Does Surgical Fragmentation of Odontogenic Keratocystic Capsule Interfere With the Recurrence Rate?

PURPOSE: We hypothesized that fragmentation of the cystic capsule during surgery would influence the recurrence rate of odontogenic keratocysts (OKCs) regardless of the treatment modality chosen. MATERIALS AND METHODS: We reviewed, in a retrospective study, cases diagnosed as OKCs on histopathologic examination at the oral pathology department between 1991 and 2013. Fragmentation data were obtained from the records of the oral surgical department. RESULTS: Fragmentation of the capsules of OKCs during surgery did not affect recurrence, irrespective of the chosen treatment modality. The addition of techniques such as cryotherapy lowered the risk of recurrence of OKCs (P = .013) compared with after enucleation alone. Furthermore, patients with associated nevoid basal cell carcinoma syndrome had a greater recurrence rate than that of those with no associated syndrome (P = .033). CONCLUSIONS: Fragmentation of the cystic capsule does not play an important role in the rate of OKC recurrence. The rate of recurrence can be modified by using additional strategies such as cryotherapy.

Current concepts of oral and maxillofacial rehabilitation and treatment in aviation.

Aerospace medicine is the medical discipline responsible for assessing and conserving the health, safety, and performance of individuals involved in air and space travel. With the upward trend in airline travel, flight-related oral conditions requiring treatment have become a source of concern for aircrew members. Awareness and treatment of any potential physiological problems for these aircrews have always been critical components of aviation safety. In a flight situation, oral and maxillofacial problems may in fact become life-threatening clinical conditions. The unusual nature of aerospace medicine requires practitioners to have unique expertise. Special attention to aerospace medicine will open the way for professionals to develop and apply their skills and capabilities. Both dentists and aviators should be aware of the issues involved in aviation dentistry. This article presents the principles of prevention, treatment guidelines, and dental-related flight restrictions.

[Dissertations 25 years after date 22. Surgical treatment of keratocysts]. / Proefschriften 25 jaar na dato 22. Chirurgische behandeling van keratocysten.

In 1984, the dissertation 'The incredible keratocyst' was published. A postscriptum of this dissertation introduced a new and simplified approach in the treatment of keratocysts. Keratocysts are disreputable for a high recurrence prevalence and the new method is minimizing the chance of recurrence. The essence of the method is fixation of the cystwall with a modified Carnoy's solution before enucleation. During the past 25 years no new developments have been published concerning surgical treatment of keratocysts, which are essential divergent of this method. However, some authors have objections to the use of the modified Carnoy's solution because of feasible pathologic side effects. Based on research data and experiences of the author, it can be concluded that the fixing agent may be used without any risk.

Determination of potential cellular proliferation in the odontogenic epithelia of the dental follicle of the asymptomatic impacted third molars.

PURPOSE: The aim of this study is to determine the proliferative potentials of dental follicles (DF) of radiographically asymptomatic impacted third molar teeth by using Ki-67 and mini-chromosome maintenance protein 2 (MCM-2) proliferation markers, and to discuss whether there is any necessity for the removal of all impacted third molars by detecting the potential of the developing cysts and tumors of its DF. MATERIALS AND METHODS: This study involved 59 DF of 54 patients referred for clinically and radiographically asymptomatic lower impacted third molars. Thirteen healthy gingiva tissues obtained during the impacted third molar operation in 13 patients served as a control group. DF widths on periapical radiographs below 2.5 mm were included in the study. The epithelial and mesenchymal components of DF were examined histologically. All specimens were stained with periodic acid Schiff, Alcian blue, and mucin for the evaluation of mucous cell prosoplasia. Epithelial cell proliferation was determined by using immunohistochemical labeling. RESULTS: The histologic examinations showed 11.9% mucous cell prosoplasia, 55.9% squamous metaplasia, 15.3% glandular epithelium, and 33.9% inflammation. Ki-67 expression was found to have higher values than MCM-2 expression in controls 6.15 (3.18) and 10.53 (5.77) and in DF 4.46 (1.39) and 5.89 (2.89), respectively. The expression of both proliferation markers in the basal epithelial cells, mucous, and squamous epithelium and inflammatory cells were statistically significant (P < .01). CONCLUSION: The results of this study indicate that the odontogenic epithelium in DF of asymptomatic impacted third molars might be actively proliferating and may be an indicator for the differentiation potential of DF. It would also seem that the inflammation observed in the mesenchymal components of DF up-regulate the cell turnover of odontogenic epithelium and lead to proliferation. Based on these observations, we support prophylactic removal of impacted third molars.

Pathologic changes in soft tissues associated with asymptomatic impacted third molars.

OBJECTIVE: The aim of this study was to examine the need for routine removal of asymptomatic impacted third molars under the prophylactic indication, based on the incidence of pathologic changes. The frequency and type of pathologic conditions associated with impacted third molars were also evaluated. STUDY DESIGN: One hundred twenty impacted third molar dental follicles were submitted for histopathologic examination. The association between dental follicles and pathologic changes, age, gender, and angular position were statistically evaluated. RESULTS: Among these dental follicles, pathologic conditions were found in 23%. The relation between pathologic changes and angular position was not statistically significant (chi(2) = 2.040; P > .05). Pathologic changes were seen mostly in women who were > or = 20 years old. CONCLUSIONS: Cystic changes may be developed in asymptomatic impacted third molars. Asymptomatic impacted third molars should be removed before pathologic changes can occur.

Rationale for removing impacted teeth: when to extract or not to extract.

Age, crowding, disease and root resorption all influence the decision to remove impacted teeth. While not every impacted tooth causes a significant problem, each has that potential.

[Preventive removal of displaced teeth]. / Müssen verlagerte Zähne prophylaktisch entfernt werden, ja oder nein?

Using the data acquired from our catamnestic survey, we were able to establish a broad catalogue of complications involved with impacted and displaced teeth. Given these complications, it is not medically responsible to leave impacted and displaced teeth in the jaw, even if they are asymptomatic. The risks increase considerably with age. Late operative removal of such teeth can be a dangerous intervention due to local complications such as abscesses, cysts, osteomyelitis, tumors, systemic diseases, and age-related changes in the cardiovascular system.