Search Results (78)

Background: Dental eruption pathways could be influenced by several factors, both general and local, with different prevalence and morbidity. This study aims to report our experience of pediatric impacted teeth due to local factors, with the exclusion of the third molars, illustrating their prevalence, diagnostic and therapeutic pathways, and treatment outcomes. Methods: The inclusion criteria were minor age (<18 years) and the presence of impacted teeth due to a local cause, excluding wisdom teeth. The complete diagnostic and therapeutic procedures and their outcomes were described. The relationship between the treatment and the outcomes was assessed with a chi-square test. Results: One hundred twelve patients with a single impaction were included in the study. The local causes of single impaction were: 63 odontogenic cysts (57%), 24 supernumerary teeth (21%), 17 odontogenic tumors (15%), and eight primary bone lesions (7%). During the follow-up period, 83 teeth erupted spontaneously 12–36 months following surgery (74%), 12 were extracted during surgery (11%), and 17 needed orthodontic traction to achieve their aesthetic and functional position (15%). The relationship between mini-invasive surgery and spontaneous eruption was significant (p < 0.00001). Conclusions: Within the limitations of this study, mini-invasive surgical treatment preceded by a correct diagnosis may lead to a spontaneous eruption of permanent teeth, avoiding further orthodontic intervention and premature loss of permanent teeth. Full article

Background: Odontogenic cysts can damage the surrounding bone tissue as they grow, making it essential to implement effective regenerative strategies tailored to each patient. Personalised approaches in oral surgery, such as selecting the most suitable bone graft materials, can lead to improved treatment outcomes. Filling the bone defect created after cyst removal, root resection, or extraction with a bone graft material can stabilise the weakened tooth and promote faster bone regeneration. This article shares our experiences with the therapeutic effects of albumin-coated bone allograft (BoneAlbumin^®) placed in the bone defect following cyst removal in the oral cavity, compared to cases where the defect was left untreated (controls). Methods: The study involved thirty patients who underwent the removal of maxillary odontogenic cysts. In 15 of these patients, the bone defect was filled with albumin-coated bone allograft (BoneAlbumin^®, OrthoSera, Budapest, Hungary). In the control group, which consisted of 15 patients, the defect was left untreated. A consistent surgical protocol was adhered to throughout the study. Follow-up periapical X-rays were taken immediately after surgery as well as at 6 and 12 weeks post-surgery, using a standardised template. These images were used to assess the shrinkage and healing of the defect caused by the cyst. Measurements were adjusted to reference points to account for potential distortions in the X-rays. Results: The control and study groups exhibited no statistically significant differences in their basic parameters. Additionally, there was no notable difference in the sizes of postoperative defects between the two groups. However, statistical analysis revealed a significant difference in the changes in defect size (∆defect size) between the groups at both 6 weeks (p < 0.000001) and 12 weeks (p = 0.000296). This suggests that the BoneAlbumin^®-graft group experienced significantly greater changes in defect size over time. Conclusions: The use of BoneAlbumin^® graft leads to a markedly better reduction in defect size as time progresses, although these changes have only been compared to graft-free healing. Full article

Background: Periapical cysts are the most common odontogenic cysts, often resulting in large bone defects. Guided tissue regeneration techniques support tissue healing by means of membranes and bone grafts. The present case report evaluates for the first time clinical application of a resorbable magnesium membrane in guided bone regeneration (GBR) following cystectomy. Case report: A 35-year-old male patient presented with a large periapical cystic lesion in the maxillary anterior region. Treatment involved marsupialization followed by cyst enucleation and GBR using a resorbable magnesium membrane and bovine xenograft. The magnesium membrane served as a structural support to bridge the bony discontinuity in the palatal bone. Cone-beam computed tomography (CBCT) was used for diagnosis, treatment planning, and follow-up assessments. At 16 months post-treatment, CBCT imaging revealed significant bone regeneration, with restoration of the palatal contour and cortication of the palatal wall. Clinical examination showed asymptomatic teeth with normal mobility and optimal soft tissue healing. Conclusions: This case demonstrates the potential of resorbable magnesium membranes in managing large periapical defects, offering a promising alternative to traditional GBR materials by combining mechanical strength with complete resorption, therefore eliminating the need for membrane removal surgery. However, future studies on larger patient samples should focus on confirming the long-term outcomes of this approach and investigating patient-specific factors that are important in choosing effective treatment options. Full article

