Odontogenic Lesions Research Articles

Malunion of Mandible Fracture: A Case Report

Radicular cysts are the most common odontogenic cystic lesions of jaws. They are asymptomatic lesions associated with the root apex of a non-vital tooth that slowly progresses rarely to large symptomatic swelling. Here we describe a patient with large radicular cyst involving maxillary sinus secondary to traumatized non-vital tooth 21 treated by surgical enucleation. Key words: Maxillary sinus, Radicular cyst, Surgical enucleation

Multiple complex odontomas of the mandible: a rare case report and literature review

Odontomas are the most common tumor-like (hamartoma) odontogenic lesions in the gnathic bones. There are two main types: complex odontoma which is composed mainly of amorphous calcification, and compound odontoma which is characterized by irregular tooth-like structures. Odontomas are generally asymptomatic and in most cases involve only one quadrant of the maxilla or mandible. The treatment of choice is surgical removal. The aim of the present study is to report a rare case of multiple complex odontomas affecting the mandible and to review the literature on the clinical and pathological features of these tumors.

Unraveled roles of Cav1.2 in proliferation and stemness of ameloblastoma

BackgroundTranscriptome analysis has been known as a functional tool for cancer research recently. Mounting evidence indicated that calcium signaling plays several key roles in cancer progression. Despite numerous studies examining calcium signaling in cancer, calcium signaling studies in ameloblastoma are limited.ResultsIn the present study, comparative transcriptome profiling of two representative odontogenic lesions, ameloblastoma and odontogenic keratocyst, revealed that Cav1.2 (CACNA1C, an L-type voltage-gated calcium channel) is strongly enriched in ameloblastoma. It was confirmed that the Ca2+ influx in ameloblastoma cells is mainly mediated by Cav1.2 through L-type voltage-gated calcium channel agonist and blocking reagent treatment. Overexpression and knockdown of Cav1.2 showed that Cav1.2 is directly involved in the regulation of the nuclear translocation of nuclear factor of activated T cell 1 (NFATc1), which causes cell proliferation. Furthermore, a tumoroid study indicated that Cav1.2-dependent Ca2+ entry is also associated with the maintenance of stemness of ameloblastoma cells via the enhancement of Wnt/β-catenin signaling activity.ConclusionIn conclusion, Cav1.2 regulates the NFATc1 nuclear translocation to enhance ameloblastoma cell proliferation. Furthermore, Cav1.2 dependent Ca2+ influx contributes to the Wnt/β-catenin activity for the ameloblastoma cell stemness and tumorigenicity. Our fundamental findings could have a major impact in the fields of oral maxillofacial surgery, and genetic manipulation or pharmacological approaches to Cav1.2 can be considered as new therapeutic options.

IDENTIFICATION OF MOLECULAR ASPECTS OF ODONTOGENIC LESIONS BY BIOINFORMATICS TOOLS - A SYSTEMATIC REVIEW

Objectives The objective of this review was to systematically assess the bioinformatics methods currently used to recognize the molecular aspects of odontogenic lesions (OL). Study Design A literature search was conducted in PubMed, Web of Science, Scopus, and Embase up to March 2021, following the PRISMA statement. Studies presenting molecular findings of OL through bioinformatics methods were included. Results From 87 references, 9 full texts were screened, and 5 met the eligibility criteria. The articles were conducted in Europe, North America, and Asia between 2011 to 2020. All studies analyzed ameloblastoma samples, and 1 also used odontogenic keratocyst. Four studies (4, 80%) choose the microarray technology to characterize gene expression of the lesions, whereas 1 study (1/20%) applied the whole exome sequencing technology to identify mutation signatures. The results showed the microarray as a highly efficient approach for establishing gene expression and identifying noncoding transcripts (miRNAs, lncRNAs, and snoRNAs); information about the possible etiology of mandibular ameloblastoma was acquired through whole exome sequencing. Conclusions The microarray technology was the main method used in this systematic review. Bioinformatics technologies provide insights and highlight potential targets for OL diagnostic and therapeutic approaches. The objective of this review was to systematically assess the bioinformatics methods currently used to recognize the molecular aspects of odontogenic lesions (OL). A literature search was conducted in PubMed, Web of Science, Scopus, and Embase up to March 2021, following the PRISMA statement. Studies presenting molecular findings of OL through bioinformatics methods were included. From 87 references, 9 full texts were screened, and 5 met the eligibility criteria. The articles were conducted in Europe, North America, and Asia between 2011 to 2020. All studies analyzed ameloblastoma samples, and 1 also used odontogenic keratocyst. Four studies (4, 80%) choose the microarray technology to characterize gene expression of the lesions, whereas 1 study (1/20%) applied the whole exome sequencing technology to identify mutation signatures. The results showed the microarray as a highly efficient approach for establishing gene expression and identifying noncoding transcripts (miRNAs, lncRNAs, and snoRNAs); information about the possible etiology of mandibular ameloblastoma was acquired through whole exome sequencing. The microarray technology was the main method used in this systematic review. Bioinformatics technologies provide insights and highlight potential targets for OL diagnostic and therapeutic approaches.

