Clinicopathological study of jaw cysts in southeast region of Turkey

Decompression-first or direct enucleation: The choice of treatment for medium-sized odontogenic jaw cysts

BACKGROUND

The treatment of medium-sized odontogenic jaw cysts is inconsistent at present. Two main treatments, namely decompression and enucleation, are used overlappingly. This retrospective analysis aims to provide useful references for technique selection for future management of medium-sized odontogenic jaw cysts.

METHODS

Odontogenic cysts with lesion sizes ranging 2-4 cm were included. The clinical and radiological data of the patients were reviewed. Decompression-first and direct enucleation treatments were the two main surgical techniques. The preoperative parameters and postoperative outcomes were compared between the two groups.

RESULTS

Out of 69 patients included, 40 (58 %) were in the decompression group and 29 (42 %) in direct enucleation group. The logistic regression analysis of preoperative parameters demonstrated that the maximum lesion size and the chief surgeon's preference could affect the selection of surgical techniques for medium-sized cysts (P < 0.05). Receiver operating characteristic curve analyses demonstrated that a lesion size >2.5 cm was the best cutoff value for predicting a decompression selection. Most postoperative outcomes differed significantly between the two groups (P < 0.05). Lower-risk anesthesia, shorter hospitalization, tooth function protection, and fewer neurosensory impairments were decompression-favoring outcomes. However, more follow-up visits, more postoperative X-rays, and longer postoperative care were outcomes against decompression. The recurrence rate was low and did not differ significantly between the two groups (P > 0.05).

CONCLUSIONS

There is no apparent preference for treating medium-sized jaw cysts. The maximum lesion size is a moderate-impact factor for treatment selection. A tendency to prefer decompression-first with larger lesion size was found in medium-sized jaw cysts. The advantages of teeth preservation and low neurosensory impairment of decompression were verified in the medium-size jaw cysts. The burden of postoperative care should be considered when selecting decompression.

Jaw Cysts: A Retrospective Study in a Turkish Subpopulation

Objectives: Cysts seen in the jaws may be odontogenic or non-odontogenic, depending on the tissue of origin. Although there are different methods to diagnose these lesions, histopathological examination of tissue biopsy of the lesion is accepted as the 'gold standard' in cases where the diagnosis is insufficient. Although there are different methods to diagnose these lesions, histopathological examination of tissue biopsy of the lesion is accepted as the 'gold standard' in cases where the diagnosis is insufficient. Materials and Methods: Pathology results of 436 patients who applied to Zonguldak Bülent Ecevit University Faculty of Dentistry, Oral and Maxillofacial Radiology Clinic between 2016-2021 for any reason and underwent biopsy were retrospectively scanned using digital archives. While classifying the cyst, the criteria published by the World Health Organization (WHO) in 2017 were taken into account. Obtained results were recorded for statistical analysis. SPSS 22.0 Software Package Program (SPSS 22.0 Software Package Program, Inc. Chicago, IL, USA) was used as statistical software in the study. Results: Of the 436 patients included in the study, 250 (57.3%) were male and 186 (42.7%) were female. The ages of the patients ranged between 7 and 82 years, and the mean age of the patients was 35.5±15.8. As a result of the findings, it was determined that the most common cysts were radicular cysts (53.7%). Radicular cysts were most commonly located in the posterior mandible and anterior maxilla anatomically. Conclusions: In addition to clinical and radiological examination, histopathological examination of biopsy samples taken from tissues is of great importance in the correct diagnosis and treatment planning of jaw cysts.

Functional denture obturator for marsupialization of residual cyst: A novel approach

In this report, we have introduced a novel technique for marsupialization treatment in a 50-year-old edentulous female patient with residual cysts in the mandibular bone. The clinical symptoms and para-clinical founding in addition to the surgical procedure and post-operative outcome have been discussed.

