Mucous cell differentiation in a unicystic ameloblastoma

The authors report a case of unicystic ameloblastoma with mucous cell differentiation in the right mandible of a 24-year-old Korean male who suffered from painful swelling for 2 months. A radiograph showed a well-circumscribed radiolucent lesion between the root of the right first premolar and the first molar tooth. Microscopic examination revealed the cystic lesion was lined with ameloblastic epithelium and goblet cells in the epithelium. The mucous cells reacted positively to mucicarmine stain. The possible pathogenic mechanism of this case reflects the pluripotential character of the odontogenic epithelium. The prognosis is probably that expected for conventional unicystic ameloblastoma.     

Ameloblastoma--a diagnostic problem

A 50-year-old female was referred by her dental practitioner. She had a periapical radiolucency associated with the lower right second premolar tooth. The tooth was root treated and subsequently apicected. Tissue curetted at the time of surgery was shown to be a solid ameloblastoma which was managed initially by marginal excision. Histopathological examination of the resection specimen demonstrated tumour at the inferior margin. A segmental resection of the mandible with an immediate reconstruction using a free tissue transfer of the iliac crest was therefore performed. The case shows the need for vigilance in dealing with periapical pathology and underlines the importance of sending all tissue specimens for histopathological analysis.     

Ameloblastoma located in the alveolar bone: a case report

A small ameloblastoma located in the alveolar bone of a 34-year-old male is presented. Clinical examination revealed slight swelling of the alveolar bone between the lower second premolar and first molar areas with bone-like hardness, and radiographic examination showed a well circumscribed radiolucent lesion surrounded by a thin radiopaque layer, within which was contained the root of the second premolar tooth. Histopathologically, the lesion was compatible with a diagnosis of follicular ameloblastoma. A review of the literature yielded only four cases of small ameloblastoma located in the alveolar bone. These four previously reported cases and the present case strongly suggest that a small ameloblastoma located in the alveolar bone of adults arises from Malassez's epithelial rests scattered in the periodontal membrane.     

Intentional replantation for the management of maxillary sinusitis

AIM: To present a case that emphasizes the importance of the use of intentional replantation as a technique to successfully treat a periapical lesion and an odontogenic maxillary sinusitis through the alveolus at the same time. SUMMARY: This case report presents a patient with odontogenic maxillary sinusitis secondary to periapical disease of a maxillary molar that had previously received root canal treatment. The molar was extracted, with drainage and rinsing of the maxillary sinus. The apices were resected extra-orally, the retrograde cavities prepared with ultrasound and retrograde fillings of silver amalgam placed. The tooth was then replanted. After 2 years, the patient was asymptomatic, periapical radiography showed no evidence of root resorption and computed tomography scanning demonstrated the resolution of maxillary sinusitis. Key learning points: *When root canal treatment or periapical surgery cannot be undertaken or has failed, intentional replantation may be considered. *This alternative treatment may be predictable in certain cases.     

Central adenoid cystic carcinoma of the mandible manifesting as an endodontic lesion

AIM: To present a case of adenoid cystic carcinoma (ACC) in the mandible, and manifesting as a periapical lesion. SUMMARY: A 56-year-old male suffered from pain around the right mandibular first molar for approximately 1 week. Oral examination revealed that the involved tooth was restored by a full coverage crown with no obvious abnormalities. A periapical radiograph revealed two ill-defined radiolucencies associated with the tooth, one over the mesial and another over the distal roots of the tooth; incomplete root filling and furcation involvement also being noted. The affected tooth was extracted based on the clinical impression of apical periodontitis. The surrounding tissue of the root apex was curetted and sent for histopathological examination, which revealed ACC. KEY LEARNING POINTS: Adenoid cystic carcinoma affecting the mandible may mimic a periapical lesion. Proper diagnosis of such a lesion is dependent on thorough clinical, radiographic and microscopic examinations. Such a case highlights the benefits of biopsy and histological examination of collected tissues. Diagnosis of lesions in the mandible should include salivary gland tumours.     

Unicystic ameloblastoma of the maxilla: a case report

Unicystic ameloblastoma is believed to be less aggressive and responds more favorably to conservative surgery than the solid or multicystic ameloblastomas. This report is a rare case of unicystic ameloblastoma of the maxilla that was treated by enucleation under suspicion of a radicular cyst related to a dens in dente. The neoplastic nature of the lesion became evident only when the enucleated material was available for histologic examination. With this report, the authors illustrate the importance and complexity of a differential diagnosis of lesions with a cystic aspect in the anterior region of the maxilla, among them - inflammatory radicular cysts, odontogenic keratocysts, adenomatoid odontogenic and unicystic ameloblastoma. Relevant diagnostic problems and choice of treatment of unicystic ameloblastoma are presented along with a review of the literature.     

