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Dental and Medical Problems 2019Based on a literature review, we analyzed the World Health Organization (WHO) classification and the treatment algorithm for the odontogenic keratocyst (OKC), formerly...
Based on a literature review, we analyzed the World Health Organization (WHO) classification and the treatment algorithm for the odontogenic keratocyst (OKC), formerly referred to as keratocystic odontogenic tumor (KCOT). The KCOT reclassification from benign odontogenic tumors to odontogenic developmental cysts resulted from the emergence of new evidence regarding their morphogenesis and biological behavior. The authors of the most recent 2017 classification do not provide specific guidelines for OKC. Nevertheless, it has been observed that conservative surgical management is not necessarily associated with recurrences characteristic of neoplastic disease. The aim of this paper was to present the effective management strategy for a local recurrence that developed following conservative OKC enucleation in a 53-year-old patient. The treatment for recurrence consisted of enucleation, marginal osteotomy and augmentation with a cancellous bone graft harvested from a tibial tuberosity. A 6-year observation period (clinical and radiological monitoring) revealed normal bone regeneration and no evidence of recurrence. The algorithm applied in our center for the treatment of OKC/KCOT was compared with the management strategies proposed by other authors.
Topics: Humans; Mandible; Middle Aged; Neoplasm Recurrence, Local; Odontogenic Cysts; Odontogenic Tumors; Radiography
PubMed: 31689015
DOI: 10.17219/dmp/110682 -
BMC Oral Health Apr 2021A dentigerous cyst (DC) is a pathology embracing the crown of an unerupted tooth at risk of malignant transformation. The causal tooth is usually removed together with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A dentigerous cyst (DC) is a pathology embracing the crown of an unerupted tooth at risk of malignant transformation. The causal tooth is usually removed together with the cyst. However, if there are orthodontic contraindications for extraction, two questions arise. (1) Which factors favor spontaneous eruption? (2) Which factors imply the necessity of applying orthodontic traction? This systematic review aimed to identify factors conducive/inconducive to the spontaneous eruption of teeth after dentigerous cyst marsupialization.
METHODS
In accordance with the PRISMA guidelines, the main research question was defined in the PICO format (P: patients with dentigerous cysts; I: spontaneous tooth eruption after surgical DC treatment; C: lack of a spontaneous tooth eruption after surgical DC treatment; O: determining factors potentially influencing spontaneous tooth eruption). The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for keywords combining dentigerous/odontogenic/follicular cysts with teeth and/or orthodontics, as well as human teeth and eruption patterns/intervals/periods/durations. The following data were extracted from the qualified articles (4 out of 3005 found initially): the rate of tooth eruption after surgical treatment of the cyst, the age and sex of the patients, the perpendicular projection distance between the top of the tooth cusp and the edge of the alveolar process, tooth angulation, the root formation stage, the cyst area, and the eruption space. The articles were subjected to risk of bias and quality analyses with the ROBINS-I protocol and the modified Newcastle-Ottawa QAS, respectively. Meta-analyses were performed with both fixed and random effects models. The GRADE approach was used to evaluate the quality of the evidence. The systematic review was registered in PROSPERO under ID CRD42020189044.
RESULTS
Nearly 62% of DC-associated premolars erupted spontaneously after cyst marsupialization/decompression. Young age (mean = 10 years) and root formation not exceeding 1/2 of its fully developed length were the factors likely to favor spontaneous eruption.
CONCLUSION
The small number of published studies, as well as their heterogeneity and the critical risk of bias, did not allow the creation of evidence-based protocols for managing teeth with DC after marsupialization. More high-quality research is needed to draw more reliable conclusions.
Topics: Bicuspid; Child; Dentigerous Cyst; Humans; Tooth Eruption; Tooth, Impacted; Tooth, Unerupted
PubMed: 33827533
DOI: 10.1186/s12903-021-01542-y -
Medicine Dec 2019The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with... (Review)
Review
INTRODUCTION
The odontogenic keratocyst (OKC), previously known as keratocystic odontogenic tumor has been the most disputable pathologies of the maxillofacial region. Patients with OKC are often asymptomatic but may present with pain, swelling, or discharge. Despite the aggressive nature, previous literature as early as 1970s reported the fact that parakeratinized OKC can be treated by means of marsupialization alone.
PATIENTS CONCERNS
The patient had reported with a complaint of pain and swelling in relation with a tooth in mandibular right quadrant.