Gorlin-Goltz syndrome (GGS) is also known as Nevoid basal cell carcinoma syndrome (NBCCS). In the most common manifestation, GGS is diagnosed based on multiple cysts in the jaw bones, namely OKCs (odontogenic keratocysts). Other features might include major and minor clinical and radiological criteria to confirm this syndrome. Quite commonly, BCCs (basal cell carcinomas), bifid ribs, palmar and plantar pits, and ectopic calcification of the falx cerebri can be found in the majority of patients. Currently, the mutation of the PTCH1 gene seems to be responsible for GGS occurrence, while the male-to-female ratio is 1:1. The following radiological study based on OPGs and CBCT confirmed multiple cystic lesions in jaw bones, confirmed to be OKCs in the histopathological evaluation with an occurrence of numerous skin BCC lesions. In cases of most oral OKC cystic lesions, either surgical removal, curettage, or enucleation with or without any bone grafting can be used with a good amount of success. Rarely, some stable bone osteosynthesis procedures have to be carried out to avoid pathological bone fractures after cyst removal. A special consideration should include the temporomandibular joint. TMJ surgery and the replacement of the joint with an alloplastic material can be performed to improve biting, chewing, proper mouth opening, and maintain good patient occlusion. The authors want to present how effective and simple a standard dental panoramic radiograph combined with CBCT is and how it is suitable for GGS detection. They also want to underline how a standard TMJ prosthesis can be used as an alternative to a custom-made prosthesis. Full article

Background/Objectives: Odontogenic cysts are pathological cavities lined by cells arising from odontogenic epithelial cells, occurring mostly on the tooth-bearing areas of the jaws. It is common to find that the apices of the teeth around the cyst are within the cyst’s cavities due to its expansion. This study aims to assess the outcome of cyst enucleation on the associated teeth, specifically the latter’s responsiveness after cyst enucleation. Methods: This retrospective study examined a sample of patients who had been previously treated for odontogenic cysts from 1 January 2000 to 31 December 2021. A list of patients was obtained and included whether they met the imposed inclusion criteria. The data collected included the patients’ preoperative and postoperative electric pulp testing readings and their timings. Results: In total, 77 individual teeth from 19 patients were included after meeting the inclusion/exclusion criteria. Overall, 57 out of the 77 (74%) teeth were responsive following long-term follow-up. Among the 57 teeth with a positive response, 8 teeth were initially non-responsive and regained their responsiveness after a period of time. Pulp responsiveness recovery was seen even 300 days after surgery. Conclusions: It is not certain that a tooth with apices involved in a cyst cavity will be non-vital following enucleation. It is recommended that these teeth be reassessed for a minimum of 10 months postoperatively before proceeding with root canal treatment. Full article

Background/Objectives: Large cystic lesions in the maxillofacial region present a challenge for clinicians due to their impact on the health and functionality of the involved teeth. This longitudinal, ambidirectional cohort study aimed to evaluate the prognosis of vital teeth affected by large cystic lesions following surgical intervention. Methods: Data were gathered from patients at King Abdulaziz University Dental Hospital and King Fahad General Hospital in Jeddah, Saudi Arabia, between July 2021 and August 2022. Seventeen individuals with large jawbone cysts were included in the study. Clinical and radiographic assessments were performed including sensibility testing and the function of teeth. The results indicated a linear relationship between the size of postoperative bony defects and the sensibility testing of teeth. Results: Of the 63 examined teeth, 54% did not receive endodontic treatment, 33% had pre-surgical treatment, and 12.7% had post-surgical treatment. The study revealed a high prevalence of inflammatory cysts, particularly in the maxilla. Surgical enucleation was the primary treatment modality, with few postoperative complications. Conclusions: This study highlights the necessity for standardized follow-up protocols and more extensive research to develop universal guidelines for managing large cystic lesions affecting vital teeth. Understanding the prognosis of cystic lesions is crucial for effective treatment planning and ensuring optimal patient outcomes. Full article