单囊型成釉细胞瘤临床病理及凝集素免疫组织化学研究

目的 研究单囊型成釉细胞瘤的临床病理及凝集素免疫组织化学特点，探索有助于诊断和临别诊断的组织学标记物。方法 对４０例单囊型成釉细胞瘤行ＨＥ染色及组织学观察；并对其中的２５例行荆豆凝集素（ＵＥＡ－１）、兀鹰血凝集素（ＢＳＡ－１）免疫组织化学染色。结果 ４０例 单囊型成釉细胞瘤，组织学上可分为３个亚型：第一型５例（１２．５％），第二型２０例（５０．０％），第三型１５例（３７．５％）；ＵＥＡ－１、ＢＳＡ     

Ameloblastoma suggesting large apical periodontitis

This case report describes the endodontic treatment of a large apical periodontitis with well-defined margins adjacent to teeth #22-24. After the initial endodontic treatment, continued expansion of the mandible cortical bone was observed, indicating a need to surgically enucleate the lesion and submit it for histopathologic examination. The microscopic examination indicated a diagnosis of ameloblastoma. Ameloblastoma is a benign epithelial neoplasm of odontogenic origin, and depending on the stage of development, it can mimic a periapical lesion and therefore should be considered in establishing an endodontic differential diagnosis. The definitive diagnosis for some periapical lesions can only be made by a histopathologic examination.     

20-year Follow-up of Recurrent Glandular Odontogenic Cyst Mimicking a Periapical Lesion

Periapical lesions usually are caused by root canal infection; nevertheless, other pathologies may eventually involve the tooth apex, making the correct diagnosis more difficult. Glandular odontogenic cysts (GOCs) are uncommon and, despite their cystic nature, may present an aggressive behavior and a high recurrence rate. This report describes a recurrent GOC mimicking a periapical lesion that was followed up for 20 years. A 45-year-old woman described tooth discomfort for several years in the anterior region of the mandible that was not exacerbated during eating or occlusion. Clinical examination revealed no signs of swelling, redness, or inflammation in the gingival or surrounding soft tissue. Nevertheless, periapical radiography showed a well-defined large radiolucent lesion in the periapical region of teeth #22, #23, #24, and #25. The pulp test confirmed that all these teeth were vital. An incisional biopsy was performed, and with the histopathological diagnosis of an odontogenic cyst, the lesion was enucleated surgically. After recurrence, the extensive periapical multilocular lesions were again surgically removed. Based on the microscopic findings, the final diagnosis was GOC. One year later, there were no signs of recurrence. GOCs associated with the root apex may mimic periapical inflammatory diseases. Clinical, radiographic, and histopathological findings are essential for the diagnosis of inconclusive radiolucent findings in the periapical region. Biopsy specimens should be sent to a specialized oral pathology laboratory.     

The challenges of treating a fused tooth

This paper describes and discusses the multidisciplinary treatment involving a permanent maxillary lateral incisor fused to a supernumerary tooth, both presenting pulp necrosis and periapical lesion. A 15-year-old male patient sought treatment complaining of pain, swelling and mobility on the maxillary right lateral incisor. After clinical and radiographic examination, root canal preparation was performed according to the crown-down technique and a calcium hydroxide dressing was placed for 15 days. The patient returned and the definitive endodontic filling was done with thermomechanical compaction of gutta-percha and sealer. After 18 months, clinical and radiographic examinations were carried out and no pain or swelling was reported. Two years after endodontic treatment, the patient returned for periodontal and cosmetic treatments. Nine months later, a cone-beam computed tomography (CBCT) revealed that the previously detected periodontal defect and periapical lesion were persistent. Apical endodontic surgery was indicated. The supernumerary tooth was removed, the communicating distal surface was filled and the surgical site received bioactive glass and demineralized bovine organic bone. The pathological tissue was submitted to histopathological examination and the diagnosis was periapical cyst. One year after the apical endodontic surgery, CBCT showed bone formation at maxillary lateral incisor apical area. Two years after the surgery, the restoration was replaced due to aesthetic reasons and periapical radiograph showed success after 5 years of treatment. A correct diagnosis and establishment of an adequate treatment plan resulted in a successful management of the case.     

