Odontogenic Cysts Research Articles

The Surgical Management of a Cystic Lesion in the Same Cystic Follicle Related to Lateral Incisor and Impacted Permanent Maxillary Canine: (A Case Study)

The most common kind of developing odontogenic cysts are dentigerous cysts. They frequently push impacted teeth into ectopic locations by encircling the crown of the tooth. The mandibular third molar, maxillary canine, mandibular premolar, and maxillary third molar are the teeth that are most commonly afflicted, in decreasing order. Although these cysts are more prevalent in men, they can also occur in children and teenagers, especially in the second and third decades of life. Dentigerous cyst-related teeth in the maxilla frequently cause root dilatation in the mandibular area, permanent tooth bud displacement close to the sinus, and cortical bone enlargement, sometimes, even up to the level of the orbit or floor of the nose. Clinically, these cysts do not cause any symptoms and are frequently found by chance during radiographs done to look into cases of primary teeth that are retained, teeth that are missing, teeth that erupt slowly, or orthodontic issues. Cone-beam computed tomography’s advent has just made it possible to shed fresh, extensively documented light on diagnostic and treatment approaches. Protocol for management: Surgery is typically used to treat dentigerous cysts. In this instance, the affected tooth underwent endodontic therapy, after which the cyst was curettaged, a further apicoectomy was performed, and canine impaction was completed. In the end, a bone graft and platelet-rich fibrin were implanted for rehabilitation.

Ameloblastic Carcinoma in a Young Adult Male Patient - A Case Report

ABSTRACT Ameloblastic carcinoma is a rare malignant odontogenic tumor that is further classified into being primary or secondary arising from a preexisting benign ameloblastoma. It affects the mandible in two thirds of the patients. There is no standard treatment protocol for this lesion but radicalsurgical excision with or without radiotherapy is reported in the majority of cases. In this paper, we present a case of a 22 year old male diagnosed with Ameloblastic carcinoma of the mandible with a clinical course of typical aggressiveness and extensive destruction. Histopathological examination of the incised biopsy showed a parakeratinized stratified squamous epithelium with underlying fibrous connective tissue stroma. The stroma is highly myxomatous and exhibits islands of odontogenic epithelium and chronic inflammatory cell infiltrates. Interlacing strands of odontogenic epithelium shows stellate reticulum-like cells and occasional areas of squamous metaplasia with cellular and nuclear pleomorphism. In addition, mitotic figures were noted. With the correlation of clinical, radiographic, and histological features, the lesion is diagnosed as ameloblastic carcinoma. The lesion was surgical excised and post-treatment follow-up for 6 months revealed no recurrence of the malignancy.

Metaplastic Epithelium in an Odontogenic Keratocyte. A Case Report

The diagnostic dilemma is possessed when one lesion that mimics the other.1One of the most prevalent pathologic disorders in the alveolar bone are periapical lesions, which arise from necrotic tooth pulp.2 . Multiple pathogenic entities are included in odontogenic cysts of the jaws. “A benign uni- or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinized stratified squamous epithelium and potential for aggressive, infiltrative behaviour,” is the definition of keratocystic odontogenic tumour (KCOT).” There are two important diagnostic problems with OKC. Firstly, they frequently exhibit active epithelial growth, leading some experts to speculate that they would be better classified as neoplasms rather than cysts. Second, two patterns of occurrence are recognized: single (or irregular) and as a part of the BCNS.3 Numerous investigations have focused on the aggressive clinical behavior and frequent recurrence after curettage, suggesting that the OKC epithelial lining may have some intrinsic growth capacity.5 This case of an odontogenic keratocyst with changed epithelial activity that mimics a radicular cyst is presented in light of the epithelial behavior.

