de la estabilidad en medidas cefalométricas de pacientes Clase III sometidos a cirugía ortognática bimaxilar*

Objetivo: evaluar cefalométricamente en los planos sagital y vertical la estabilidad de pacientes con maloclusión clase III sometidos a cirugía ortognática bimaxilar. Métodos: estudio longitudinal en 20 pacientes (11 mujeres), con un promedio de 22.5 años y diagnóstico de hipoplasia del tercio medio facial y prognatismo mandibular, tratados con ortodoncia y cirugía ortognática bimaxilar. Se realizaron tres radiografías cefálicas laterales por cada paciente: una previa al procedimiento quirúrgico (T1), otra a los 8 meses posquirúrgicos (T2) y a los 18 meses posquirúrgicos (T3). Se evaluaron los cambios en el plano X y Y en los tres tiempos, realizando las pruebas estadísticas pertinentes con el fin de observar diferencias. Resultados: se encontraron medidas más estables en el maxilar superior en sentido vertical y sagital, mientras que la mandíbula es menos estable a los movimientos quirúrgicos, principalmente en sentido vertical (diferencias estadísticamente significativas p<0.05) Conclusión: la cirugía ortognática bimaxilar en casos de clase III es muy estable (especialmente en el maxilar); dicha estabilidad fue definida solamente con medidas cefalométricas, sin tener en cuenta variables como la función o las características clínicas de los pacientes.