Quiste dentígero gigante en seno maxilar: Caso Clínico / Giant dentigerous cyst in the maxillary sinus: A Case Report

El proceso biológico de la odontogénesis es complejo, en ella participan mecanismos moleculares y celulares orientados a formar las estructuras dentarias, la alteración de estos mecanismos pueden originar los quistes dentígeros o foliculares. Estas patologías son cavidades anormales recubiertas por epitelio y con contenido líquido o semilíquido, rodeados generalmente de una capa de tejido conectivo; siempre asociados a la corona de dientes incluidos, son asintomáticos y de evolución lenta, descubiertas radiográficamente como una imagen unilocular y radiolúcidos, los de gran tamaño son infrecuentes, el tratamiento consiste en remoción quirúrgica completa.

The biological process of odontogenesis is complex, where molecular and cellular mechanisms participate at forming dental structures. The alteration of these mechanisms can cause dentigerous or follicular cysts, which are pathologies with abnormal cavities lined by epithelium and with liquid or semi-liquid content, usually surrounded by a layer of connective tissue; always associated with the crown of included teeth, they are asymptomatic and of slow evolution, discovered radiographically as a unilocular image and radiolucent. The large ones are infrequent and their treatment consists of complete surgical removal.

Quiste dentígero en relación con tercer molar inferior retenido

Introducción: El quiste dentígero es un quiste odontogénico, casi siempre asociado a la corona de un diente retenido. Sus ubicaciones más frecuentes son la zona de tercer molar inferior y canino superior. Objetivo: Caracterizar la presentación de un quiste dentígero en un paciente adulto. Presentación de caso: Se presentó el caso de una paciente de 27 años de edad que acude a consulta por presentar sensación de opresión, dolor e inflamación en región de tercer molar inferior izquierdo. Al examen oral se observa tejido dentario en correspondencia con molar 38 parcialmente brotado con ligero edema de la mucosa a su alrededor. En radiografía panorámica se observa imagen radiolúcida en relación con cara mesial del 38 con discreto halo radiopaco, redondeada, compatible con un quiste dentígero. Conclusiones: Un diagnóstico a tiempo de estas lesiones constituye la clave para un tratamiento exitoso y menos invasivo, lo cual evitaría complicaciones mayores como la malignización, el crecimiento exagerado que puede ocasionar deformidad facial y la disfunción masticatoria permanente.

Introduction: Dentigerous cyst is an odontogenic cyst, almost always associated with the crown of a retained tooth. Its most frequent locations are the areas of the lower third molar and the upper canine. Objective: To characterize the presentation of a dentigerous cyst in an adult patient. Case presentation: The case is presented of a 27-year-old female patient who came to the clinic with a sensation of pressure, pain and inflammation in the region of the lower left third molar. Oral examination permits to observe some dental tissue corresponding with molar 38 partially erupted with slight edema of the surrounding mucosa. Panoramic radiograph shows a radiolucent image related to the mesial side of 38, with a discrete radiopaque halo, rounded, compatible with a dentigerous cyst. Conclusions: A timely diagnosis of these lesions is the key to a successful and less invasive treatment, which would avoid major complications, such as malignization, the exaggerated growth that can cause facial deformity and permanent masticatory dysfunction.

Tratamento de odontoma composto e cisto dentígero: relato de caso / Treatment of compound odontoma and dentigeral cyst: case report

Introdução: o odontoma é considerado como um frequente tumor odontogênico benigno, podendo ser classificado em tipo composto ou tipo complexo. O cisto dentígero é o mais comum entre os cistos odontogênicos de desenvolvimento, onde envolve a coroa da unidade dentária no nível da junção amelocementária. Há poucos estudos na literatura do encontro das duas lesões, acometendo o mesmo local na cavidade oral. O diagnóstico pode ser constituído por exame clínico e de imagem. Objetivo: apresentar um caso clínico de odontoma composto e cisto dentígero em região de parassínfise mandibular esquerda abordando as caraterísticas clínicas destas duas lesões e as adequadas formas de tratamento. Relato de caso: paciente do sexo masculino, 16 anos de idade, compareceu ao ambulatório do Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), portando encaminhamento de ortodontista, solicitando exodontia da unidade dentária 33 inclusa associada a um odontoma. Ao realizar exames físicos e imaginológicos detectou-se a hipótese diagnóstica de odontoma composto associado a unidade dentária, envolto em folículo pericoronário ou cisto dentígero. Foi realizada biópsia excisional das duas lesões e exodontia da unidade. A análise histopatológica confirmou o diagnóstico para odontoma composto associado a cisto dentígero na unidade 33. Ao acompanhamento de 03 meses, paciente apresentou neoformação óssea da região de parassínfise mandibular, mediante a análise de novos exames imaginológicos. Discussão: há poucos estudos na literatura da associação entre as duas lesões, porém relatos afirmam que o odontoma pode ser encontrado associado aos cistos odontogênicos. Por conta da falta de maiores estudos dessa associação, há escassez de recomendações terapêuticas de acordo com faixa etária e extensão do acometimento das lesões. Considerações finais: lesões comumente assintomáticas, tem o diagnóstico constituído por exame clínico e avaliação de exames de imagem(AU)