CLINICAL AND RADIOGRAPHIC FEATURES OF ODONTOGENIC CYSTS OF JAW PRESENTED TO THE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, KHYBER COLLEGE OF DENTISTRY PESHAWAR

Objectives: To determine frequency, clinical and radiographic features of diff erent types of odontogenic cysts in patients reported to the department of Oral and Maxillofacial surgery, Khyber College of Dentistry Peshawar.Materials and Methods: This descriptive, cross sectional study was conducted at department of Oral and Maxillofacial Surgery, Khyber College of Dentistry, Peshawar from November 2019 to October 2021.This study was conducted on 89 patients with histopathologically confi rmed reports of odontogenic cysts. Data with respect to age, gender, type of odontogenic cyst, clinical and radiographic features of these cysts were analyzed from the data obtained through a customized structured proforma.Results: Out of the total 89 patient, there was male predilection (2.17:1). The most frequent age group was 2nd and 3rd decades. Among diff erent types of odontogenic cysts, radicular cyst (37.1%) was the most common cyst followed by dentigerous cyst (33.7%) and odontogenic keratocyst (27%). The most common aff ected site was posterior mandible (46.1%). Paresthesia was present in 22.5% cases. Unicortical expansion was present in 59.6 % and bicortical expansion in 38.2% cases. Tenderness was present in 50.6% cases and teeth mobility in 28.1% cases. Needle aspiration test was positive in 78.7% cases. Mean size was 32.23mm + 14.53 standard deviation. Unilocular radiolucency was present in 74.2% and multilocular radiolucency in 25.8%. Root resorption was present in 64% cases and impacted tooth was associated with 52.2% odontogenic cysts.Conclusion: It is concluded from this study that odontogenic cysts frequently encountered during 2nd and 3rd decades of life and more common in males with a predilection for the posterior mandible. Radicular cysts are most frequent among the other types of odontogenic cysts. Majority of patients has cortical expansion and positive needle aspiration test. Impacted tooth is associated with all the dentigerous cysts and most of OKC‘s and none of radicular cyst. Odontogenic cysts can reach to a considerable size to involve even half of the mandible.

Accuracy of machine learning in the diagnosis of odontogenic cysts and tumors: a systematic review and meta-analysis.

The recent impact of artificial intelligence in diagnostic services has been enormous. Machine learning tools offer an innovative alternative to diagnose cysts and tumors radiographically that pose certain challenges due to the near similar presentation, anatomical variations, and superimposition. It is crucial that the performance of these models is evaluated for their clinical applicability in diagnosing cysts and tumors. A comprehensive literature search was carried out on eminent databases for published studies between January 2015 and December 2022. Studies utilizing machine learning models in the diagnosis of odontogenic cysts or tumors using Orthopantomograms (OPG) or Cone Beam Computed Tomographic images (CBCT) were included. QUADAS-2 tool was used for the assessment of the risk of bias and applicability concerns. Meta-analysis was performed for studies reporting sufficient performance metrics, separately for OPG and CBCT. 16 studies were included for qualitative synthesis including a total of 10,872 odontogenic cysts and tumors. The sensitivity and specificity of machine learning in diagnosing cysts and tumors through OPG were 0.83 (95% CI 0.81-0.85) and 0.82 (95% CI 0.81-0.83) respectively. Studies utilizing CBCT noted a sensitivity of 0.88 (95% CI 0.87-0.88) and specificity of 0.88 (95% CI 0.87-0.89). Highest classification accuracy was 100%, noted for Support Vector Machine classifier. The results from the present review favoured machine learning models to be used as a clinical adjunct in the radiographic diagnosis of odontogenic cysts and tumors, provided they undergo robust training with a huge dataset. However, the arduous process, investment, and certain ethical concerns associated with the total dependence on technology must be taken into account. Standardized reporting of outcomes for diagnostic studies utilizing machine learning methods is recommended to ensure homogeneity in assessment criteria, facilitate comparison between different studies, and promote transparency in research findings.