A case of an odontogenic cutaneous sinus tract

CASE REPORT: A 22-year-old female presented with a draining sinus tract on her left cheek. The tooth responsible was examined clinicopathologically. On clinical examination, the mandibular left first molar tooth was restored with an amalgam filling. Radiographic examination revealed base or pulp capping material below the restoration and a radiolucent periapical lesion surrounding the distal root apex. Conservative non-surgical root canal treatment was performed; 10 months later, the sinus had healed completely and the periapical lesion had resolved. Histopathological examination of pulp tissue recovered during treatment revealed foreign bodies, made up of capping material and amalgam, associated with chronic inflammation. These findings suggested that chronic inflammation in the pulp tissue had resulted in a draining sinus tract.     

Focal cemento-osseous dysplasia involving a mandibular lateral incisor

AIM: To report a case of focal cemento-osseous dysplasia (FCOD) affecting a single tooth misdiagnosed as an inflammatory periapical lesion.SUMMARY: The patient, a black 47-year-old woman complained of pain affecting the right side of the mandible. Routine X-ray examination discovered a periapical radiolucency on the mandibular left lateral incisor (tooth 32), which was otherwise normal and not carious. As the response of this tooth to a vitality test was doubtful, the lesion was diagnosed as a periapical granuloma or cyst secondary to pulpal necrosis. Endodontic treatment and curettage of the periapical lesion were performed, and histological examination of the curettage material revealed a localized osseous dysplasia. KEY LEARNING POINTS: FCOD may rarely affect only one tooth, resembling a periapical granuloma or cyst. Careful diagnosis is of paramount importance in cases of questionable periapical lesions affecting normal-looking teeth, before beginning treatment. FCOD generally requires no treatment. Biopsy is warranted in case of doubt.     

Bilateral mandibular infected buccal cyst: a new image

BACKGROUND: The mandibular infected buccal cyst is an uncommon lesion associated with the permanent mandibular first or second molar in children just prior to tooth eruption. The World Health Organization includes this lesion under the category of paradental cyst and suggests the term "mandibular infected buccal cyst" (MIBC) for lesions that occur on the buccal surface of the permanent mandibular first molar in children approximately 6 to 8 years of age. We present the case of a patient with bilateral mandibular cyst affecting the second molars of an 8-year-old boy. To the best of our knowledge, this is the first case of bilateral MIBC published with a three-dimensional model made using an interactive three-dimensional (3D) implant planning system. METHODS: An 8-year-old boy presented with swelling over the buccal gingiva of his lower left first molar. He complained of pain on chewing. Clinical examination revealed a 10-mm, firm, round swelling buccal to the lower left first molar. Computed tomography with multiplanar reconstruction of the jaws showed well-defined bilateral ovoid radiolucencies at the apices of the lower left first molar and the lower right first molar. A three-dimensional study was made using the interactive 3D implant planning system showing the presence of the cyst and its relation with the molar and the dental nerve. The treatment was to enucleate the left cyst and maintain the involved tooth. RESULTS: The histopathologic diagnosis of the lesion was an MIBC. CONCLUSION: The objective of the present study is to 1) familiarize dentists and oral surgeons with the entity of the MIBC; 2) show new image techniques for the diagnosis; and 3) emphasize the appropriate treatment approach.     

Conservative management of a case of plexiform ameloblastoma

Ameloblastomas are locally aggressive, benign odontogenic neoplasms having a wide variety of histologic patterns. It is essential to distinguish between the three clinical types of ameloblastomas - the intra-osseous solid lesion, the unicystic type and the extra-osseous lesion, as they differ in their biological behaviour and rate of recurrence and therefore require different forms of treatment. The case presented here is of a 9-year-old boy who reported to the department with pain and swelling along the right side of the mandible of 3 months'duration. Previous histopathological examination of the lesion, performed at a local hospital, produced a picture consistent with unicystic ameloblastoma. The lesion was managed by enucleation and the patient has been followed up for the past 5 years. Radiographic and clinical examinations reveal signs of healing without recurrence. CLINICAL RELEVANCE: Conservative management of unicystic ameloblastomas may be justified in children provided that the patient can be followed up at regular intervals.     

保留第二磨牙的开窗减压术治疗单囊型成釉细胞瘤

目的 观察开窗减压术治疗单囊型成釉细胞瘤,同时保留下颌第二磨牙的疗效.方法 对6例包埋下颌第二磨牙的单囊型成釉细胞瘤采用开窗减压术结合肿瘤摘除术,同时保留下颌第二磨牙的手术方式进行治疗,随访5年.结果 开窗减压术后8个月,肿瘤平均缩小61.62％,下颌骨下缘骨质增厚,骨小梁形成;肿瘤摘除后6个月,颌骨形态基本恢复,下颌第二磨牙功能保留;术后随访1～5年,肿瘤无复发,下颌第二磨牙功能良好.结论 采取保留下颌第二磨牙的开窗减压术及肿瘤摘除术,不仅为患者降低了面容的毁损程度,还保存了颌骨及牙齿的功能,在临床上取得了满意的效果.     