Treatment of Inflammatory Dentigerous Cyst Using a Surgical T Drain in a Child

Dentigerous cysts are rarely reported in young children. They are usually asymptomatic and only identified when becoming significantly large. Treatment by enucleation may damage structures like the inferior alveolar nerve, maxillary sinus, or permanent teeth, thus reducing the child's quality of life. Therefore, conservative surgical treatment such as decompression is indicated. This case report describes the treatment and subsequent complete regression of an inflammatory dentigerous cyst based on the decompression method using a customized surgical tube in a 10-year-old girl. The innervation was preserved, and permanent teeth erupted.

Epidemiological evaluation of jaw cysts according to the new WHO classification: a 30-year retrospective analysis

The aim of the present study was to analyze the epidemiology of maxillofacial odontogenic and non-odontogenic cysts diagnosed for 30 years in a Brazilian population. A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of a Brazilian referral center between 1989 and 2019. Data regarding age, gender, anatomical location, and histopathological diagnosis were collected and categorized. Further, a literature search for similar studies was performed. A total of 6.994 biopsy records were evaluated, but only 367 (5.24%) cases were classified as odontogenic cysts (OC) or non-odontogenic cysts (NOC). Among all cystic lesions, 341 cases (92.9%) were OC and 26 cases (7.1%) were NOC. These lesions were more common in females (n = 208 / 56.67%) and located mostly in the mandible (n = 195 / 53.1%). In patients with OC, the radicular cyst was the most frequent (n = 134 / 36.5%), followed by the dentigerous cyst (n = 101 / 27.5%) and the odontogenic keratocyst (n = 52 / 14.2%). Patients with NOC had a higher frequency of epidermoid cyst (n = 12 / 3.3%), oral lymphoepithelial cyst (n = 7 / 1.9%), and nasopalatine duct cyst (n = 4 / 1.1%). The OCs were more prevalent than NOCs, and inflammatory cysts were the most common among all the OCs.

Differential Expression of Claudin in Odontogenic Cysts

Objective  This study aimed to analyze claudin-1, -4, and -7 expression in different types of odontogenic cysts (odontogenic keratocysts [OKCs], dentigerous cysts [DCs], calcifying odontogenic cysts [COCs], and radicular cysts [RCs]) as well as its association with OKC recurrence.

Materials and Methods  Seventy samples of odontogenic cysts samples were immunohistochemically stained to detect claudin-1, -4, and -7 expression. Patient information and OKC recurrence data were recorded. The staining was analyzed semiquantitatively and categorized based on the pattern and percentage of positively stained cystic epithelial cells.

Statistical Analysis  Expression of different claudins between groups was analyzed using the Kruskal–Wallis test with Dunn's test, followed by post hoc pairwise comparison. The association between claudin expression and OKC recurrence was analyzed by the Mann–Whitney U test. Correlations among claudin expression were examined with Spearman's correlation coefficient. Level of significance was at p  < 0.005.

Results  Claudin-1 was widely expressed in every odontogenic cyst. Most DCs (50%) expressed claudin-1 in more than 75% of cells, as did RCs (65%), while most OKCs (50%) expressed claudin-1 in 26 to 50% of cells. Most COCs (50%) expressed claudin-1 in 51 to 75% of cells. Every sample of OKC and RC was positive for claudin-4, but no sample showed staining in more than 51% of cells. Every odontogenic cyst was positive for claudin-7. DCs (35%), OKCs (55%), and RCs (40%) mostly showed staining in 26 to 50% of cells. High claudin-1 expression was shown in COCs, DCs, and RCs, while low expression of claudin-4 was shown in every odontogenic cyst. For claudin-7, the expression is high only in COCs. Claudin-1 and -4 was significantly different among each odontogenic cyst. High expression of claudin-1 was correlated with OKC recurrence. The correlations of claudin-1 with claudin-7 expression and claudin-4 with claudin-7 expression were significant in DCs. In COCs, claudin-1 and claudin-7 expression was significantly correlated.

Conclusions  The expression of claudin-1, -4, and -7 was present in every odontogenic cyst, but the proportion of positive staining cells was different. Expression of claudin-1 is associated with OKC recurrence. Dysregulation of claudin expression may play a pathogenic role in cyst pathogenesis.

