Clinical and radiological documentation of complete remodeling of the mandibular bone after the enucleation of a large odontogenic keratocyst: 15 years follow-up of a unique case - A case report

INTRODUCTION AND IMPORTANCE

Odontogenic keratocysts (OKC) are benign intraosseous cysts with expansive growth. They account for approximately 7.8 % of all jaw cysts and have a high recurrence rate. Herein, we present a minimally invasive approach for the surgical treatment of a remarkable variation of OKC with a 15-year radiological and clinical follow-up.

PRESENTATION OF THE CASE

We present the case of a 42-year-old female patient with a large cyst in the mandible between teeth 35 and 45, who reported spontaneous swelling and paresthesia of the lower lip. Radiological imaging is crucial for treatment planning. The cyst was surgically treated with a single enucleation combined with adjuvant therapy to minimise recurrence. A titanium plate was inserted because of the size of the defect. Recurrence was observed one year later and treated with single enucleation and adjuvant therapy. After 15 years, complete healing, no signs of recurrence, and complete remodeling of the mandible were observed.

CLINICAL DISCUSSION

The treatment of OKC remains the subject of varying approaches in the literature due to the lack of established general guidelines. One treatment option is single enucleation combined with adjuvant therapy to minimise recurrence, which can result in complete clinical and radiological remodeling of the bone.

CONCLUSION

Direct enucleation combined with adjuvant therapy is a practical approach for treating large OKCs. It is associated with less morbidity and burden on the patient than enucleation with prior decompression or radical resection. Additionally, it shows no deficits in bone defect healing.

Bimaxillary fixed implant-supported zirconium oxide prosthesis therapy of an adolescent patient with non-syndromic oligodontia and two WNT10 variants: a case report

Introduction and importance

Oligodontia is a rare genetic condition characterized by more than six congenitally missing teeth, either as an isolated non-syndromic condition or in association with other genetic syndromes. The impact of WNT10A variants on dental development increases with the presence of the c.321C>A variant and the number of missing teeth.

Case presentation

A 21-year-old man with non-syndromic oligodontia was diagnosed at 15 years of age with misaligned teeth, speech problems, and the absence of 24 permanent teeth. Interdisciplinary collaboration between specialists was initiated to enable comprehensive treatment. DNA analysis confirmed that the patient was a carrier of the known pathogenic WNT10A variant c321C>A and WNT10A variant c.113G>T of unknown clinical significance.

Clinical discussion

Dental implants are a common treatment; however, bone development challenges in adolescent patients with non-syndromic oligodontia necessitate careful planning to ensure implant success. Many WNT variants play crucial roles in tooth development and are directly involved in non-syndromic oligodontia, especially the WNT10 variant c.321C>A.

Conclusion

A full-arch implant-supported monolithic zirconia screw-retained fixed prosthesis is a viable treatment option for young adults with non-syndromic oligodontia. Further studies are needed to clarify the possible amplifying effect of the WNT10A variants c321C>A and c.113G>T on the pathogenic phenotype of non-syndromic oligodontia.

Can jaw bone healed from chronic sclerosing osteomyelitis be considered healthy when planning dental implants? Case report with 20-year follow-up

Introduction and importance

Extraction of mandibular third molars can lead to complications such as chronic sclerosing osteomyelitis (CSO), an inflammatory bone marrow disease that tends to progress. CSO involves the cortical plates and often the periosteal tissues and is caused by a variety of microorganisms, including Corynebacterium spp. The treatment of chronic osteomyelitis (CO) and CSO remains challenging, as there is no universal treatment protocol. This case report investigated whether jaw bone that has healed from chronic sclerosing osteomyelitis can be considered healthy bone when planning dental implants.

Case presentation

A 21-year-old Caucasian woman developed CO and CSO after third molar surgery.

Clinical discussion

A combination of alveolar ridge bone resection, extraction of teeth 47-32, and long-term specific antibiotic therapy against Corynebacterium spp. was administered. An attempt at preprosthetic alveolar ridge reconstruction with an anterior superior iliac crest bone graft resulted in graft failure and the patient refused further harvesting procedures. Implantation in the intraforaminal zone also resulted in the loss of two implants after loading. Finally, inferior alveolar nerve transposition resulted in the successful reimplantation of two implants, which were fully functional almost 11 years later.

Conclusion

This case report presents the treatment history of this patient. With a longitudinal observation period of greater than 20 years, the results of this case demonstrate the successful treatment of bone with CO, CSO, and Corynebacterium spp. infection. Following the removal of infected bone, radical debridement, and long-term antibiotic therapy, bone health was restored.

