Effective Treatment of Odontogenic Keratocysts

Effective Treatment 1

Effective Treatment of Odontogenic Keratocysts

Ferris Prado

Riverside Community College

Abstract

The aggressive and possible recurrence of the odontogenic keratocyst (OKC) poses a problem in deciding the appropriate treatment of the lesion. Although conservative treatment is theoretically always best, it may not always prevent recurrence and future treatment. Most standard procedures used to initially treat the lesion will be deemed successful for the first few years following the procedure. At times ranging from two years post treatment and on, many cases will recur and need secondary or additional treatment. While many standard procedures such as enucleation may be useful in the initial treatment, many other procedures such as peripheral ostectomy and the use of Carnoy’s solution, either solely or in combination, are more successful at preventing future recurrence.

Effective Treatment of Odontogenic Keratocysts

Since the identification of odontogenic keratocysts (OKCs) in the middle of the 20th century, much research has been conducted regarding successful therapy and treatment. Interestingly enough, treatment not only has to take into consideration the ability of the therapy to eliminate the pathologic lesion from further recurrence but also the ability to be conservative enough to maintain vital tissues and bone. The aggressive nature of this cystic lesion often leaves the dental professional undecided about which treatment is ideal for each individual circumstance. The purpose of this paper is to present current research regarding conservative and aggressive treatment of odontogenic keratocysts and their ability to reduce the rate of recurrence.

Etiology

According to Tsukamoto et al., odontogenic keratocysts (OKC) are believed to originate from the dental lamina or the remnants of the dental lamina (2002). This would then classify OKCs as a developmental cyst associated with the presence of an existing tooth. Tsukamoto et al. further explains that odontogenic keratocysts do not develop at the same rate from the initial formation of the dental lamina but occur randomly at different periods of life for different people (2002). The ages of individuals affected with OKCs thus vary widely from early adolescents to elderly individuals.

Clinical Manifestations

Although many cases of OKCs are identified solely through radiographic examination and may appear asymptomatic, many patients will present with such symptoms as swelling, drainage, infection, and pain (Morgan, Burton & Qian, 2005). As a result, OKCs that are symptomatic tend to be more destructive, large, and difficult to treat versus asymptomatic occurrences (Morgan et al., 2005).

Differential Diagnosis

Radiographically, OKCs appear as multilocular or unilocular radiolucencies that are well defined with smooth borders that commonly contain corticated margins (Chrapathomsakul, Sastravaha & Jansisyanont, 2006). The wide array of lesions that match this appearance lead the diagnosing clinician to require a histological test to determine the exact diagnosis. Common differential diagnosis of the OKC include: dentigerous cyst, adenomatoid odontogenic tumor, ameloblastoma, ameloblastic fibroma, and calcifying odontogenic cyst (Newland, 2007).

Current Treatment Modalities

Therapy and treatment of OKCs tend to differ based on the progression and aggression of the individual lesion. In some cases, treatment may be based off both clinical and/or radiographic progression of the lesion and its ability to perforate cortical bone and involve adjacent tissue (Kolokythas, Fernandes, Pazoki & Ord, 2007). Common treatment includes marsupialization which is the creation of an opening through the cystic wall that allows alleviation of pressure from cystic fluid (Kolokythas et al., 2007). Another mode of treatment discussed by Maurette, Jorge, and Moraes is decompression which is similar to marsupialzation but includes the insertion of an intraoral device that prevents infection and food impaction and allows irrigation of involved area (2002). Other treatment includes enucleation, curettage, peripheral ostectomy, Carnoy’s solution therapy, and combination therapy of any of the previously mentioned procedures (Kolokythas et al., 2007; Morgan et al., 2005). A higher rate of recurrence is related to enucleation therapy (Chirapathomsakul et al., 2006) whereas studies regarding treatment of peripheral ostectomy in combination with Carnoy’s solution have yielded little or no recurrence (Morgan et al., 2005).

Conclusion

The ability of the OKC to cause mass tissue and bone destruction makes the desire for conservative treatment a great desire since therapy can involve removal of tooth or tissue in the areas involved. On the other hand, the ability of OKCs to be recurrent and cause further destruction allow the treating clinician the opportunity to be as aggressive with treatment in order to prevent any chance of recurrence. In conclusion, in order to reduce any chance of recurrence aggressive treatment with peripheral ostectomy with Carnoy’s solution should be used if deemed effective.

Reference(s)

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Appendix

Figure 1. Radiograph of odontogenic keratocyst in right body of mandible (Regezi, 2006)