Optimal time to definitive enucleation of large cysts following marsupialization: A single center, retrospective study

ObjectivesOptimal time to enucleation following marsupialization of large odontogenic mandibular cysts is undefined. We aim to assess volume reduction throughout follow-up, to indicate optimal time to enucleation. Secondary objectives include the identification of factors influencing cyst reduction. Study designWe retrospectively enrolled 15 patients with mandibular cysts of different histological types treated with marsupialization at our center between 2018 and 2022. Cyst volume was assessed with cone-beam computed tomography (CBCT) and a semi-automatic segmentation algorithm, at baseline and between 6 and 8 months post marsupialization. ResultsThe overall mean cyst volume reduction percent (VR%) was 57.7 % or 0.2 % per day. VR% at 8 months was significantly higher than those assessed at 6 and 7 months (67.1% vs 47.1 %, p = 0.003). Time to CBCT was the only independent variable influencing cyst VR%. ConclusionOur study proves that the optimal time to enucleation for mandibular cyst is 8 months, independent of histological cyst type, patient age, baseline cyst volume and the number of pre-operative residual bone walls.

Assessment of MUC5AC and MUC2 Immunoexpression in Glandular Odontogenic Cysts, Dentigerous Cysts, and Mucoepidermoid Carcinomas.

Glandular odontogenic cysts (GOCs) and dentigerous cysts may show mucous metaplasia. Central mucoepidermoid carcinoma is very rare and mostly associated with dental cysts. It is hypothesized that odontogenic cysts showing mucus differentiation in their lining, have a propensity to transform into MEC. The present study is the first attempt to explore the relationship between odontogenic cysts [GOCs and dentigerous cysts with mucus metaplasia (DCMM)] and MEC by evaluating immunoexpression of MUC5AC and MUC2. Immunoexpression of MUC5AC and MUC2 was evaluated semiquantitatively in GOCs (20 cases), DCMMs (20 cases), and MECs (20 cases). The percentage of positive cells, intensity, and localization of immunoexpression were assessed for each marker in all cases. Of GOCs, DCMMs, and MECs cases, 85%, 70%, and 80%, respectively, were immunopositive for MUC5AC. Strong cytoplasmic immunoreactivity for MUC5AC was noted, particularly in mucous cells present diffusely within MECs. However, the immunoreactivity was limited to the epithelial lining of GOCs and DCMMs. Most of the MECs (60%) showed more than 25% positivity for MUC5AC, followed by GOCs, and the least in DMMCs. Mild cytoplasmic and nuclear positivity of MUC2 was noted only in epithelial lining cells of 70% GOCs and 45% DCMMs. Whereas, 55% of MECs displayed moderate to strong cytoplasmic and membranous immunopositivity for MUC2 exclusively within mucous cells. As MECs showed strong MUC5AC immunoreactivity in mucous cells, immunoexpression of MUC5AC in odontogenic cysts with mucus cells can possibly explain the pathogenesis of MEC from cysts. However, the variable expression of MUC2 did not give any strong evidence regarding its role as a marker.

The Management of a Geriatric Patient Using Dabigatran Therapy on Dentigerous Cyst with Oral Bleeding.

Jaw cysts represent a great matter of interest in oral and maxillofacial surgery. Jaw cyst surgery is a common intervention in oral surgery but, in the case of a multidisciplinary patient, the oral surgeon needs to meet with other specialists. A cyst is an epithelium-lined sac containing fluid and/or semisolid material due to epithelial cell proliferation, degeneration, and liquefaction; the hypertonic solution withdraws liquids from the surrounding tissues, while internal pressure exerts an equal strength on the cyst walls. Dentigerous cysts are the second most common odontogenic cysts after radicular cysts, and commonly few or no symptoms are reported. However, the most common diagnosis for dentigerous cyst is represented by eruption of the affected tooth or accidental diagnosis. Commonly, dentigerous cysts may be related to impacted third molars; in the case of impacted third molars and a dentigerous cyst, the tooth should be removed along with the cyst in the same intervention. Mandibular dentigerous cysts are common in children and adults, while dentigerous cysts are a rare neoformation in elderly patients. Treatment usually involves removal of the entire cyst and the associated unerupted tooth. This intervention may be more difficult if the cyst is large, the third molar is in contact with the mandibular nerve, and/or the patient has a medical history that may represent a relative or absolute contraindication. We present the case of a rare symptomatic manifestation of dentigerous cyst in an elderly patient in treatment with dabigatran therapy; for the treatment of dentigerous cysts in the elderly, we suggest a multidisciplinary approach with the use of the histological examination and a careful follow-up.

