A Fortuitous Finding of Asymptomatic Compound Odontoma Consisting of 156 Denticles on a Routine Radiographic Examination: A Case Report.

Odontomas are the most common odontogenic tumors and are classified into compound and complex types. They result from a combination of odontogenic epithelium and ectomesenchyme. Complex odontomas frequently occur in the posterior mandible, whereas compound odontomas are more commonly found in the anterior region of the maxilla. Due to their small size and asymptomatic nature, odontomas are often diagnosed incidentally. Typically, odontomas are <3 cm in diameter; those exceeding this size are classified as giant odontomas and may present with extraoral swelling. This case report documents an unusual instance of a giant compound odontoma, containing 156 denticles, in a 15-year-old girl. Despite the odontoma's large size in the mandibular anterior region-an uncommon site for compound odontomas-the patient was completely asymptomatic and presented with only intermittent pain in the lower right back tooth region over the past month. The denticles were extracted, and intentional root canal treatment was performed on teeth 41, 42, 31, and 32 under general anesthesia. How to cite this article: Chiranjeevi S, Prabhuraj SN. A Fortuitous Finding of Asymptomatic Compound Odontoma Consisting of 156 Denticles on a Routine Radiographic Examination: A Case Report. Int J Clin Pediatr Dent 2024;17(6):723-727.

A Comparative immunohistochemical analysis of epithelial-mesenchymal transition biomarkers in odontogenic keratocyst, dentigerous cyst, and radicular cyst.

Background: Odontogenic keratocyst (OKC) is one of the common odontogenic cysts with aggressive clinical behavior and a high recurrence rate. Epithelial-mesenchymal transition (EMT) is a process, in which the epithelial cell loses its epithelial characteristics and acquires mesenchymal features. Since the evidence for the involvement of EMT in the development of OKC is still limited, the present study aimed to investigate the immunohistochemical expression of EMT-related proteins (E-cadherin and N-cadherin) in OKC and compare them to radicular cyst (RC) and dentigerous cyst (DC). Materials and Methods: In this descriptive analytical study, 75 paraffin blocks, including 25 DCs, 25 OKC, and 25 RCs, were selected. Immunohistochemical staining was performed to determine the expression and staining intensity of E-cadherin and N-cadherin proteins. The specimens were examined under an optical microscope, and the data were analyzed using the Kruskal-Wallis test in SPSS statistical software (version 23) with a significance level of 5%. Results: The expression of N-cadherin in OKC was higher than that in other cysts; nonetheless, there was no statistically significant difference (P = 0.331). The staining intensity of N-cadherin was weak in most cases, and this difference was not statistically significant (P = 0.252). E-cadherin expression in OKC was significantly lower than that in radicular and DCs (P = 0.003). In addition, the staining intensity of E-cadherin in OKC was weak and moderate (P = 0.003). Conclusion: In this study, we observed an increase in the expression of N-cadherin in OKC. In addition, the protein expression levels of E-cadherin in OKC were significantly lower compared to DC and RC. Therefore, it appears that the EMT process likely occurs in OKC and may contribute to its local aggressive behavior.

Rare Histologic Imitator Central Mucoepidermoid Carcinoma Arising from Glandular Odontogenic Cyst of the Mandible: Case Report with Updated Review of Literature.

