Life threatening hemorrhage associated with a dentigerous cyst in a dog: Case report.

Dentigerous cysts are the most common type of odontogenic cysts and arise from an unerupted tooth. These cysts have stereotypical radiographic and clinical findings. They can be extremely invasive but rarely present as a life-threatening emergency. This case report describes the stabilization and treatment of a 6-year-old mixed breed dog with a dentigerous cyst with concurrent life-threatening hemorrhage. The dog presented with severe oral hemorrhage from the mandibular artery and required multiple blood transfusions. It was ultimately diagnosed with a dentigerous cyst. Complications from dental issues and potential life-threatening complications, such as this case, can be prevented by routine annual oral examination and full mouth dental radiographs if an unerupted tooth is suspected.

Assessment of MUC5AC and MUC2 Immunoexpression in Glandular Odontogenic Cysts, Dentigerous Cysts, and Mucoepidermoid Carcinomas.

Glandular odontogenic cysts (GOCs) and dentigerous cysts may show mucous metaplasia. Central mucoepidermoid carcinoma is very rare and mostly associated with dental cysts. It is hypothesized that odontogenic cysts showing mucus differentiation in their lining, have a propensity to transform into MEC. The present study is the first attempt to explore the relationship between odontogenic cysts [GOCs and dentigerous cysts with mucus metaplasia (DCMM)] and MEC by evaluating immunoexpression of MUC5AC and MUC2. Immunoexpression of MUC5AC and MUC2 was evaluated semiquantitatively in GOCs (20 cases), DCMMs (20 cases), and MECs (20 cases). The percentage of positive cells, intensity, and localization of immunoexpression were assessed for each marker in all cases. Of GOCs, DCMMs, and MECs cases, 85%, 70%, and 80%, respectively, were immunopositive for MUC5AC. Strong cytoplasmic immunoreactivity for MUC5AC was noted, particularly in mucous cells present diffusely within MECs. However, the immunoreactivity was limited to the epithelial lining of GOCs and DCMMs. Most of the MECs (60%) showed more than 25% positivity for MUC5AC, followed by GOCs, and the least in DMMCs. Mild cytoplasmic and nuclear positivity of MUC2 was noted only in epithelial lining cells of 70% GOCs and 45% DCMMs. Whereas, 55% of MECs displayed moderate to strong cytoplasmic and membranous immunopositivity for MUC2 exclusively within mucous cells. As MECs showed strong MUC5AC immunoreactivity in mucous cells, immunoexpression of MUC5AC in odontogenic cysts with mucus cells can possibly explain the pathogenesis of MEC from cysts. However, the variable expression of MUC2 did not give any strong evidence regarding its role as a marker.

Immunohistochemical expression of SPARC in odontogenic keratocysts: a comparative study with other odontogenic cysts.

BACKGROUND: Secreted protein acidic and rich in cysteine (SPARC) has been shown to modulate aggressive behavior in several benign and malignant tumors. Little is known about SPARC expression in odontogenic keratocyst (OKC), an odontogenic cyst with an aggressive nature. To the best of our knowledge, only one study has been investigated the expression of this protein in OKCs. This study aimed to characterize SPARC expression in OKCs. Additionally, to determine whether SPARC is associated with aggressive behavior in OKCs, SPARC expression in OKCs was compared with radicular cysts (RCs), dentigerous cysts (DCs) and calcifying odontogenic cysts (COCs). These odontogenic cysts showed no or less aggressive behavior. METHODS: SPARC expression was evaluated in 38 OKCs, 39 RCs, 35 DCs and 14 COCs using immunohistochemistry. The percentages of positive cells and the intensities of immunostaining in the epithelial lining and the cystic wall were evaluated and scored. RESULTS: Generally, OKCs showed similar staining patterns to RCs, DCs and COCs. In the epithelial lining, SPARC was not detected, except for ghost cells in all COCs. In the cystic wall, the majority of positive cells were fibroblasts. Compared between 4 groups of odontogenic cysts, SPARC expression in OKCs was significantly higher than those of RCs (P < 0.001), DCs (P < 0.001) and COCs (P = 0.001). CONCLUSIONS: A significant increase of SPARC expression in OKCs compared with RCs, DCs and COCs suggests that SPARC may play a role in the aggressive behavior of OKCs.

