Management of a solitary bone cyst using a custom-made surgical guide for a minimally invasive approach: technical note and case report.

BACKGROUND: Solitary Bone Cyst (SBC), also known as a simple bone cyst, hemorrhagic cyst, or traumatic cyst is classified by the WHO among non-odontogenic benign lesions of the jaw. The article explores the use of a static 3D-printed surgical guide to treat mandibular SBC, emphasizing a minimally surgical approach for this lesion. CASE PRESENTATION: A 20-year-old woman was referred for a persistent mandibular SBC lacuna, without specific complaints. Her medical history included a previous bone trepanation for a SBC in the same area, radiologically and surgically confirmed. X-ray assessment showed a well-defined unilocular radiolucency surrounding the root of the first left lower molar (tooth #36), measuring 10 × 10 mm. Pulp sensitivity was normal. CBCT data and STL files of dental cast were obtained preoperatively and registered. A 3D-printed surgical guide was used for minimally invasive trepanation of the buccal cortical. The simulation used a targeted endodontic microsurgery approach in order to determine axis and diameter of the trephine. Surgery was performed under local anesthesia. The guide was tooth supported integrating tubes and a fork for guiding precise trepanation. A 3.5 mm round bone window was created, leaving an empty cavity confirming SBC diagnosis and permitting bone curettage. A blood clot was obtained to promote bone healing. Complete reossification was observed after 6 months. The follow-up at 2 years confirmed a complete bone healing with normal pulp sensitivity. DISCUSSION: The 3D-printed windowed surgical guide with dental support offers big advantages, including improved visibility and reduced errors. Compared to traditional guides, it eliminates visual hindrance and allows easier and quick access to confined areas as well as an improved irrigation during drilling process. The article also highlights the importance of preoperative planning while acknowledging potential limitations and errors and surgical complications. CONCLUSION: The use of the 3D-printed surgical guide could be used in routine for minimally invasive intervention of SBC. This case also demonstrates the potential utility of this approach in various procedures in oral and maxillofacial surgery. The technique provides precise localization, reducing complications and enhances operative efficiency.

Autotransplantation for Restoration of Dentition Defects After Excision of Jaw Cysts.

Bone defect caused by jaw cystectomy has always been the main factor affecting postoperative wound healing and is also the common cause of maxillofacial bone defect, which brings challenges to the subsequent restoration of missing teeth. In this paper, the authors report a 22-year-old young woman who had a mandibular cyst in the left lower posterior tooth area. She underwent mandibular bone cyst excision and simultaneous extraction of teeth 36 and 37. One and two months after the removal of the mandibular bone cyst, autologous tooth transplantation was performed in stages from tooth 28 to tooth 36 and from tooth 18 to tooth 37. The case shows that tooth autotransplantation is a viable option for the restoration of dentition defects after the excision of jaw cysts, which can promote the healing of the bone defect after the operation.

Application of Vacuum-Formed Cyst Plug-in Conservative Treatment of Jaw Cyst in Children.

Fenestration decompression, which can protect important anatomic structures and reduce surgical risk is the most preferred way for the treatment of jaw cysts in children, and wearing a cyst plug after the operation is the key to success. To enhance the retention of the cyst plug and promote the healing of the cyst, our team designed the vacuum-formed cyst plug to replace the classic one. This article presents a case of a jaw cyst in a 6-year-old girl who wore the vacuum-formed cyst plug after the fenestration decompression. Six months later, the cyst healed, and the permanent teeth affected by the cyst returned. This case showed that the vacuum-formed cyst plug offered a more comfortable experience and an explicit prognosis for children with jaw cysts, having high clinical application value.

Effect of Intracapsular Pressure on Decompression Effectiveness.

