Presentation of a keratocystic odontogenic tumor with agenesis: a case report

Minocycline hydrochloride ointment combined with Vitapex paste is effective for middle-aged and elderly patients with combined periodontal-endodontic lesions

OBJECTIVE

This study was designed to determine the efficacy of minocycline hydrochloride ointment (MHO) combined with Vitapex paste on middle-aged and elderly patients with combined periodontal-endodontic lesions (CPELs) and its effect on the inflammatory factors.

METHODS

The data of 88 elderly patients with CPELs treated in the First Affiliated Hospital of Gannan Medical University from March 2020 to March 2022 were analyzed retrospectively. Among them, the patients treated with MHO and iodoform zinc oxide clove oil paste were assigned into the control group (n = 42) and the rest of the patients treated by MHO and Vitapex paste were assigned to the study group (n = 46). The inflammatory factors, periodontal indexes and efficacy were determined and compared between the two groups. The MOS 36-Item Short-Form Health Survey (SF-36) was adopted to evaluate the quality of life (QoL) of patients before and after treatment. Additionally, the adverse reactions of the two groups during treatment were analyzed and compared. The prognosis of the two groups of patients was analysed, and factors impacting their prognosis was analysed through the Logistic regression analysis.

RESULTS

Before treatment, the levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were not significantly different between the two groups (all P > 0.05), while after treatment, these levels in both groups decreased significantly, with notably lower levels in the study group than those in the control group (all P < 0.05). Before treatment, the gingival index (GI), plaque index (PLI), probing depth (PD) and bleeding index (BD) of the two groups were similar (all P > 0.05); however, after treatment, the levels of GI, PD, PLI and BI of both groups decreased significantly (all P < 0.05), with more notable decreases in the study group than those in the control group (all P < 0.05). The study group showed a significantly higher overall response rate than the control group (P < 0.05). Before treatment, the SF-36 scores of the two groups were not significantly different (P > 0.05), while after treatment, both groups had significantly increased SF-36 scores, and the score in study group was significantly higher than the control group (P < 0.05). In addition, the incidence of adverse reactions was not notably different between the two groups (P > 0.05). According to univariate analysis, age, dental lesion grade, course of disease, and persistent dull pain were the risk factors affecting the prognosis of patients. According to multivariate analysis, dental lesion grade was the independent risk factor affecting the prognosis.

CONCLUSION

MHO combined with Vitapex paste is effective for middle-aged and elderly patients with CPELs, which can effectively inhibit the patients' inflammatory reaction and improve their periodontal condition and QoL, with a low adverse reaction rate, so it is worthy of clinical promotion.

Prognostic Factors of Combined Periodontal and Endodontic Lesions: A Retrospective Study

Objective. This study used a retrospective method to explore the relevant factors affecting the prognosis of periodontal-endodontic combined lesions. Methods. According to the changes of subjective feelings and clinical indicators of affected teeth, selected patients were divided into an effective group and an ineffective group. The natural conditions (age, gender, and smoking status) of the patients and various clinical indicators at the initial and follow-up visits were collected, including the periodontal clinical indicators of the whole mouth and the clinical indicators of the affected teeth. The full-mouth periodontal clinical indicators include periodontal probing depth (PD), clinical attachment loss (CAL), sulcus bleeding index (SBI), and simplified oral hygiene index (OHI.S); clinical indicators of affected teeth include PD, CAL, SBI, mobility (TM), clinical crown-to-root ratio (CR), periapical index (PAI), and number of root canals. Results. There were 74 cases of endodontic combined treatment, with a total of 86 teeth. There was no significant difference in age and gender ratio between the effective group and the ineffective group, and the proportion of smoking patients in the ineffective group was significantly higher than that in the effective group $\left(P<0.05\right)$ . At the initial diagnosis, there was no significant difference in the clinical indicators of the whole mouth between the effective group and the ineffective group. After a combined endodontic treatment, the clinical indicators of the two groups were significantly improved $\left(P<0.01\right)$ . There was no significant difference in other periodontal clinical indicators between the two groups. Conclusion. The prognosis of nonsurgical treatment of periodontal and periodontal combined lesions is mainly correlated to the patient’s oral hygiene maintenance, as well as the loss of attachment, the degree of loosening, the clinical crown-to-root ratio, the periapical index, and the number of root canals.

Surgical removal of keratocystic odontogenic tumours via a Le Fort I osteotomy approach: a retrospective study of the recurrence rate

The keratocystic odontogenic tumour (KCOT) is one of the most aggressive odontogenic cysts and has a high recurrence rate. The treatment of these tumours is the subject of debate. A KCOT in the posterior maxilla with sinus involvement is rare. Few reports have been published in the literature. The purpose of this study was to evaluate the recurrence rate after surgical removal of maxillary KCOTs via a Le Fort I osteotomy. A search was performed to identify patients with a follow-up time of at least 5 years. Nine patients were included in the study. The following clinical variables were analyzed: age at surgery, sex, symptoms, site and size of the tumour, surgical approach, and recurrence rate. The surgical approaches were curettage (n=6) and enucleation (n=3). Recurrence was seen in three patients (33%); all had multilocular tumours. No recurrence was seen in patients with unilocular tumours. The Le Fort I osteotomy approach allows direct visualization and ensures wide excision, minimizing the risk of recurrence. In this series, cases with a multilocular KCOT showed a higher risk of recurrence due to the difficulty of removing the tumour in total. All recurrences took place within 2 years of the intervention; a 5-year follow-up is recommended.