Dentigerous cysts suspected the other odontogenic lesions on panoramic radiography and CT.

Dentigerous cysts are known as the second most common type of cyst in the jaws. The cyst is one of the lesions occurred frequently in the posterior body of the mandible and is often related to the unerupted third molar and forms around the crown of the unerupted tooth attaching at the cementoenamel junction. Such characteristic appearances are the diagnostic points differentiating from ameloblastoma or odontogenic keratocyst. However, it would be hard for us to diagnose it as a dentigerous cyst if the lesion does not show its typical appearance. We experienced two cases of dentigerous cysts which did not form around the crown of the unerupted tooth on radiologically. Both cysts were relatively large and resorbed adjacent teeth roots. Therefore, an ameloblastoma or an odontogenic keratocyst was suspected rather than a dentigerous cyst as the imaging diagnosis. The biopsy revealed that the lesion was a "dentigerous cyst" in one of the cases and "developmental cyst with inflammation" in another case. After the excision, the histopathological diagnosis was a dentigerous cyst with inflammation in both cases. This report shows the two cases of dentigerous cysts focusing on panoramic radiography and CT images. Also, we discuss the differential diagnosis by reconsidering those diagnostic points.

Using autogenous tooth sticky bone graft repair mandibular third molar dentigerous cyst osseous defects.

BACKGROUND: Dentigerous cyst are most common odontogenic cyst and they frequently occur at the mandibular third molar. Their asymptomatic long medical history always resulted in severe bone resorption at the distal aspect of the adjacent second molar. BonMaker® ATB demonstrate an excellent autogenous bone graft candidacy. The aim of this study is to share a single team's experience of dentigerous cyst osseous defect repairing by applying autogenous tooth sticky bone graft. METHOD: In total, 18 patients with dentigerous cyst, which was arised from mandibular third molar unilaterally, were enrolled in this study. Enucleation of dentigerous cyst was performed extracting with involving teeth under general anesthesia. Autogenous tooth sticky bone graft was prepared using extracted tooth and autogenous fibrin glue. Subsequently, grafting was performed above covering with concentrate growth factors. Patients were followed up at sixth months. RESULTS: They were eleven male and seven female patients. Their ages ranged from 20 to 40 years, with a mean of 31 years. Primary wound healing of all sites was achieved in all the patients. Sixth months postoperative radiographic assessment show that dentigerous cysts osseous defects of seventeen patients were good bone filling and ossification. One patient occurred slight bone resorption at the distal aspect of the adjacent second molar. CONCLUSION: Within the limitation of sample size and retrospective nature of the present study, autogenous tooth sticky bone graft demonstrates one of the best alternative alveolar bones repairing graft.

The IL-1ß-p65 axis stimulates quiescent odontogenic epithelial cell rests via TGF-ß signalling to promote cell proliferation of the lining epithelia in radicular cysts: A laboratory investigation.