Odontogenic cysts, commonly detected during routine examinations involving head and neck imaging such as orthopantomograms and computed tomography (CT), are classified into two groups: developmental and inflammatory. Radicular cysts, which belong to the inflammatory group, originate from odontogenic epithelium, while dentigerous cysts of developmental origin are observed as a result of peri-coronal expansion of fluid in the dental follicle. The diagnosis and identification of odontogenic cysts rely on clinical, radiographic, and histological evaluations. This study aimed to demonstrate the expression of Dlx-5 and HLX proteins in radicular and dentigerous cysts. A total of 40 radicular and 40 dentigerous cysts were obtained from patients who visited private oral and dental health clinics in Bingöl and Diyarbakır provinces. After undergoing routine histological procedures, the cysts were stained using Masson’s Trichrome and immunohistochemistry techniques. As a result, the epithelium of radicular cysts was found to be keratinized stratified squamous, with hyaline (Rushton) bodies located within the epithelium. Dentigerous cysts, on the other hand, consisted of non-keratinized stratified squamous epithelium, rete ridges with hyperplastic areas, and inflammatory cell infiltrations. The immunoreactivity induced by Dlx-5 in epithelial and connective tissue cells of radicular and dentigerous cysts was found to be stronger than that of HLX. The positive expression of Dlx-5 and HLX proteins in radicular and dentigerous cysts suggests that these proteins may play a potential role in the pathogenesis of these cysts. Furthermore, it was considered that the expression of Dlx-5 and HLX might help reveal the behavioral differences between odontogenic cysts. Full article

Objective: To determine the prevalence of oral and maxillofacial lesions among patients at King Abdulaziz University from January 2016 to December 2022. Methods: This cross-sectional observational study included patients diagnosed with oral and maxillofacial intra-bony lesions based on radiological findings and confirmed by histopathological examination. The lesions were classified according to the fourth edition of the World Health Organization Classification of Head and Neck Tumors. Results: This study included 237 patients with a mean age of 31.53 ± 14.97 years, of which 45.1% were female. Most patients (46.7%) had mandibular lesions, followed by maxillary lesions (35.9%). Only 2.95% of the tumors were malignant. Odontogenic cysts were the most prevalent (65.40%), with radicular cysts and keratocytes being the most common types. The most prevalent tumor types were odontoma and ameloblastoma. The most malignant lesion was multiple myeloma. Conclusions: Our findings reveal that mandibular cystic lesions predominated, and emphasize the low incidence of malignancy in the study population. They provide valuable insights into the oral and maxillofacial lesion landscape at a high-volume tertiary care center. Full article

