Buccal Cortical Plate Research Articles

AMELOBLASTIC FIBROMA: A CASE REPORT

A 27-year-old male was referred to a Brazilian School of Dentistry, in November 2016, complaining about a slowly progressive asymptomatic swelling on the right side of the posterior mandible. The medical history was unremarkable. Upon intraoral examination, the right lower buccal vestibule was obliterated due to the expansion of the buccal cortical plate. The extraoral examination showed slight facial asymmetry. Panoramic radiographs showed a large unilocular radiolucent lesion with well-defined borders involving the unerupted 48 teeth. An incisional biopsy was performed. Microscopically, hematoxylin and eosin sections presented strands, cords, and nests of odontogenic epithelium supported by a primitive-looking myxoid connective tissue, resembling the dental papilla. The islands showed a peripheral rim of columnar similar to the inner enamel epithelium. The center of the islands revealed a loosely arranged spindle-shaped epithelium identical to stellate reticulum. The patient is undergoing regular clinical and radiographic follow-up; after 6 years, no recurrence was observed. A 27-year-old male was referred to a Brazilian School of Dentistry, in November 2016, complaining about a slowly progressive asymptomatic swelling on the right side of the posterior mandible. The medical history was unremarkable. Upon intraoral examination, the right lower buccal vestibule was obliterated due to the expansion of the buccal cortical plate. The extraoral examination showed slight facial asymmetry. Panoramic radiographs showed a large unilocular radiolucent lesion with well-defined borders involving the unerupted 48 teeth. An incisional biopsy was performed. Microscopically, hematoxylin and eosin sections presented strands, cords, and nests of odontogenic epithelium supported by a primitive-looking myxoid connective tissue, resembling the dental papilla. The islands showed a peripheral rim of columnar similar to the inner enamel epithelium. The center of the islands revealed a loosely arranged spindle-shaped epithelium identical to stellate reticulum. The patient is undergoing regular clinical and radiographic follow-up; after 6 years, no recurrence was observed.

Post-operative histogenesis in the allogeneic dura mater placement area in a laboratory rat experiment: laboratory and histomorphological research

Relevance. Gum recession is a pathology often encountered both in Russia and worldwide. Modern surgical methods allow for the complete elimination of recession signs when adequately choosing strategy, tactics, methodology and surgical treatment protocol; for complication prevention and stable long-term outcome. Autograft and allogeneic dura mater as a grafting material for creating/increasing the volume of the attached gingiva in recession treatment have comparable results in all clinical indications. The reason for result stability and the absence of relapse is poorly studied; the data are scarce and do not give a full understanding. In the scientific literature, we did not encounter histological tissue composition analysis in the graft placement area. In recession coverage, the graft is partially placed subperiosteally (in the tooth root area) and partially in the thickness of the soft tissues of the gum. Purpose. The study aimed to determine the histological composition of tissues in the dura mater placement area, to compare with the control group without a graft, and to assess follow-up changes in the graft and surrounding tissue reaction as a result of cellular-level surgery.Material and methods. A laboratory histomorphological examination involved 60 laboratory rats. All underwent surgery adequate to gum recession surgical treatment technique: the control group had no graft, and the study group had allogeneic dura mater. The samples were collected on the 3rd, 7th, 14th, 28th, 90th and 107th days after surgery.Results. In all cases, the tissue complex regenerated, and the reaction to the operation was the same. The plastic material replacement was at the same period. Bone tissue replaced subperiosteally placed graft, connective tissue intragingivally. Gingival biotype thickening was considerably due to the surgical trauma, less – from the graft material. Allogeneic dura mater stimulated earlier ossification.Conclusion. In all cases, the use of grafting material for surgical gum recession coverage is justified if placed subperiosteally, forming a full-thickness mucoperiosteal flap surgically (with a scalpel) to preserve the cambium periosteum on the flap. Bone volume and buccal cortical plate reconstruction/ regeneration support soft tissues of the newly formed ligament of the tooth and prevent recurrent recession formation. The formation of bone and connective tissues in the dura mater placement area determines the result stability of gingival recession surgical treatment and a long-term favourable prognosis without complications and relapse.

