Conservative Treatment of Calcifying Odontogenic Cyst: Report of 3 Cases

Compound odontoma associated with a calcifying odontogenic cyst. Case report and systematic review

The objectives of the present study were to comprehensively evaluate all the published cases on compound odontoma associated with calcifying odontogenic cyst (COaCOC) in the English literature and to describe the clinical, imaging and therapeutic variables for this condition. In August 2020, an electronic search of the PubMed / MEDLINE, Web of Science, ScienceDirect, Springer, and Scopus databases was carried out. The eligibility criteria included publications with enough information to confirm the diagnosis. Furthermore, we present a clinical case of a 16-year-old male patient with OCCaC, who was treated with enucleation, obtaining favorable and functional results. A total of 32 cases reported in the literature that met the inclusion and exclusion criteria, including ours, were analyzed and discussed. The mayority of the patients were women (n = 17) with an average age of 14.4 years, the maxilla was the most affected bone (n = 22) and the maxillary anterior region was the area with the highest number of cases (n = 18), the main clinical presentations were the volume increase (n = 14) and asymptomatic (n = 14). The choice treatment was enucleation (n = 26) and, in most cases, no recurrence was reported (n = 20). This study allows to update the characteristics of the OCCaC, giving an effective vision of how to treat this rare pathological association made up of two conditions that are completely different from each other.

Calcifying odontogenic cyst of anterior maxillary: Case report and review

INTRODUCTION AND IMPORTANCE

Calcifying odontogenic cyst (COC) is a rare lesion of jawbone. It is classified among development cyst in the new WHO classification of tumors of the head and neck in 2017. It is a rare pathology, which is found more in the upper maxillae, with a predominance in women in the second or third decade. The diagnosis is based on the analysis of clinical, radiological and histological features.

CASE PRESENTATION

We report the case of a 17-year-old patient referred by his orthodontist following the fortuitous discovery of a mixed radiolucent/radiopaque image in the right jaw ranging from the tooth 11 to the tooth 16, for whom the clinical, radiological examination associated with fine needle aspiration cytology suggested a cystic lesion.

CLINICAL DISCUSSION

Management initially consisted of decompression of the lesion and complete enucleation after nine months. Histopathological examination gave the diagnosis of calcifying odontogenic cyst. The follow-up showed favorable evolution.

Active decompression and distraction sugosteogenesis for the treatment of calcifying odontogenic cyst

The calcifying odontogenic cyst is as a benign, rare developmental odontogenic cyst with a wide range of histologic characteristics. It may present along with other odontogenic pathologies such as odontoma, ameloblastoma, adenomatoid odontogenic tumor, ameloblastic fibroma, and ameloblastic fibro-odontoma. Clinically, it can be an either intra- or extraosseous painless swelling that can produce cortical expansion. It affects mostly the anterior area of the mandible. Radiographically, it appears as a well-circumscribed unilocular radiolucency containing flecks of indistinct radiopacities. In about one third of cases, an impacted tooth is associated. In this paper, we employ a patient with an enormous calcifying odontogenic cyst to review both the pathology and active decompression and distraction sugosteogenesis, a novel technique employed to treat odontogenic entities. This dual approach usually results in an accelerated bone healing (sugosteogenesis), partial removal of the cystic epithelium, thickening of the wall, and migration of chronic inflammatory cells which triggered epithelial modulation, ultimately causing a realignment in the biologic behavior of the lesion.

Marsupialization before enucleation as a treatment strategy for a large calcifying odontogenic cyst: Case report

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Two-stage treatment strategies are effective for large lesions.

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Marsupialisation promotes lesion decompression and decreases lesion volume.

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Reduction of the lesion allows lower risk enucleation of the structures.

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This strategy prevents damage to important anatomical structures.

Introduction

Odontogenic pathological lesions can generally be divided into cysts and tumors. Calcifying odontogenic cyst (COC) is a non-aggressive odontogenic cyst, however, in a few occasions, COC can show excessive growth and destruction. This study describes an uncommon aggressive presentation of a large COC and discusses the treatment strategies used to achieve a favorable result.

Presentation of case

A 11-year-old child sought treatment for a painless growth on his mandible that caused facial asymmetry. On clinical and imaging examination, a large radiolucent lesion was observed in a panoramic x-ray involving the right side of the mandible. Radiopaque areas were observed within the lesion. Treatment comprised of an initial marsupialization followed by surgical removal of the lesion. Follow up extended for more than 10 years and no signs of recurrence were observed.

