Odontogenic keratocyst management using guided tissue regeneration: Literature review - Two case reports.

Abstract

Background: Odontogenic cysts of the jaws are pathologies that require timely recognition and management. The initial diagnosis is based on clinical and radiographic appearance and dental history. A variety of surgical treatments are used for odontogenic keratocyst (OKC) depending on the clinical and radiographic presentation. The aim of this report and literature review is to highlight methods to treat OKC combined with guided tissue regeneration (GTR).

Methods: Two cases with similar clinical presentations are included. Case 1 was a 60-year-old healthy Caucasian female who presented with jaw expansion around teeth #'s 21 and 22. Initial exam revealed clinical gingival health on an intact periodontium. The patient presented with enlarged gingival tissue between teeth #'s 21 and 22 measuring 9 × 12 mm and vital teeth without root displacement radiographically. Case 2 had a similar clinical and radiographic presentation located between teeth #'s 5-6.

Results: Case 1 treatment included excisional biopsy with complete enucleation of the cystic lesion. Thereafter, GTR was performed using allograft internally then covered with a xenograft externally, resorbable collagen membrane (RCM), and primary closure. Case 2 was managed with excisional biopsy with lesion enucleation, GTR with allogenic bone graft, enamel matrix derivative and RCM, and primary closure.

Conclusion: OKC enucleation combined with GTR using mineralized allograft, enamel matrix derivative, and collagen membrane or a layering technique of allograft internally and xenograft externally covered by a collagen membrane showed proper regeneration with stable periodontium at 6-36 months.

Key points: Guided tissue regeneration is an acceptable treatment for management of OKC. Complete enucleation of an OKC lesion is important to reduce recurrence. The use of allograft with xenograft or allograft with enamel matrix derivative and RCM can provide proper bone fill after OKC removal.

Plain language summary: Odontogenic cysts are growths that can form in the jaw or soft tissues around the teeth. If not treated, they can grow larger, damage the bone, and even push teeth out of place. To prevent this, it's important to diagnose and remove them early. The most common way to treat these cysts is through a surgical method called enucleation, where the cyst is carefully removed. In these two cases, enucleation was used along with guided tissue regeneration, a technique to help the bone and tissue heal better after surgery. In the first case, a bone graft (made from human and animal bone) and a special material called a resorbable collagen membrane were used to protect and support the healing area. In the second case, a mineralized bone graft along with a substance that helps repair tissues called an enamel matrix derivative, and the same collagen membrane were used. Both patients healed well, and over the next 6 to 36 months, their bone and tissues around the teeth regenerated properly.