MULTIPLE COMPLEX ODONTOMAS: A RARE CASE REPORT

Odontomas are the most common tumor-like (hamartoma) odontogenic lesions in the gnathic bones. Multiple odontomas are rare and characterized by numerous odontomas involving 1 to 4 quadrants of the gnathic bones. We report the case of a 16-year-old female patient without noteworthy extra- and intraoral physical examination alterations. Panoramic radiography revealed a well-delimited, unilocular, bilateral radiolucent lesion in the ascending ramus of the mandible. An incisional biopsy was performed, which revealed a developing complex odontoma at both sites. The treatment of choice was enucleation, followed by curettage of the bone defect. The removed material was sent for anatomopathologic analysis, which confirmed the diagnosis of complex odontoma. The patient has been in follow-up for 10 months and shows no signs or symptoms of recurrence.

THE IMPORTANCE OF THE ORAL PATHOLOGIST IN THE DIAGNOSTIC PROCESS OF INJURIES OROMAXILLOFACIALS: CASE REPORT

The correct histopathologic diagnosis is crucial to choose the correct therapy to prevent irreversible damage to the patient. The objective of this work is to present a clinical case of a maxillary lesion first histopathologically diagnosed as unicystic ameloblastoma, but the second opinion of an oral pathologist resulted in a new histopathologic diagnosis of calcifying odontogenic cyst associated with a compound odontoma. Both odontogenic lesions are benign, well-defined, slow growing, with little morbidity, differing from the previous report; therefore, treatment was conservative. This work highlights the importance of a capable professional for the histopathologic diagnosis of lesions occurring in oral and perioral regions for adequate treatment and management.

PERIPHERAL ADENOMATOID ODONTOGENIC TUMOR IN MAXILLA: A CASE REPORT

A 26-year-old female patient was referred to the stomatology clinic with a complaint of "lump in the gums." Physical examination revealed a discrete swelling laterally to the upper lip on the left side. On intraoral examination, a dome-shaped swelling that was sessile, normochromic, with an intact surface, painless and firm in the alveolar mucosa, above the crowns of teeth 23 and 24, and with a year of evolution was noted. Periapical and panoramic radiographic revealed a single radiolucent image with sclerotic borders limited by the adjacent bone and displacement of the premolar roots. Excisional biopsy was performed during the surgery, and upon detaching the buccal mucosa, it was noted that the lesion was located peripherally and that the cortical bone was intact, showing only an erosion where the lesion was lodged. The diagnostic hypotheses were odontogenic lesions with peripheral variant and other reactive lesions. Histopathologic analysis was conclusive to adenomatoid odontogenic tumor. The patient is being followed up with no recurrence.