Introduction: odontoma is considered a frequent benign odontogenic tumor and can be classified as a compound or complex type. The dentigerous cyst is the most common among developmental odontogenic cysts, where it involves the crown of the dental unit at the level of the cementoenamel junction. There are few studies in the literature on the meeting of the two lesions, affecting the same site in the oral cavity. The diagnosis can be made by clinical and imaging examination. Objective: to present a clinical case of compound odontoma and dentigerous cyst in the left mandibular parasymphysis region, addressing the clinical characteristics of these two lesions and the appropriate forms of treatment. Case report: male patient, 16 years old, attended the outpatient clinic of the Centro Odontológico da Escola Bahiana de Medicina e Saúde Pública (Salvador, Bahia), having been referred by an orthodontist, requesting extraction of the included dental unit 33 associated with an odontoma. Upon physical and imaging examinations, the diagnostic hypothesis of a compound odontoma associated with a dental unit, surrounded by a pericoronal follicle or dentigerous cyst, was detected. Excisional biopsy of the two lesions and extraction of the unit were performed. The histopathological analysis confirmed the diagnosis of compound odontoma associated with dentigerous cyst in unit 33. At the 03-month follow-up, the patient presented bone neoformation in the mandibular parasymphysis region, through the analysis of new imaging exams. Discussion: there are few studies in the literature on the association between the two lesions, but reports state that odontoma can be found associated with odontogenic cysts. Due to the lack of further studies on this association, there is a lack of therapeutic recommendations according to age group and extent of lesion involvement. Final considerations: commonly asymptomatic lesions, the diagnosis consists of clinical examination and evaluation of imaging tests(AU)

Tercer molar heterotópico, etiología y manejo quirúrgico / Heterotopic third molar, etiology and surgical management

Los terceros molares heterotópicos son dientes que se encuentran incluidos en los maxilares y la mandíbula distantes a su sitio de erupción habitual. Su etiología no está bien definida y existen diversas teorías. Estos dientes pueden aparecer en diferentes zonas de las estructuras óseas, teniendo predilección por la mandíbula. Suelen aparecer entre la segunda y la séptima década de la vida, la mayoría de los casos son hallazgos imagenológicos en la consulta odontológica. El tercer molar mandibular es el diente que presenta heterotopía con mayor frecuencia, siendo su localización habitual en rama mandibular y en la región subcondílea. El quiste dentígero es la patología asociada más común. Presentamos un caso de tercer molar heterotópico en rama mandibular derecha de larga evolución, relacionado a un quiste dentígero, el cual se manejó bajo anestesia regional. Se describe la etiología, técnica quirúrgica y consideraciones especiales relacionados con los dientes heterotópicos (AU)

Heterotopic third molars are teeth that are embedded in the maxilla and mandible, remote from their usual eruption site. Its etiology is not well defined and there are various theories at the moment. These teeth can appear in different areas of the bone's structures, having a predilection for the jaw. They usually appear between the second and seventh decade of life, and in most cases are imaging findings. The mandibular third molar is the tooth with the most frequent heterotopia, being its usual location in the mandibular branch and in the subcondylar region. The dentigerous cyst is the most common associated pathology. We present a case of a long evolution heterotopic third molar in the right mandibular branch, related to a dentigerous cyst which was managed under local anesthesia. The etiology, surgical technique and special considerations related to heterotopic teeth are described (AU)