An inflammatory Odontogenic Cyst (Unusual Case): A case report

An inflammatory Odontogenic Cyst (Unusual Case): A case report

EXPRESSION OF CALRETININ IN AMELOBLASTOMA AND ODONTOGENIC CYST IN A.W. SJAHRANIE GENERAL HOSPITAL SAMARINDA

Background : Ameloblastoma and odontogenic cysts have similar clinical and radiographic features but different treatments. Diagnosis is established by histologic features, but sometimes this step have difficulty making appropriate assessment because epithelial cells can show various variations. Preoperative misdiagnosis may result in inefficient treatment. In such situations, immunohistochemistry (IHC) with the use of proper markers might be needed for the differentiation of these lesions. Purpose : This study aimed to assess calretinin expression in ameloblastoma and various odontogenic cysts so that calretinin can be used as a specific diagnostic marker for ameloblastoma. Method : This was a retrospective analytical study of immunohistochemical examination of calretinin expression in ameloblastoma and odontogenic cysts. A total of eighty cases, in which thirty four cases of ameloblastoma and forty six cases of odontogenic cysts were included in the study. Slides were made from the paraffin blocks of each case and were stained immunohistochemically with calretinin. Results : In ameloblastoma, almost all subjects expressed calretinin, i.e. 33 (97.1%), followed by radicular cyst 7 (46.7%), odontogenic cyst 2 (40.0%), then dentigerous cyst 6 (26.1%) and OKC 0 (0.0%). The results of the analysis of the Chi-Square test showed a significant difference with a p-value < 0.001. Conclusion : The study concluded that calretinin was mainly expressed in ameloblastoma, whereas majority of odontogenic cyst groups showed negative for calretinin in various percentages. Calretinin may be a specific immunohistochemical marker for ameloblastoma. Keywords : Ameloblastoma, Calretinin, Immunohistochemical, Odontogenic cyst, Odontogenic tumor

Histopathologic Evaluation of Periapical Radiolucencies Clinico-Radiographically Diagnosed as Endodontic Lesions: A Retrospective Analysis.

Periapical cyst and granuloma are inflammatory endodontic lesions. Periapical granuloma usually heals spontaneously after endodontic treatment; however, periapical cyst mostly needs to be removed via surgical approaches. Although some clinicians believe that microscopic examination of periapical lesions is unnecessary, it is proved that some of them has non-endodontic nature that need critical consideration. The purpose of this study was to assess the disagreement between clinico-radiographic and microscopic diagnosis of periapical cysts and granulomas in a major center of oral pathology service in Iran. In this retrospective, descriptive cross-sectional study, the archives of the oral and maxillofacial pathology department of Shahid Beheshti University of Medical Sciences served as the source of the material during an 18-year-period for this retrospective, descriptive cross-sectional study. The reports of all patients whose initial clinical diagnosis was a periapical cyst/granuloma were extracted. In the present study, 474 cases were diagnosed with a periapical cyst/granuloma clinico-radiographically, of which 61 cases (12.86%) received a microscopic diagnosis of a non-endodontic pathology. The most frequent lesion was odontogenic keratocyst (n= 12, 19.67%) followed by infected odontogenic cyst (n= 12, 19.67%). About 21.31% of diagnoses were non-cystic lesions and 4.9% were malignancies. The most odontogenic tumors that were diagnosed as periapical cyst/granuloma in clinico-radiography were the ameloblastoma variants (n= 4, 6.55%). A wide variety of microscopic diagnoses, including aggressive lesions such as ameloblastoma, as well as other malignant lesions was noted in this study. These misdiagnoses can lead to an inappropriate treatment plan. It is important to microscopically examine all lesions removed from the jaw.

Glandular Odontogenic Cyst: A Case Report and Literature Review

Glandular Odontogenic Cyst: A Case Report and Literature Review

Immunohistochemical expression of beta-catenin, BMP4 and TGF-beta in odontomas.