MAXILLARY ODONTOGENIC FIBROMYXOMA: A CASE REPORT

A 30-year-old indigenous man sought dental care for swelling in the maxilla, palate, and part of the oropharynx. On clinical examination, a lesion was observed with areas of hardened and resilient consistency, with expansive growth causing tooth displacement. Radiographically, there was a well-defined unilocular radiolucent image invading the maxillary sinus and reaching the left orbit. After negative aspiration, incisional biopsy was performed, and the obtained material had a firm consistency and whitish color. Histopathologic analysis revealed that it was an odontogenic myxoma. After maxillectomy, the histopathologic examination confirmed that it was a benign odontogenic mesenchymal lesion, characterized by sparse cells, with a shape varying from round to stellate, immersed in abundant collagenized stroma, with basophilic myxoid areas and sparse strands of pervading odontogenic epithelium, then called odontogenic fibromyxoma. After 45 days of follow-up, the lesion area showed satisfactory epithelialization without signs of infection or pain.

CALCIFYING ODONTOGENIC CYST WITH 10 YEARS OF EVOLUTION: A CASE REPORT

Calcifying odontogenic cyst (COC) is a rare, benign odontogenic lesion that sometimes may be present along with odontogenic tumors. A 22-year-old female patient was referred for evaluation of an asymptomatic swelling on the anterior maxilla with approximately 10 years of evolution. Physical examination showed firm swelling with cortical expansion within intact bluish mucosa. Computed tomography showed a unilocular hypodense image with hyperdense foci, causing loss of bone structure in the vestibular cortical and anterior wall of maxillary sinus. Diagnostic hypotheses were calcifying epithelial odontogenic tumor, ameloblastic fibro-odontoma, and complex odontoma, and incisional biopsy was performed. Microscopic analysis revealed a pathologic cavity lined by odontogenic epithelium with variable thickness, along with ghost cells, eosinophilic acellular material resembling dentinoid, and foci of dystrophic calcifications. The cyst was surrounded by a fibrous capsule. Histopathologic diagnosis was COC. The patient was referred for enucleation of the lesion for complete analysis and final diagnosis.

IMMUNOEXPRESSION OF STEM CELL MARKERS SOX-2, NANOG, AND OCT4 IN AMELOBLASTOMA

<h3>Objectives</h3> To analyze the expression of classic stem cell markers, SOX-2, NANOG, and OCT4, in ameloblastoma using immunohistochemistry. <h3>Study Design</h3> Twenty-three cases of ameloblastoma (AME), 10 cases of dentigerous cyst (DC), and 10 cases of dental follicle (DF) were submitted to immunohistochemistry to detect SOX-2, NANOG, and OCT4. Protein expression was compared between AME, DC, and DF. Additionally, the correlation and association of markers studied was verified. <h3>Results</h3> AME samples showed overexpression of the studied proteins when compared with DC and DF (<i>P</i> < .001), with a correlation between the immunostaining of OCT4 and SOX-2 proteins in AME neoplastic cells (<i>r</i> = 0.4544, <i>P</i> = .0294), as well as a positive linear relationship between OCT4 and SOX-2 staining in AME neoplastic cells (<i>r</i>² = 0.2065, <i>P</i> = .0294). Interestingly, both the DC and the DF showed expression of stem cell markers. <h3>Conclusions</h3> The immunolabeling of the proteins studied in AME indicates the probable role of stem cells in the genesis and progression of this neoplasia. Additionally, the presence of these markers on the DC and DF suggests that the genesis of odontogenic lesions may begin in odontogenic cysts and tissues that have stem cells.

IL-8 Is Upregulated in the Tissue-Derived EVs of Odontogenic Keratocysts.