AIM: Cyst formation of the jaws is frequently accompanied by the proliferation of odontogenic epithelial cells located in the periodontal ligament (PDL), which consists of heterozygous cells and includes the most fibroblasts. The lining epithelium of radicular cyst, an odontogenic cyst of inflammatory origin, is derived from the proliferation of the remnants of the Hertwig epithelial root sheath (odontogenic epithelial cell rests of Malassez; ERMs) in the PDL. ERMs are maintained at a lower proliferative state under physiological conditions, but the regulatory mechanisms underlying the inflammation-dependent enhanced-proliferative capabilities of ERMs are not fully understood. The aim of this study was to evaluate the effects of cytokine pathway association between TGF-ß signalling and IL-1ß signalling on the regulation of odontogenic epithelial cell proliferation using radicular cyst pathological specimens and odontogenic epithelial cell lines. METHODOLOGY: Immunofluorescence analyses were performed to clarify the expression levels of Smad2/3 and Ki-67 in ERMs of 8-week-old mouse molar specimens. In radicular cyst (n = 52) and dentigerous cysts (n = 6) specimens from human patients, the expression of p65 (a main subunit of NF-κB), Smad2/3 and Ki-67 were investigated using immunohistochemical analyses. Odontogenic epithelial cells and PDL fibroblastic cells were co-cultured with or without an inhibitor or siRNAs. Odontogenic epithelial cells were cultured with or without TGF-ß1 and IL-1ß. The proliferative capabilities and Smad2 phosphorylation levels of odontogenic epithelial cells were examined. RESULTS: Immunohistochemically, Smad2/3-positivity was increased, and p65-positivity and Ki-67-positivity were decreased both in ERMs and in the epithelial cells in dentigerous cysts, a non-inflammatory developmental cyst. In contrast, p65-positive cells, along with the expression of Ki-67, were increased and Smad2/3-positive cells were decreased in the lining epithelia of radicular cysts. Co-culture experiments with odontogenic epithelial cells and PDL fibroblastic cells revealed that PDL cells-derived TGF-ß1/2 and their downstream signalling suppressed odontogenic epithelial cell proliferation. Moreover, TGF-ß1 stimulation induced Smad2 phosphorylation and suppressed odontogenic epithelial cell proliferation, while IL-1ß stimulation reversed these phenotypes through p65 transactivation. CONCLUSIONS: These results suggest that IL-1ß-p65 signalling promotes odontogenic epithelial cell proliferation through suppressing TGF-ß-Smad2 signalling, which would be involved in the pathogenesis of radicular cysts.

Orthodontic management of a developing dentigerous cyst related to lower second molar: a case report.

The dentigerous cyst is a developmental odontogenic asymptomatic cyst, that is associated with the crown of an unerupted or impacted tooth. Early diagnosis is important to avoid any future complications and choose the best treatment option. The purpose of this case report is to describe the management of a dentigerous cyst related to lower second molar in a young female patient using orthodontic traction as a conservative treatment approach. This procedure helps to spare the patient an unnecessary surgical excision procedure and the associated excessive bone removal for a safety margin, stimulates bone healing and promotes the eruption of the cyst-associated tooth.

Identification of ferroptosis-related proteins in ameloblastoma based on proteomics analysis.

PURPOSE: We used proteomic sequencing and experimental verification to identify the potential ferroptosis-related proteins in ameloblastoma. METHODS: Samples of ameloblastoma (n = 14) and normal gingival tissues (n = 5) were collected for proteomic sequencing to identify differentially expressed proteins (DEPs) in ameloblastoma. Ferroptosis-related genes were downloaded from FerrDb V2, which were then compared with DEPs to obtain ferroptosis-related DEPs (FR-DEPs). A functional enrichment analysis was performed, and a protein-protein interaction network was built. The hub proteins were screened using the Cytoscape software, and potential drugs targeting them were retrieved from the DrugBank database. A hub protein was selected for immunohistochemical validation, and its expression was assessed in ameloblastomas, odontogenic keratocysts, dentigerous cysts, and normal gingival tissues. The primary ameloblastoma cells were cultured to explore the effect of the protein on the migratory properties of the tumour cells. RESULTS: A total of 58 FR-DEPs were screened, and six hub proteins were identified: mTOR, NFE2L2, PRKCA, STAT3, EGFR, and CDH1. Immunohistochemical analysis showed that mTOR expression was upregulated in ameloblastomas compared with that in odontogenic keratocysts, dentigerous cysts, and normal gingival tissues. p-mTOR was highly expressed in ameloblastomas, with a positivity rate of 83.3%. In addition, rapamycin, an inhibitor of mTOR, can inhibit the migratory capacity of primary cultured ameloblastoma cells. CONCLUSION: Our results revealed the ferroptosis-related proteins in ameloblastomas and their underlying biological processes. Additionally, mTOR was overexpressed and was found to be associated with the aggressiveness of ameloblastomas, which may be a potential target for future treatments.