Central mucoepidermoid carcinoma is a relatively rare salivary gland tumour of the jawbone. Glandular odontogenic cyst is another unique odontogenic developmental cyst characterised by glandular differentiation. Both entities share several histological characteristics, and a pre-existing Glandular odontogenic cyst can evolve into Central mucoepidermoid carcinoma. Case 1: A 56-year-old male presented with chief complaint of swelling in lower left facial region since 1 year. Histopathology revealed multicystic compartments resembling mucoepidermoid carcinoma, but strong positive expression of Cytokeratin 13 upon immunohistochemistry helped us in rendering the final diagnosis as Glandular odontogenic cyst Case 2: A 34-year-old female presented with a lesion on right side of face. Histologically, the biopsy specimen revealed both typical findings of a Glandular odontogenic cyst component and a recognizable component of Mucoepidermoid carcinoma. The results from cytokeratin profiling demonstrated that, while both Mucoepidermoid carcinoma and Glandular odontogenic cyst expressed Cyokeratins 7, 18, and 19. Cytokeratin 13 was interestingly exclusively expressed in Glandular odontogenic cyst. Present case findings showed that central mucoepidermoid carcinoma and Glandular odontogenic cyst may be part of the same disease spectrum. However, because the expression profile of Cytokeratin13 in mucoepidermoid carcinoma and Glandular odontogenic cyst was so diverse, it can be used to differentiate both.

Recurrence and Prognosticators of Recurrence in Odontogenic Keratocyst of the Jaws.

Introduction: The incidence of recurrence of OKC varied from 2.5 to 62%. Studies have linked recurrence to treatment methods and also clinical and pathological features. The aim of this study was to evaluate the 5-year recurrence and the factors associated with recurrence in odontogenic keratocysts of the jaws. Methods: A retrospective review of records was done from the Institute's Medical Records Directory from 2010 to 2021. The following data were obtained of the lesion; age at presentation, gender, site, subsite, radiographic presentation (locularity), radiographic borders, presence or absence of satellite cysts, inflammatory infiltrate, and treatment rendered presence or absence of cortical perforation and soft-tissue extension and presence or absence of recurrence. Kaplan Meir estimator was used to evaluate recurrence rate and log rank test was used to compare the survival amongst groups. Cox regression analysis was used to evaluate the odds ratio to find out the possible factors influencing risk of recurrence. A p value of < 0.05 was considered statistically significant at 95% confidence interval. Results: In our study cohort, 27.2% of patients had recurrence. Posterior maxillary lesions, multilocular lesions, lesions with scalloped borders, presence of soft-tissue extension and cortical perforation, presence of satellite cysts and inflammatory infiltrate and enucleation with peripheral ostectomy were significantly associated with recurrence. However, soft-tissue extension, cortical perforation, multilocular lesions and presence of satellite cysts were independent risk factors. Conclusion: There is still debate on the best treatment modality for the management of OKCs. More studies are required to quantify the results.

Bilateral Primordial Odontogenic Tumour of Mandible: A Rare Case Report.

Primordial odontogenic tumour is a recently categorised rare benign mixed epithelial and mesenchymal odontogenic tumour which occurs most frequently in first two decades of life. It is composed of cellular myxoid connective tissue lined by cuboidal to columnar odontogenic epithelium resembling inner enamel epithelium in early stages of tooth development. Here, we are presenting a unique case of bilateral primordial odontogenic tumour of mandible in a paediatric patient. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-023-02075-3.

Network pharmacology and experimental validation reveals the potential therapeutic effects of Polygonum cuspidatum against odontogenic keratocyst.

This study aimed to explore active ingredients in Polygonum cuspidatum with potential effects on odontogenic keratocysts (OKCs) using network pharmacological approach and bioinformatic gene analysis. The active ingredients and targets of P. cuspidatum were selected from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) database, and the ingredient-target network was constructed using Cytoscape software. Differentially expressed genes (DEGs) of OKC were selected and Gene Ontology (GO) enrichment analysis were performed through bioinformatic analysis using Gene Expression Omnibus (GEO) dataset GSE38494. The STRING database platform was used to draw protein-protein interaction network diagram, then the hub gene analysis was performed by Cytoscape software. AutoDock Vina software was used to perform molecular docking verification of the effects of the active ingredients on potential core targets. Finally, we use OKC nude animal model to testify the potential effects of P. cuspidatum. Ten active ingredients of P. cuspidatum were obtained. A total of 205 drug targets and 38 potential core targets of P. cuspidatum were confirmed in OKCs. The hub genes included PPARG, SPP1, COL3A1, MMP2, HMOX1, CCL2, CXCL10, VCAM1, RUNX2 and IRF1. Molecular docking showed that the key active ingredients including luteolin and quercetin which exhibited good docking activity with key target proteins (VCAM1, HMOX1 and MMP2). GO enrichment revealed that the pathways of P. cuspidatum acting on OKCs included the response to toxic substance, response to nutrient levels and response to xenobiotic stimulus. P. cuspidatum treatment in OKC could significantly down-regulate COL3A1 and MMP2 expressions in vivo and vitro. Our study indicated that P. cuspidatum is a potential therapeutic candidate for OKCs.

