Search

Odontogenic keratocysts are significant cysts of the jaw that are characterized by aggressive behavior and a high tendency to recur. The treatments of choice may be radical or conservative, and in the literature a debate is still open about the gold standard in the treatment of OKCs.This report describes a wide multilocular OKC extended in the right mandibular ramus and illustrates atypical behavior of a cystic lobe after marsupialization, not found to our knowledge in the previous literature. Moreover, an orthognathic procedure, consisting of sagittal osteotomy was chosen for the excision of the cyst to preserve as much bone as possible and the integrity of the inferior alveolar nerve.

Mural ameloblastoma is a subtype of Unicystic Ameloblastoma characterised by the expansion or infiltration of tumour nodules into the fibrous wall of the cyst. The behaviour of this subtype is highly aggressive, with a risk of recurrence comparable with that of Conventional Ameloblastoma. Consequently, the preferred treatment for Unicystic mural Ameloblastom is broad resection of the tumour. In this case report we describe the successful conservative treatment of a Unicystic mural Ameloblastom associated with an impacted tooth. The conservative treatment consinsted in a initial marsupialization followed by the enucleation of the lesion performed with a lateral corticotomy to create a “bone door” and the relocation of the “bone door” using microplates and titanium screws. Our conservative approach preserved the integrity of the inferior alveolar nerve as well as mandibular functionality and resulted in a good aesthetic outcome. Due to the behaviour of this lesion, a strict follow up is mandatory. In our experience, follow-up is conducted as long as possible regardless of the surgical treatment. This protocol includes Cone Beam CT performed 1 year after surgery and panoramic radiology (OPG) once a year until 5 years after surgery. OPG is then repeated every 3 years in patients with Unicystic Ameloblastoma and every 2 years in those with Conventional Ameloblastoma or ameloblastoma with mural invasion. Suspected recurrence should be evaluated by CBCT.

Marsupialization, designed to reduce the mandibular cyst volume, has continued to debated regarding its influence on the healing of the related bone cavity. The aim of the present study was to evaluate the 3-dimensional radiographic variation over time in mandibular odontogenic cystic lesions after marsupialization and assess the correlations between these variations and variables that can affect the procedure.We planned a retrospective cohort study. The predictor variables were the treatment duration, preoperative volume, patient age, histologic type, and number of preoperative residual bony walls. The outcomes variables were the postoperative volume reduction and the daily reduction rate calculated using computed tomography (CT) from before to after marsupialization using software designed for volumetric reconstruction and measurement of cyst-related bone defects. The descriptive and bivariate statistics were computerized, and the significance level was set at P = .05.The sample included 15 patients (12 men and 3 women; mean age, 51.6; range, 27 to 85 years) affected by keratocysts (n = 6), dentigerous cysts (n = 6), and radicular cysts (n = 3) who had undergone marsupialization. The median duration of marsupialization was 406 days (25th to 75th percentile, 276 to 519). The mean ± standard deviation (SD) pre- and postdecompression volumes were 6,908.27 ± 2,669.058 and 2,468.13 ± 1,343.517 mmMarsupialization appears useful in improving the healing of cyst-related bone defects in mandibles, especially larger defects. Further studies with a wider sample size would add more knowledge to this topic.

Purpose: This randomized controlled trial compared fresh-frozen versus autologous bone blocks for maxillary horizontal ridge augmentation in patients with Cawood and Howell class IV atrophies. Materials and Methods: Twenty-four patients were allocated to the autologous and fresh-frozen groups in a 1:1 ratio. Patients underwent computed tomography scans 1 week and 6 months after surgery for graft volume and density analysis. Doxycycline was administered at day 120 and day 150 to label new bone formation. Biopsy for histologic and histomorphometric analyses was performed at reentry for implant insertion, 6 months after grafting. Results: Fresh-frozen grafts had lower density than autologous bone. Autologous and fresh-frozen grafts lost, respectively, 25% and 52% of their initial volume (p = .0041). Histology revealed the presence of newly formed bone within both graft types, but clear signs of inflammation were present in fresh-frozen blocks. Conclusions: According to these 6-month results, autologous bone blocks are preferable to fresh-frozen bone grafts. Purpose: This randomized controlled trial compared fresh-frozen versus autologous bone blocks for maxillary horizontal ridge augmentation in patients with Cawood and Howell class IV atrophies. Materials and Methods: Twenty-four patients were allocated to the autologous and fresh-frozen groups in a 1:1 ratio. Patients underwent computed tomography scans 1 week and 6 months after surgery for graft volume and density analysis. Doxycycline was administered at day 120 and day 150 to label new bone formation. Biopsy for histologic and histomorphometric analyses was performed at reentry for implant insertion, 6 months after grafting. Results: Fresh-frozen grafts had lower density than autologous bone. Autologous and fresh-frozen grafts lost, respectively, 25% and 52% of their initial volume (p = .0041). Histology revealed the presence of newly formed bone within both graft types, but clear signs of inflammation were present in fresh-frozen blocks. Conclusions: According to these 6-month results, autologous bone blocks are preferable to fresh-frozen bone grafts.