Quiste dentígero en relación con tercer molar inferior retenido / A Dentigerous Cyst Related to Retained Lower Third Molar

Introducción: El quiste dentígero es un quiste odontogénico, casi siempre asociado a la corona de un diente retenido. Sus ubicaciones más frecuentes son la zona de tercer molar inferior y canino superior. Objetivo: Caracterizar la presentación de un quiste dentígero en un paciente adulto. Presentación de caso: Se presentó el caso de una paciente de 27 años de edad que acude a consulta por presentar sensación de opresión, dolor e inflamación en región de tercer molar inferior izquierdo. Al examen oral se observa tejido dentario en correspondencia con molar 38 parcialmente brotado con ligero edema de la mucosa a su alrededor. En radiografía panorámica se observa imagen radiolúcida en relación con cara mesial del 38 con discreto halo radiopaco, redondeada, compatible con un quiste dentígero. Conclusiones: Un diagnóstico a tiempo de estas lesiones constituye la clave para un tratamiento exitoso y menos invasivo, lo cual evitaría complicaciones mayores como la malignización, el crecimiento exagerado que puede ocasionar deformidad facial y la disfunción masticatoria permanente(AU)

Introduction: Dentigerous cyst is an odontogenic cyst, almost always associated with the crown of a retained tooth. Its most frequent locations are the areas of the lower third molar and the upper canine. Objective: To characterize the presentation of a dentigerous cyst in an adult patient. Case presentation: The case is presented of a 27-year-old female patient who came to the clinic with a sensation of pressure, pain and inflammation in the region of the lower left third molar. Oral examination permits to observe some dental tissue corresponding with molar 38 partially erupted with slight edema of the surrounding mucosa. Panoramic radiograph shows a radiolucent image related to the mesial side of 38, with a discrete radiopaque halo, rounded, compatible with a dentigerous cyst. Conclusions: A timely diagnosis of these lesions is the key to a successful and less invasive treatment, which would avoid major complications, such as malignization, the exaggerated growth that can cause facial deformity and permanent masticatory dysfunction(AU)

Differential expression of PEA3 in odontogenic cysts and tumors.

BACKGROUND: PEA3 transcription factor has been identified as a downstream target of the MAPK and PI3K pathways, and PEA3 overexpression has been observed in a variety of tumor types. We aimed to evaluate PEA3 expression in odontogenic cysts and tumors and compare the expression among odontogenic lesions. In addition, the correlations between PEA3 expression and clinicopathological characteristics of conventional ameloblastoma and unicystic ameloblastoma were investigated. METHODS: This study was performed on 165 samples of odontogenic cysts and tumors including 20 dentigerous cysts, 20 odontogenic keratocysts, 16 adenomatoid odontogenic tumors, 5 ameloblastic fibromas, 45 unicystic ameloblastomas, and 59 conventional ameloblastomas. The sections were immunohistochemically stained with mouse monoclonal anti-PEA3 antibody and PEA3 expression was evaluated as the immunoreactive score. RESULTS: PEA3 expression was absent in all dentigerous cysts (DCs) and odontogenic keratocysts, while all adenomatoid odontogenic tumors showed either no (75%) or low (25%) expression of PEA3. Most of the ameloblastic fibromas (60%) displayed no PEA3 expression. A high expression of PEA3 was observed in a substantial number of unicystic ameloblastomas (48.9%) and conventional ameloblastomas (49.2%) in our study. PEA3 expression in DCs, odontogenic keratocysts and adenomatoid odontogenic tumors were significantly different from that in conventional ameloblastomas and that in unicystic ameloblastomas (p < 0.05). The expression of PEA3 was significantly different in the age groups of unicystic ameloblastomas and histological subtypes of conventional ameloblastomas (p < 0.05). CONCLUSION: PEA3 overexpression is predominant in unicystic ameloblastomas and conventional ameloblastomas compared to other odontogenic lesions, indicating a pivotal role of PEA3 as a downstream effector of MAPK pathway in these two odontogenic lesions.