Changes in the expression of nuclear β-catenin are responsible for tumorigenesis. Beta-catenin acts synergistically with the TGF-β/BMPs pathway. This interaction leads to greater dentin deposition and may explain the differences between distinct tooth morphologies and hamartomas. The aim of this study was to investigate the role of β-catenin, BMP4 and TGF-β in the development of odontomas. This cross-sectional, retrospective, immunohistochemical study evaluated 30 compound odontomas, 30 complex odontomas and 17 tooth germs. The results showed that BMP4 and TGF-β were more immunoexpressed in the ectomesenchyme of complex odontomas (median = 33.7, p < 0.001; median = 76.4, p = 0.002, respectively). Higher immunoexpression of BMP4 and TGF-β was also observed in the epithelium of tooth germs (median = 2.0, p < 0.001; median = 120.3, p < 0.001, respectively). TGF-β and BMP4 showed a positive and significant correlation (p < 0.001). Both TGF-β and BMP4 were positively correlated with nuclear β-catenin in ectomesenchyme (p = 0.047 and p = 0.023, respectively). Developing teeth exhibited higher concentrations of the proteins studied in odontogenic epithelium, especially during the bud and cap stages. Higher immunoexpression in odontomas occurred mainly in the ectomesenchyme. We therefore suggest that changes in the ectomesenchyme can lead to the development of odontomas.

Digital pathology-based artificial intelligence models for differential diagnosis and prognosis of sporadic odontogenic keratocysts

Odontogenic keratocyst (OKC) is a common jaw cyst with a high recurrence rate. OKC combined with basal cell carcinoma as well as skeletal and other developmental abnormalities is thought to be associated with Gorlin syndrome. Moreover, OKC needs to be differentiated from orthokeratinized odontogenic cyst and other jaw cysts. Because of the different prognosis, differential diagnosis of several cysts can contribute to clinical management. We collected 519 cases, comprising a total of 2 157 hematoxylin and eosin-stained images, to develop digital pathology-based artificial intelligence (AI) models for the diagnosis and prognosis of OKC. The Inception_v3 neural network was utilized to train and test models developed from patch-level images. Finally, whole slide image-level AI models were developed by integrating deep learning-generated pathology features with several machine learning algorithms. The AI models showed great performance in the diagnosis (AUC = 0.935, 95% CI: 0.898–0.973) and prognosis (AUC = 0.840, 95%CI: 0.751–0.930) of OKC. The advantages of multiple slides model for integrating of histopathological information are demonstrated through a comparison with the single slide model. Furthermore, the study investigates the correlation between AI features generated by deep learning and pathological findings, highlighting the interpretative potential of AI models in the pathology. Here, we have developed the robust diagnostic and prognostic models for OKC. The AI model that is based on digital pathology shows promise potential for applications in odontogenic diseases of the jaw.

Orthokeratinized Odontogenic Keratocyst: Report of Nine Cases with Review of Literature

Abstract Formerly believed to be a subtype of odontogenic keratocyst (OKC), orthokeratinized odontogenic cyst (OOC), a rare developing odontogenic cyst, is now believed to be distinct. The clinical, radiographic, histological data are included in this report, along with a review of the literature to aid in comprehending the cyst. A retrospective search in the oral pathology department between 2018 and 2022 was conducted to recover all cases reported as OOC in SRM Dental College, Ramapuram. Radiographs and Haematoxylin and Eosin stained histological slides were re-examined. Overall, there were nine cases in which men were engaged in 80% of the instances and the group’s ages varied from 20 to 35. The primary symptoms of all of the patients were pain and edema. The vast majority of cases had an impacted tooth in the jaw. All of the lesions showed clearly visible radiolucency on orthopantomographs [OPG], with the exception of one specific case. Additionally, histological examination of each patient revealed the characteristic microscopic traits and enucleation was done to treat all the cases. OOC has a more favourable outcome than OKC due to variations in prognosis, management and must be considered distinct from OKC. Most of our cases—a large majority—involved adolescent males’ mandibles and involved pain and edema. Most were unilocular and all were radiolucent. The literature-recommended histopathological findings were present and all cases were enucleated.