Extenso quiste odontogénico radicular mandibular / Extensive mandibular radicular odontogenic cyst

Los quistes radiculares constituyen los quistes odontogénicos más comunes de la cavidad bucal. El objetivo de esta investigación es caracterizar un paciente con quiste odontogénico radicular mandibular. Se presenta un individuo masculino de 86 años, que fue atendido en el Servicio de Cirugía Maxilofacial del Hospital Provincial General Universitario «Mártires del 9 de abril», de Sagua la Grande, durante los años 2017-2018. Inicialmente, se le realizó el estudio clínico correspondiente (interrogatorio y examen físico), y se observó una evidente tumefacción y abombamiento cortical en relación a dientes residuales permanentes mandibulares; se asoció radiográficamente a una imagen radiolúcida ovoide extensa, que justificó la realización de biopsias incisionales en primer orden. Se siguió una conducta quirúrgica, con resección total de la lesión mediante enucleación, y se confirmó el diagnóstico de quiste odontogénico radicular mandibular a través del estudio histopatológico.

Radicular cysts are the most common odontogenic cysts in the oral cavity. The objective of this investigation is to characterize a patient with a mandibular radicular odontogenic cyst. We present an 86-year-old male individual who was treated in the maxillofacial surgery service at "Mártires del 9 de Abril" Provincial General University Hospital in Sagua la Grande from 2017 to 2018. Initially, a corresponding clinical study was performed (interrogation and physical examination), and an evident swelling and cortical bulging was observed in relation to mandibular permanent residual teeth; it was radiographically associated with an extensive ovoid radiolucent image, which justified the performance of first-order incisional biopsies. A surgical procedure was followed, with total resection of the lesion by means of enucleation, and the diagnosis of mandibular radicular odontogenic cyst was confirmed through the histopathological study.

Tracción de tercer molar asociado a quiste dentígero y a nervio alveolar inferior: Reporte de caso

El objetivo de este estudio es presentar un reporte de caso de un paciente que presenta un tercer molar inferior asociado a un quiste dentígero, cuya lesión desplazó el diente hasta quedar inmerso dentro del canal alveolar inferior. Caso: Paciente acude por tratamiento de un quiste dentígero asociado a un tercer molar desplazado hacia nervio alveolar inferior y borde basilar. Se realiza una descompresión del quiste, además de una tracción de la pieza con ortodoncia para posteriormente ser extraída de forma segura. Conclusión: La tracción ortodóntica de tercer molar ofrece una buena alternativa frente a estos casos. Si bien la evolución del paciente frente a este tratamiento es favorable, falta evidencia que demuestre significativamente su eficacia.

The aim of this study is to present a case report of a patient with a lower third molar associated with a dentigerous cyst, whose lesion displaced the tooth into the inferior alveolar canal. Case: Patient asks for treatment of a dentigerous cyst associated with a displaced third molar towards the inferior alveolar nerve and basilar border. A cyst decompression was performed, in addition to a traction of the tooth with orthodontics to be later extracted in a safe way. Conclusion: Traction of the third molar offers a good choice in cases such as the one presented in this article. Although the evolution of the patient is favorable, there is a lack of evidence demonstrating its efficacy.

Relación entre el diagnóstico histopatológico de sacos foliculares de terceros molares y la medida radiográfca estandarizada en radiografía panorámica digital / Relationship between histopathologic diagnosis of third molar follicular sacs and standardized radiographic measurement on digital panoramic radiography

Objetivo: establecer la relación entre el diagnóstico histopatológico de sacos foliculares de terceros molares y la medida radiográfca estandarizada en radiografía panorámica digital. Métodos: se llevó a cabo un estudio descriptivo en el que se incluyeron 28 sacos foliculares de terceros molares. Dos observadores midieron la radiolucidez pericoronal en radiografías panorámicas digitales usando un método estandarizado y se calculó el índice de correlación intraclase. Se estableció un diagnóstico radiográfco según la medida del saco, con <2.5 mm como el límite para sacos foliculares normales. Dicho diagnóstico fue comparado con el respectivo diagnóstico histopatológico. Se calculó sensibilidad y especifcidad; se aplicó la prueba de chi-cuadrado, exacta de Fisher y, fnalmente, el índice Kappa. Resultados: se obtuvo un alto grado de acuerdo entre los observadores. La prueba radiográfca tuvo una baja sensibilidad (0.27) y especifcidad (0.6) y no se encontró diferencia estadísticamente signifcativa entre estos. Conclusiones: la ausencia de hallazgos radiográfcos no implica ausencia de enfermedad. Además, no se puede establecer relación entre la presencia de quistes dentígeros y radiolucidez ≥ 2.5 mm en radiografía panorámica digital.