Background and Clinical Significance: Among the odontogenic tumors, ameloblastoma is one of the most notorious, although it remains relatively rare, accounting for approximately one percent of all oral tumors. This neoplasm, derived from odontogenic epithelium, may arise from the developing enamel organ, epithelial cell rests of dental lamina, epithelial lining of odontogenic cysts, and basal cells of oral epithelium. This is a case presentation of a mural unicystic ameloblastoma, the most aggressive subtype and the one with the highest chance of recurrence. Case Presentation: A patient was referred by his dentist for root canal treatment at the Emergency Dental Clinic of Boston University. The patient complained of mandibular numbness. A panoramic radiograph was acquired, revealing a radiolucent lesion in the right mandible. Clinical examination detected a soft swelling perforating the buccal cortex in the area of #27–#30. A Cone-Beam CT (CBCT) was acquired in the Oral and Maxillofacial Radiology Clinic revealing a well-defined, partially corticated entity in the periapical area of teeth #27 through #30, with evidence of scalloping borders. The internal structure was unilocular and uniformly low-density. The entity caused interruption of the lamina dura of the associated teeth and inferior displacement of the inferior alveolar canal. Differential diagnoses included unicystic ameloblastoma (UA) and central giant cell granuloma as a second less likely diagnosis. An incisional biopsy was performed for further evaluation. Biopsy confirmed UA with mural involvement. Conclusions: UAs typically exhibit less aggressive behavior. However, cases like this one, where mural involvement is noted and no associated impaction is detected, underline the possibility of variable radiographic presentation and the significance of a multidisciplinary approach in correct diagnosis and treatment. Histological subtyping is crucial for guiding treatment. Full article

The objective of this study is to present an uncommon case of adenomatoid odontogenic tumor (AOT) with an impacted maxillary canine, initially mimicking a follicular cyst. AOT is a rare odontogenic tumor, accounting for approximately 1% to 9% of all odontogenic tumors. It primarily occurs in the maxilla and is often associated with an unerupted permanent tooth. Follicular cysts, also known as dentigerous cysts, are benign odontogenic cysts that encase the crown of an unerupted or impacted tooth. We describe a case of AOT occurring in a 14-year-old male. Both the follicular cyst and adenomatoid odontogenic tumor (AOT) can exhibit similar clinical and radiographic presentations. It is crucial to accurately differentiate between the two to ensure appropriate treatment and prognosis. Full article

Odontogenic cysts are frequently encountered in clinical practice. However, residual cysts, a specific type of inflammatory odontogenic cyst, are relatively rare. These cysts may slowly expand over time, damaging surrounding soft tissues and bone, typically without posing a threat to life. We report the case of a 67-year-old man with liver failure and a cystic tumor in his right maxilla that had invaded his oral cavity and cheek, causing nasal obstruction and severe bleeding following an incisional biopsy. A computed tomography (CT) scan of the mass was nonspecific, and an initial histopathological analysis of the tissues was inconclusive due to chronic inflammation and hemorrhagic alterations, complicating the diagnostic pathway. The suspicion of a potentially aggressive malignant neoplasm and the need for immediate intervention due to bleeding necessitated a tracheotomy, tumor removal, percutaneous endoscopic gastrostomy, and transfusions of red blood cells. A subsequent histopathological examination revealed features indicative of a residual cyst. The entire lesion was excised through functional endoscopic sinus surgery. The surgical treatment was performed safely and effectively. Follow-up CT confirmed complete removal of the lesion. This case highlights a rare yet possible complication of odontogenic cysts and underscores the necessity of early diagnosis and comprehensive prophylaxis to prevent severe complications. Full article

Background and Objectives: Dentigerous cysts are one of the most frequent pathologies associated with unerupted or impacted teeth. Such cysts show a male predilection and a preference for the mandibular region. Also, they commonly occur in the second and third decades of life, with only 9% occurring in the first decade. The aim of this work is to apply and study the therapeutic algorithms developed for dentigerous cysts and their outcomes, from the early diagnostic stage to the complete healing phase of pediatric patients diagnosed with this medical condition. Materials and Methods: The study included 19 pediatric patients diagnosed with dentigerous cysts who underwent the enucleation and extraction or conservative attitude of the associated tooth. The bony healing was also followed-up 9 months after the surgery. Results: A higher incidence in the posterior area of the mandible and maxilla was observed, as well as a higher incidence in boys. The 9 months postoperative radiographic assessment showed that the bony defects were completely healed. Conclusions: A thorough understanding of the nature of the lesion backed by a good clinical history and by state-of-the-art radiographic and radiologic examinations can go a long way in helping the surgeon to choose the correct therapeutic approach and to ameliorate the medical condition in the best long-term interest of the young patient. The considered dentigerous cyst cases demonstrated that an early diagnosis and treatment of this pathology is followed by a responsive treatment. Full article