A Retrospective Study to Evaluate Biopsies of Oral and Maxillofacial Lesions

Background:

The clinical manifestations of these lesions comprises pain, paresthesia, swelling, drainage, tooth loss, root resorption, and facial deformity. Alteration in oral and maxillofacial (OMF) tissues of the lesions may cause esthetically and functionally unfavourable effects in patients.

Aims and Objectives:

To determine the frequency of odontogenic cysts, tumors, and other lesions.

Materials and Methods:

Patient's records of histopathological reports from the archives of the Department of Oral and Maxillofacial Pathology were obtained and reviewed over a period of 2 years, and therefore, the lesions were classified into four groups. In cases of recurrent lesions, only the primary diagnosis was considered. The research protocol was approved by the ethical committee of the institution.

Results:

About 56.4% of males had ameloblastoma, 54.9% of females had cementoma. 59.4% females had giant cell granuloma, 87.5% females had pyogenic granuloma, 77.2% females had osteoma, 65.1% of the female population were belongs to the benign fibro-osseous lesions and 50.2% of females were from fibrous dysplasia in group 3. About 58.8% females had squamous cell carcinoma in group 4.

Conclusion:

To adequately determine the prevalence and incidence rate of OMF lesions, biopsies performed by other specialists such as otolaryngologists and plastic surgeons in OMF regions should also be evaluated.

An observational retrospective study of odontogenic cyst´s and tumours over an 18-year period in a Portuguese population according to the new WHO Head and Neck Tumour classification

Background

Odontogenic cysts and tumours of the jaws represent one of the most prevalent groups of oral-maxillofacial lesions. We aimed to evaluate the clinical and pathological characteristics of a cohort of odontogenic cysts (OC) and odontogenic tumours (OT) of the jaws in a Portuguese population.

Material and Methods

This observational retrospective study analysed patients diagnosed with either an OC or OT of the jaws at a central hospital of Oporto, Portugal, between 1988 and 2006. Data collected from patients’ files included demographic, clinical, radiological and histopathological information. Recurrence was evaluated using univariate and multivariate analysis.

Results

The sample consisted of 397 patients, 231 males (58.2%) and 166 females (41.8%), with a mean-age of 36.7±17 years. Twenty-seven patients (6.8%) presented with more than one lesion providing a total of 433 lesions. There were 396 (91.5%) OC, mostly represented by radicular cysts (n=257;59.4%), dentigerous cysts (n=79;18.2%), or odontogenic keratocysts (n=50;11.5%). There were 37 (8.5%) OT, mostly represented by ameloblastomas (n=16;3.7%), and odontomas (n=9;2.1%). The most common initial clinical manifestation was swelling (n=224;51.7%). Recurrence was observed in 30 cases (6.9%), mostly in ameloblastomas (n=6;37.5%) and odontogenic keratocysts (n=12;24%). In the multivariate analysis the diagnosis classification of the lesion was the only independent and significant variable related with the recurrence (P=0.04).

Conclusions

Radicular cysts were the most commonly occurring type of OC and ameloblastomas the most commonly occurring OT. Amelobastomas and odontogenic keratocysts were the lesions with the highest rates of recurrence. This large sample provides useful information about the frequency profile and characteristics of OC and OT over a period of 18 years, allowing valuable comparison with data from other countries.

Key words:Odontogenic cysts and tumours, radicular cyst, dentigerous cyst, odontogenic keratocyst, ameloblastoma, recurrence.

Prevalence of odontogenic cysts and its associated factors in South Indian population

Background:

Odontogenic cysts (OCs) constitute a major part of oral pathological lesions, but little is known about their distribution patterns in various populations.

Aims:

The aim was to determine the prevalence and factors associated with the cases of histopathologically diagnosed OCs that report to our institution and to analyze the factors associated with the presence of OCs and to study the biologic behavior of different types of cysts.