AIM: The objective of this research was to analyse the correlation between intracapsular pressure and shrinkage rate of cystic lesion volume at different time points after decompression and to evaluate the relationship between the concentration of interleukin-1α (IL-1α) in cystic fluid and intracapsular pressure. METHODS: Fifty patients with jaw cystic lesions who underwent decompression were included. We measured the intracapsular pressure and IL-1α concentration in the cyst fluid. Moreover, we calculated the rate of shrinkage (RS) of cystic cavity volume at different time points. In addition, data on age, sex, preoperative cystic cavity volume, and lesion location were collected. Linear correlation analysis and variance analysis were used for statistical analysis. RESULTS: Fastest volume decline was observed between 0 and 3 months after surgery; the average RS0-3 was 45.71%. RS3-6 presented the second-fastest volume decline, with an average of 17.46%, and RS6-12 presented the slowest volume decline, with an average of 3.933%. A statistically significant difference in RS was observed amongst the 3 time points (P < .0001). RS0-3 was negatively correlated with intracapsular pressure (r = -0.6326, n = 50, P < .0001). A negative correlation between the preoperative cystic cavity volume and intracapsular pressure (r = -0.6384, n = 50, P < .001) was also observed. A significant positive correlation was observed between preoperative cystic cavity volume and RS0-3 (r = 0.611, n = 50, P < .0001). Moreover, a significant positive correlation was observed between the intracapsular pressure and IL-1α concentration in the cystic fluid (r = 0.03477, n = 50, P < .0001). CONCLUSIONS: Intracapsular pressure and the preoperative volume were the factors that affected the RS during the first 3 months after surgery. Therefore, the effectiveness of decompression can be evaluated by the intracapsular pressure and preoperative volume.

Radiographic bone volume alteration after jaw cyst enucleation with or without simultaneous bone grafts: A prospective randomized study.

OBJECTIVE: This study was aimed to evaluate bone healing after jaw cyst enucleation with or without bone substitutes by cone beam computed tomography, and to analyze potential influence factors for bone formation as well. MATERIALS AND METHODS: Sixty seven jaw cyst patients were randomly assigned to two groups. Thirty three patients in control group accepted cystectomy without any filling material. The rest 34 bone cavities which filled with xenograft (DBBM, Bio-Oss®) and covered by absorbable membrane (Bio-Gide®) were included in the guided bone regeneration (GBR) group. All patients were examined with cone bean computerized tomography before operation, 3 and 6 months after surgery. Linear regression analysis was applied to evaluate the influence factors of bone healing. RESULTS: There was no significant difference in bone formation rate at 3 months after enucleation, with shrinkage rate (SR) of cystic lesion in control group and GBR group of 26.43 ± 14.98% and 20.78 ± 10.80%, respectively (p > 0.05). Larger shrinkage area in GBR group was detected on postoperative radiographs after 6 months with SR of 60.11 ± 19.23%, when compared to those in patients without filling (6 months SR: 48.63 ± 19.39%, p = 0.018, <0.05). Linear regression analysis showed that cyst size was negatively correlated with bone formation. CONCLUSION: GBR with bovine xenograft and absorbable membrane showed considerable bone regeneration property in the healing of jaw cystic defects after enucleation of radicular cysts. Cyst size showed a suppressive influence on bone formation.

Effect of Application of Platelet-Rich Plasma on Bone Regeneration after Removal of Jaw Cysts.

Platelets are involved in regeneration at sites of bony defect, apart from their function in coagulation. An autologous preparation platelet-rich plasma gel applied to sites of bony defects after surgical treatment of jaw cyst. This case-control study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) in the department of Oral and Maxillofacial Surgery from September 2017 to August 2018. Total 30 patients were chosen having jaw cyst. They were divided into 2 groups; Group A and Group B, where Group A got the platelet rich plasma, after removal of the cystic lesion; and Group B got the normal usual treatment. Platelet rich plasma gel was prepared using a standardized technique and applied to the surgical site of the Group A. The differences of radiographic changes between the two groups at 6th, 12th, 18th and 24th weeks after surgery were analyzed. Study showed significant changes in early bone regeneration in group A at 12th and 18th weeks post operatively. Platelet rich plasma induces early bone regeneration and it has proven successful outcome.

Surgical Treatment of Voluminous Jaw Cysts with a Buccal Plate: A Study of 20 Clinical Cases.

AIM AND OBJECTIVE: The aim of this paper is to present, with a series of clinical cases, some advantages of a modified surgical technique using fixed bone flaps in an approach to voluminous maxillary or mandibular odontogenic cysts (excluding keratocysts) and highlight the positive impact on the healing of mucus and bone tissues. BACKGROUND: The surgical approach of the enucleation of voluminous maxillary cysts is generally realized with a subtractive osteoplasty. The major problem with this kind of procedure is frequent fibrous healing (or scar formation) of the cavity due to mucosal invagination, especially for large lesions more than 2 cm in diameter. Several techniques have been proposed to limit these side effects. Very contrasting results have been observed in the techniques with graft or exogenous materials, and the scarring effects on mucus and bone tissues are poorly described. In situations where a vestibular cortical bone remains, our modification of the former technique is the use of this bone like a repositioned flap. TECHNIQUE: The present study is a cases series and was carried out on 20 adult patients with maxillary or mandibular cystic lesions larger than 25 mm. For all the patients, our modified technique consisted of using a bone flap to expose more widely the site and to carry out the enucleation of the cyst. Repositioning the flap in the final stage of the operation with osteosynthesis material allowed controlled mucosal and bone healing confirmed by clinical and radiographic follow-up. CONCLUSION: In all cases of our study, no invagination of the soft tissues in the cystic cavity was observed and postoperative bone volumes were identical to the initial state. Only minor postoperative complications were observed in three cases. CLINICAL SIGNIFICANCE: A bone flap approach seems to allow a tissue interception, thus better control of mucosal and bone healing, which is borne out by the clinical and radiographic controls 24 months after surgery.