Epidemiological Features of 4777 Cysts and Odontogenic Tumors Based on the 2022 WHO Classification.

OBJECTIVE: The epidemiology of cysts and odontogenic tumors is important for differential diagnosis and treatment strategies. We aimed to describe the epidemiological features of cysts and odontogenic tumors in the Chilean population using the current WHO classification. MATERIALS AND METHODS: We reviewed 22,914 biopsy requests received between January 1984 and September 2023 at the oral pathology department, School of Dentistry, Universidad Mayor, Santiago, Chile. Patients diagnosed with cysts of the jaws and odontogenic tumors were selected and information regarding age, sex, and location was recorded. RESULTS: 4226 (18.4%) were cysts, and 551 (2.4%) were odontogenic tumors, ranging from 2 to 97 years old. Males represented 54.4% and females 45.7% of the total sample. The most prevalent cysts were radicular cysts (58.6%), dentigerous cysts (17.9%), and odontogenic keratocysts (13.3%). The most prevalent odontogenic tumors were odontomas (40.1%) and conventional ameloblastoma (17.6%). CONCLUSIONS: Our study was the first retrospective analysis to determine the epidemiological features of both cysts and odontogenic tumors together, based on the 2022 WHO classification. This is relevant as it offers a potential basis for comprehensive comparisons of the epidemiological features of these entities, which could contribute to an accurate differential diagnosis, therefore, leading to more effective therapeutic interventions.

Surrogate Immunohistochemical Markers of Proliferation and Embryonic Stem Cells in Distinguishing Ameloblastoma from Ameloblastic Carcinoma.

PURPOSE: The current study aimed to investigate the use of surrogate immunohistochemical (IHC) markers of proliferation and stem cells to distinguish ameloblastoma (AB) from ameloblastic carcinoma (AC). METHODS: The study assessed a total of 29 ACs, 6 ABs that transformed into ACs, and a control cohort of 20 ABs. The demographics and clinicopathologic details of the included cases of AC were recorded. The Ki-67 proliferation index was scored through automated methods with the QuPath open-source software platform. For SOX2, OCT4 and Glypican-3 IHC, each case was scored using a proportion of positivity score combined with an intensity score to produce a total score. RESULTS: All cases of AC showed a relatively high median proliferation index of 41.7%, with statistically significant higher scores compared to ABs. ABs that transformed into ACs had similar median proliferation scores to the control cohort of ABs. Most cases of AC showed some degree of SOX2 expression, with 58.6% showing high expression. OCT4 expression was not seen in any case of AC. GPC-3 expression in ACs was limited, with high expression in 17.2% of ACs. Primary ACs showed higher median proliferation scores and degrees of SOX2 and GPC-3 expression than secondary cases. Regarding SOX2, OCT4 and GPC-3 IHC expression, no statistically significant differences existed between the cohort of ABs and ACs. CONCLUSION: Ki-67 IHC as a proliferation marker, particularly when assessed via automated methods, was helpful in distinguishing AC from AB cases. In contrast to other studies, surrogate IHC markers of embryonic stem cells, SOX2, OCT4 and GPC-3, were unreliable in distinguishing the two entities.

Calcifying cystic odontogenic tumour: Dilemma and pitfalls.

