Bone regeneration with plasma-rich-protein following enucleation of traumatic bone cyst

Traumatic bone cyst of mandible: a case series

BACKGROUND

A traumatic bone cyst is an uncommon nonneoplastic lesion of the jaws that is considered as a "pseudocyst" because of the lack of an epithelial lining. This lesion is particularly asymptomatic and therefore is diagnosed by routine dental radiographic examination as a unilocular radiolucency with scalloped borders, mainly in the posterior mandibular region. The exact etiopathogenesis of the lesion remains uncertain, though it is often associated with trauma.

CASE PRESENTATION

We report three Persian cases of traumatic bone cyst with different clinical and radiographic features, and we present a review of the literature to further discuss diagnostic and treatment challenges. Only one of the three patients reported a history of trauma, and despite the usual signs and symptoms of the lesion, extension of the defect to the ramus, swelling of the lingual cortex, and their unusual presence in the anterior mandible were noted in these patients.

CONCLUSIONS

Because features of this cyst can be varied, careful history taking and radiographic evaluation alongside the clinical signs and symptoms have a very significant role in definitive diagnosis, appropriate treatment, and accurate assessment of prognosis.

Immediate Insertion of Dental Implants Immediate Insertion in Bilateral Traumatic Bone Cysts With or Without a Bone Grafting Material: A 5-Year Follow-Up Case Report

This case report describes the rehabilitation of a patient who received dental implants in traumatic bone cyst areas (TBC). A 24-year-old male patient sought dental treatment for the bilateral absence of the mandibular second premolars. Radiographic examination revealed bilateral large radiolucent images in the mandible body. Surgical exploration confirmed the diagnosis of TBC. Rehabilitation with dental implants was performed using different approaches on each side. One cystic cavity was filled with blood clot and allogenic bone graft; the other was filled only with blood clot. After 5 years, the implants are osseointegrated and functioning. The filling of the traumatic bone cyst cavity with local blood clot in contact with the implant presented clinical and radiographic success similar to that obtained with filling with bone graft in the same patient. Thus, in this patient, the blood clot-only approach can be considered as a viable, safe-low cost alternative to blood clot and grafting material.

Comparison of the Efficacy of Three Different Bone Regeneration Materials: An Animal Study

Objective The proposed study aimed to evaluate and compare the bone regeneration between commercially available hydroxyapatite–β-tricalcium phosphate (Ossifi; Equinox, the Netherlands), powdered polylactic acid (powdered PLA; Sigma-Aldrich, United States), and three-dimensionally printed PLA (3D-printed PLA; Cubex, SC, United States) using 3D printer (Cube X trio) in an animal model.

Materials and Methods Eighteen New Zealand rabbits were divided into three groups with six animals each. Platelet-rich fibrin (PRF) was collected from the venous blood and preserved. Bone defect (4 mm × 2 mm) without disturbing the bone marrow was created and filled with bone graft material (group 1–Ossifi, group 2–powdered PLA, and group 3–3D-printed PLA), over which PRF membranes were placed. The graft material and the barrier were stabilized using resorbable sutures, and all the animals were maintained for 4, 8, and 12 weeks, after which they were euthanized, and bone samples were retrieved. Retrieved bone samples were subjected to radiological and histological analysis.

Results The radiographic and histological changes of 3D-printed PLA in comparison with other two materials (Ossifi and powdered PLA) seemed to have a significant difference.

Conclusion 3D-printed PLA scaffolds showed positive signs of bone regeneration around the material in continuity defects. PLA material can be a promising alternative bone regenerative material.

Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management

Bone replacement might have been practiced for centuries with various materials of natural origin, but had rarely met success until the late 19th century. Nowadays, many different bone substitutes can be used. They can be either derived from biological products such as demineralized bone matrix, platelet-rich plasma, hydroxyapatite, adjunction of growth factors (like bone morphogenetic protein) or synthetic such as calcium sulfate, tri-calcium phosphate ceramics, bioactive glasses, or polymer-based substitutes. All these substitutes are not suitable for every clinical use, and they have to be chosen selectively depending on their purpose. Thus, this review aims to highlight the principal characteristics of the most commonly used bone substitutes and to give some directions concerning their clinical use, as spine fusion, open-wedge tibial osteotomy, long bone fracture, oral and maxillofacial surgery, or periodontal treatments. However, the main limitations to bone substitutes use remain the management of large defects and the lack of vascularization in their central part, which is likely to appear following their utilization. In the field of bone tissue engineering, developing porous synthetic substitutes able to support a faster and a wider vascularization within their structure seems to be a promising way of research.