Materials and Methods:

A cross-sectional study was performed on 596 oral and maxillofacial specimens during 2013–2017. Out of these, the cases which were histopathologically proven as OCs were separated and data were collected and analyzed regarding the age, gender, primary symptom, site, radiographic feature, histopathologic diagnosis, treatment given, recurrences and associated conditions if any.

Results:

Of the 596 cases included in the study, 67 (11.2%) had a histopathological diagnosis of OCs. 41 cases were inflammatory cysts and 26 developmental cysts. 28 cases (41.8%) were reported as periapical cysts, 10 cases (14.9%) were odontogenic keratocysts (OKCs), 9 cases (13.4%) were dentigerous cysts, 8 cases (11.9%) were inflamed cyst wall, 5 cases (7.5%) each of residual cyst and developmental OCs and one case (1.5%) each of orthokeratinized OC and calcifying OC.

Conclusion:

This study showed that the prevalence of OCs was similar to other reported studies. Periapical cysts were the most common cysts reported, followed by OKCs showing that the latter were more frequent than dentigerous cysts.

Evaluation of biopsies of oral and maxillofacial lesions: a retrospective study

Objectives

This study aimed to determine the prevalence of odontogenic cysts, tumors, and other lesions among reports in the archives of the Department of Oral and Maxillofacial Surgery at the Faculty of Dentistry affiliated with Kocaeli University collected over a four-year period.

Materials and Methods

In this retrospective study, patient records from the archive of the Department of Oral and Maxillofacial Surgery from 2014 to 2018 were reviewed. Patient demographic information (age and sex) and lesion location were recorded and analyzed.

Results

From a total of 475 files reviewed, odontogenic cyst was confirmed in 340 cases (71.6%), and odontogenic tumor was confirmed in 52 cases (10.9%). Regarding odontogenic cyst type, the most common was radicular cyst (216 cases), followed by dentigerous cyst (77 cases) and odontogenic keratocyst (23 cases). Among odontogenic tumors, the most frequent was odontoma (19 cases), followed by ossifying fibroma (18 cases) and ameloblastoma (9 cases). Giant cell granuloma was also reported in 35 cases.

Conclusion

The distribution pattern of odontogenic cysts and tumors in our retrospective study is relatively similar to that reported in the literature. Complete clinical reports for final diagnosis of these lesions and routine follow-up examinations are very important for treatment.

Comparative analysis between developmental and inflammatory odontogenic cysts: retrospective study and literature review

PURPOSE

To assess epidemiological, clinical, and radiographic characteristics of odontogenic cysts (OCs) in a South Brazilian sample and to compare the results with international literature.

METHODS

For the main study purposes, biopsy and histopathological records were retrospectively analyzed from December 2006 to December 2018, OC cases were selected, and data about clinical characteristics were evaluated. Further, a literature review was performed for similar studies.

RESULTS

In the main study, the prevalence of OCs was 11.26% (n = 406), the majority of patients was male (56.73%), and the mean age was 39 ± 17.33 years. Radicular cyst was the most common OC (46.06%), followed by the odontogenic keratocyst (15.02%), dentigerous cyst (14.04%), and paradental cyst (13.55%). Inflammatory OCs were more prevalent in the maxilla (54.84%) and developmental cysts in the mandible (69.92%) (p < 0.05). Individuals with inflammatory OCs were usually older (41.0 ± 15.34 years) than the ones with developmental OC (28.0 ± 19.68 years) (p < 0.05). Regarding the literature review, 22 articles were included. Analysis of pooled data showed that global prevalence of OCs was 11.62% (95%CI = 9.97-13.37), from which radicular cyst was the most common (54.26%; 95%CI = 49.30-59.18), followed by dentigerous cyst (22.94%; 95%CI = 19.22-26.89) and odontogenic keratocyst (11.99%; 95%CI = 8.88-15.49). Furthermore, studies from Asia (72.40%; 95%CI = 70.30-74.40) and South America (68.48%; 95%CI = 64.07-72.72) presented the highest frequencies of inflammatory OCs.

