Idiopathic bone cavity mimicking a botryoid odontogenic cyst: A rare radiographic presentation in an older adult

OBJECTIVES

This report describes an unusual case of a multilocular idiopathic bone cavity (IBC) that presented as a botryoid odontogenic cyst situated between the mandibular lateral incisor and canine in an older adult.

BACKGROUND

The IBC represents an intraosseous concavity that appears radiographically as a unilocular or multilocular radiolucent lesion found in various skeletal sites, including the jaw. Atypical cases of gnathic IBC have not been appreciated in the gerodontologic literature.

MATERIALS AND METHODS

The teeth adjacent to the bony lesion had normal pulpal responses to cold. A full-thickness flap was elevated and provided a direct entry into a bony concavity, which was devoid of an epithelial lining and fluid.

RESULTS

The lack of a cystic lining within the empty osseous lesion following surgical entry, concomitant with the vital pulpal status of the proximal teeth, led to a diagnosis of an IBC. The bony walls underwent curettage and copious irrigation prior to primary closure. A 10-month follow-up revealed partial evidence of osseous repair. The patient will continue to be monitored.

CONCLUSION

Timely surgical intervention of central lesions of the jaws may improve clinical outcomes. Variants of the IBC should be included in the differential diagnosis of multilocular lesions, particularly in the geriatric population.

Idiopathic Bone Cavity: Clinicopathologic Features from a Case Series with Emphasis on Differential Diagnosis of Chronic Apical Periodontitis

INTRODUCTION

Idiopathic bone cavity (IBC) is an uncommon bone lesion that usually affects youngsters as an unilocular radiolucency with predilection for the posterior mandible. Because the lesion is frequently located in proximity to the adjacent teeth, chronic apical periodontitis is commonly included as a differential diagnosis. The aim of the present study was to analyze the clinical and radiologic features of a series of IBCs diagnosed in a single service.

METHODS

All cases diagnosed as IBC were retrieved from the files of an oral pathology laboratory, and the clinical and radiologic characteristics were described with a focus on the differential diagnosis with chronic apical periodontitis.

RESULTS

Thirty cases composed the final sample. The mean age of the affected patients was 22 years old; there was no sex predilection, and most lesions were located on the posterior (47%) and anterior (43%) mandible. Most lesions presented as unilocular radiolucencies (87%), and 90% were located in close association with the adjacent teeth. The associated teeth presented no endodontic involvement, and all proved to be vital.

CONCLUSIONS

IBC usually affects young patients as an unilocular radiolucency in close association with the adjacent teeth. Careful radiologic analysis and vitality tests of the adjacent teeth are essential to rule out chronic apical periodontitis, thus avoiding any unnecessary endodontic treatment.

Does platelet-rich plasma enhance healing in the idiopathic bone cavity? A single-blind randomized clinical trial

The presence of an idiopathic bone cavity (IBC) is usually identified during routine dental radiographic examinations. The purpose of this study was to investigate the effect of platelet-rich plasma (PRP) on bone healing in the idiopathic bone cavity. This was a single-blind randomized clinical trial. Twenty-four subjects were assigned randomly to two groups. Subjects in group 1 received PRP through a buccal window approach, and those in group 2 underwent conventional management via the creation of a window on the buccal wall and curettage of the walls of the defect. Subjects were followed up at 3, 6, and 9 months after the intervention. The amount of bone formation as determined on panoramic radiographs was divided into four categories: stage 1: ≤25% of the defect showed opacity; stage 2: 25-50% of the defect showed opacity; stage 3: 50-75% of the defect showed opacity; and stage 4: >75% of the defect showed opacity. There was a significant difference between the two groups with regard to the various healing stages at the three time points (P<0.05). When compared with conventional management of the idiopathic bone cavity, the use of PRP may enhance bone formation.