Effect of metal artifact removal modes on the accuracy of linear measurement around titanium implants by applying different voltages: an original article

BackgroundThis study aims to evaluate the effects of the artifact removal algorithm on linear measurements of the buccal cortical plate by altering the voltage.MethodsTen titanium fixtures were inserted at the site of central, lateral, canine, premolars and molars of dry human mandibles. Vertical height of buccal plate was measured using a digital caliper as a gold standard. Mandibles were scanned with 54 and 58 kVp. Other parameters were constant. Images were reconstructed with none, low, medium and high artifact removal modes. Two Oromaxillofacial radiologists evaluated and measured the buccal plate height using Romexis software. Statistical package for the social sciences (SPSS) version 24 was used for data analysis.ResultsIn medium and high modes, the difference between 54 and 58 kVp was significant (p < 0.001). No significance was noted by using low ARM (artifact removal mode) at the 54 kVp and 58 kVp.ConclusionUsing artifact removal in low voltage decreases the accuracy of linear measurement and buccal crest visibility. By using high voltage, artifact removal would have no significant effect on accuracy of linear measurements.

A Three-Dimensional (3D) Evaluation Unveiling if the Anterior Mandible Is Truly a Safe Zone for Implant Placement.

Background Dental implants are increasingly being used in the rehabilitation of the edentulous areas in the maxilla and mandible. The anterior mandible is considered a safe zone for implant placement, but clinicians often find it challenging to control bleeding in this area. This is due to the presence of the sublingual artery, which can be of varying dimensions and can cause severe bleeding. This can be of higher significance in patients with high or uncontrolled blood pressure and in patients on blood thinners like Aspirin or Coumadin where establishing a clot can be difficult. With newer guidelines recommending that medication be discontinued only a few hours before surgery and that bleeding be managed locally, this issue has become even more challenging. With three-dimensional (3D) imaging using cone beam computed tomography (CBCT) becoming more common for implant planning, the presence of the sublingual artery can be evaluated and incorporated into the treatment plan. The objective of this study is to evaluate the 3D location of the sublingual artery in the edentulous anterior mandible of CBCT scans of patients referred for dental implant therapy. Methodology A total of 50 de-identified CBCT scans with an edentulous anterior mandible referred for dental implant therapy were evaluated for this study. Cross-sectional images were generated using a CBCT reconstruction program INVIVO-5 (Anatomage, San Jose, CA, USA). After the sublingual artery was localized, measurement was conducted from a standardized point on the alveolar crest to the artery's entry point on the lingual aspect. Measurements were also obtained from the terminal point of the artery's course to the buccal cortical plate. Alveolar crest can either resorb or be subjected to alveoloplasty during implant placement, similar measurements were also done from a standardized point on the inferior cortical border of the mandible to the artery's entry points on the lingual aspect. Two oral and maxillofacial radiologists conducted all measurements. Results It was found that the median value of the sublingual artery from the alveolar crest to the level of entry (V1) was 6.78, the vertical measurement of the artery coursing into the alveolar bone was ~4.03 mm (V2), the vertical measurement of the artery's position within the alveolar bone at the terminal point form the crest was ~11.71 (V3), and the inferior vertical measurement from the course of the artery to the inferior border of the mandible was 9.60 mm. The artery extended about ~8.3 mm within the alveolar bone from the lingual cortex (H1), and the artery was located about 4.97 mm away from the buccal cortex (H2).Cronbach's Alpha test showed high interoperator reliability. Conclusions In this retrospective study, the sublingual artery was noted to be at a critical location in the potential implant site. A site-specific evaluation using CBCT can help in localizing and avoiding perforation of the sublingual artery.