Tratamento de odontoma composto e cisto dentígero: relato de caso / Treatment of compound odontoma and dentigeral cyst: case report

Introdução: o odontoma é considerado como um frequente tumor odontogênico benigno, podendo ser classificado em tipo composto ou tipo complexo. O cisto dentígero é o mais comum entre os cistos odontogênicos de desenvolvimento, onde envolve a coroa da unidade dentária no nível da junção amelocementária. Há poucos estudos na literatura do encontro das duas lesões, acometendo o mesmo local na cavidade oral. O diagnóstico pode ser constituído por exame clínico e de imagem. Objetivo: apresentar um caso clínico de odontoma composto e cisto dentígero em região de parassínfise mandibular esquerda abordando as caraterísticas clínicas destas duas lesões e as adequadas formas de tratamento. Relato de caso: paciente do sexo masculino, 16 anos de idade, compareceu ao ambulatório do Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), portando encaminhamento de ortodontista, solicitando exodontia da unidade dentária 33 inclusa associada a um odontoma. Ao realizar exames físicos e imaginológicos detectou-se a hipótese diagnóstica de odontoma composto associado a unidade dentária, envolto em folículo pericoronário ou cisto dentígero. Foi realizada biópsia excisional das duas lesões e exodontia da unidade. A análise histopatológica confirmou o diagnóstico para odontoma composto associado a cisto dentígero na unidade 33. Ao acompanhamento de 03 meses, paciente apresentou neoformação óssea da região de parassínfise mandibular, mediante a análise de novos exames imaginológicos. Discussão: há poucos estudos na literatura da associação entre as duas lesões, porém relatos afirmam que o odontoma pode ser encontrado associado aos cistos odontogênicos. Por conta da falta de maiores estudos dessa associação, há escassez de recomendações terapêuticas de acordo com faixa etária e extensão do acometimento das lesões. Considerações finais: lesões comumente assintomáticas, tem o diagnóstico constituído por exame clínico e avaliação de exames de imagem(AU)

Introduction: odontoma is considered a frequent benign odontogenic tumor and can be classified as a compound or complex type. The dentigerous cyst is the most common among developmental odontogenic cysts, where it involves the crown of the dental unit at the level of the cementoenamel junction. There are few studies in the literature on the meeting of the two lesions, affecting the same site in the oral cavity. The diagnosis can be made by clinical and imaging examination. Objective: to present a clinical case of compound odontoma and dentigerous cyst in the left mandibular parasymphysis region, addressing the clinical characteristics of these two lesions and the appropriate forms of treatment. Case report: male patient, 16 years old, attended the outpatient clinic of the Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), having been referred by an orthodontist, requesting extraction of the included dental unit 33 associated with an odontoma. Upon physical and imaging examinations, the diagnostic hypothesis of a compound odontoma associated with a dental unit, surrounded by a pericoronal follicle or dentigerous cyst, was detected. Excisional biopsy of the two lesions and extraction of the unit were performed. The histopathological analysis confirmed the diagnosis of compound odontoma associated with dentigerous cyst in unit 33. At the 03-month follow-up, the patient presented bone neoformation in the mandibular parasymphysis region, through the analysis of new imaging exams. Discussion: there are few studies in the literature on the association between the two lesions, but reports state that odontoma can be found associated with odontogenic cysts. Due to the lack of further studies on this association, there is a lack of therapeutic recommendations according to age group and extent of lesion involvement. Final considerations: commonly asymptomatic lesions, the diagnosis consists of clinical examination and evaluation of imaging tests(AU)

Tercer molar heterotópico, etiología y manejo quirúrgico / Heterotopic third molar, etiology and surgical management

Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

Comprehensive cornified envelope protein profile of odontogenic keratocysts clarifies the characteristics of non-keratinized oral epithelium.