DIAGNOSIS
This case report discusses features of a rare, extensive, panmandibular OKC that is only second of its kind mentioned in the literature.
INTERVENTION
As a usual treatment protocol, marsupialization was attempted first. Immunohistochemical analysis revealed reduced expression of Ki-67 and B cell lymphoma 2 (bcl-2) markers after marsupialization from 2 separate sites. However, due to incomplete resolution in the lower right anterior region, an aggressive approach was taken by curetting it out surgically along with associated teeth and cortical plate followed by application of Carnoy's solution.
OUTCOME
Postsurgery uneventful healing of the lesion was noted on regular follow-up visits with complete resolution at 40 months. The case has been followed for 10 years with no sign of relapse and reoccurrence.
CONCLUSIONS
Based on the expression of markers it can thus be concluded that Ki-67 and bcl-2 are site specific and bear strong relationship with the recurrence of OKCs.
Topics: Adult; Biopsy, Needle; Dentistry, Operative; Female; Follow-Up Studies; Humans; Immunohistochemistry; Mandibular Diseases; Odontogenic Cysts; Preoperative Care; Radiography, Dental; Rare Diseases; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome
PubMed: 31860950
DOI: 10.1097/MD.0000000000017987 -
Brazilian Dental Journal 2021The aim of this study was to assess and compare RANK, RANKL, and OPG immunoexpression in dentigerous cyst, odontogenic keratocyst, and ameloblastoma. The protocol was... (Meta-Analysis)
Meta-Analysis
The aim of this study was to assess and compare RANK, RANKL, and OPG immunoexpression in dentigerous cyst, odontogenic keratocyst, and ameloblastoma. The protocol was registered in PROSPERO (CRD42018105543). Seven databases (Embase, Lilacs, LIVIVO, PubMed, Scopus, SciELO, and Web of Science) were the primary search sources and two databases (Open Grey and Open Thesis) partially captured the "grey literature". Only cross sectional studies were included. The JBI Checklist assessed the risk of bias. A meta-analysis with random effects model estimated the values from the OPG and RANKL ratio reported by the individual studies and respective 95% confidence intervals. The heterogeneity among studies was assessed with I2 statistics. Only nine studies met the inclusion criteria and were considered in the analyses. The studies were published from 2008 to 2018. Two studies presented low risk of bias, while seven studies presented moderate risk. The meta-analysis showed the highest OPG>RANKL ratio for dentigerous cyst (ES=43.3%; 95% CI=14.3-74.8) and odontogenic keratocyst (ES=36.8%; 95% CI=18.8-56.7). In contrast, the highest OPG
odontogenic epithelial region. The results may explain the aggressive potential of ameloblastoma from the higher OPG cyst and odontogenic keratocyst. Topics: Ameloblastoma; Cross-Sectional Studies; Dentigerous Cyst; Humans; Odontogenic Cysts; Odontogenic Tumors
PubMed: 33913997
DOI: 10.1590/0103-6440202103387 -
Analytical Cellular Pathology... 2018Growth factors like bone morphogenetic protein 4 (BMP4) and fibroblast growth factor 8 (FGF8) play a major role in organogenesis and specifically in odontogenesis. They...
Growth factors like bone morphogenetic protein 4 (BMP4) and fibroblast growth factor 8 (FGF8) play a major role in organogenesis and specifically in odontogenesis. They are also believed to have a role in oncogenesis. Thus, any discrepancies in their standard behavior and activity would lead to serious abnormalities including odontogenic cyst and tumors. The present research work investigated the expression of BMP4 and FGF8 in odontogenic tumors (OT) and cyst as well as developing tooth germs to elucidate their roles. Dental organs of various odontogenic stages and 30 OTs including solid multicystic ameloblastomas (SMA, 10 cases), ameloblastic fibroma (AF, 10 cases), odontogenic myxoma (OM, 10 cases), and odontogenic cysts: odontogenic keratocyst (OKC, 10 cases) were evaluated in both epithelial and mesenchymal components for the expression of BMP4 and FGF8 using immunohistochemistry. The epithelial nuclear expression of BMP4 was highest in OKC (9 cases) while FGF8 was highest in SMA (10 cases). The mesenchymal nuclear expression of both BMP4 (8 cases) ( = 0.001) and FGF8 (9 cases) ( = 0.045) were significantly high in OMs among all OTs. Both growth factors were actively expressed in different stages of tooth development. The expression of BMP4 and FGF8 corelates well with the proliferative component of the pathologies, indicating a possible role in the pathogenesis and progression.
