Conservative Management of Odontogenic Keratocyst in a Tertiary Hospital

Volumetric changes in the size of odontogenic keratocysts after decompression followed by enucleation, peripheral ostectomy, and Carnoy's solution: A retrospective study

The study aimed to retrospectively analyze the reduction pattern of odontogenic keratocysts (OKCs) after decompression, followed by enucleation (EN), peripheral ostectomy (PO), and Carnoy's solution (CS) to establish the appropriate time for inserting implants, along with assessing the long-term success of conservative treatment with adjunctive therapy. The predictable variables were the reduction pattern and the study's treatment option. The outcome variable was the volumetric changes in the size of bony defects. These changes were determined using a percentage difference and a reduction rate. They were recorded after decompression and one, three, six, twelve, and eighteen months after EN. P-values of .05 were considered significant. The study included 66 patients with 71 OKCs. Males, younger ages, and mandibular OKCs significantly predominated. The decompression significantly changed the initial volume from 135.40 ± 1.2 cm3 to 101.55 ± 0.1 cm3 with 28.6 percentage difference and 25% reduction rate. At the end of the first and third months after EN, the reduction pattern is 50.0%-75.5% of the initial volume, with no significant prediction for the direction of the reduction pattern. After 18 months, all bony defects disappeared, with no recurrences for the next 18 years. In conclusion, the reduction pattern is 75.5% of its initial volume at the end of the third month after OKC management. Therefore, within the limitations of the study, its treatment approach seems to be an option amongst other protocols that includes a view to early implant based dental rehabilitation.

Autologous bone marrow aspirate concentrate (BMAC) for treatment of keratocystic odontogenic tumour (KCOT)-a case report

Management of keratocystic odontogenic tumor (KCOT) has always remained a conundrum due to its aggressive behavior, indicating wide resection. Achieving an esthetically and functionally acceptable reconstruction remains a challenge. Herein, we present a novel and less invasive technique for the treatment of KCOT. A 55-year-old female presenting with pain in the lower jaw for the past 3 months was diagnosed with a large KCOT extending from 35 to 47 region. CT images revealed buccal and lingual cortical bone erosion. Management was done in two stages: cyst curettage and chemical cauterization, followed by application of Bone Marrow Aspirate Concentrate (BMAC) with a delay of two months, to increase the thickness of eroded cortical bone. On follow-up at one year, ossification of the defect was observed. BMAC is a cocktail of mesenchymal stromal cells, hematopoietic stem cells, fibroblasts, mononuclear cells, macrophages, endothelial cells, progenitor cells, growth factors and cytokines. BMAC cocktail provide an anti-inflammatory, anti-fibrotic, anti-apoptotic, and immunomodulatory environment. Autologous platelet rich plasma provides various growth factors (TGF-β, PDGF, EGF, HGF, NGF, IGF-1) and cytokines. Addition of PRP in BMAC cocktail enhance the regeneration of tissues, where PRP act as a functional regenerative scaffold for cell integration, proliferation, and differentiation that can expedite macroscale musculoskeletal tissue healing. Autologous BMAC with corticocancellous bone acts as an osteoconductive scaffold capable of regenerating the large bone defect created by the curettage of KCOT.