Background Interleukin 8 (IL-8) is a chemotactic cytokine released by various cells including leukocytes, endothelial cells, and epithelial cells. IL-8 has multiple functions in inflammation, tumour invasion, or angiogenesis. Human odontogenic cystic lesions are chronic and frequently inflamed. Tissue-derived extracellular vesicles (Ti-EVs) are widely present in various tissues and could more accurately reflect the characteristics of the primary tissue. However, the involvement of IL-8 in Ti-EVs of human odontogenic lesions is still unclear. This study aimed to explore the expression of IL-8 in Ti-EVs of human odontogenic lesions and the potential roles of Ti-EVs that carried IL-8. Methods Fresh tissue samples of dentigerous cyst (DC, n = 5) and odontogenic keratocyst (OKC, n = 5) were collected for Ti-EVs isolation. Ti-EVs were characterised by transmission electron microscopy and nano-flow cytometry analysis. The cytokine profile of Ti-EVs was explored by cytokine antibody array. The IL-8 expression was examined by immunochemical staining in tissue of odontogenic lesions (DC, n =12; OKC, n =28). Antioxidants (N-acetyl-L-cysteine and diphenyleneiodonium) were employed to treat HaCaT cells, and the expression of IL-8 was detected by enzyme-linked immunosorbent assay. The gene expression of MMP9 was explored by quantitative real-time polymerase chain reaction in co-culture system of fibroblasts of OKC with Ti-EVs. Results Compared with DC, the expression of IL-8 in Ti-EVs and fixed tissue specimens of OKC was markedly upregulated. The antioxidants decreased the expression level of IL-8 protein in the supernatant of HaCaT cells. The Ti-EVs treatment (10 μg/ml) of fibroblasts significantly induced the MMP9 mRNA expressions in OKC fibroblasts. Conclusions IL-8 was upregulated in Ti-EVs of OKC and might be involved in the tissue destruction of OKC.

Status of Microbiota in Odontogenic Inflammatory Lesions and Dental Surgery Procedures Performed on an Outpatient Basis

Inflammations of the facial part of the skull are most commonly caused by a bacterial infection. They are a frequently occurring pathological process, which results from a rich bacterial flora of the oral cavity, as well as diseased teeth and periodontal tissues. These inflammations have a primarily mixed character with the prevalence of anaerobic bacteria. Gangrene of the dental pulp is the most common odontogenic cause. In the case of inflammations of oral tissues an early and corrective treatment results in quick recovery. The purpose of this work was to assess the efficiency of empirical antibiotic therapy applied in patients with inflammations of oral tissues on the basis of a drug susceptibility profile of bacteria isolated from material extracted from inflammatory lesions. The research material consisted of smears collected from patients with existing acute inflammations in the oral cavity. The smear was collected from the bottom of the lesion after its prior surgical treatment and pus evacuation, and again, 7 days after surgery. In patients with acute odontogenic inflammations the recommended first-line therapy are extended-spectrum penicillins, characterized by a low risk of side effects and strong antimicrobial activity. In the study group, both clindamycin and amoxicillin exhibited high efficiency in treating acute odontogenic inflammatory lesions in the oral cavity.

The Prevalence of EBV and KSHV in Odontogenic Lesions

ObjectivesOdontogenic lesions evolve as a result of altered dental development. This study aimed to evaluate the prevalence and the coinfection of Epstein-Barr virus (EBV) and Kaposi sarcoma–associated herpesvirus (KSHV) in radicular cysts, dentigerous cysts, odontogenic keratocysts, and ameloblastomas. MethodsPolymerase chain reaction (PCR) was used to analyse 66 cases of odontogenic lesions for the presence of EBV-DNA and KSHV-DNA. These lesions were 15 radicular cysts, 16 dentigerous cysts, 18 odontogenic keratocysts, and 17 ameloblastomas. ResultsEBV-DNA was detected in 24 (36.4%) of the studied samples as follows: 6 samples (40.0%) of radicular cysts, 4 (25.0%) of dentigerous cysts, 10 (55.6 %) of odontogenic keratocysts, and 4 (23.5%) of ameloblastomas (P = .168). KSHV-DNA was found in 16 (24.2%) of the studied samples as follows: 1 sample (6.7%) of radicular cysts, 6 (37.5%) of dentigerous cysts, 8 (44.4 %) of odontogenic keratocysts, and 1 (5.9%) of ameloblastomas (P = .001). Additionally, EBV and KSHV were positively correlated in all studied samples (P = .002). ConclusionsBoth EBV and KSHV are found in odontogenic cysts and ameloblastomas. KSHV and EBV are more prevalent in odontogenic keratocysts than in other studied odontogenic lesions. Further, there is a high prevalence of EBV and KSHV coinfection in odontogenic cysts and ameloblastomas.