Topics: Ameloblastoma; Bone Morphogenetic Protein 4; Cell Nucleus; Fibroblast Growth Factor 8; Humans; Immunohistochemistry; Mesoderm; Myxoma; Odontogenic Cysts; Odontogenic Tumors
PubMed: 30079292
DOI: 10.1155/2018/1204549 -
Cureus Dec 2021The glandular odontogenic cyst (GOC) is a rare odontogenic cyst that can develop in the maxillofacial region with aggressive behavior. It tends to develop into enormous...
The glandular odontogenic cyst (GOC) is a rare odontogenic cyst that can develop in the maxillofacial region with aggressive behavior. It tends to develop into enormous proportions with high recurrence rates. The mandibular anterior area is the common site of occurrence of GOC, and it appears as an asymptomatic slow-growing swelling. GOC mimics other odontogenic cysts and tumors both clinically and radiographically, thus posing difficulty in diagnosis. Due to the aggressive potential of GOC, precise diagnosis and prompt treatment are crucial. Both conservative and aggressive surgical therapies have been advocated for GOC with a preference for aggressive therapy due to its high potential for recurrence. In this report, we present a case of GOC of the mandible in an adult female patient, which was successfully treated by segmental resection and primary reconstruction with stainless steel recon plate with uneventful healing during the one-year postoperative follow-up period.
PubMed: 35106238
DOI: 10.7759/cureus.20701 -
Diagnostic Pathology Apr 2019Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst which was considered in the past to be a variant of Odontogenic keratocyst (OKC) later...
BACKGROUND
Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst which was considered in the past to be a variant of Odontogenic keratocyst (OKC) later renamed as keratocystic odontogenic tumor (KCOT). The treatment of OOC is by enucleation and the prognosis, following enucleation is excellent with a recurrence rate of less than 2%. On the other hand, OKC has a recurrence rate between 8 and 25% after enucleation. Thus it is important to differentiate between the two entities.
METHODS
All cases reported in our section as OOC during the period 2013 to 2018 were retrieved from the surgical pathology files and slides were reviewed by the authors. All cases which met the histological criteria for OOC were included.
RESULTS
A total of 10 cases were included. 70% patients were males, ages ranged from 23 to 60 years, with mean age of 38.9 years. 70% of cases were located in the mandible and 90% patients presented with swelling. Radiologically, 90% cases were unilocular, all were radiolucent lesions. Mean size was 4.0 cm. Histologically, all cases demonstrated the classic microscopic features. Follow-up was available in 8 patients. All were treated by enucleation. All 8 were alive with no recurrences over a follow-up period ranging from 7 to 62 months.
CONCLUSIONS
OOC has a better prognosis than OKC and needs to be differentiated from OKC due to differences in treatment and prognosis. Large majority of our cases presented with swelling and occurred in the mandibles of young males. All were radiolucent and most were unilocular. All were treated by enucleation and no recurrences occurred over follow up period ranging up to 62 months. Our findings were similar to those described in other published series.
Topics: Adult; Female; Humans; Male; Middle Aged; Odontogenic Cysts; Odontogenic Tumors; Radiography; Young Adult
PubMed: 30947718
DOI: 10.1186/s13000-019-0801-9 -
Head and Neck Pathology Mar 2023Cystic lesions of the gnathic bones present challenges in differential diagnosis. This category includes a smorgasbord of odontogenic and non-odontogenic entities that... (Review)
Review
BACKGROUND
Cystic lesions of the gnathic bones present challenges in differential diagnosis. This category includes a smorgasbord of odontogenic and non-odontogenic entities that may be reactive or neoplastic in nature. While most cystic jaw lesions are benign, variability in biologic behavior makes distinction between these entities absolutely crucial.
METHODS
Review.
RESULTS
Two clinical cases are presented in parallel and are followed by an illustrated discussion of the ten most likely differential diagnoses that should be considered when confronted with a cystic jaw lesion. Strong emphasis is placed on the histologic differences between these entities, empowering readers to diagnose them with confidence. Perhaps even more importantly, the more common diagnostic pitfalls in gnathic pathology are discussed, recognizing that a definitive diagnosis cannot be rendered in every situation. The histologic diagnoses for the two clinical cases are finally revealed.