1例意向性牙再植治疗下颌磨牙难治性根尖周炎

[摘要] 目的 观察意向性牙再植治疗下颌磨牙难治性根尖周炎的临床疗效。方法 将诊断为难治性根尖周炎的下颌第二磨牙(47)拔出后,彻底去除根尖和牙槽窝内的炎症组织,即刻回植入牙槽窝内并固定。 结果 术后2周再植47牙龈红肿症状减轻,窦道闭合。术后4周无不适症状,3个月牙齿基本稳定。术后6个月复查,患牙临床检查正常,根尖区被新骨充填。结论 对于不利于行根尖手术,或由于经济原因不接受种植的难治性根尖周炎,意向性牙再植是一种有效的治疗方法。     

单囊型成釉细胞瘤行开窗减压术联合刮治术的临床研究

目的:探讨开窗减压术联合刮治术治疗单囊型成釉细胞瘤的治疗效果和预后。方法:20例单囊型成釉细胞瘤行开窗减压术,术后佩戴超软热凝树脂塞治器,Ⅱ期行刮治术,术后严密随访,观察瘤腔变化。结果:锥形束CT显示病变范围明显缩小,病变区解剖结构接近正常。开窗术后3个月瘤腔平均缩小28.66%,术后6个月平均缩小58.51%,术后12个月平均缩小为79.33%,瘤腔面积与术前比较明显缩小(P<0.05)。术后6个月瘤腔骨密度冠状位、矢状位及水平位分别为371.32、361.74、384.71 Hu,术后12个月分别为517.64、523.22、521.05 Hu,与术前相比有明显差异(P<0.05)。术后12~24个月行二期刮治,随访3~5年无复发。结论:单囊型成釉细胞瘤行开窗减压术,术后佩戴超软热凝树脂塞治器能维持开窗口通畅,在瘤腔变化不明显时进行二期刮治术,是治疗单囊型成釉细胞瘤的一种有效方法。     

Early unicystic ameloblastoma: report of case.

The occurrence of an atypical cystic lesion of the mandible in a 13-year-old boy is described. At first, a diagnosis could not be made. The biopsy specimen showed features resembling an ordinary follicular cyst, together with areas in which distinct alterations in the epithelium were noticed. These alterations seemed to be in accordance with findings of Vickers and Gorlin in cases of early or unicystic ameloblastoma. The lesion was treated by enucleation. After almost three years, no recurrence has been noticed. Long-term follow-up care is necessary. The case illustrates the obvious need for meticulous histologic examination of every cystic lesion of the jaw.     

Odontoma associated with unerupted primary tooth in primary dentition – Three cases

Odontomas are generally encountered in permanent dentition and rarely seen in primary dentition. These lesions are regarded as essentially benign, though they often cause disturbances in eruption of the associated tooth. We present clinical findings and management of 3 cases of odontomas that occurred in primary dentition, including a 3-year-old girl referred for examination of an unerupted left upper primary canine, a 6-year-old boy with an unerupted left lower second primary molar, and a 5-year-old girl who was presented with an unerupted right upper second primary molar. In all cases, periapical and panoramic radiography revealed a radio-opaque mass surrounded by a narrow radiolucent space located above the crown of the unerupted tooth. Each was diagnosed as a compound odontoma interfering with eruption of a primary tooth and surgical removal was performed under general anesthesia for all patients, with the final diagnosis based on histological findings. Following surgery, the primary canine in Case 1 spontaneously erupted, while a space maintenance appliance was applied in Case 2 and 3. It is important to recognize that an odontoma can appear in primary dentition, though the incidence is quite low. Early detection and removal of an odontoma associated with an impacted primary tooth is necessary for optimal dentition.     

Atypical plexiform ameloblastoma with dentinoid: adenoid ameloblastoma with dentinoid

In this study, we report a tumor that resembled previously reported uncommon tumors histologically similar to ameloblastoma or adenomatoid odontogenic tumor (AOT), showing the formation of hard tissue. We evaluated the histological characteristics by reviewing the literature. The patient was a 19-year old male. The lesion was located from the canine to third molar in the right mandible and was unicystic with a comparatively clear demarcation. The tumor tissue was cystic overall, showing multiple formation of small and large cysts. The tumor tissue resembled a variant form of plexiform ameloblastoma. Formation of dentin and dentinoid was observed in the tumor stroma, whereas formation of enamel was not observed. Very few cases of a variant form of ameloblastoma that shows formation of dentinoid have been reported, and the histological picture in this study closely resembled previously reported "adenoid ameloblastoma with dentinoid".