A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.

A large radiolucent lesion in anterior maxilla: A case report

Cystic lesions of the jaw are a common occurrence. We present a case of a large unilocular cystic lesion in maxilla associated with an impacted tooth, impinging on the nasal floor. The uniqueness of the case is the high probability of a dual pathology; a cystic pathology associated with the impacted tooth (likely dentigerous cyst) and a large radicular cyst involving the apices of teeth from 21 to 26. The patient presented with a rare finding of a palatal swelling rather than a buccal swelling associated with cystic lesions involving maxillary posterior teeth. Enucleation of the cyst and extraction of the impacted tooth were performed, no other teeth were extracted. The report describes the treatment and follow up of the patient.

Unpredictable Outcomes of a Regenerative Endodontic Treatment

Regenerative endodontic treatment (RET) is a valuable treatment for necrotic immature teeth with many advantages such as increasing root length and thickness of root wall. The success of RETs is based on healthy stem cells, suitable scaffolds, and growth factors and takes place when bacterial contamination is well controlled. The aim of this article is to address controversy in a case with multiple success criteria. This paper reports a 9-year-old boy with a complicated crown fracture of the maxillary left central incisor about three years prior to referral with a diagnosis of intrusive luxation with spontaneous reeruption. The tooth had an underdeveloped root and a well-defined periapical radiolucent lesion around the root apex. RET was considered according to the stage of root development. Upon the three-week recall session, the clinical examination indicated that the patient was asymptomatic in the affected site. However, the patient returned two weeks later with a sinus tract pertaining to the apex of tooth #9. Therefore, debridement of the root canal space was repeated and the RET redone. On the second trial, the patient was symptom-free, but no more evidence of root maturation was observed on 18-month follow-up. The tooth was asymptomatic (without swelling, drainage, and pain) during this time, and esthetics was provided for the patient.

Expect the unexpected – A rare case of Orthokeratinized Odontogenic Cyst and its surgical management

Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst of the dental lamina. It was initially defined as the uncommon orthokeratinized variant of the Odontogenic Keratocyst (OKC), until the World Health Organization’s (WHO’s) classification in 2005 and 2017, where it was separated from the Keratocystic Odontogenic Tumor (KCOT) and has been included as a separate entity from the category of developmental odontogenic cysts respectively. It presents as a unilocular radiolucent lesion involving the posterior mandible and is frequently related to impacted teeth, often similar to other odontogenic cysts. Due to low local aggressiveness and less proliferative activity, it has to be differentiated from the other cysts in terms of surgical management. Here we report a rare case of OOC involving the maxilla along with an impacted canine and discuss the surgical management and why a secondary surgical intervention is unnecessary.

Can Vitamin D Therapy Contribute to the Conservative Resolution of Osteolytic Lesions of the Jaws?

Osteolytic lesions of the jaw are not uncommon. Such lesions usually arise from local pathologies, but some have systemic backgrounds. We describe a 12-year-old girl who presented with an asymptomatic left mandibular swelling. The bony swelling was corresponding to a radiolucent lesion in the left premolar/molar region. This lesion could have represented an inflammatory and developmental odontogenic jaw cyst, giant cell lesion, and odontogenic tumor. However, the workup investigations revealed secondary hyperparathyroidism due to vitamin D deficiency. A vitamin D replacement was initiated with a single I.M. injection of 300,000 I.U followed by 10,000 I.U orally, weekly. Six weeks later, her Vitamin D and parathyroid hormone were normalized, and she showed significant clinical and radiological improvement of the jaw lesion. At 18 months, follow-up the panoramic image revealed complete resolution of the radiolucency and stable normal parathyroid hormone and vitamin D levels. In conclusion, Jaw bone lesions can develop secondary to hyperparathyroidism due to vitamin D deficiency, and this should be ruled out before any surgical intervention. Treatment of such lesions lies in the correction of parathyroid excess with a careful and systematic approach. This may prevent unnecessary surgical intervention in such patients.

Clinicoradiographic Features and Histopathologic Variations of Intraosseous Lipoma: Report of a Case and Review of the Literature

Intraosseous lipoma is a very rare lesion, and the jaw is its least common bone location. Fibrolipoma is a microscopic variant of lipoma which is characterized by a significant fibrous component intermixed with lobules of fat cells. Intraosseous fibrolipoma of the jaw is a rare lesion, and to the best of our knowledge, only two cases have been reported from 1948 in English literature. This paper presents a 39-year-old man with a chief complaint of tooth displacement in the anterior region of the mandible. Radiographic evaluation revealed a unilocular radiolucent lesion with sclerotic borders located between the left lateral incisor and canine. Histopathologic evaluation after an excisional biopsy confirmed the diagnosis of intraosseous fibrolipoma. We also reviewed the literature on this rare lesion.

A Calcifying Odontogenic Cyst Associated with Compound Odontoma Mimicking a Tooth Germ

Calcifying odontogenic cyst (COC) is a rare cyst that affects mainly the anterior region of the jaws. Generally, it appears as a unilocular radiolucent lesion containing peripheral foci of calcification, but with radiographic variations depending on the type of presentation. Here, we report an atypical case of COC associated with odontoma, initially diagnosed as a tooth germ, in the posterior region of the mandible of a 10-year-old male patient. Interestingly, the radiographic aspect appeared as a unilocular radiolucent lesion without peripheral foci of calcification in the edentulous region, having its size increased after traction of the impacted tooth adjacent to that area. Thus, the case presented in this study is aimed at calling dentists’ attention to its developmental changes and related pathologies.