Spontaneous Bone Regeneration After Enucleation of Large Jaw Cysts: A Digital Radiographic Analysis of 44 Consecutive Cases

Abstract

Purpose: This study evaluated the healing in cystic defect of the jaw to substantiate our understanding of spontaneous bone healing after enucleation of jaw cysts subjectively and with analysis of digital postoperative panoramic radiographs.

Materials and methods: Fourty four consecutive patients reporting to the Department of Dental and Oral Surgery, during the period between 2008-2012 having maxillary and mandibular cysts treated by either surgical enucleation or by marsupialization followed by enucleation were evaluated for subsequent bone formation at the site of cystectomy defect by subjective clinical examination along with digital radiographic examination. Postoperative clinical and radiographic examinations were performed at 6,9,12, and 24 months. Bone regeneration was evaluated by reduction of the size of residual cavities at the cystectomy defect using digital orthopantomogram.

Results: Out of 44 patients 15 patients completed two years of follow-up with all the patients having 6 months follow-up. The maximum size of the cystic pathology was 150.40mm and minimum of 14.73mm at the time of presentation (average size of 58.16mm). Twenty patients were diagnosed with odontogenic keratocyst, with one patient having multiple OKC associated with Gorlin Goltz Syndrome, 17 patients had dentigerous cyst, 5 had Radicular cyst; solitary bone cyst and globulomaxillary cyst formed one each. Uneventful healing and spontaneous filling of the residual cavities were obtained in all cases. The digital analysis of the postoperative radiographs showed mean values of reduction in size of the residual cavity of 25.85% after 6 months, 57.13% after 9 months, 81.03% after one year and 100% after two year.

Conclusion: Spontaneous bone regeneration can occur after surgical removal of jaw cysts without the aid of any graft materials even in large cystic cavity sufficiently surrounded by enough bony walls. This simplifies the surgical procedure, decreases the overall cost of surgery, and reduces the risk of postoperative complications associated with grafting.

Keywords: Bone grafting; Cyst recurrence; Odontogenic cyst.

Figures

[Table/Fig-2]:

Flowchart BIIPS Pack – sterile gauze (ribbon) impregnated with ‘Bismuth lodine Paraffine Paste’ [1. One part bismuth subnitrate 2. Two parts iodoform 3. One part sterile liquid paraffin by weight]

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Cyst in right side body of the mandible

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Six months follow-up

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One year follow-up

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Cyst in the left side angle-ramus of the mandible

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Immediate bipps packing after enucleation

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Nine months follow-up.

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Right side upper maxillary cyst

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One year follow-up

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Two years follow-up

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Right side upper maxillary cyst

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Six months follow-up

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Nine months follow-up

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One year follow-up

[Table/Fig-17]:

Cyst in right side body of the mandible

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Nine months follow-up

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One year follow-up

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Cyst in the angle ramus region, immediate post bone biopsy, OPG shows bipps pack in place

[Table/Fig-21]:

OPG immediate marsupialisation and bipps pack placement

[Table/Fig-22]:

Patient at 9 months of follow-up showing residual cyst at the ramus

[Table/Fig-23]:

3D CT showing persistant lingual cortical perforation