Bone Trabecular Pattern Analysis in Odontogenic Cysts Using Cone Beam Computed Tomography: A Clinical Retrospective Study.

Introduction The cysts of the maxillofacial region account for one of the most common pathologies of the head and neck region after the mucosal pathologies. Radiography provides an essential clue in early diagnosis and triaging, but it continues further as it is used to evaluate the post-treatment outcome. However, manual analysis is prone to errors. In this scenario, fractal analysis (FA) in radiographs uses mathematical methods to analyse the changes in grey scales in a given radiographic image. FA in odontogenic cysts is used to characterise their complexity, uncover hidden patterns, monitor treatment response, and potentially provide prognostic information. This paper aimed to assess the fractal characteristics of the radicular cyst (RC), dentigerous cyst (DC), and odontogenic keratocyst (OKC) using cone beam computed tomography (CBCT). The objective was to calculate fractal dimension (FD) values expressed in each of these cysts, which could prove to be a radiological adjunct in diagnosing the above cysts. Materials and methods As this is a retrospective study, the archives of CBCT images from June 2021 to December 2023 were obtained from patients diagnosed and confirmed with a histopathological diagnosis with RC, DC, and OKC. The FA was performed using Image J Software(Ver 1.51, National Institute ofHealth Bethesda, Fiji). The cortical and cancellous bones were segmented using thresholding techniques and converted to binary images. The mean FD of the three planes was then compared to establish the distinctive fractal characteristic for the specific odontogenic cysts. A one-way ANOVA was performed using the Statistical Product and Service Solutions (SPSS) (version 23.0; IBM SPSS Statistics for Windows, Armonk, NY) to determine the difference between FD values of RC, DC, and OKC with a significance level less than 0.05. Results The FD values of DC, RC, and OKC were 1.33 ± 0.17, 1.08 ± 0.16, and 1.65 ± 0.12, respectively. The results indicated that OKC had higher FD values than DC and RC, which means that OKC had lesser bone destruction compared to DC and RC. Inferential statistics showed that the one-way ANOVA was used to compare the means of the three groups of FD data. When calculated for the three groups, the F-statistic value was at 7.29, which yielded a P value of 0.03, making it statistically significant for a 95% confidence interval (p<0.05). Conclusion Our CBCT study on bone trabecular pattern analysis using FD and FAin odontogenic cysts reveals distinct alterations in bone parameters among different cyst types. The probability of higher FD values in OKC is because of lesser cortical bone destruction in OKC compared to the other cyst types. These findings have potential implications for diagnosing, treating, and prognosticating odontogenic cysts.

Non-Ossifying Fibroma in Posterior Mandible, A Case Report

In this case report, we present a case of non-ossifying fibroma in the mandible of an eleven-year-old girl who reported to the Oral and Maxillo-Facial Surgery Department with facial asymmetry and painless swelling on palpation over the lower right mandibular region. In this paper, we review the radiographic features, clinical presentation, and histopathological features of non-ossifying fibromas. Non-ossifying fibromas present with a unique extra-gnathic appearance in the skull. It is usually asymptomatic and has diverse histological features. Co-related histological, radiological, and clinical features differentiate it from other odontogenic and non-odontogenic tumors and cysts of the oral cavity. Ortho-pantogram revealed a well-demarcated, expansile radiolucency with pronounced sclerotic borders with striations reaching the anterior and superior regions and thus slowly approaching a multilocular stage. The treatment plan comprised of excisional resection with curettage under general anesthesia. After excisional biopsy of the lesion, the specimen was sent for histopathological evaluation in neutrally buffered 10 % formalin solution, which confirmed it to be a Non-Ossifying Fibroma. Prior to surgery, informed consent and written permission to collaborate with a case report encompassing her findings were obtained from the patients’ guardians. Confidentiality of patient has been taken care of before documenting the report. A meticulous literature review of previous case reports on non-ossifying fibromas revealed typical behaviors and characteristics of this lesion.