Dentigerous cyst in a young child

Dentigerous cyst is a type of odontogenic cysts and generally occurs in the ages of twenties or thirties. Dentigerous cyst always includes a tooth which cannot complete the eruption process and occurs around the crown by the fluid accumulation between the layers of enamel organ. In rare cases, dentigerous cyst occurs in the first decade of life and develops in an immature permanent tooth as a result of a chronic inflammation of overlying nonvital primary tooth. In this report, a case of dentigerous cyst in primary dentition in a 5-year-old child patient and its treatment were presented. The dentigerous cyst was totally enucleated, and the unerupted permanent first premolar tooth was removed from the primary mandibular right premolar region. There was no recurrence observed after 18 months follow-up.

Platelet preparations in dentistry: How? Why? Where? When?

The aim of this article is to review the outcomes of platelet preparations in dentistry. A structured electronic search discovered 348 articles, which described the use of autologous platelet concentrates with a relevance to clinical dentistry. Among these articles, 220 articles investigated platelet rich plasma, 99 investigated platelet rich fibrin, 22 investigated plasma rich in growth factors and 7 investigated the use of concentrated growth factors. Several studies reported beneficial treament outcomes in terms of enhanced bone and soft tissue regeneration.

Evaluation of intrabony defects treated with platelet-rich fibrin or autogenous bone graft: A comparative analysis

OBJECTIVE

The primary objective of this study was to compare clinically and radiographically the efficacy of autologous platelet rich fibrin (PRF) and autogenous bone graft (ABG) obtained using bone scrapper in the treatment of intrabony periodontal defects.

MATERIALS AND METHODS

Thirty-eight intrabony defects (IBDs) were treated with either open flap debridement (OFD) with PRF or OFD with ABG. Clinical parameters were recorded at baseline and 6 months postoperatively. The defect-fill and defect resolution at baseline and 6 months were calculated radiographically (intraoral periapical radiographs [IOPA] and orthopantomogram [OPG]).

RESULTS

Significant probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, defect fill and defect resolution at both PRF and ABG treated sites with OFD was observed. However, inter-group comparison was non-significant (P > 0.05). The bivariate correlation results revealed that any of the two radiographic techniques (IOPA and OPG) can be used for analysis of the regenerative therapy in IBDs.

CONCLUSION

The use of either PRF or ABG were effective in the treatment of three wall IBDs with an uneventful healing of the sites.

Treatment of lateral periodontal cyst with guided tissue regeneration

Lateral periodontal cyst (LPC), originated from epithelial rests in the periodontal ligament, is a noninflammatory cyst on the lateral surface of the root of a vital tooth. LPC is generally asymptomatic and presents a round or oval uniform lucency with well-defined borders radiographically. In this case report, clinical, histological and radiographical findings and periodontal treatment of 32-year-old female patient, who was referred to Department of Periodontology Clinic of Faculty of Dentistry, Marmara University with a painless hyperplastic lesion on the distobuccal site of the tooth number 12, were presented. The tooth number 12 was vital and a well-defined round radiolucent area with corticated borders was determined radiographically. Preliminary diagnosis was LPC based on clinical and radiographical findings. Mechanical periodontal treatment consisted of oral hygiene instructions, scaling and root planing was applied and flap operation was performed to gain access to the lesion. Following enucleation of the lesion, alveolar bone destruction shaped as a tunnel from labial to palatinal site was observed. The bone cavity was grafted with bovine-derived xenograft, followed by placement of a resorbable collagen membrane. Tissues removed from of the lesion were examined histologically. Hematoxylen-eosin stained sections showed vasculature granulomatous structure underlying squamous epithelium, and destructed bone spaces, all of which were consisted with LPC. Acceptable clinical healing was achieved at 6 months follow-up period. Satisfactory clinical and radiographical outcome can be achieved in the treatment of LPC using regenerative periodontal approach.