Cone Beam CT Assessment of Bone Width of Upper and Lower Jaws for Dental Implant Placement: An Iraqi Study.

Implantology focuses on the measurement of bone thickness in both the lower and upper jaws. This study aimed to measure and compare alveolar bone thickness of the upper and lower jaws at single edentate sites and cortical bone thickness of their mesial and distal dentate sites. Thickness of alveolar bone thickness was measured in 80 upper and 80 lower implant edentate sites and that of buccal and lingual cortical plates of their mesial and distal dentate sites using Cone beam CT. The bone thickness of the edentulous sites was recorded at 3 points (crestal bone, five mm from the crest, and ten mm from the crest), while the bone thickness of the dentate sites was determined at four points (crestal bone, midroot bone, mid of the alveolar bone housing, and apical portion). An increased amount of bone was measured from the crest to the apical portion of the dentate sites on the buccal and lingual sides of both jaws with a highly significant difference detected among all the tested points (P < 0.0001). No statistical difference was detected between the means of buccal bone width at the first 3 points, except at point 4 (the apical portion), where the mean of the lower jaw (3.35 ± 0.54) was significantly larger than that of the upper jaw (3.17 ± 0.55) (P = 0.04). Bone width measured in the edentulous sites showed a gradual increase from the crest to the apical portions in both jaws. Bone thickness at the coronal levels is low and susceptible to resorption compared to the apical portions regardless of the dentate state.

Implant exfoliation within 10 days: A case report

Implant failure can be because of many reasons, it is difficult to determine the exact cause of the implant failure, especially when there are many factors contributing.This case report reviews the case in which implant failure occurred. A female patient of 34 years came with the complaint of edentulous space in the region of 11. An implant was placed which got exfoliated on 10th day.In this case Norris Implant 3.75 /8 was placed in the region of 11. 6 months back extraction was done with respect to 11 but after 6 months the bone formation was not adequate. The same region was having buccal cortical plate defect. An implant planning was done.During implant placement we came to know that buccal cortical plate defect was large, as there was insufficient bone so threads of implant were exposed so Osseo graft (periocol) and collagen membrane was placed for additional bone support.This case highlights the unusual implant failure that occurred because of the inappropriate analyzing of the bone defect and inaccurate planning of the implant.

Autotransplantation of Maxillary Third Molar with Its Attached Buccal Cortical Plate Combined with a Connective Tissue Graft

IntroductionTooth replacement often leads to insufficient vertical volume in the recipient socket bone. The aim of this novel report is to present a successful fully guided autotransplantation of a maxillary right third molar (tooth #1) with its attached buccal plate. The procedure was combined with a palatal connective tissue graft to reconstruct a buccal hard and soft tissue defect of an irreparable maxillary right first molar (tooth #3). MethodsA 45-year-old man complaining of pain in tooth #3 came to the clinic. Tooth #3 was non-restorable due to an extensive caries and a vertical root fracture of the mesiobuccal root, leading to a total loss of the buccal cortical plate. Guided autotransplantation of tooth #1 was completed by using 3-dimensional surgical templates for implant burs and a 3-dimensional-printed replica. After positioning the donor tooth, the cortical plate was fixed to the recipient socket with osteosynthesis screws. A connective tissue graft was also harvested to increase the band of keratinized gingiva and the thickness of the buccal soft tissue. At 6-month follow-up, the screws were removed, showing excellent regeneration throughout the buccal area. ResultsAt 3-year follow-up, the transplanted tooth was asymptomatic, with a natural bone level and no signs of replacement or inflammatory root resorption. ConclusionsThe use of a donor tooth and its attached bone cortical plate combined simultaneously with a connective tissue graft appears to improve hard and soft tissues in a single procedure.