Odontogenic lesions are a category of lesions, which are found to be arising from the remnants of the tooth-bearing tissues of the body, that can be cystic in nature as a result of degeneration or as a result of excessive proliferation of these cells, can result in the formation of odontogenic tumours which are found in gnathic bones in the body. Since their discovery in literature and the explanation provided for their pathogenesis, these lesions have been the subject of debate and controversy amongst researchers as well as practitioners. Thereby, this review has taken into consideration one such odontogenic tumour, Calcifying Cystic Odontogenic Tumour (CCOT), which first were included under the namesake (Calcifying odontogenic cyst) as a sperate subheading under this cyst, but now has been designated under the category of tumours along with various histologic subtypes classified and described henceforth. Although the lesion has been removed in the recent classification, a wide variety of lesions in biphasic form has been reported in the past. Therefore, this present review takes a sneak-peek into this lesion with insight into its presentation, incidence, aetiology, pathogenesis, histopathology and all the controversies surrounding this category of lesion and the current literature about this lesion with proving the fact that this needs to be considered again in the category of odontogenic tumours.

Clinical and radiological characteristics of odontogenic orbital cellulitis.

PURPOSE: To assess the radiological features and clinical outcomes of odontogenic orbital cellulitis. METHOD: Multi-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes. RESULTS: Four patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25-56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n = 1, 25%), hand movements (n = 1, 25%) and no perception of light (n = 2, 50%). The organisms implicated were Streptococcus milleri (n = 3, 75%) and Streptococcus constellatus (n = 1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration. CONCLUSIONS: Odontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.

Exceptional Evolution of a Squamous Odontogenic Tumor in the Jaw: Molecular Approach.

A squamous odontogenic tumor (SOT) is an epithelial locally benign neoplasia derived from the periodontium of the jaws. It is considered a lesion of low incidence. Predominantly, it affects the mandible, although both jaw bones may be involved. Here, we discuss the malignant clinical evolution of an SOT lesion in an 80-year-old female patient. The patient exhibited an expansive triangular lesion at the inferior right quadrant. Surgery was performed and an SOT was diagnosed (2019). Two years after, the lesion grew, and the analysis of the biopsy revealed SOT malignization with pleomorphic atypical squamous cells, characteristics of a squamous cell carcinoma (2021). Massive DNA sequencing of formalin-fixed-paraffin-embedded specimens of the initial and relapsed tumors indicated pathogenic mutations in RET and POLE genes in both tumors, loss of ALK, and gain of CDKN1B and MAP2K in the relapse. In addition, the clinical, radiographic, and microscopic features of this neoplasm are discussed and compared with those already published. The case presented contributes to the better understanding of this SOT tumor entity and to indicates its malignant evolution, together with its biological behavior and its histologic, clinical, and radiographic features. Also, it aims to stress the importance of deeper genetic analyses in rare diseases to uncover mutations that help to select a personalized treatment.

Efficacy of topical application of corticosteroids in the remineralization of dental pulp tissue. A systematic review of the literature.

OBJECTIVES: The aim of this systematic review was to demonstrate the efficacy of topical application of corticosteroids in remineralization of dental pulp tissues to preserve their vitality and function. DATA, SOURCES AND STUDY SELECTION: An electronic search was performed using MEDLINE by PubMed, EMBASE, Web of Science (WOS), and Scopus databases. The inclusion criteria were in vitro studies that employed dental pulp tissue obtained from extracted healthy permanent human teeth and were subjected to topical administration of corticosteroids and evaluated tissue remineralization by performing any mineralization assay. A total of 11 studies were selected for inclusion. PRISMA guidelines were followed, and the methodological quality and risk of bias of the included studies were evaluated using the RoBDEMAT guidelines. Also, tables were designed for data extraction, including tissue mineralization and osteogenic differentiation as primary and secondary outcomes, respectively. CONCLUSIONS: Alizarin Red S (ARS) has been able to demonstrate a possible mineralizing power of corticosteroids, applied at an adequate dose. The up-regulation of Alkaline phosphatase (ALP), osteocalcin (OCN), osteopontin (OSP), sialophosphoprotein (DSPP), runt-related transcription factor 2 (RUNX2), collagen type 1 alpha 1(COL1α1) and dentin matrix protein 1 (DMP-1) induced the osteogenic/odontogenic differentiation of dental pulp stem cells (DPSCs). CLINICAL SIGNIFICANCE: Deep carious lesions treatment is still challenging in restorative dentistry. Some treatments have been focused on dental pulp tissue remineralization to maintain the function and vitality. After corticosteroids topical application, mineral deposition and osteogenic differentiation have been detected.