BACKGROUND: Odontogenic keratocysts constitute 10%-20% of odontogenic cysts and exhibit a distinctive corrugated parakeratinized lining epithelium. Considering that cornified envelope formation is an important phenomenon during keratinocyte differentiation, this study aimed to clarify the characteristics of cornified envelope formation in odontogenic keratocysts. METHODS: We investigated the cellular distribution of cornified envelope-related proteins (transglutaminases and their substrates), as well as the upstream regulatory protein c-Fos, by immunohistochemical analysis of the lining epithelium of 20 odontogenic keratocysts. We examined the corresponding mRNA levels by quantitative polymerase chain reaction. Ten dentigerous cysts served as control non-keratinized cysts. RESULTS: The distributions of transglutaminase and their substrates except loricrin and small protein-rich protein 1a significantly differed between odontogenic keratocysts and dentigerous cysts. There was no significant difference in c-Fos expression between odontogenic keratocysts and dentigerous cysts. The mRNA levels of transglutaminases and their substrates were significantly higher in odontogenic keratocysts than in dentigerous cysts. However, c-Fos mRNA levels did not significantly differ between groups. CONCLUSION: Surprisingly, the overall appearance of cornified envelope-related proteins of odontogenic keratocysts was consistent with the characteristics of non-keratinized oral mucosa identified in previous studies. These findings indicate that the contribution of cornified envelope-related molecules in odontogenic keratocysts is similar to that in non-keratinized oral epithelium, rather than keratinized oral epithelium, suggesting that odontogenic keratocysts are not genuine keratinized cysts. The upregulation of cornified envelope-related genes in odontogenic epithelium could be an important pathognomonic event during odontogenic keratocyst development.

Extenso quiste odontogénico radicular mandibular / Extensive mandibular radicular odontogenic cyst

Los quistes radiculares constituyen los quistes odontogénicos más comunes de la cavidad bucal. El objetivo de esta investigación es caracterizar un paciente con quiste odontogénico radicular mandibular. Se presenta un individuo masculino de 86 años, que fue atendido en el Servicio de Cirugía Maxilofacial del Hospital Provincial General Universitario «Mártires del 9 de abril», de Sagua la Grande, durante los años 2017-2018. Inicialmente, se le realizó el estudio clínico correspondiente (interrogatorio y examen físico), y se observó una evidente tumefacción y abombamiento cortical en relación a dientes residuales permanentes mandibulares; se asoció radiográficamente a una imagen radiolúcida ovoide extensa, que justificó la realización de biopsias incisionales en primer orden. Se siguió una conducta quirúrgica, con resección total de la lesión mediante enucleación, y se confirmó el diagnóstico de quiste odontogénico radicular mandibular a través del estudio histopatológico.

Radicular cysts are the most common odontogenic cysts in the oral cavity. The objective of this investigation is to characterize a patient with a mandibular radicular odontogenic cyst. We present an 86-year-old male individual who was treated in the maxillofacial surgery service at "Mártires del 9 de Abril" Provincial General University Hospital in Sagua la Grande from 2017 to 2018. Initially, a corresponding clinical study was performed (interrogation and physical examination), and an evident swelling and cortical bulging was observed in relation to mandibular permanent residual teeth; it was radiographically associated with an extensive ovoid radiolucent image, which justified the performance of first-order incisional biopsies. A surgical procedure was followed, with total resection of the lesion by means of enucleation, and the diagnosis of mandibular radicular odontogenic cyst was confirmed through the histopathological study.

Pediatric Oral Pathology: Odontogenic Cysts.