A Cone Bean Computer Tomography Investigation of the Newly Formed Mandibular Anterior Ridge following the Treatment of an Extended Comminuted Fracture: A 12-Year Follow-Up

Introduction

Extensive comminuted fractures are associated with tooth loss that ultimately leads to dimensional changes in the hard and soft tissues of the alveolar ridge. Reconstruction of the lost mandibular anterior ridge is very complex due to the natural curvature of the region. Case Presentation. In this case report, the combination of the modified shell technique with autologous bone plates and the guided bone regeneration (GBR) technique was performed on an 18-year-old patient after a comminuted fracture, to ensure new bone formation in the anterior ridge with a natural curvature. After the treatment progressed without complications, three dental implants were placed. Annual cone beam computed tomography (CBCT) images were obtained and evaluated using the GNU Image Manipulation Program (GIMP© 2.10). This allowed measurements of the buccal and lingual bone around the implants, showing the annual bone loss in a twelve-year observation period. Discussion. The treatment of the comminuted fracture and the combination of the modified shell technique with autologous bone plates, the GBR technique, and implant placement can be considered successful. The three dental implants were osseointegrated in 2010, with the buccal bone level averaging 1.31 mm below the implant shoulder and the lingual bone level 1.57 mm above the implant shoulder. In 2021, the measurements showed a bone loss of 0.99 mm at the buccal implant shoulder and 0.69 mm at the lingual implant shoulder.

Conclusion

The combination of the modified shell technique with autologous bone plates and the GBR technique is a reliable method to ensure new bone formation in the anterior ridge. The use of CBCT is an excellent method to evaluate bone resorption around dental implants, but due to minimal bone resorption in the observation period, an annual CBCT examination is exaggerated.

Radiographic feature changes in an antral pseudocyst that existed prior to sinus floor augmentation and dental implant placement, 15 years after initial detection - a case report

INTRODUCTION AND IMPORTANCE

Maxillary sinus floor augmentation is acceptable and safe for bone augmentation prior to insertion of dental implants in atrophied maxillary bones. Anatomical variations and lesions of the maxillary sinus, including antral pseudocysts, are common radiological findings that can affect the outcomes of maxillary sinus augmentation. We show the changes in the radiological features of an antral pseudocyst that existed before maxillary sinus augmentation and 15 years after the insertion of dental implants.

CASE PRESENTATION

The patient was a 69-year-old male with an unremarkable medical history. The initial orthopantomogram revealed a very large antral pseudocyst in the left maxillary sinus. After upper left second molar extraction and maxillary sinus augmentation, two dental implants were inserted in regions 26 and 27. The pseudocyst had changed radiologically 15 years later, but a biopsy showed no characteristic changes, and the dental implants showed no functional failures.

CLINICAL DISCUSSION

We present a case of an antral pseudocyst that was not removed before or during sinus floor augmentation. A debate is ongoing regarding whether antral pseudocysts affect maxillary sinus augmentation, and various strategies have been applied to prevent intraoperative and postoperative complications, including removal of pseudocysts 3-12 months before maxillary sinus augmentation, removal during maxillary sinus augmentation, and leaving them alone when the floor is raised.

CONCLUSION

The present case showed a preexisting antral pseudocyst at maxillary sinus floor augmentation and insertion of the implants, which changed radiologically 15 years later, but did not affect the function of the dental implants.

Bone remodeling of the sinus floor observed 19 years after third molar transplantation to close a maxillary defect: a case report

Autologous tooth transplantation is the transplantation of an erupted, partially erupted, or unerupted tooth from one site to another in an individual. This is expected to maintain alveolar bone volume through physiological stimulation of the periodontal ligament (PDL). Tooth transplantation can be used for the closure of oroantral communication. As a simple, useful, and minimally invasive method, it should be considered a surgical option when a donor tooth is available in indicated cases. Herein, the authors report the case of a 20-year-old female patient whose left permanent maxillary first molar had to be extracted due to a longitudinal fracture and radicular cyst in the maxillary sinus floor. After the extraction, tooth 28 was exposed through an osteotomy and positioned in the gap. Nineteen years later, the autologous grafted tooth 28 could no longer be retained due to massive external resorption and was replaced by an implant. Human PDL stem cells can differentiate into bone-, fiber-, and cementum-forming cells and have the potential to build a PDL complex. Therefore, care must be taken to avoid damaging the PDL of the donor tooth during extraction. Autotransplanted teeth are expected to retain the alveolar bone volume. This case demonstrates the use of a transplanted tooth 28 for the treatment of a maxillary defect caused by the extraction of tooth 26 and removal of a radicular cyst. External resorption and regeneration of the bone of the maxillary sinus floor around the transplanted tooth occurred after 19 years.