Surgically treated chronic maxillary sinusitis: Does the odontogenic etiology alone or in combination with a fungus ball matter?

PURPOSE: To determine whether odontogenic maxillary sinusitis, either alone (OMSw/oFB) or in combination with fungus ball (OMSwFB), is associated with specific clinical characteristics and treatment outcomes compared to non-odontogenic maxillary sinusitis. MATERIALS AND METHODS: A retrospective cohort study was performed on patients who underwent surgical treatment for chronic maxillary sinusitis between 2013 and 2021. OMSw/oFB and OMSwFB patients, were selected as the study group, while patients diagnosed with non-odontogenic maxillary sinusitis (non-OMS) were enrolled as the control group. Predictor variables were OMSw/oFB and OMSwFB. Outcomes were clinical presentation, postoperative complications, and treatment outcome. Descriptive, bivariate, and multiple logistic regression statistics were calculated, and the significance level was set at P ≤ 0.05. RESULTS: The sample included 200 patients with a mean age of 49.6 ± 20.1 years and 57.5 % were men. Of the 200 patients, 123 (61.5 %) had non-OMS, 55 (27.5 %) had OMSw/oFB, and 22 (11 %) had OMSwFB. Multivariate analysis showed that OMSw/oFB was associated with more successful treatment rates (OR = 8.19, p < 0.01), whereas OMSwFB was associated with a less favorable outcome (OR = 0.27, p = 0.03). Age was associated with an unfavorable outcome in both OMS groups (OR: 0.98, p = 0.03 and p = 0.03, respectively), but no significant associations with other outcomes were found. CONCLUSION: This study suggests that OMSwFB is a recalcitrant form of OMS associated with a higher risk of persistent symptoms and less favorable outcome. These patients should be informed about the challenging nature of the disease and closely monitored.

Effect of polydatin on the viability and odontogenic differentiation of human dental pulp stem cells: An in-vitro study.

Background/purpose: Various materials have been used to promote human dental pulp stem cells (hDPSCs) differentiation to produce dentin bridge formation with less-than-optimal results. Polydatin (PD), a naturally present material with osteogenic properties can be a promising material in the pulp regeneration/repair process. The aim of this study was to evaluate the effect of (PD) on the viability and differentiation of human dental pulp stem cells. Materials and methods: PD effect on hDPSCs in terms of cellular viability, alkaline phosphatase (ALP) production, and messenger RNAs (mRNA) of odontogenic markers production using quantitative reverse transcription polymerase chain reaction (RT-qPCR) were evaluated. In addition, mineral deposits were detected with Alizarin red stain. Results: The viable hDPSCs in the presence of 0.01 µM and 0.1 µM PD were significantly higher than the control on days 3 and 7, respectively. In addition, ALP activity of hDPSCs was significantly increased with 0.01, 0.1, and 1 µM of PD. In addition, increased expression mRNAs of ALP, osteocalcin (OC), osteonectin (ON), osteopontin (OP), Runt-related transcription factor-2 (RUNX-2), dentin sialophosphoprotein (DSPP), and dentin matrix protein-1 (DMP-1) was observed after PD treatment, however, the difference was not statistically significant. Furthermore, increased size of mineral deposits was observed with PD. Conclusion: PD promoted the expression of markers associated with odontogenic differentiation and mineralized tissue deposition in hDPSCs.