Efficacy of Periotome Versus Conventional Forceps Extraction in Socket Preservation and Reduction of Postoperative Pain: A Randomised Clinical Trial

Introduction: Atraumatic extraction is necessary when a patient undergoes dental implant rehabilitation. Various tooth extraction systems are used and regularly upgraded. The periotome is a tool that severes the Periodontal Ligaments (PDL) and aids in atraumatic extraction while preserving the socket. Aim: To evaluate the efficacy of conventional forceps versus periotome extractions of single-rooted maxillary teeth in terms of socket preservation, procedure duration, and postoperative pain. Materials and Methods: This was a single-blinded randomised clinical trial conducted at Department of Oral and Maxillofacial Surgery, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharastra, India from December 2020 to March 2021 involved 42 patients aged 18-60 years who required extraction of maxillary single-rooted teeth that had failed endodontic treatment. The patients were randomly divided into two groups: a periotome group and a conventional forceps group. Clinical assessment was conducted to evaluate socket preservation, extraction time, postoperative pain, and any complications related to the extraction procedure. Statistical analysis was performed using the Mann-Whitney U test, Chi-square test, and unpaired t-test. Results: The majority of patients were within the age group of 51-60 years, with 13 males and 29 females. The difference in extraction time between the two groups was not statistically significant (p=0.368). The periotome group exhibited a significantly lower incidence of buccal cortical plate fractures compared to the conventional forceps group (p=0.048). Regarding the severity of postoperative pain, the periotome group demonstrated a significantly lower value than the conventional forceps group (p=0.028). Conclusions: The periotome proved to be a more efficient choice for preserving the socket in endodontically non treatable teeth requiring extraction, as compared to conventional forceps.

Stafne defect as a rare anomaly of the lower jaw growth

Defects in mandible growth are of undoubted interest for practical healthcare. During the diagnosis, for a more accurate diagnosis and differential diagnosis, it is necessary to understand the criteria for the norm and pathology of diseases of the jaw bones. Often in the body of the mandible at the level of the lower molars, slightly below the maxillofacial line, defects are detected in the form of a depression of the cortical layer towards the unchanged buccal cortical plate. These defects, being the clinical norm, need to be differentiated with many tumor diseases of the maxillofacial region. The literature sources indicate that the cause of these defects is the pressure of the capsule of the submandibular salivary gland in the area of the fossa on the lower jaw. Modern additional diagnostic methods, for example, CBCT and MRI, make it possible to identify a Stafne defect.

Diagnostic accuracy of cone-beam computed tomography with modified grayscale range for detection of buccal cortical plate defects adjacent to dental implants

Diagnostic accuracy of cone-beam computed tomography with modified grayscale range for detection of buccal cortical plate defects adjacent to dental implants

CBCT analysis of crestal soft tissue thickness before implant placement and its relationship with cortical bone thickness.

The importance of crestal soft tissue thickness and its influence in peri-implant tissue health has been evaluated in few clinical studies. Cone beam computed tomography imaging offers a unique opportunity to investigate variations in crestal soft tissue thickness. The aim of this retrospective study was to evaluate the possible correlation between crestal soft tissue thickness and hard tissue measurements on CBCT images, and to compare crestal soft tissue thickness among different patients and edentulous site groups. CBCT images of partially edentulous adult patients treated at ECU School of Dental Medicine were evaluated. 267 patients with 321 edentulous sites were included. Demographic data were collected from electronic health records. Cross-sectional CBCT images at the center of each edentulous site were used to measure soft tissue and hard tissue parameters. Linear mixed models were used to compare crestal soft tissue thickness and hard tissue measurements by gender, age groups, and edentulous sites. Pearson correlation was applied to evaluate the correlation between crestal soft tissue thickness and different hard tissue measurements. Association between crestal soft tissue thickness and independent variables (gender, age groups, edentulous sites) was evaluated using repeated measure logistic regression, while the crestal soft tissue thickness was dichotomized by a threshold of 2mm. Mean age of patients included was 60 (range 21-85years). Female to male ratio was 1.07. Mean crestal soft tissue thickness of all non-grafted native bone sites was 2.17mm. Mean thickness of cortical bone at alveolar crest was 0.94mm. Thickness of buccal and lingual cortical plates 5mm apical to alveolar crest were 1.17mm and 1.58mm, respectively. Pearson's correlation showed moderate positive correlation among hard tissue measurements, but weak correlation between soft tissue thickness and hard tissue measurements. Anterior sites [OR = 3.429 (1.100-10.69)] and maxillary posterior sites [OR = 1.937 (1.077-3.482)] had higher odds of presenting with more than 2mm of soft tissue at the alveolar crest. More than half of the patients had crestal soft tissues at edentulous sites thicker than 2mm. Thickness of crestal soft tissue was not significantly associated with hard tissue measurements. Edentulous anterior sites and maxillary posterior sites presented with thicker crestal soft tissue at alveolar crest as compared to mandibular posterior sites.

