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Stomatologija 2017; 19 (1):23-32 429 KB

Conservative management of large mandibular dentigerous cysts with a novel approach for follow up: Two case reports

Ieva Gendviliene¹, Paul Legrand^2,3, Laura Ferreira Pinheiro Nicolielo², Deepti Sinha2, Yannick Spaey^2,3, Constantinus Politis², Reinhilde Jacobs²

Summary

Background. Dentigerous cysts are odontogenic cysts of the jaws accounting for approximately 24% of all epithelium-lined jaw cysts. Rarely, these cysts can become extremely large causing additional symptoms, while challenging treatment. This article represents a novel approach for radiological treatment follow up of large dentigerous cysts.

Material and methods. Dentigerous cysts were treated by marsupialization, using dedicated obturators and enucleation of the cyst afterwards. Teeth vitality in the lesion was regularly assessed by laser doppler flowmetry, follow-up of lesion regression was accomplished using semi-automatic radiographic analysis of bone healing quantification.

Results. Cystic marsupialization by means of the obturator resulted in a number of advantages compared to a conventional approach: lower risk of spontaneous fracture of the mandible, anatomical structure preservation, mandibular canal identification and preservation of tooth vitality as measured by intraoral laser doppler flowmetry. Notwithstanding that a 1-year follow-up panoramic image could not visualize a remnant bone defect nor cystic lesion recurrence, 3D-CBCT based semi-automated bone quantification could only demonstrate an increase of 46% of mineralized bone volume one year after surgery. Bone healing typically occurred starting from the periphery of the original lesion towards the inner core.

Conclusions. The presently reported cystic marsupialization was useful as a preliminary treatment for subsequent enucleation. 3-D CBCT based objective quantification of the bone volume and healing can provide new insights in lesion healing in general and more particular in the outcome of specific diagnostic and therapeutic challenges.

Key words: cone-beam computed tomography, dentigerous cyst, surgical decompression.

Received: 14 03 2016

Accepted for publishing: 27 03 2017

¹Institute of Odontology, Faculty of Medicine, Vilnius University, Lithuania

²Omfs Impath Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium

³Department of Oral and Maxillofacial Surgery, Maria ziekenhuis Overpelt, Belgium

Address correspondence to Ieva Gendviliene, Institute of Odontology, Faculty of Medicine, Vilnius University, Zalgiris str. 115, LT-08217, Vilnius, Lithuania..

E-mail address: ieva.gendviliene@gmail.com



	Baltic Dental and Maxillofacial Journal

March, 2017, Vol. 19, No. 1 CONTENTS SCIENTIFIC ARTICLES The relationship between pathological wear of teeth and temporomandibular joint dysfunction Egle Mickeviciute, Ausra Baltrusaityte, Gaivile Pileicikiene 3-9 REVIEW Surgery-related factors affecting the stability of orthodontic mini implants screwed in alveolar process interdental spaces: a systematic literature review Greta Gintautaitė, Alė Gaidytė 10-18 A review of PEEK polymer’s properties and its use in prosthodontics Gediminas Skirbutis, Agnė Dzingutė, Viltė Masiliūnaitė, Gabrielė Šulcaitė, Juozas Žilinskas 19-23 CASE REPORT Conservative management of large mandibular dentigerous cysts with a novel approach for follow up: Two case reports Ieva Gendviliene, Paul Legrand, Laura Ferreira Pinheiro Nicolielo, Deepti Sinha, Yannick Spaey, Constantinus Politis, Reinhilde Jacobs 24-32 © 2017 Stomatologija		Stomatologija 2017; 19 (1):23-32 429 KB Conservative management of large mandibular dentigerous cysts with a novel approach for follow up: Two case reports Ieva Gendviliene¹, Paul Legrand^2,3, Laura Ferreira Pinheiro Nicolielo², Deepti Sinha2, Yannick Spaey^2,3, Constantinus Politis², Reinhilde Jacobs² Summary Background. Dentigerous cysts are odontogenic cysts of the jaws accounting for approximately 24% of all epithelium-lined jaw cysts. Rarely, these cysts can become extremely large causing additional symptoms, while challenging treatment. This article represents a novel approach for radiological treatment follow up of large dentigerous cysts. Material and methods. Dentigerous cysts were treated by marsupialization, using dedicated obturators and enucleation of the cyst afterwards. Teeth vitality in the lesion was regularly assessed by laser doppler flowmetry, follow-up of lesion regression was accomplished using semi-automatic radiographic analysis of bone healing quantification. Results. Cystic marsupialization by means of the obturator resulted in a number of advantages compared to a conventional approach: lower risk of spontaneous fracture of the mandible, anatomical structure preservation, mandibular canal identification and preservation of tooth vitality as measured by intraoral laser doppler flowmetry. Notwithstanding that a 1-year follow-up panoramic image could not visualize a remnant bone defect nor cystic lesion recurrence, 3D-CBCT based semi-automated bone quantification could only demonstrate an increase of 46% of mineralized bone volume one year after surgery. Bone healing typically occurred starting from the periphery of the original lesion towards the inner core. Conclusions. The presently reported cystic marsupialization was useful as a preliminary treatment for subsequent enucleation. 3-D CBCT based objective quantification of the bone volume and healing can provide new insights in lesion healing in general and more particular in the outcome of specific diagnostic and therapeutic challenges. Key words: cone-beam computed tomography, dentigerous cyst, surgical decompression. Received: 14 03 2016 Accepted for publishing: 27 03 2017 ¹Institute of Odontology, Faculty of Medicine, Vilnius University, Lithuania ²Omfs Impath Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium ³Department of Oral and Maxillofacial Surgery, Maria ziekenhuis Overpelt, Belgium Address correspondence to Ieva Gendviliene, Institute of Odontology, Faculty of Medicine, Vilnius University, Zalgiris str. 115, LT-08217, Vilnius, Lithuania.. E-mail address: ieva.gendviliene@gmail.com