Central retinal vein occlusion typically manifests in older individuals with underlying systemic pathology, leading to a spectrum of symptoms ranging from blurred vision to complete vision loss. While odontogenic infections are recognized for causing complications affecting the eye and vision, their potential role as an etiological factor in cases of sudden vision impairment merits consideration. This article presents a case involving central retinal vein thrombosis, wherein resolution was achieved through a combination of ophthalmic therapy and the surgical removal of a concurrently existing large inflamed odontogenic cyst located in the ipsilateral hemimaxilla. This case underscores the importance of recognizing odontogenic factors in the assessment of sudden vision impairment and the efficacy of a multidisciplinary therapeutic approach. Full article

Gingival cysts of the adult are rare and benign odontogenic lesions of the oral cavity, accounting for almost 0.3% of all odontogenic cysts. Their differential diagnosis is still challenging for surgeons as it includes other gingival inflammatory or non-inflammatory lesions and peripheral odontogenic tumors. The aim of this paper is to report a new case occurring in an adult, analyzing the clinical, radiographic, and histopathological features as guidelines for a differential diagnosis. We report a 49-year-old patient complaining of a small, pigmented lesion localized on the attached gingiva with no history of trauma, which was surgically excised and histologically diagnosed as a gingival cyst. A differential diagnosis may be challenging for clinicians it includes a wide spectrum of inflammatory and non-inflammatory lesions, so a correct diagnostical–therapeutical approach is needed to avoid possible overtreatment and minimize the recurrence rate. Full article

Objective: This systematic review investigates the diagnostic, prognostic, and therapeutic implications of immunohistochemical markers in dentigerous cysts (DCs) and odontogenic keratocysts (OKCs) associated with impacted third molars. Materials and Methods: A comprehensive search strategy was employed across major databases including MEDLINE/PubMed, EMBASE, and Web of Science, from the inception of the databases to March 2024. Keywords and Medical Subject Heading (MeSH) terms such as “dentigerous cysts”, “odontogenic keratocysts”, “immunohistochemistry”, “Ki-67”, and “p53” were used. The PRISMA 2020 guidelines were followed to ensure methodological rigor. Inclusion criteria encompassed studies on humans and animals providing definitive diagnoses or specific signs and symptoms related to DCs and OKCs, with results on protein expression derived from immunohistochemistry, immune antibody, proteomics, or protein expression methods. Results: Of the 159 studies initially identified, 138 met the inclusion criteria. Our analysis highlighted significantly higher expressions of Ki-67 (22.1% ± 4.7 vs. 10.5% ± 3.2, p < 0.001), p53 (15.3% ± 3.6 vs. 5.2% ± 1.9, p < 0.001), and Bcl-2 (18.4% ± 3.2 vs. 8.7% ± 2.4, p < 0.001) in OKCs compared to DCs, indicating a higher proliferative index, increased cellular stress, and enhanced anti-apoptotic mechanisms in OKCs. Additionally, PCNA levels were higher in OKCs (25.6% ± 4.5 vs. 12.3% ± 3.1, p < 0.001). Genetic mutations, particularly in the PTCH1 gene, were frequently observed in OKCs, underscoring their aggressive behavior and potential malignancy. Conclusions: The findings emphasize the significant role of immunohistochemical markers in distinguishing between DCs and OKCs, with elevated levels of Ki-67, p53, Bcl-2, and PCNA in OKCs suggesting a higher potential for growth and recurrence. Genetic insights, including PTCH1 mutations, further support the need for personalized treatment approaches. These markers enhance diagnostic accuracy and inform targeted therapeutic strategies, potentially transforming patient management in oral and maxillofacial surgery. Full article