Calcifying odontogenic cyst mimicking dentigerous cyst in a 36 year old male: A case report

Odontogenic and nonodontogenic cystic lesions of the mandible have wide range of pathologic features but similar imaging findings. Their locations in the mandible and prevalence rate often help narrow the differential diagnosis. Histological findings are crucial and direct the workup and treatment of a lesion. This case report presents calcifying odontogenic cyst mimicking dentigerous cyst involving left angle of mandible in a 38 year old male.

The Interdisciplinary Orthodontic–Surgical Diagnostic and Treatment Protocol for Odontogenic Cyst-like Lesions in Growing Patients—A Literature Review and Case Report

Tooth eruption disturbances associated with developmental odontogenic cysts represent a particular challenge in orthodontic treatment. Early diagnosis, crucial for prompt and effective therapy, is possible with a thorough radiological analysis. Three-dimensional digital images provided by CBCT are indispensable to establish an interdisciplinary orthodontic–surgical treatment plan. The aim of this paper is to present a case of an odontogenic cyst in a nine-year-old male patient. Particular attention is paid to radiological findings, possible therapeutic approaches and potential complications connected with an attempt to improve the alignment of teeth. Orthodontic implications associated with cysts in growing patients are widely described according to clinical observations and literature review.

A giant adenomatoid odontogenic tumor of the mandible: A case report and literature review.

Introduction and importanceAn adenomatoid odontogenic tumor is a rare medical condition. Large tumor (or several) often appears in the maxillae. In a minority of cases, the tumor(s) appear in the mandible.Case presentationWe report on a case of a 24-year-old female diagnosed with a mandibular adenomatoid odontogenic tumor, a giant tumor measuring approximately 22 × 25 × 17 cm. The tumor was located on the side of the mandible, causing facial deformity, malnutrition, and hemorrhaging. We assessed the patient's overall condition, carried out a resection of the tumor and mandible from the right condyle to the left mandibular angle, and reconstructed the mandibular defect with a fibula free flap. After the treatment, the patient was followed up for 1 year, with no recurrence detected over this period.Clinical discussionBecause adenomatoid odontogenic tumors are benign odontogenic lesions, which are painless and slow-growing, most are surgically removed or treated conservatively. However, the above treatment measures cannot be applied in the case of a giant tumor that causes facial deformity, destroys the entire jawbone, and has complications such as hemorrhaging and malnutrition. After the tumor resection, the defect is still significant. Accordingly, reconstruction using a microsurgical bone flap is an effective method instead.ConclusionLarge adenomatoid odontogenic tumors in the mandible are rare, and treatment cannot follow conventional methods. Accordingly, defect reconstruction after tumor resection is essential.

Immunohistochemical Analysis of Unicystic Ameloblastoma and Dentigerous Cyst: A Comparative Study

Background: Diagnosis of odontogenic cystic lesions is challenging because their lining epithelia, which are basically stratified squamous epithelia, resemble each other, especially when they become hyperplastic from an inflammatory reaction. The histological distinction between unicystic ameloblastomas (UAs) and certain non-neoplastic odontogenic cysts can be problematic. Thus, Notch 2 expression has been observed in this immunohistochemical study to discriminate reliably and objectively UA from dentigerous cysts (DCs) in routine practice. Literature search has shown that Notch 2 has not been studied in any of the odontogenic lesions to date, and this study is the first of its kind both nationally and internationally. Thus, the aim of this study is to determine whether Notch 2 can be used to discriminate reliably and objectively cystic jaw lesions in routine practice. Materials and Methods: A total of 26 paraffin-embedded tissues of 13 UA and 13 DC were included, and serial 3 or 4 μm sections were produced from paraffin blocks. One section from each tissue was stained with a routine stain, hematoxylin and eosin to re-evaluate the final histopathologic diagnosis and the other section was expended for immunohistochemistry. Results: The Notch 2 immunoexpression in UA and DC tissue sections demonstrated a mixed result. Four cases of DC showed strong expression, whereas two cases of UA strongly expressed Notch 2. Conclusion: Notch 2 can form a reliable marker in differentiating DC from unicystic ameloblastoma. Thus, the study proved the utility of Notch 2 in differentiating unicystic ameloblastoma from DC.

