Chemical adjuncts and cryotherapy in the management Of odontogenic keratocysts: A systematic review

Abstract

IntroductionOdontogenic keratocysts are benign lesions but are locally aggressive, forming multiple daughter cysts which have a tendency to recur. Practitioners who advocate a conservative approach suggest enucleating the lesion and then treating the residual bony cavity with an adjunctive therapy in order to minimise the possibility of recurrence. Many forms of adjunctive therapy have been described such as cryotherapy, chemical cauterisation with Carnoy's or Modified Carnoy's solution and the use of topical 5-fluorouracil (5-FU) but there has not been a systematic review to compare these various adjunctive treatments in the management of odontogenic keratocysts. MethodPRISMA guidelines for systematic reviews were followed. An electronic literature search from the databases Medline, PubMed, the Cochrane database and the Web of Sciences were performed, and relevant articles were selected based on the inclusion criteria. Disputes were resolved by an independent third party. Statistical analysis was performed to identify trends of recurrence for each treatment arm. ResultsA total of 28 studies managing a total of 1430 odontogenic keratocysts were included in the review. It was observed that only Carnoy's solution resulted in statistically different outcomes compared to no adjunct therapy. There was weak evidence on the efficacy of modified Carnoy's solution but no evidence that cryotherapy or 5-FU resulted in statistically different outcome compared to no adjunct therapy. ConclusionCarnoy's solution appears to be the best adjunct therapy for now but further studies are needed to establish the roles of modified Carnoy's solution, cryotherapy and 5-FU in the management of odontogenic keratocyst.