Para-implant residual cyst: A case report and review of the literature

Residual Cyst (RC) is an odontogenic inflammatory pathology that appears at the site of a previous odontogenic inflammatory lesion. In this report, we present a 65-year-old male, with a history of pulpal pathology in tooth 2.5, which was extracted and treated with dental implants. He currently refers pain in the upper left maxilla with great peri-implant probing depth and marginal bone loss. During the surgical procedure, a para-implant lesion was discovered and sent for analysis. This corresponded to an odontogenic cyst without inflammation and a non-keratinized polystratified epithelial lining, with positive expression for CK14 and CK19. Final diagnosis was para-implant residual cyst. To date, five para-implant residual cysts have been described. These cystic lesions appear as an irregular radiolucency with marginal bone loss. In most cases, the implant remains stable after cyst removal. It is key to perform a good clinical history and radiological examination in patients with dental implants, as well as an active monitoring, in order to reach an early diagnosis of the peri-implant disorders.

Immunohistochemical expression of SPARC in odontogenic keratocysts: a comparative study with other odontogenic cysts

BackgroundSecreted protein acidic and rich in cysteine (SPARC) has been shown to modulate aggressive behavior in several benign and malignant tumors. Little is known about SPARC expression in odontogenic keratocyst (OKC), an odontogenic cyst with an aggressive nature. To the best of our knowledge, only one study has been investigated the expression of this protein in OKCs. This study aimed to characterize SPARC expression in OKCs. Additionally, to determine whether SPARC is associated with aggressive behavior in OKCs, SPARC expression in OKCs was compared with radicular cysts (RCs), dentigerous cysts (DCs) and calcifying odontogenic cysts (COCs). These odontogenic cysts showed no or less aggressive behavior.MethodsSPARC expression was evaluated in 38 OKCs, 39 RCs, 35 DCs and 14 COCs using immunohistochemistry. The percentages of positive cells and the intensities of immunostaining in the epithelial lining and the cystic wall were evaluated and scored.ResultsGenerally, OKCs showed similar staining patterns to RCs, DCs and COCs. In the epithelial lining, SPARC was not detected, except for ghost cells in all COCs. In the cystic wall, the majority of positive cells were fibroblasts. Compared between 4 groups of odontogenic cysts, SPARC expression in OKCs was significantly higher than those of RCs (P < 0.001), DCs (P < 0.001) and COCs (P = 0.001).ConclusionsA significant increase of SPARC expression in OKCs compared with RCs, DCs and COCs suggests that SPARC may play a role in the aggressive behavior of OKCs.

Imaging Characteristics of Embedded Tooth-Associated Cemento-Osseous Dysplasia by Retrospective Study.

Since there are many differential diagnoses for cemento-osseous dysplasia (COD), it is very difficult for dentists to avoid misdiagnosis. In particular, if COD is related to an embedded tooth, differential diagnosis is difficult. However, there have been no reports on the characteristics of the imaging findings of COD associated with embedded teeth. The aim of the present study was to investigate the occurrence and imaging characteristics of cemento-osseous dysplasia (COD) associated with embedded teeth, in order to appropriately diagnose COD with embedded teeth. The radiographs with or without histological findings of 225 patients with COD were retrospectively analyzed. A retrospective search through the picture archiving and communication system (PACS) of the Division of Oral and Maxillofacial Radiology of Kyushu Dental University Hospital was performed to identify patients with COD between 2011 and 2022. Fifteen COD-associated embedded mandibular third molars were identified in 13 patients. All 13 patients were asymptomatic. On imaging, COD associated with embedded mandibular third molars appeared as masses that included calcifications around the apex of the tooth. On panoramic tomography, COD showed inconspicuous internal calcification similar to that of odontogenic cysts or simple bone cysts, especially in patients with COD only around the mandibular third molar region. Those with prominent calcification resembled cemento-ossifying fibroma, calcifying epithelial odontogenic tumor, calcifying odontogenic cyst, adenomatoid odontogenic tumor, and so on, as categories of masses that include calcifications on panoramic tomography and computed tomography. The current investigation is the first to report and analyze the imaging characteristics of COD associated with embedded teeth. It is important to consider the differences between COD and other cystic lesions on panoramic tomography, and the differences between COD and masses that include calcifications on CT.