Cisto ósseo traumático associado a odontoma composto: relato de um caso incomum / Aneurismal bone cyst with a compound odontoma: unusual case report

Introdução: o cisto ósseo traumático (COT) é um pseudocisto que se apresenta assintomático e é descoberto frequentemente em exames de rotina. Outra lesão também presente nos maxilares é o odontoma, sendo dividido em dois subtipos, o composto e o complexo; os odontomas são geralmente descobertos como um achado acidental, visto que não apresentam sintomatologia. Objetivo: relatar um caso incomum de um COT, associado à odontoma composto (OC). Relato de caso: paciente do gênero masculino, 16 anos de idade, compareceu à clínica escola de odontologia da Universidade Federal de Campina Grande (UFCG), campus Patos, PB, referenciado pelo cirurgião-dentista após solicitar exame radiográfico para tratamento ortodôntico e observar lesão radiolúcida em região anterior da mandíbula. Durante a anamnese, o paciente não relatou nenhuma alteração sistêmica ou doença de base, mas relatou trauma de infância na região acometida. No exame clínico intraoral, não foi observado nenhum aumento de volume na região. Realizou-se palpação na região, não havendo relato de dor. Ao analisar a radiografia panorâmica, observou-se a presença de pequenas estruturas calcificadas com radiopacidade semelhante às estruturas dentárias, delimitada por uma linha radiolúcida, sugestiva de OC. Para melhor localização, delimitação, relação com estruturas anatômicas e planejamento cirúrgico da lesão, foi solicitado um exame de tomografia computadorizada de feixe cônico (TCFC). Considerações finais: com base nos achados clínicos e radiográficos, optou-se por abordagem cirúrgica da lesão cística e enucleação do OC, sob anestesia local. No pós-operatório de um ano, o paciente evoluiu satisfatoriamente sem queixas clínicas.(AU)

Introduction: traumatic bone cyst (TBC) is a pseudocyst that usually presents asymptomatically and is found frequently in routine exams. Another lesion also present in the jaws is odontoma. The odontoma is divided into two subtypes, the compound and the complex; odontomas are usually discovered as an accidental finding, since they do not present symptomatology. Objective: the present article aims to report an unusual case of a TBC associated with a composite odontoma. Case report: a 16-year-old male patient attended the Clinic School of Dentistry of the Universidade Federal de Campina Grande (UFCG), Patos-PB campus, referenced by the dentist after identify radiolucent lesion in the anterior region of the mandible on radiographic examination for orthodontic treatment. During the anamnesis, the patient did not report any systemic alteration or underlying disease, but reported trauma in the region affected in childhood. The intra oral clinical examination, was not observed any increase in volume in the region. Palpation was performed in the region, and there was no report of pain. When analyzing panoramic radiography the presence of small calcified structures with radiopacity similar to dental structures was observed, delimited by a radiolucent line, suggestive of compound odontoma. To better location, delimitation, compared with anatomy and surgical planning of the injury, it was requested an cone beam computed tomography (CBCT). Final considerations: based on the clinical and radiographic findings, we opted for a surgical approach to cystic lesion and enucleation of composite odontoma, under local anesthesia. In the one-year postoperative period, the patient progresses satisfactorily without clinical complaints.(AU)

A Retrospective Cohort Study of the Cumulative Survival Rate of Obturator Prostheses for Marsupialization.