Sphingosine-1-phosphate receptor 1-mediated odontogenic differentiation of mouse apical papilla-derived stem cells.

Background/purpose: Sphingosine-1-phosphate (S1P) exhibits receptor-mediated physiological effects by facilitating the differentiation of mesenchymal stem cells toward the osteoblast lineage. This study aimed to determine the effect of S1P on odontogenic differentiation of mouse immortalized stem cells of dental apical papilla (iSCAP) and assess the distribution of the S1P receptor 1 (S1PR1) in the apical papilla and the root canal wall of immature rat molars. Materials and methods: Immunostaining for S1PR1 was conducted at the apex of the rat mandibular first molar and within the root canal wall. The iSCAP was treated with S1P and bone morphogenetic protein (BMP)-9 (for comparison), and the expression levels of the odontogenic differentiation marker were evaluated via real-time reverse-transcriptase quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. Mineralization and lipid droplet formation were evaluated via Alizarin red and Oil red O staining. Results: S1PR1-positive cells were expressed in areas of both apical papilla and dentin-pulp interface of root canal wall. During the odontogenic differentiation of iSCAP, S1P and BMP-9 increased the expression of the differentiation marker mRNA and secreted proteins including dentin sialophosphoprotein, dentin matrix phosphoprotein 1, and matrix extracellular phosphoglycoprotein. The S1PR1 signaling pathway is involved in the action of S1P, but not that of BMP-9. S1PR1 signaling also facilitated mineralization in iSCAP and suppressed the differentiation of these cells into adipocytes. Conclusion: S1P induced odontogenic differentiation of iSCAP through S1PR1. Furthermore, S1PR1-positive cells were expressed in the apical papilla of immature rat molars and in the dentin-pulp interface where odontoblast-like cells exist.

Peripheral calcifying odontogenic cyst in maxillary anterior gingiva: A case report.

BACKGROUND: Calcifying odontogenic cysts (Gorlin cysts) most commonly present centrally and have only rarely been reported in peripheral locations. The purpose of this report is to describe a new case of peripheral calcifying odontogenic cyst (PCOC) occurring in the anterior maxillary gingiva and to review the management and differential diagnosis of such a lesion. METHODS: A 37-year-old female presented with a long-standing submucosal nodule on the gingiva between the maxillary central incisors, with asymptomatic growth over the last three years. Following an initial incisional biopsy, a diagnosis of PCOC was established. To exclude the possibility of a central process, a corresponding small field of view cone beam CT scan was obtained and the patient returned for a 6 mm excisional biopsy to the depth of the periosteum. RESULTS: Results of these additional assessments supported the original diagnosis of PCOC. Following uneventful healing of the second biopsy, no recurrence or other clinical findings were noted at 1-year follow-up. CONCLUSION: While rare, the peripheral variant of calcifying odontogenic cyst, and other peripheral counterparts to recognized central cysts and tumors, should be considered in a differential diagnosis for a benign gingival nodule. Gingival tissue should be submitted for histologic evaluation to ensure a neoplastic process is not present. KEY POINTS: Various lesions may present on the gingiva as a "bump"; these can represent common clinical entities, such as pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma, and fibroma, or more rare conditions that may not be adequately considered in the differential diagnosis. A rarely documented case of peripheral calcifying odontogenic cyst (PCOC; Gorlin cyst) on the maxillary anterior gingiva of an adult female is reported here and compared with the few other similar PCOC cases in the literature. A biopsy of gingival lesions is always necessary to establish the correct diagnosis and provide the appropriate treatment. PLAIN LANGUAGE SUMMARY: Several different lesions can appear on the gingiva (gums). Some are quite common, and some are rare. This report documents the occurrence of a new case of calcifying odontogenic cyst (Gorlin cyst), a type of cyst that has been rarely found outside the jawbone, presenting as a "bump" on the gingiva between the maxillary central incisor teeth of an adult female. Because of the patient history, a peripheral calcifying odontogenic cyst (PCOC) was not initially suspected. Following a biopsy, a PCOC diagnosis was given. The possibility of a lesion within the bone was then excluded by an X-ray (cone beam CT) scan examination. A second, more extensive biopsy confirmed the diagnosis and the removal of the lesion. The patient had no complications or recurrence for the following 12 months. This case highlights the need to always biopsy lesions presenting on the gums to obtain a proper diagnosis and provide the correct treatment.