Cysts encountered in the head and neck typically arise from epithelium that would normally be programmed to form teeth or tooth-supporting structures (odontogenic epithelium). These cysts come with a confusing array of similar-sounding names and histopathologic features that are sometimes shared between conditions. Here we describe and contrast the relatively-common lesions: hyperplastic dental follicle, dentigerous cyst, radicular cyst, buccal bifurcation cyst, odontogenic keratocyst, glandular odontogenic cyst, and the less-common gingival cyst of the new-born and thyroglossal duct cyst. The goal of this review is to help clarify and simplify these lesions for the general pathologist, pediatric pathologist, and surgeon.

The Temporary Mental Nerve Paresthesia as an Outcome of Dentigerous Cyst Removal during Preparation for Dental Implant Placement: A Case Report.

The usage of xenograft material is widely used in almost all oral cavity bone defects for regenerative and reconstructive purposes. The presented xenograft usage in the following care report enabled good bone defect healing and enabled the preservation of affected premolars. It is quite common to use any possible variations of bone materials to ensure bone defect improved healing. In some cases, the scope of surgeries requires the removal of each cyst within close proximity to various nerves and vessels. The inferior alveolar, infraorbital, lingual, and mental nerves are those most commonly adjacent to most operating sites in jaw bones. The usage of some additional materials such as collagen sponges, bone substitutes, resorbable membranes, or other additional materials are useful in each bone defect reconstruction but should be handled with care, as described in the following case. Before planning their usage, it is important to perform each surgery with close cone beam computed tomography imaging, which is very helpful to establish the scope of each lesion and the proximity of vital structures. There are a lot of factors that might influence any possible nerve damage, especially the different nerve anatomical variations. Even factors including the subperiosteal preparation and compression of adjacent tissues might influence later nerve function. When the lesion is expanding through the buccal cortical plate and when soft tissue fluctuation is present, some special care is needed. Similar to the presented case, a limitation in crushing, blowing, or any irritation of nerve fibers improves later postoperative outcomes. When the wound and surrounding tissues are handled with care, a limited possibility of any damage or paresthesia can occur. When the nerve itself is damaged or cut, loss of function can be permanent. Immediately after or even prophylactic prescription 1-2 days before the surgery of Vitamin B with NSAIDs (Non-steroidal anti-inflammatory drugs) (or other additional supplementary medicaments can improve nerve function in time. Possible nerve damage can be divided into many etiological factors. A quite different situation arises when the nerve is pulled in by the cyst growth into the cyst wall. The presented case report describes the outcomes of a cyst removal from the mandibular basis and treatment modalities.

Bilateral Dentigerous Cysts of the Permanent Mandibular First Molars Treated with Marsupialization.

Bilateral dentigerous cysts (DC) associated with unerupted mandibular first molars in a non-syndromic pediatric individual are rare. Secondary infections may lead to complications, such as discomfort due to pain, disfigurement caused by enlargement of the cyst with cortical expansion of the jawbone, displacement of teeth and paraesthesia of the adjacent nerve. This case report describes the occurrence of bilateral DC in an eight-year-old patient. Marsupialization was the treatment of choice to preserve the permanent teeth and other adjacent tissues.

A proteomics study to explore differential proteins associated with the pathogenesis of ameloblastoma.