PURPOSE: After marsupialization of benign tumors and jawbone cysts, insertion of an obturator prosthesis maintains the surgical opening and improves hygiene. To date, there have been no reports clarifying the relationship between the obturator design and treatment outcomes. The purpose of this study was to examine the survival rate of three types of obturator, and to investigate the factors that expedite the removal of the obturator. MATERIALS AND METHODS: The subject group comprised 100 patients who had an obturator inserted after marsupialization at Kagoshima University Hospital between May 31, 2012 and March 31, 2015; 73 patients with lesions in the mandible were eligible. Three types of mandibular obturator were designed and inserted, considering the teeth missing, the anteroposterior position of the lesion, and the buccolingual direction of marsupialization. The endpoint of this study was defined as the removal of the obturator. The analyzed predictor values for the endpoint were age, gender, remaining teeth, nature of primary disease, anteroposterior location of primary disease, buccolingual direction of marsupialization, type of obturator, and dates of insertion and removal. RESULTS: No significant differences were found in the cumulative survival rate among the three types of obturator. Early obturator removal was more frequent in patients with cysts, anterior lesions, and/or marsupialization from the occlusal direction CONCLUSIONS: Because obturator design had minimal effect on the ability of the appliance to maintain the surgical opening, it is preferable to use the least invasive design. Our findings also suggest that the follow-up examination should account for the type of primary disease, the anteroposterior location of the lesion, and the buccolingual direction of marsupialization.

The effectiveness of decompression as initial treatment for jaw cysts: A 10-year retrospective study.

BACKGROUND: Decompression is an approved alternative to cystectomy in the treatment of jaw cysts. This study aimed to evaluate its effectiveness as an initial procedure, as well as factors with potential to influence outcome. MATERIAL AND METHODS: the frequency of decompression was analysed, whether completed in one session or followed by enucleation at the Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, from 2005 to 2015. Further analysis focussed on factors potentially influencing outcome: cyst location, histopathology, means of preserving the cyst opening, cyst size, patient age. RESULTS: In all, 53 patients with 55 jaw cysts (mean age of 35.1) were treated by initial decompression in the ten-year period. In the majority of cases, histopathological analysis revealed a follicular cyst (43.6%), followed by odontogenic keratocysts (23.7%), radicular cysts (21.8%), residual cysts (7.3%) and nasopalatine cysts (3.6%) Treatment was completed with a single decompression in 45.5% of the cases. Among those, 72.0% were follicular cysts and 8.0% odontogenic keratocysts. Subsequent enucleation was needed in 54.5% of all cases, with a majority in the keratocystic group (36.7%). Histological findings, means of keeping the cyst open, and patient age were found to influence the effectiveness of decompression. CONCLUSIONS: Decompression could be performed as a procedure completed in one session or combined with subsequent enucleation, mainly dependent on histopathological findings. Subsequent enucleation of odontogenic keratocysts is highly recommended.

Cisto ósseo solitário em mandíbula: relato de caso clínico / Solitary bone cyst of the mandible: clinical case report

Objetivo: apresentar um caso clínico de paciente com cisto ósseo solitário em mandíbula e sua evolução após o tratamento de exploração e curetagem cirúrgica por meio de achados radiográficos. Caso clínico: paciente do sexo masculino, 45 anos, compareceu à clínica da Faculdade de Estudos Administrativos ­ Fead. Ao exame clínico, os tecidos se apresentavam dentro dos padrões de normalidade e ao exame radiográfico observou-se área radiolúcida unilocular, limites regulares e bem definidos em região anterior de mandíbula entre ápices dos dentes 33, 32, 31, 41 e 42, sem deslocamento desses. Para confirmação do diagnóstico, além do exame clínico, foi necessário realizar a tomografia de feixe cônico e exploração cirúrgica. Após a exploração cirúrgica foi realizada a curetagem das paredes ósseas e a proservação do caso para acompanhar a sua evolução. Considerações finais: por ser uma lesão de comportamento não agressivo, responde bem a este tipo de tratamento, sendo notável sua melhora durante o período de acompanhamento.(AU)

Objective: To present a clinical case report of a patient with solitary bone cyst of the mandible and its evolution after exploration and surgical curettage treatment through radiographic findings. Case report: A 45-year-old male patient attended the clinic of the School of Administrative Studies - FEAD. The clinical examination showed normal tissues and the radiographic examination showed unilocular radiolucent area and regular and well-defined boundaries in the anterior mandible between the apexes of teeth 33, 32, 31, 41, and 42, without displacement. To confirm the diagnosis, in addition to the clinical examination, cone beam tomography and surgical exploration were required. After the surgical exploration, bone wall curettage and case proservation were performed to monitor the evolution. Final considerations: Considering it is a non-aggressive lesion, it responds well to this type of treatment, with considerable improvement during follow-up.(AU)

Implants placed simultaneously with maxillary sinus floor augmentation in the presence of antral pseudocysts: Presentation of a case series.

