Thirty years clinicopathological study of 60 calcifying cystic odontogenic tumors in Iranian population.

AIM: To reevaluate all cases previously diagnosed as calcifying odontogenic cyst (COC) from the archives of the Department of Oral Pathology at Mashhad Faculty of Dentistry from 1978 to 2008. MATERIALS AND METHODS: Clinical histories and microscopic slides of all cases diagnosed as COC were reviewed and analyzed statistically. The information about patients such as age, sex, clinical features, radiographic view and other necessary data was gathered from biopsy files. RESULTS: The majority of cases occurred in mandible and four cases were peripherally. Thirteen cases were associated with other odontogenic tumors and 11 cases were odontoma type. In two cases, recurrence was reported after surgical treatment which underwent malignant transformation. CONCLUSION: Calcifying cystic odontogenic tumor (CCOT) in Iranian population occurs in younger age group with slightly male predilection and more mandibular, unicystic and simple type. CLINICAL SIGNIFICANCE: It is better to address the noncystic CCOT lesions with their specific terms in order to make histopathological characteristics clear.

Healing process following application of set or fresh mineral trioxide aggregate as a root-end filling material.

OBJECTIVES: An unsuccessful attempt to reach the apical area or to place the retrograde material is a major difficulty in periradicular surgery. The aim of this study was to compare the histological evaluation of the healing process following an orthograde versus a retrograde application of mineral trioxide aggregate (MTA) as a root-end filling material during apical surgery on cats' teeth in order to find out whether orthograde placement of MTA before surgery can be used instead of retrograde placement during surgery. METHODS: In this experimental study, 24 canine teeth in 12 mature and healthy cats were filled with either MTA or gutta-percha in an orthograde manner. Two weeks later, the teeth with MTA were surgically exposed and resected to the set-MTA within the canals. The teeth previously filled by gutta-percha were also surgically exposed, and retrograde cavities were prepared at the root ends and filled with fresh-MTA. After 8 weeks, the animals were euthanized by vital perfusion. Six-micron histological slices were prepared from samples, stained by Hematoxylin & Eosin, and histologically studied by means of a light microscope. The collected data was analyzed by the Chi-square and the T-test. RESULTS: One of the samples in the fresh-MTA group was omitted during processing because of inappropriate sectioning. In the set-MTA group, 5 out of 12 showed chronic abscess, while in the fresh-MTA group, 2 out of 11 were discovered to have chronic abscess; however, no significant difference was observed (P>.05). Hard tissue healing (cementum, bone, cementum + bone formation) in the set-MTA and fresh-MTA groups were 7 out of 12 and 9 out of 11, respectively. While healing seemed more likely to occur in the fresh-MTA group, the difference was statistically insignificant (P>.05). The magnitude of bone, cementum, or bone and cementum formation showed slight differences between the two groups; however, the figures failed to show any marked differences (P>.05). CONCLUSIONS: Orthograde placement of MTA could be used as an obturation material before surgery. In this way, after root-end resection, there would be no need for root-end preparation and filling procedures.

Nevoid basal cell carcinoma syndrome: a 17-year study of 19 cases in Iranian population (1991-2008).

BACKGROUND: Nevoid basal cell carcinoma syndrome (NBCCS) is a hereditary autosomal dominant disorder with a wide range of clinical signs and symptoms. The major criteria are more than two basal cell carcinoma, keratocystic odontogenic tumor, three or more palmar pits, and calcification of the falx cerebri, spine and rib anomalies, and a family history of the syndrome. METHODS: This study reports 19 cases in an Iranian population and presents this rare syndrome as a differential diagnosis of skeletal anomalies. Between 1991 and 2008, the demographic, clinical, radiologic and histologic data of 19 patients with NBCCS were analyzed. RESULTS: The average age at the time of diagnosis of NBCCS was 35.12 years. All patients had a minimum of two major criteria. The major criteria with the most frequency were the keratocysts odontogenic tumor (19 patients), and the average number was 6.2. Basal cell carcinoma (8 patients), and the average number was 14.7 calcification of the falx cerebri (17 patients), palmo-plantar pits (14 patients), mild hypertelorism (10 patients), and bilateral cleft lip and palate (1 patient). Only one patient was affected with an unusual case of NBCCS in a 30-year-old man with an associated squamous cell carcinoma of the maxillary sinus. Only two cases of this unusual association have been reported. This case is one of a large family including 14 NBCCS-affected patients.

Clear cell variant of extraosseous calcifying epithelial odontogenic tumor: a case report.