BACKGROUND: Reports on the proteomic studies of ameloblastoma and other common odontogenic lesions are limited. We thus explored the differential proteins among ameloblastoma, odontogenic keratocyst, dentigerous cyst, and normal gingival tissue using proteomics and identified hub proteins involved in the local aggressiveness and recurrence of ameloblastoma. METHODS: Samples were obtained from 14 patients with ameloblastoma, 6 with odontogenic keratocyst, 9 with a dentigerous cyst, and 5 with normal gingival tissue. Proteins were then extracted, purified, quantified, and analysed using Easy-nLC chromatography and mass spectrometry. Further functional annotation and enrichment analyses were performed using Gene Ontology and the Kyoto Encyclopedia of Genes and Genomes on the target protein collection. Protein clustering and protein-protein interaction network analyses were used to screen the hub proteins. Proteins with significant interactions were screened according to their degree index. These results were verified by immunohistochemical staining. Proteins meeting the screening criteria of expression difference ploidy >1.2-fold (upregulation and downregulation) and p < 0.05 were considered differential proteins. RESULTS: In ameloblastoma, 808 differential proteins were upregulated and 505 were downregulated compared with those in odontogenic keratocyst; 309 were upregulated and 453 were downregulated compared with those in dentigerous cyst; and 2210 were upregulated and 829 were downregulated compared with those in normal gingival tissue. The three groups of differential proteins were associated with cellular exosomes, antigen binding, complement activation, human papillomavirus infection, focal adhesion, cell adhesion molecules, and metabolic pathways. CONCLUSION: CDH3 is associated with the local aggressiveness and recurrence of ameloblastoma and is a potential therapeutic target.

Diagnóstico e tratamento de extenso cisto dentígero mandibular em um paciente pediátrico / Diagnosis and treatment of extensive mandibular dentigerous cyst in a pediatric patient

Introdução: lesões gnáticas pediátricas são comumente assintomáticas e diagnosticadas em exames de imagem de rotina. Entretanto, algumas podem cursar com dor, assimetria facial, destruição óssea e rápida evolução, requerendo diagnóstico preciso e precoce. Objetivo: o objetivo desse estudo é reportar o processo de diagnóstico e tratamento de um extenso cisto dentígero (CD) em um paciente pediátrico. Relato do caso: um menino de 5 anos idade apresentou queixa de aumento de volume doloroso na região posterior de mandíbula com tempo de evolução de 4 meses. A tomografia computadorizada demonstrou uma imagem hipodensa, bem delimitada, envolvendo a coroa do dente 37, causando a expansão da cortical vestibular e erosão da cortical lingual, com aproximadamente 3cm. Com as hipóteses diagnósticas de fibroma ameloblástico ou CD, a lesão foi enucleada totalmente. Microscopicamente, observou-se uma lesão cística com revestimento epitelial odontogênico, áreas de hiperplasia e exocitose, além de cápsula de tecido conjuntivo densamente colagenizado, com áreas de hemorragia e infiltrado inflamatório linfoplasmocitário. Resultados: baseado nas características clínicas, imagenológicas e histopatológicas, o diagnóstico final foi de CD inflamado. O paciente continua em acompanhamento clínico e radiográfico, com ausência de recidiva. Conclusão: CD inflamados em pacientes pediátricos podem apresentar comportamento peculiar e mimetizar outras lesões de natureza odontogênica. O diagnóstico precoce permite uma menor morbidade associada aos tratamentos cirúrgicos.

Introduction: pediatric gnathic lesions are commonly asymptomatic and diagnosed in routine imaging exams. However, some of them may cause pain, facial asymmetry, bone destruction and rapid evolution, requiring accurate and early diagnosis. Objective: the aim of this study is to report the diagnosis and treatment of an extensive dentigerous cyst (DC) in a pediatric patient. Case report: a 5-year-old boy complained of painful swelling in the posterior region of the mandible with an evolution time of 4 months. Computed tomography showed a hypodense, well-delimited image involving the crown of tooth 37, causing buccal cortical expansion and lingual cortical erosion, measuring approximately 3cm. With the diagnostic hypotheses of ameloblastic fibroma or DC, the lesion was completely enucleated. Microscopically, a cystic lesion with an odontogenic epithelial lining with areas of hyperplasia and exocytosis was observed, in addition to a densely collagenous connective tissue capsule, with areas of hemorrhage and lymphoplasmacytic inflammatory infiltrate. Results: based on clinical, imaging and histopathological characteristics, the final diagnosis was inflamed DC. The patient remains under clinical and radiographic follow-up, with no recurrence. Conclusion: inflamed DC in pediatric patients may show a peculiar behavior and mimic other odontogenic lesions. Early diagnosis allows for lower morbidity associated with surgical treatments.