OBJECTIVE: To report the outcome of simultaneous placement of dental implants with maxillary sinus elevation in the presence of antral pseudocysts. METHOD AND MATERIALS: This case series involved 14 patients with 28 implants placed simultaneously with maxillary sinus elevation. The psuedocysts were treated by cystic fluid extraction. Postoperative examinations were performed at 3, 6, and 12 months. RESULTS: All restorations were finished 6 to 9 months after implant placement. Nine antral pseudocysts disappeared and five decreased in size. All implants were deemed successful at 1 year postoperatively, showing osseointegration and masticatory function. No mobility was found during the follow-up period. CONCLUSION: In the absence of maxillary sinus infection, the combination of cystic fluid extraction, maxillary sinus elevation, and immediate implantation showed an acceptable clinical outcome in this series of patients.

Fate of mandibular canals displaced by enlarged cystic lesions: does the inferior alveolar neurovascular bundle relocate to its original position?

Our aim was to identify the positional changes of the inferior alveolar neurovascular bundle and evaluate the relocation of the displaced mandibular canal after enucleation of a cyst. Seventy patients (72 sites) who had had cysts enucleated were divided into three groups based on the degree of encroachment of the cystic lesion into the mandibular canal and whether a bone graft had been inserted after the cyst had been enucleated. The mean (range) of patients' ages was 45 (18-75) years, and there were 29 male and 41 female patients. Group A comprised cysts with encroachment on the mandibular canal that were enucleated without a bone graft; Group B consisted of cysts with no encroachment of the mandibular canal, but were enucleated without a bone graft; and Group C comprised cysts with encroachment of the mandibular canal that were enucleated with a bone graft. The displacement of the mandibular canal was identified from analysis of computed tomographic (CT) images. Changes in the position of the mandibular canal were measured on panoramic radiographs. The mandibular canal was repositioned superiorly by a mean (SD) of 2.4 (1.65)mm after enucleation of the cyst, which was significant in Group A (p<0.001), but not in Groups B and C. These results indicate that the displaced inferior alveolar neurovascular bundles that were not surrounded by bony canal tended to relocate towards a supposedly normal position, and after enucleation of the cyst the mandibular canal was remodelled in this new location. This tendency to relocate was blocked by bone grafting. Bone grafts are therefore recommended in cases where enough bony height is required for future insertion of implants.

Transnasal endoscopic removal of bilateral postoperative maxillary cysts after aesthetic orthognathic ssurgery: Differences from that of Caldwell-Luc operations.

Postoperative maxillary cysts (PMCs) after orthognathic surgery are a rare disease condition. In this study, we reported first case of bilateral PMCs after cosmetic orthognathic surgery which was treated via the intranasal endoscopic approach. In addition, we compared the characteristics of PMCs after aesthetic orthognathic surgery with those of PMCs after Caldwell-Luc operation. We expect that this case will be helpful to surgeons who encounter similar cases.

Resolución quirúrgica de quistes de los maxilares con técnica descompresiva / Surgical resolution of jaw cysts with decompressive technique

Podemos definir "quiste" como una bolsa conectivoepitelial, tapizada en su interior por epitelio y recubierta en su cara externa por tejido conectivo, que encierra un contenido líquido o semisólido. Según su patogénesis, los clasificamos como lesiones de desarrollo o de tipo inflamatorio (1, 17). Tanto los quistes de desarrollo como los inflamatorios se caracterizan por un crecimiento lento y una tendencia expansiva. A pesar de ser entidades con un comportamiento benigno, pueden alcanzar un tamaño considerable si no se diagnostican y se tratan a tiempo (2). El tipo de tratamiento de la lesión está condicionado por múltiples factores como el tamaño de la misma, su localización, su relación con estructuras anatómicas vecinas, la posible afectación de estructuras dentales, entre otras. (3) El objetivo es elegir la modalidad de tratamiento que conlleve el menor riesgo posible de recurrencia, el cuidado, en lo posible, de las estructuras nobles vecinas y, por supuesto, la erradicación de la lesión. (4) Dentro de los tratamientos de los quistes maxilares, podemos mencionar la enucleación total de los mismos o técnica de Parstch II, la marsupialización o técnica de Parstch I y la técnica descompresiva, también llamada técnica de Waldron- Axhausen. El objetivo de este trabajo es el de mostrar un caso clínico donde se realizó la técnica descompresiva para el tratamiento de un quiste inflamatorio en el maxilar inferior en íntimo contacto con el nervio dentario inferior y la basal mandibular (AU)