CONCLUSION

The main study showed that the prevalence of OCs was 11.26%, which corroborates with international literature. Considering geographic variability of OC distribution, public health authorities and researchers could use these data for the development of focused prevention interventions, especially with regard to inflammatory OCs.

A Clinical, Radiographic and Histological Study of Unerupted Teeth in Dogs and Cats: 73 Cases (2001-2018)

Lack of dental eruption may be accompanied by development of dentigerous cysts and has also been rarely associated with neoplasia. However, little information is available on prevalence of unerupted teeth and associated lesions in dogs and cats. The main objective of this study was to describe the epidemiologic data of canine and feline dental patients with unerupted teeth, and assess the prevalence of associated dentigerous cysts and tumors. Secondary aims included the evaluation of possible factors implicated in cystic development, and description of the histological features of dentigerous cysts. Medical and dental records, intraoral photographs, intraoral radiographs of client-owned dogs and cats with clinically missing teeth examined between 2001 and March 2018 were reviewed. Collected data included signalment, reason for presentation, number, type, depth of inclusion and angulation of unerupted teeth, presence of cystic lesions or tumors, abnormalities affecting involved teeth, histopathological findings, performed treatment and outcome. Seventy-three animals (69 dogs and 4 cats) with 113 unerupted teeth were included. The most frequent unerupted tooth in dogs was the first premolar teeth (78%), followed by the canine and third molar teeth. Dentigerous cysts were diagnosed associated with 48 (44.4%) teeth in dogs and one out of five unerupted teeth in cats. The affected teeth in dogs were predominantly in horizontal inclination (40%) and in soft tissue inclusion (77%). Brachycephalic canine breeds were overrepresented. The only unerupted tooth in boxer dogs was the first premolar tooth (32 teeth). Ninety percentage of boxers with unerupted teeth developed associated lesions (25 dentigerous cysts and one tumor). Two ameloblastomas (one in a dog and one in a cat) and one osteosarcoma (in a dog) were diagnosed in association with three unerupted teeth. Histology was essential in diagnosing two odontogenic cysts not evident on radiographs. In all cases that were followed-up, treatment (i.e., extraction, extraction and surgical curettage, or operculectomy) appeared successful. Untreated dentigerous cysts showed progression at re-examination. None of the unerupted teeth without evidence of cyst at the time of diagnosis showed incipient cystic development. None of the evaluated factors were associated with lack of eruption and/or development of associated lesions.

Angiogenesis in odontogenic keratocyst and dentigerous cyst: Evaluation of JunB and VEGF expression

BACKGROUND

Nowadays, different clinical behaviors of odontogenic cysts, little information about their biological agents, importance of diagnosis, and early diagnosis of these lesions have encouraged the researchers to conduct new studies. JunB acts as a regulator of vascular endothelial growth factor (VEGF) protein production and affects vessel proliferation and tissue angiogenesis. Hence, this study was conducted to compare angiogenesis through VEGF and JunB expression in odontogenic keratocysts (OKCs) and dentigerous cysts (DCs).

MATERIALS AND METHODS

A total of 25 paraffin blocks of OKCs and 25 DCs were included in this experimental descriptive cross-sectional study, and immunohistochemical expression of VEGF and JunB was evaluated. Percentage and score of expression were recorded for each sample, and independent t-test, Mann-Whitney U, and Spearman statistical tests were run to analyze the data. The statistical significance level was set at <0.05.

RESULTS

From 50 studied samples, 39.6% belonged to women and 60.4% belonged to men, with mean age of 34.2 ± 1.7 years. The mean percentages of JunB expression were 52.88 ± 17.35 and 74.6 ± 18.55 for DC and OKC samples, respectively. This expression was significantly higher in OKC than DC, and it had significantly higher scores as well (P = P = 0.0001 and 0.00033, respectively). The means of VEGF were 20.2% ±11.86 and 52.6% ±19.98 in DC and OKC samples, respectively. The mean VEGF expression was significantly higher in OKC than DC (P = 0.045), and it had significantly higher scores, too (P = 0.000). Furthermore, there was a significant correlation between VEGF and JunB expression in the studied samples (r_s = 0.3 and P = 0.005).