Discussion

Initial marsupialization was successfully employed in order to decrease the lesion, inducing bone formation, and reducing the risk of mandibular fracture and inferior alveolar nerve damage. Four months after marsupialization, the lesion substantially reduced its volume and enucleation with peripheral ostectomy was carried out. This approach allowed a safer surgical removal of the lesion and achieve an excellent result.

Conclusion

Although some authors consider marsupialization as an unnecessary step that delays final treatment, when well indicated, it facilitates surgical treatment, promotes and preserves normal tissues, reduces the necessity of surgical reconstruction and costs, yet showing excellent results.

Odontogenic Cysts

Odontogenic cysts are epithelial-lined pathologic cavities and surrounded by fibrous connective tissue that originate from odontogenic tissues that occur in tooth-bearing regions of maxilla and mandible. Cystic conditions of the jaw cause bony destruction and may cause resorption or displacement of adjacent teeth. Odontogenic cysts have developmental or inflammatory origins. More cases have been published in the adult age group than the pediatric population. Periapical cyst and dentigerous cysts are frequently reported conditions in dental practice. Histopathologic examination remains the gold standard investigation. Odontogenic cysts are managed with enucleation or marsupialization procedures. Early recognition and referral to oral surgery minimize the extent of jaw bone destruction.

Perfil clínico e histopatológico do cisto odontogênico calcificante: relato de caso

O cisto odontogênico calcificante (COC) foi primeiramente descrito em 1962, considerado como condição patológica benigna de ocorrência rara em maxila e mandíbula, caracterizado por revestimento cístico de células epiteliais odontogênicas contendo células fantasmas com propensão a regiões de calcificação.  Neste artigo, descreveu-se a configuração clínica e histopatológica do COC por meio de relato de caso submetido a tratamento cirúrgico e acompanhamento pós-operatório. Uma paciente de 11 anos apresentou um aumento de volume em região maxilar a esquerda próxima ao sulco nasolabial sem sintomatologia dolorosa. Os exames radiográficos indicaram lesão radiolúcida, bem circunscrita e expansiva em maxila, que foi submetida a enucleação associada a ostectomia marginal das paredes corticais ósseas. O quadro histopatológico foi caracterizado por revestimento cístico com epitélio odontogênico ameloblástico, ninhos espalhados de células fantasmas e regiões eosinofílicas de material compatível com dentinóide. O relato de caso apresentou perfil clínico de COC, que pode ser confundido com outras lesões císticas ou tumorais, sendo essencial diagnóstico por meio de análise histopatológica. A abordagem cirúrgica proporcionou diagnóstico e tratamento. Após acompanhamento clínico e radiográfico, não houve recorrência do COC.

Calcifying odontogenic cysts

INTRODUCTION

Calcifying odontogenic cysts (COC) represent 0.3-0.8% of all odontogenic cysts. We describe the finding and the treatment of a COC in a 67-year-old female.

OBSERVATION

An asymptomatic well-limited radioluscent mandibular lesion was fortuitously discovered on the panoramic X-ray in the periapical region of teeth No. 33 and 34. Treatment consisted in enucleation and curettage. Histologic examination was in favour of a COC. At 6 years follow-up, X-ray control showed new bone formation and the patient was free of symptoms. Pulp vitality was maintained in all teeth in the operated area.

DISCUSSION

Total enucleation is the preferred treatment of COC. Absence of recurrence is attested by X-ray controls and pulp vitality tests.

Conservative approach to recurrent calcifying cystic odontogenic tumor occupying the maxillary sinus: a case report

Calcifying cystic odontogenic tumor (CCOT) is an uncommon benign cystic neoplasm of the jaw that develops from the odontogenic epithelium. Invasion into the maxillary sinus by a CCOT is not a typical, and the recurrence of the cystic variant of CCOT in the posterior maxilla is rare. This report describes a recurrent CCOT occupying most of the maxillary sinus of a 24-year-old male patient. As a treatment, marsupialization was carried out as a means of decompression, and the involved teeth were all endodontically treated. Afterward, surgical enucleation was performed. The size of the lesion continued to shrink after marsupialization, and the maxillary sinus restored its volume. This patient has been followed-up for 3 years after the surgery, and there have not been any signs of recurrence.