Bone Window Technique in Endodontic Microsurgery – Report of Two Cases

Endodontic microsurgery was introduced in the ‘90s and has significantly increased the success rate of apical surgical intervention the last few decades. Utilizing the dental operating microscope, ultrasonic tips for root end preparation and biocompatible root end filling materials, predictably manages the apical pathology preserving the buccal cortical plate. The bone window technique for buccal approach to the apical area involves the use of piezoelectric unit to prepare and elevate a buccal cortical bony window and the reposition of the bone after the apical root end filling is completed. Two cases are reported in this article, highlighting the importance of endodontic microsurgery and buccal bone window technique in addressing apical pathology in a minimally invasive way, preserving the hard tissues and the tooth structure. Cases were reevaluated clinically and radiographically after a period of 3 months up to 36 months.

Assessment of the Proximity of the Inferior Alveolar Canal with the Mandibular Root Apices and Cortical Plates-A Retrospective Cone Beam Computed Tomographic Analysis.

116 cone beam computed tomography (CBCT) scans were examined and the shortest distance of IAC with the root apices of mandibular canines, premolars and molars, and with cortical plates was analyzed. The data were statistically analyzed using SPSS. The shortest mean distance between IAC and lingual cortical plate (LCP) was found in the third molar area, and between IAC and buccal cortical plate (BCP) in the second premolar area. A high incidence of 60% direct communication (DC) was present in mandibular second molars; 38% in mandibular third molars; 13% in mandibular second premolars; 12% in mandibular first molars; and 1% in mandibular first premolars. Anteriorly, IAC was found to be significantly present in close approximation to the roots of mandibular canines. Posteriorly, IAC was found to be in significant proximity to the distal roots of mandibular second molars.

X-ray and anatomical features of the lower jaw alveolar cortical layer in children