CONCLUSION
Cystic lesions of the maxilla and mandible may be odontogenic or non-odontogenic. The most common cystic lesions are the reactive periapical cyst, and the dentigerous cyst (which is developmental in nature). It is important to note that cystic neoplasms also occur in the jaws, and that the presence of inflammation may obscure the diagnostic histologic features of lesions like odontogenic keratocyst and unicystic ameloblastoma. Ancillary testing is of limited diagnostic value in most scenarios. However, both clinical and radiographic information (such as the location, size, duration, associated symptoms, and morphology of the lesion in its natural habitat) are significantly useful.
Topics: Humans; Diagnosis, Differential; Jaw Neoplasms; Odontogenic Cysts; Odontogenic Tumors; Ameloblastoma; Maxilla
PubMed: 36928736
DOI: 10.1007/s12105-023-01525-1 -
Head & Face Medicine Jul 2021Aberrant expression of stem cell markers has been observed in several types of neoplasms. This trait attributes to the acquired stem-like property of tumor cells and can...
BACKGROUND
Aberrant expression of stem cell markers has been observed in several types of neoplasms. This trait attributes to the acquired stem-like property of tumor cells and can impact patient prognosis. The objective of this study was to comparatively analyze the expression and significance of SOX2 and OCT4 in various types of odontogenic cysts and tumors.
METHODS
Fifty-five cases of odontogenic cysts and tumors, including 15 ameloblastomas (AM), 5 adenomatoid odontogenic tumors (AOT), 5 ameloblastic fibromas (AF), 5 calcifying odontogenic cysts (COC), 10 dentigerous cysts (DC) and 15 odontogenic keratocysts (OKC) were investigated for the expression of SOX2 and OCT4 immunohistochemically.
RESULTS
Most OKCs (86.7 %) and all AFs expressed SOX2 in more than 50 % of epithelial cells. Its immunoreactivity was moderate-to-strong in all epithelial cell types in both lesions. In contrast, SOX2 expression was undetectable in AOTs and limited to the ameloblast-like cells in a minority of AM and COC cases. Most DCs showed positive staining in less than 25 % of cystic epithelium. Significantly greater SOX2 expression was noted in OKC compared with DC or AM, and in AF compared with COC or AOT. OCT4 rarely expressed in odontogenic lesions with the immunoreactivity being mild and present exclusively in OKCs.
CONCLUSIONS
SOX2 is differentially expressed in odontogenic cysts and tumors. This could be related to their diverse cells of origin or stages of histogenesis. The overexpression of SOX2 and OCT4 in OKC indicates the acquired stem-like property. Future studies should investigate whether the overexpression of OCT4 and SOX2 contributes to the aggressive behaviors of the tumors.
Topics: Ameloblastoma; Humans; Odontogenic Cysts; Odontogenic Tumors; SOXB1 Transcription Factors; Stem Cells
PubMed: 34261507
DOI: 10.1186/s13005-021-00283-1 -
Turk Patoloji Dergisi 2018The purpose of this study was to assess and compare fascin expression in 4 lesions which differ in aggressiveness: odontogenic keratocyst, dentigerous cyst and two types...
OBJECTIVE
The purpose of this study was to assess and compare fascin expression in 4 lesions which differ in aggressiveness: odontogenic keratocyst, dentigerous cyst and two types of ameloblastoma (solid and unicystic), and to find out whether fascin expression is associated with aggressiveness of these lesions or not.
MATERIAL AND METHOD
Nine solid ameloblastomas , 12 unicystic ameloblastomas, 13 odontogenic keratocyst and 12 dentigerous cyst were assessed in this study. The slides were examined at x400 magnification. Finally the lesions were divided into two groups based on microscopic examination, "low expression" and "high expression".
RESULTS
There were no significant differences between the lesions, except that fascin expression was slightly higher in unicystic ameloblastomas in comparison to other groups in intensity and count of the immunostaining cells.
CONCLUSION
The results of this study suggest that local aggressiveness does not result in fascin expression. We suggest more studies with more samples, assessing expression of different proteins be done in the future.
Topics: Ameloblastoma; Biomarkers, Tumor; Carrier Proteins; Dentigerous Cyst; Humans; Jaw Diseases; Jaw Neoplasms; Microfilament Proteins; Odontogenic Cysts; Retrospective Studies
PubMed: 29926463
DOI: 10.5146/tjpath.2018.01433