We can define "cyst" like a connective-epitelial bag, upholstered inside by epithelium and covered on the outside by connective tissue, enclosing a liquid or semisolid contents. According to its pathogenesis, classify them as development or inflammatory (1, 17). Injury both the inflammatory and developing cysts are characterized by slow growth and an expansionary trend. Despite being entities with a benign behavior, they can reach a considerable size if not diagnosed and treated in time. (2) The type of treatment of injury, is determined by multiple factors such as the size, its location, its relationship with neighboring anatomical structures, possible involvement of dental structures, among others. (3) The objective is to choose the modality of treatment involving the least possible risk of recurrence, care, as far as possible, of the neighboring noble structures and of course the elimination of the lesion. (4) Inside of the Maxillary cysts treatments we can mention the enucleation total thereof or technical Parstch II, the marsupialization or technique of Parstch I and the decompression technique, also called Waldron - Axhausen technique. The objective of this work is the show a clinical case where took place the decompression technique for the treatment of inflammatory cyst in the lower jaw in intimate contact with the inferior alveolar nerve and the mandibular basal (AU)

Conservative surgical treatment of the jaw cysts in children: Case study of five patients.

AIMS: Conservative treatment of jaw cysts establishes low surgical complication risk and protects vital anatomical structures such as inferior alveolar nerve, maxillary sinus and permanent tooth germs. Marsupialization and decompression have been widely used in children. The aim of this study was to evaluate the results of the conservative treatment of jaw cysts in five children. MATERIALS AND METHODS: This article presents case series of marsupialization in jaw cysts associated with impacted teeth in five children. A total of nine impacted teeth within the cystic lesions were observed. RESULTS: Complete resolution of all cystic lesions and simultaneous eruption of six impacted teeth within the cyst were managed. The other two teeth were erupted orthodontically and one had to be extracted. CONCLUSIONS: Marsupialization is effective for the treatment of cystic lesions in growing patients as it preserves vital anatomical structures and enables eruption of the impacted teeth within the cyst.

Cystic lesions of the jaws: a retrospective clinicopathologic study of 2030 cases.

OBJECTIVE: The aim of this study was to perform an epidemiologic analysis of cases of jaw cysts treated from 1973 to 2012 at the Dentistry and Maxillofacial Surgery Unit of the Verona Hospital, Italy, and to compare the data obtained with those published in the literature. STUDY DESIGN: A retrospective survey of 2030 patients treated for jaw cysts from 1973 to 2012 was performed. The lesions were classified according to the 2005 World Health Organization histologic classification, and the following variables were analyzed: age, gender, histopathologic diagnosis, and site of onset. RESULTS: Of 2030 total lesions, there were 1970 odontogenic cysts (97.04%), 50 nonodontogenic cysts (2.46%), and 10 pseudocysts (0.49%). Of the patients, 314 were children (15.47%), and 1716 were adults (84.53%). Mean age was 37.24 years, with a male/female ratio of 1.71:1. CONCLUSIONS: There is a wide variety of cysts, some of which are subject to variations according to gender, localization, and age.

Regeneration of Cystic Bone Cavities and Bone Defects With Bioactive Glass S53P4 in the Upper and Lower Jaws.

Cysts and tumors are common lesions in the jaws. To be able to retain a good volume of the alveolar ridge during healing as well as strengthening the angle and body of the mandible and provide an instant improved support for adjacent teeth, reliable long-term bone regeneration is needed. The purpose of this prospective study was to promote bone regeneration by filling bony defects in the upper or lower jaw with granules of the bioactive glass S53P4 (BAG), which have osteostimulative and antimicrobial properties.The authors treated 20 patients (21 defects) surgically; benign tumors, cysts, or infection related to impacted teeth in the maxilla or mandible. The tumor or cyst was removed or enucleated and thorough cleaning of the infected area was performed. The bone cavity was filled with granules of the BAG S53P4 despite signs of chronic infection in the area at the time of surgery. The patients were followed up for an average of 34 months clinically and with cone beam computerized tomography for 28 months. In 20 defects the final outcome was successful. Despite infection at the time of surgery in 65% of the patients, no material associated infection was seen during the follow-up. The BAG S53P4 granules were radiologically remodeled into bone after 2 years follow-up. The use of granules of the BAG S53P4 in the treatment of large bone defects provides infection-free reliable bone regeneration despite chronic infection at the time of surgery, which improves the prognosis of adjacent teeth.