CONCLUSION

Based on the results of this study, it seems evaluation of angiogenesis through JunB expression can be helpful in the prediction of more aggressive behavior in pathologic lesions such as OKC.

The effectiveness of decompression as initial treatment for jaw cysts: A 10-year retrospective study

Background

Decompression is an approved alternative to cystectomy in the treatment of jaw cysts. This study aimed to evaluate its effectiveness as an initial procedure, as well as factors with potential to influence outcome.

Material and Methods

The frequency of decompression was analysed, whether completed in one session or followed by enucleation at the Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, from 2005 to 2015. Further analysis focussed on factors potentially influencing outcome: cyst location, histopathology, means of preserving the cyst opening, cyst size, patient age.

Results

In all, 53 patients with 55 jaw cysts (mean age of 35.1) were treated by initial decompression in the ten-year period. In the majority of cases, histopathological analysis revealed a follicular cyst (43.6%), followed by odontogenic keratocysts (23.7%), radicular cysts (21.8%), residual cysts (7.3%) and nasopalatine cysts (3.6%) Treatment was completed with a single decompression in 45.5% of the cases. Among those, 72.0% were follicular cysts and 8.0% odontogenic keratocysts. Subsequent enucleation was needed in 54.5% of all cases, with a majority in the keratocystic group (36.7%). Histological findings, means of keeping the cyst open, and patient age were found to influence the effectiveness of decompression.

Conclusions

Decompression could be performed as a procedure completed in one session or combined with subsequent enucleation, mainly dependent on histopathological findings. Subsequent enucleation of odontogenic keratocysts is highly recommended.

Key words:Jaw cysts, decompression, enucleation, histopathology, obturator.

Management of Large Residual Cyst in Elderly Patient with Decompression Alone: Case Report

Background/Aim:Residual cysts comprise approximately 10% of all odontogenic cysts. They are more commonly seen in 4th-6th decades of life, and occur due to incomplete previous surgical removal of a radicular cyst; or due to left epithelial remnants stimulated by tooth extraction. These lesions are often treated with enucleation. However, this procedure is not always the ideal treatment solution for elderly people due to the presence of physical and mental disorders, and risk of jaw fracture.

Case Report: In this case report, the successful treatment of a large residual cyst in the symphysis of a 93 year-old female patient by performing decompression alone is presented. A plastic drain was placed on the wall of the cyst to allow irrigation. Regeneration was observed in the cyst cavity 3 months after surgery. The 1-year follow up showed that the majority of the cyst cavity was filled with new bone.

Conclusions: In elderly patients, large inflammatory cysts can be successfully treated with decompression considering the limited regeneration capacity and difficulties in follow-up.

Epidemiologic study of odontogenic and non-odontogenic cysts in children and adolescents of a Brazilian population

BACKGROUND

the objective of this study was to describe the frequency of cystic lesions in a Brazilian population of patients histopathologically diagnosed in the first and second decade of life.

MATERIAL AND METHODS

Retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of a Brazilian referral center between 1980 and 2016.

RESULTS

A total of 2.114 biopsy records of pediatric patients were analyzed with oral and maxillofacial lesions. Data such as gender, age, anatomical location, and histopathological diagnosis were collected and categorized. Among all oral and maxillofacial lesions (n=2.114), were diagnosed 294 cases of odontogenic cysts (13.9%) and 16 cases of non-odontogenic cysts (0.8%). The most frequent lesions in each group were, respectively: radicular cyst (n=145) and epidermoid cyst (n=4). These lesions were most common in female (n=158), with a mean age of 14 years. For intraosseous lesions, the mandible (n=148) was the most affected anatomic site; moreover, the floor of the mouth (n=6) was most affected by cysts in soft tissues.

CONCLUSIONS

Odontogenic cysts were relatively common in population studied, but non-odontogenic cysts were rare in these patients.