Expression of genes in the pathogenesis of ameloblastoma, dentigerous cyst and odontogenic keratocyst

This systematic review seeks to provide high-quality evidence on expression of genes in the pathogenesis of ameloblastoma, dentigerous cyst and odontogenic keratocyst. Until 2021, a systematic electronic literature search was undertaken utilizing keywords and MESH search phrases in the PubMed/Medline, Cochrane Central, Scopus, and EBSCO databases, as well as Google Scholar. In addition, the reference lists of the systematic reviews included in the study were manually searched. Articles were evaluated critically, and the MINORS scale was used to determine the risk of bias. Ameloblastoma (AB), dentigerous cyst (DC), and odontogenic keratocyst (OKC) are odontogenic lesions that have the potential to become malignant or spread locally. The molecular mechanisms underlying the development of these lesions remain unknown. However, several studies have found that tumor suppressor genes or oncogenes are dysregulated in these lesions. P53 gene downregulation has been observed in AB, DC, and OKC cells. Furthermore, several long non-coding RNAs have been found to be dysregulated in AB tissues, including ENST00000512916 and KIAA0125. Certain forms of odontogenic lesions have been linked to single nucleotide polymorphisms in a range of genes.

Large Asymptomatic Maxillary Radicular Cysts Simulating Odontogenic Keratocysts or Bone Tumor Lesions: Importance of Radiographic Investigation

Large Asymptomatic Maxillary Radicular Cysts Simulating Odontogenic Keratocysts or Bone Tumor Lesions: Importance of Radiographic Investigation

A cartilage-forming tumor of the mandibular angle: a case report\xa0

BackgroundMandible can be the site of benign or malignant lesions of different origins, including odontogenic and non-odontogenic lesions. Cartilage-forming tumors have been rarely reported at this site. Chondrosarcoma is a rare malignant cartilage-producing neoplasm that is extremely rare in the mandible. The rarity of cartilage-forming tumor occurrence in the mandible can make diagnosis difficult for pathologists, as they do not expect this type of tumor at this anatomical site. Here we report a case of chondrosarcoma of mandibular angle.Case presentationA 70-year-old Moroccan male patient consulted a dentist for wisdom tooth pain. Wisdom tooth extraction was conducted. After 6 months, the patient reported the recurrence of pain associated with swelling in the mandibular area and paresthesia along the path of the mandibular nerve. A panoramic radiograph demonstrated a mixed radiolucent–opaque lesion involving the mandibular angle. Computed tomography showed a large osteolytic spontaneously hypointense and multilobulated lesion. A biopsy was done. Histopathological examination revealed sheets and irregular lobules of atypical cells presenting cartilaginous differentiation. Tumor cells showed severe nuclear atypia and were located within a hyaline cartilage matrix. Some foci of necrosis were noted. Osteoid deposits were not found. The patient was diagnosed with grade III chondrosarcoma and underwent a right segmental mandibulectomy with submandibular lymph node dissection. Macroscopically, the tumor was localized in the mandibular angle with extension in the mandibular body. Histopathology confirmed the previous diagnosis of grade III chondrosarcoma and did not show any lymph node metastasis.ConclusionsOwing to many histological similarities, grade III chondrosarcoma must be distinguished from chondroblastic osteosarcoma and metastatic lesions. In addition, chondroblastic osteosarcoma of the jawbones has a worse prognosis than chondrosarcoma, making the distinction between these two malignant tumors the most important concern of the pathologist when dealing with a cartilage-forming tumor at this site. Surgery with wide excision margins remains the best therapeutic approach, while the role of radiotherapy is controversial. The management of mandibular chondrosarcoma requires a multidisciplinary approach involving maxillofacial surgeons, radiologists, pathologists, and oncologists.