Cone-beam computed tomography imaging of benign odontogenic lesions in the maxilla: A report of 2 cases.

Odontogenic tumors are slow-growing and generally nonaggressive; however, aggressive characteristics appear to exist in particular tumors. The author reports two cases of benign odontogenic lesions at the anterior maxilla. A 44-year-old woman came to an oral-maxillofacial surgeon with a complaint of asymptomatic swelling of the left anterior region of the maxilla 15 years ago, which started gently but gradually increased over time. The patient experienced a physical injury 15 years ago, resulting in the loss of the upper left front teeth. In the other case, a 50-year-old woman complained for 5 years about a little swelling in her left anterior maxilla that became larger over time without causing any discomfort or pain. The Cone-beam computed tomography (CBCT) exam revealed a partially multilocular radiopaque mixed radiolucent lesion in the anterior maxilla, with margins that are both well-defined and ill-defined. Both display features of infiltrative, expansive, and moderately aggressive growths, leading to the erosion and perforation of the cortical plates in the buccal and palatal regions. Based on the biopsy results, both samples showed similar findings, specifically a benign odontogenic lesion, likely desmoplastic ameloblastoma, and squamous odontogenic tumor without any atypic cells or malignancy. This study aims to further our understanding of the clinical and radiological features of these patients and emphasize the importance of investigating specific lesions as potential diagnoses.

Antibiotic Prescribing Trends in Dentistry during Ten Years' Period-Croatian National Study.

Prescribing antibiotics is a regular part of daily dental practice. Antibiotics have a significant but a limited role in general dental practice due to the threat of emergence of antimicrobial resistance (AMR). As such, the aim of this study was to assess prescribing trends in dental antibiotics use from 2014-2023 in Croatia. Data on antibiotic prescribing practices for this study were provided by the Croatian Health Insurance Fund. The analysis included the number of prescriptions, packages, cost, and the World Health Organization's defined daily dose per 1000 inhabitants (DID) per day as an objective utilization for comparison. Over the 10-year period, dentists in Croatia prescribed an annual average of 357,875 antibiotic prescriptions, representing an annual average of 78.7% of all dental prescriptions. The most commonly prescribed antibiotic was the combination of amoxicillin and the beta-lactamase inhibitor clavulanic acid, which made up 58.54% of antibiotics and 46.1% of all dental prescriptions. This was followed by amoxicillin (12.61%), clindamycin (12.58%), and metronidazole (9.96%). The trend showed two discontinuations, the first for the pandemic years, and the second caused by disruption in amoxicillin production. The rise in the use of broad-spectrum antibiotics needs to be addressed and regulated to ensure patients and dentists understand that antibiotics are not a substitute for dental treatment. Dentists should always begin treatment with narrow-spectrum antibiotics regardless of possible exceptional circumstances.

Recurrent Aggressive Cementoblastoma - A Rare Case Report.

Cementoblastoma is an odontogenic tumor of benign nature. It is of mesenchymal origin with a relatively low incidence of reappearance. Hereby we present a case report of a 14-year-old male patient with recurrent swelling on the right mandibular posterior region. Despite surgical removal of the tumor mass along with the right first molar, recurrence of the lesion was noticed. Hence, our report gives an insight on the treatment and management of the lesion by en-bloc resection on the right side of the mandible.