Introductionthe world studies showed the interest in measurement of the buccal or anterior cortical plate thickness. Data indicate a significant superiority of the spongy substance over the compact one in the distal part of the jaw, which makes it possible to think about a higher effectiveness of transcortical injections. The empirical “rule of 10″ provides for the choice of a method of anesthesia in children for primary teeth but demonstrates difficulties with high-quality anesthesia accompanied for permanent teeth. Therefore, the importance of clinical examination and anatomical investigation of the jaw cortical plate in children for competent planning of transcortical interventions has been determined. AimTo study the features of the clinical and X-ray anatomy of the cortical layer in distal alveolar part of the mandible in children. Material and methodsThe assessment of the X-ray anatomical characteristics of the mandible was carried out according to 150 anonymized cone-beam computed tomograms of patients aged 6–12 years, performed for the treatment of major diseases. Qualitative assessment and examination of the cortical plate of the distal alveolar part of the mandible were carried out on the skeletonized certified preparations of aged 6–12 in the amount of 50. ResultsThe age characteristics of the cortical plate in the area of the chewing group of teeth in the mandible were determined according to macro anatomical studies, which confirms with the X-ray results. Therefore, the obtained images serve as actual confirmation of X-ray studies, which are ranked by age. The thickness of the cortical plate in the second primary molar of the mandible in subgroups 6, 7 and 8 years has a proportional increase from the cervical region to the apical projection. The average thickness of the cortical plate is 1.57 mm at 6 years, 1.52 mm at 7 years, 1.6 mm at 8 years and 1.84 at 9 years. The cortical plate thickness in the first primary molar of the mandible in subgroups 6 and 7 years has a proportional decrease from the cervical region to the apical projection as well as an inverse proportion to age. The average thickness of the cortical plate is 1.33 mm. In the first molar of the mandible at the age limit of 6–12 years the attention is drawn to the linear increase in tissue volume from the cervical region to the apical projection up to 8 years. At 6–8 years the average thickness of the cortical plate in this age group is 1.74 ± 0.2 mm, at 9 years - 2.03 mm, at 10 - average value in the cervical region it is 1.53 ± 0.23 mm, in the root middle it is 2.19 ± 0.13 mm and in the apical projection it is 1.98 ± 0.16 mm, at 11–2.22 mm and at 12–2.35 mm. For the second primary molar the average thickness of the buccal cortical plate of the second primary molar is 1.4 mm in cervical part, 1.68 mm in the root middle and 1.81 mm in the apical projection. Finally, thickness of the buccal cortical plate in the cervical region of the first permanent molar is 2 mm in groups. ConclusionThe study makes it possible to determinate with noninvasive way the age limit for the least pronounced zone of the buccal cortical plate.

Assessment of Alveolar Bone Height and Width in Maxillary Anterior teeth - A Radiographic Study Using Cone Beam Computed Tomography

Cone beam computed tomography (CBCT) can be used for determining the height and width of alveolar bone surrounding the implant site which are important factors in implant planning. This study was done to evaluate and compare alveolar bone height and width in maxillary anterior teeth based on CBCT images from Nepalese population. This retrospective study included patients who had done CBCT scan between January 2019 to December 2020. Sagittal section views perpendicular to alveolar ridge were taken in the middle of maxillary left and right central incisor, lateral incisor, and canine regions and the linear measurements were done to measure alveolar height (between floor of nasal fossa and alveolar crest) and width (between buccal and palatal cortical plate). The result revealed no significant difference in alveolar height among maxillary anterior teeth. Mean alveolar width for maxillary right central incisor (11), lateral incisor (12), and canine (13) were 12.09 ± 2.36, 8.27 ± 1.37 and 9.99 ± 1.44 mm, respectively and for maxillary left central incisor (21), lateral incisor (22), and canine (23) were 9.51 ± 1.47, 8.27 ± 1.32 and 10.35 ± 1.85 mm, respectively. Lateral incisors have less width as compared to other maxillary anterior teeth. Pearson’s correlation analysis for correlating alveolar height with width showed p&lt;0.05 among 13, 12, 21 and 22. There is weaker correlation between the mean of alveolar height and width. The alveolar height as well as width was greater in male than female in all the six anterior teeth except for the alveolar width in relation to 11.

Computer-guided buccal cortical plate separation for removal of calcified benign odontogenic tumors affecting the mandibular angle region

PurposeSurgical removal of intra-bony calcific benign lesions is technically challenging regarding its accessibility, proximity to vital structures, and deteriorating effect on the remaining bony structures.MethodsComputer-guided buccal cortical plate separation was performed for ten patients using patient-specific osteotomy locating guides and pre-bent plates. The guide was designed to outline the osteotomy, the buccal cortical plate was separated, the lesion was removed, and finally, the pre-bent plates were used to fix the separated cortex.ResultsSurgical procedures were uneventful for all patients, operation time was 39.5 ± 13.01 min, postoperative pain decreased within the follow-up time intervals, and there was a statistical significant difference between the time intervals (P value < 0.001). Edema and trismus were acceptable. One case showed nerve affection which resolved after 4 weeks.ConclusionComputer-guided buccal cortical plate separation for removal of intra-bony calcified benign lesions provides a promising approach, especially for inexperienced surgeons.Trial registrationClinicalTrials.gov NCT05329974. Registered on 6 April 2022—retrospectively registered.