Complete resolution of a calcifying cystic odontogenic tumor with physiological eruption of a dislocated permanent tooth after marsupialization in a child with a mixed dentition: a case report

Here, we report the complete resolution of a calcifying cystic odontogenic tumor (CCOT) in the right mandible after marsupialization in an 8-year-old girl with a mixed dentition. Clinical, radiographic, and histopathological findings showed a simple cystic variant of CCOT in the region of the deciduous second molar, with dislocation of the permanent second premolar tooth germ. Initial treatment involved marsupialization, including extraction of the involved deciduous tooth, incision of pathological tissue, and creation of a window in the extraction socket. The crown of the dislocated second premolar was exposed at the base of the cystic cavity after marsupialization. One year and nine months later, complete bone healing and spontaneous eruption of the second premolar were observed, providing evidence of the bone regeneration capacity and tooth germ eruption potential in children. No recurrence was observed after 7 years. The findings from this case suggest that marsupialization can be successfully applied for the treatment of CCOT in children with a mixed dentition.

Calcifying epithelial odontogenic cyst associated with complex odontome of maxilla

The term calcifying odontogenic cyst was first introduced by Gorlin in 1962 (Eshghyar et al., Acta Med Iran 44(1):59-62, 2006). The lesion is unusual in that it has some features of a cyst but also has many characteristics of a solid neoplasm (Cysts and tumors of odontogenic origin: textbook of oral pathology, 2006). It is classified into two types-Type I-the cystic variant, Type II-solid tumor variant. This case report present Type I B-odontome producing intraosseous calcifying odontogenic cyst and Type I C-with ameloblastomatous proliferation in a 19 years old male patient in the right maxillary quadrant. The lesion involved an unerupted permanent maxillary central incisor, which was displaced to the infraorbital ridge of right side and the radiograph revealed a calcified mass in the periapical region of right incisor that was later recognized histopathologically as complex composite odontoma. The lesion was removed surgically. This case report emphasizes on the presence of this Type I B and C lesion and the need to keep them in follow up.

Distintas manifestações do tumor odontogênico cístico calcificante

O tumor odontogênico cístico calcificante normalmente se manifesta como uma massa indolor, de crescimento lento, que acomete tanto a maxila como a mandíbula, tendo predileção pelo segmento anterior (área dos incisivos e caninos). Geralmente, ocorre em adultos jovens, na terceira a quarta década de vida, sem preferência por gênero. Imagens de tomografia computadorizada revelaram características importantes não detectadas na radiografia panorâmica, tais como fenestração, calcificação e estruturas dentiformes. A característica microscópica típica dessa lesão é a presença de células epiteliais aberrantes anucleadas, em quantidades variáveis, denominadas "células fantasmas". Também se pode encontrar dentina displásica e, ocasionalmente, os cistos estão associados a tecido dentário duro, semelhante ao odontoma. O tratamento do tumor odontogênico cístico calcificante incluiu simples enucleação e curetagem. O objetivo deste trabalho foi mostrar duas manifestações diferentes do tumor odontogênico cístico calcificante, em que a tomografia computadorizada, associada às características clínicas, foi ferramenta importante para o diagnóstico, o planejamento cirúrgico e o acompanhamento dos pacientes.

Odontoma associated with calcifying cystic odontogenic tumor in deciduous dentition: case report

BACKGROUND

Initially described by Gorlin et al. in 1962, the calcifying cystic odontogenic tumor (CCOT) may be associated with unerupted teeth, ameloblastomas, adenomatoid odontogenic tumors, and, in many cases, with odontomas. It is rare in patients in the first decade of life, particularly involving deciduous teeth. Surgery is the treatment of choice, with low recurrence rates.

CASE REPORT

We present a clinical case of CCOT associated with odontoma and a missing deciduous tooth in a 3-year-old female patient. The lesion was removed under general anesthesia. The patient has been followed up for 1 year, and no recurrence was found. This appears to be the first report in such a young age.

Ameloblastic fibro-odontoma: expansile mixed radiolucent lesion in the posterior maxilla: a case report

Ameloblastic fibro-odontoma (AFO) is a benign tumor that displays properties of both ameloblastic fibroma and compound odontoma. Often, AFO presents clinically as a hamartoma or immature odontoma; however, the tumor can also present with progressive growth causing bone destruction and significant deformity, acting more like a true neoplasm. We report a case of a locally aggressive AFO in the posterior maxilla of a 7-year-old girl and discuss the clinical, radiographic, histopathologic, and conservative therapeutic approach to this locally aggressive tumor.