Bone remodelling after minimally invasive surgical management of a recurrent florid cemento-osseous dysplasia in a Caucasian woman – 18 years follow-up of a unique case - A case report

INTRODUCTION AND IMPORTANCE

Florid cemento-osseous dysplasia (FCOD) is a multifocal fibro-osseous tumour originating from the periodontal ligament that presents as being rare, benign and slow-growing. The lesion is characterised by the replacement of regular bone-structure with fibrous tissue and dysplastic bone. Depending on localisation, the initial characteristics of FCOD resemble those of periapical lesions of inflammatory origin.

CASE PRESENTATION

We report on the current findings relating to the case of a 39-year-old Caucasian woman, who initially had persistent paresthesia of the right alveolaris inferior nerve (NAI) for longer than 2 weeks. The orthopantomogram showed multiple bilateral periapical radiolucency and a biopsy was indicated to rule out malignancy. Four years later, the radiolucency occurred once again in region 37, suggesting a recurrence of the lesion. Therefore, another minimally invasive surgery had to be performed, which revealed a bone cavity. Two years later, the bone of the affected region almost completely regenerated.

CLINICAL DISCUSSION

We were aware that an invasive treatment could lead to infection of the hypovascular lesion. Because of the paresthesia, a biopsy was essential. Unexpectedly, the second minimally invasive surgical treatment was a significant success, as the bone lesion regenerated almost completely.

CONCLUSION

The follow-up of this case was documented over more than 18 years. To date, this is the longest documented case of a FCOD. Minimally invasive surgical treatment of such lesions may lead to better bone regeneration and even a better quality of life for the patient.

Melolabial interpolated island flap for reconstruction of an anterior oronasal fistula after horseshoe Le Fort I osteotomy with iliac bone grafts interposition - A case report

INTRODUCTION

Horseshoe Le Fort I osteotomy (HLFO) in combination with iliac bone grafts interposition is an established and very effective procedure for reconstructing the severely atrophic maxilla. However potential complications connected to this method, such as oronasal fistula (ONF), have not been described in the literature to date.

CASE PRESENTATION

We report the case of a female patient with severe atrophy of the edentulous maxillary alveolar ridge with type 2 diabetes (T2D). Initially, a sinus floor augmentation was performed, followed by a failed placement of dental implants. Afterwards, HLFO with simultaneous interposition of iliac bone grafts was conducted. Subsequently, an oronasal communication occurred in the antral maxilla. As several local flaps had not achieved sufficient results, a melolabial interpolated island flap was carried out, yielding satisfactory results.

DISCUSSION

Failed implant treatment or bone augmentation procedures in combination with T2D may have resulted in significant tissue irritation and subsequent wound healing complications in the antral maxilla, leading to an ONF.

CONCLUSION

In this case, an ONF occurring after HLFO was described for the first time. The melolabial interpolated island flap proved to be an outstanding long-term solution for the management of an anterior ONF occurring after HLFO over a period of 10 years. Less invasive treatment options including zygomatic implants should be taken into consideration for the treatment of such patients.

Sensory disturbance along the inferior alveolar nerve as a first clinical sign of multiple florid cemento-osseous dysplasia of the mandible-A case report

INTRODUCTION

Florid cemento-osseous dysplasia (FCOD) is a rare, benign, slow growing, multifocal fibro-osseous tumour originating from the periodontal ligament. The lesion is characterised by regular bone-structure replacement with fibrous tissue and dysplastic bone. The initial characteristics of FCOD, depending on localisation, resemble those of periapical lesions of inflammatory origin, potentially leading to misdiagnosis. In the absence of infection signs, the treatment of choice is conservative therapy with antibiotics and regular follow-up examinations.

PRESENTATION OF CASE

We report the case of a 39-year-old Caucasian woman with sensory disturbance along the inferior alveolar nerve for >2 weeks. The involved teeth were vital and the digital orthopantomogram indicated multiple bilateral periapical brightening. Biopsy was indicated to exclude malignancy and to confirm the FCOD diagnosis with predominantly reactive calcification and cell-rich connective-tissue reaction. The sensory disturbances disappeared after the biopsy. Further conservative therapy included regular radiological examinations every 2 years to prevent surgical intervention due to infection risk.

DISCUSSION

Sensory disturbances around the nervus alveolaris inferior are well-known complications of dental and maxillofacial operations and of malignant tumours. Sensitivity disorder as a first symptom of fibro-osseous dysplasia has not been previously described. Although uncommon in its clinical behaviour, FCOD was finally diagnosed after thorough clinical, radiological, and histological examinations.

CONCLUSION

Paraesthesia combined with FCOD has not been previously described. Correct diagnosis is essential for proper treatment and to avoid further complications even when the clinical symptoms appear unrelated.