Calcifying epithelial odontogenic tumor (CEOT) is a benign epithelial odontogenic tumor occurring most frequently in the posterior part of the lower jaw. Extraosseous CEOT is one of the rarest forms of this tumor, and few such cases involving the maxillary gingiva have been reported in the literature. Here we present a case that showed progressive enlargement in the left maxillary gingival area over a period of 11 years. Clinical examination showed an ulcerated mass measuring 52 x 38 mm located adjacent to the lateral incisor and canine. Histologically, the tumor showed proliferation of sheets and cords of epithelial cells with granular, eosinophilic cytoplasm and round to oval nuclei. In other areas, the epithelial cells exhibited a clear, vacuolated cytoplasm and foci of eosinophilic, homogeneous material representing amyloid deposition. The present case of extraosseous CEOT with clear cells was considered to be a very rare form of this tumor.

Odontogenic keratocysts in Nevoid basal cell carcinoma syndrome: a case report.

Nevoid basal cell carcinoma syndrome, a rare autosomal dominant disorder, comprises a number of abnormalities such as multiple nevoid basal cell carcinomas, skeletal abnormalities and multiple odontogenic keratocysts. Considering the rarity of this syndrome, we present a 12-year-old boy affected by this syndrome. He had multiple okcs, calcification of falx cerebri, bifid ribs, frontal bossing and hypertelorism. Characteristic cutaneous manifestation (nevoid basal cell carcinoma) was not present in this patient. The jaw cysts were treated with marsupialization then enucleation. The dental clinician may be the first to encounter and identify this syndrome, when the multiple cystlike radiolucencies are discovered on panoramic view.

Actinomycosis of the tongue.

Actinomycotic infections are known to be associated with difficulties in making the diagnosis and treatment. Actinomycosis of the tongue is rare and of great importance, not only because it can mimic many other diseases, but also because the tongue itself has some histophysiologic features that make it resistant to infections. In this report, we present a case of lingual actinomycosis and discuss the predisposing factors as well as the diagnostic methods and therapeutic modalities.

Silent sinus syndrome: report of a case.

Silent sinus syndrome (SSS) is a quite rare clinical entity characterized by unilateral enophthalmos and hypoglobus secondary to thinning and inward bowing of the maxillary sinus roof in the absence of signs or symptoms of intrinsic sinonasal inflammatory disease. We present a case of a 16-year-old female with a 10-month history of facial asymmetry due to swelling of the left cheek and ptosis of the left eye with no other symptoms. Computed tomography scans and Water's x-ray revealed an opacified left maxillary antrum with characteristic features of SSS. The patient underwent surgery and a thick maxillary sinus mucocele was found and enucleated successfully during the operation. Six-month and 2-year follow-ups after surgical treatment revealed satisfactory results and there was no need for reconstruction of the orbital floor. Although patients with SSS often initially present to ophthalmologists, oral and maxillofacial surgeons and radiologists should be familiar with this phenomenon since most of these patients will be referred to dental hospitals for further treatment.

Extension of Pindborg tumor to the maxillary sinus: a case report.

The calcifying epithelial odontogenic tumor is a benign epithelial odontogenic lesion that accounts for less than 1% of all odontogenic tumors. It is most frequently seen in the posterior areas of the mandible. Extension of this lesion to the maxillary sinus is extremely rare. In this paper, we report the fourth of such cases which has been reported, up to now. This tumor was encased between the right maxillary lateral and canine roots with extension to the maxillary sinus. Histologically, the tumor is composed of sheets of epithelial cells with eosinophilic or clear cytoplasm, intercellular bridges, nuclear pleomorphism, but no mitotic figures, amorphous eosinophilic and calcified materials were seen within the sheets of epithelial cells.

Keratocystic odontogenic tumor: a 10-year retrospective study of 83 cases in an Iranian population.

A retrospective analysis was conducted on patients diagnosed with and treated for keratocystic odontogenic tumor (KCOT) at Mashhad School of Dentistry between 1996 and 2006. The patients comprised 44 men and 30 women with a mean age of 27.08 years. Among the total of 83 lesions, 56 (67.5%) occurred in the mandible and 27 (32.5%) in the maxilla. Swelling tended to be the most common complaint (45.8%), while 24.1% of the lesions were diagnosed incidentally. Six patients (8.1%) with a total of 15 lesions had nevoid basal cell carcinoma syndrome; 28 lesions (33.7%) were associated with an impacted tooth, and 12 (14.5%) presented daughter cysts. Sixty-six KCOTs were treated by enucleation [5 recurrences (7.6%)], 6 by marsupialization [2 recurrences (33.3%)] and 11 by marsupialization followed by enucleation (no recurrences). KCOTs in the mandible showed a higher recurrence rate than those in the maxilla (10.7% vs 3.7%). Although the demographics of Iranian patients are closely similar to those of other nationalities, in this series KCOTs tended to develop in younger patients with a peak in teenagers. The posterior region of the mandible showed the highest likelihood of KCOT occurrence and recurrence. Marsupialization followed by enucleation resulted in the lowest recurrence rate.