Ability of Oral and Maxillofacial Surgery Residents in Diagnosing Jaw Cysts: A Retrospective 20 Years Study

INTRODUCTION

Diagnosis of odontogenic cysts despite of their benign nature is a critical and challenging problem especially among undergraduate and postgraduate students.

AIM

This study aimed to evaluate the capability of oral and maxillofacial surgery residents in diagnosing odontogenic cysts.

MATERIALS AND METHODS

This cross-sectional study was executed on 312 patient records over the past 20 years since October 1995 till December 2014 in Taleghani Hospital, Tehran, Iran. All recorded data was based on 2005 World Health Organization (WHO) classifications. The differential diagnosis was made by 65 residents based on clinical and paraclinical evaluations established in the charts. Differential diagnoses made by the residents were compared to the histopathological examination as the gold standard for identifying the nature of the cysts. Weighted kappa test was used to show the degree of agreement.

RESULTS

Data extracted from 312 records were analyzed. The mean age of examined patients was 27.6 years. The accuracy of diagnosis among the residents was moderate (k_w=0.5). The diagnosis made by the residents was significantly related to the radiographic view of the cysts (p<0.05). The residents were able to identify odontogenic keratocysts and dentigerous cysts in most cases.

CONCLUSION

There are several factors associated with the occurrence of pathologic odontogenic cysts which could help either the clinician or the pathologist in diagnosing the odontogenic cysts of the jaws. The surgeons should consider these related factors before the final diagnosis and choosing the appropriate treatment plan.

Clinical and radiological analysis of a series of periapical cysts and periapical granulomas diagnosed in a Brazilian population

BACKGROUND

Periapical cysts (PC) and periapical granulomas (PG) are the two most common chronic inflammatory periapical diseases, but their clinicoradiological characteristics can vary depending on the methods employed in each study. The aim of the present work was to analyze the clinical and radiological profile of a series of PC and PG diagnosed in a Brazilian population.

MATERIAL AND METHODS

The files of two Oral Pathology laboratories were reviewed and all cases diagnosed as PG and PC were selected for the study. Clinical and radiological information were retrieved and data were tabulated and descriptively and comparatively analyzed.

RESULTS

Final sample was composed by 647 inflammatory periapical lesions, including 244 PG (38%) and 403 PC (62%). The number of women affected by PG was significantly higher than the number of women affected by PC (p=0.037). Anterior region of the maxilla was the most common affected area for both entities (39% of the cases), but the most common anatomical location of PG (anterior maxilla and posterior maxilla) was different from PC (anterior maxilla and posterior mandible) (p<0.0001). Upper lateral incisor was the most affected tooth. The mean radiological size of the PC was larger than the mean radiological size of the PG (p<0.0001) and PC showed well-defined radiological images more frequently than PG (p<0.0001).

CONCLUSIONS

PC were more common than PG, both showed predilection for adult females, most lesions affected predominantly the anterior maxilla and PC presented larger mean radiological diameter and well-defined images when compared with PG. Key words:Periapical granuloma, periapical cyst, radicular cyst, diagnosis, Oral Pathology.

Value of Magnetic Resonance Imaging for Diagnosis of Dentigerous Cyst

Odontogenic cysts have a high prevalence in the dental clinic population, with dentigerous cyst being one of the most frequent ones and whose aetiology involves accumulation of fluid between the reduced enamel epithelium and the crown of an unerupted tooth. In the diagnostic process of these lesions, one should consider complementary imaging exams such as conventional radiography and computed tomography, which are commonly used for providing anatomical information on the tissues compromised by the lesion, but not on the nature of it. Magnetic resonance imaging (MRI) scans are noninvasive modalities which, due to their unique acquisition characteristics, can provide distinct information on the nature of the lesion. This study reports on a case of dentigerous cyst in the mandible of a 9-year-old patient, documented by means of different imaging modalities. MRI played an important role in both diagnosis of the lesion and differential diagnosis between neoplastic lesions presenting similar imagenological behaviour under other techniques of radiography.

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.

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.