To ease orthodontic extraction – A novel technique

Atraumatic extractions are always the prerequisite for immaculate orthodontic results. Of all the extractions desired by the orthodontist, maxillary first premolar is challenging for the dentist / oral surgeon specifically because of its thin and slender roots with wide variations in its anatomy. Various methods for atraumatic premolar extraction and for preserving the buccal cortical plate have been suggested in the past like use of periotomes, physics forceps etc. Following is the suggested novel technique for atraumatic premolar extractions which can be performed with routine forceps without any additional armamentarium.

ASSESSMENT OF JUXTA-APICAL RADIOLUCENCY WITH CONE BEAM CT

Aim: This study aimed to investigate the association of JAR with third molar status and mandibular canal and also describe its radiologic features through cone beam computed tomography (CBCT).&#x0D; Methods: CBCT images of 100 individuals (153 mandibular third molars) were evaluated for the presence of JAR. Than, the CBCT images were analysed to evaluate the position of the JAR and its relationship to the impacted teeth, mandibular canal and buccal-lingual cortical plates. Descriptive statistical analyses were used.&#x0D; Results: JAR was identified in 70 individuals and 95 mandibular third molars (48 right side, 47 left side). 22 of the individuals with JAR were male and 48 were female. It was found that 26 (27,4%) of the 95 third molars were erupted, 10 (10,5%) were partially erupted, 59 (62,1%) were impacted. 74,7 % were on the apical third of the root and the rest was located along the mesial or distal surfaces of root. Close proximity to the buccal cortical plate was seen in 25,35 % of JAR located apically, whereas it was seen only 25% of JAR located along the root surface. Only 23.4 % were associated with the mandibular canal.&#x0D; Conclusion: The present study gives an insight into the relationship of JAR with mandibular canal and cortical plates using CBCT. However, future studies are warranted that use a larger sample size to validate the above findings.

MULTILOCULAR APPEARANCE OF ORTHOKERATINIZED ODONTOGENIC CYST: A CASE REPORT

Orthokeratinized odontogenic cyst (OOC) was initially defined as the uncommon orthokeratinized type of odontogenic keratocyst (OKC) by the World Health Organization (WHO). Several studies have shown that OOC has different clinicopathologic aspects when compared with other developmental odontogenic cysts, especially OKC. So OOC now emerges to be a distinct entity, according to the 4th edition of the WHO Classification of Head and Neck Tumors which was published in January 2017. Clinically, it usually occurs as a single cyst with a unilocular radiographic appearance in posterior mandible with a predilection in males and mostly is seen between the third and fourth decades. In this case we present an OOC arise as a multilocular lesion causes thinning and expansion of the buccal cortical plate treated by enucleation and curettage.

INTRAOSSEOUS SCHWANNOMA AFFECTING THE MANDIBLE: CASE REPORT AND IMMUNOHISTOCHEMICAL ANALYSIS

Schwannomas are neoplasms arising from differentiated Schwann cells. These tumors most often affect the soft tissues of the head and neck and rarely occur in intraosseous location. To date, approximately 90 cases of schwannoma affecting the jaws have been reported. A 52-year-old female patient was referred for evaluation of an asymptomatic mandibular lesion. Imaginologic analysis showed a large radiolucent lesion involving the mandibular body and ramus with expansion of the buccal and lingual cortical plates. An incisional biopsy was performed, which microscopically revealed hypercellular and myxoid hypocellular areas composed of spindle cells with ill-defined cytoplasm. Nuclear palisading around cellular areas was evident. Immunohistochemistry showed positivity for S-100, CD56, and CD34 (weak). The Ki-67 labeling index was <3%. Schwannomas in an intraosseous location affecting the jaws may mimic odontogenic and nonodontogenic cysts and tumors; thus, a strict clinicopathologic correlation is required for a correct diagnosis.