Objective: To establish the relationship between the histopathological diagnosis of follicular sacs of third molars and the standardized radiographic measurement in digital panoramic radiography. Methods: This was a descriptive study in which 28 follicular sacs of third molars were included. In digital panoramic radiographs two observers measured the pericoronal radiolucency using a standardized method and the intraclass correlation index was calculated. A radiographic diagnosis was established according to the size of the sac, with <2.5mm being the limit for normal follicular sacs. This diagnosis was compared with the respective histopathological diagnosis. Sensitivity and specifcity were calculated; the chi-square test, Fisher's exact test and fnally the Kappa index were applied. Results: A high degree of agreement was obtained among the observers. The radiographic test had a low sensitivity (0.27) and specifcity (0.6) and no statistically signifcant diference was found between these. Conclusions: The absence of radiographic fndings does not imply absence of disease, furthermore, no relationship can be established between the presence of dentigerous cysts and radiolucency ≥ 2.5 mm in digital panoramic radiography.

Immunohistochemical Evaluation of Calretinin in Ameloblastoma, Odontogenic keratocyst and Dentigerous Cyst

Background: Calretinin plays an important role in calcium signalling and naturally expressed in nervous tissues. Various stud- ies suggest that calretinin may involve in amelogenesis. Calretinin also seems to have role in tumorigenesis since it regulates apoptosis. Aim: To find out whether there is any variation in expression of calretinin in Ameloblastoma, Odontogenic keratocyst and Dentigerous cyst. Materials & Methods: A total of 50 samples each from Ameloblastoma, odontogenic keratocyst and Dentigerous cyst were retrospectively studied. The immunohistochemical expression of calretinin was assessed by using calretinin antibody. Results: Chi square test was used to compare categorical parameters between groups. Kruskal Wallis Test and Mann-Whitney U Test were carried out to compare quantitative parameters among the groups. Statistically, significant values were obtained when comparing the immunohistochemical expression of calretinin in various odontogenic lesions studied and it was highest in ameloblastoma followed by OKC. None of the cases of dentigerous cyst were immunopositive for calretinin. Conclusion: There was statistically significant variation in the expression of calretinin among ameloblastoma, OKC and dentig- erous cyst and it contributes to the aggressiveness of those lesions.

Glandular Odontogenic Cyst Mimicking Dentigerous Cyst: A Rare Case Report

Background: Glandular odontogenic cyst is an uncommon developmental cyst of odontogenic origin. Till now, around 200 cases have been reported in the English literature, out of which approximately 25 of them are associated with an unerupted tooth. Herein we present a case report of a 7-year-old boy with swelling in the anterior maxillary region which was later diag- nosed as a Glandular odontogenic cyst that mimicked a Dentigerous cyst. Case presentation: A painless swelling was noted in the anterior palatal region. Orthopantamogram was advised which re- vealed a unilocular radiolucency associated with an impacted supernumerary tooth. Provisional diagnosis of Dentigerous cyst was made. The cyst was enucleated in conjunction with peripheral osteotomy. The histopathological examination revealed a cystic capsule with non-keratinized stratified squamous epithelium with 2-4 cell layer thickness, with some areas showing epithelial plaque, microcysts, hobnail cells and few clear cells. Contemplating all the histological features, final diagnosis of Glandular odontogenic cyst was given. Conclusions: The presented case emphasizes the importance of histopathological examination of the unusual and rarely ob- served Glandular odontogenic cyst which can be missed due to similarities with other entities. Recurrence rates being very high, follow up of the cases is imperative.

Quistes Dentígeros Asociados a Sacos Foliculares Patológicos de Terceros Molares Incluidos

Establecer la frecuencia y características de quistes dentígeros asociados a sacos foliculares de terceros molares incluidos, extraídos en las clínicas de cirugía oral de la Facultad de Odontología de la Universidad Nacional de Colombia. Estudio cuantitativo, se realizó el análisis histopatológico de 30 sacos foliculares de terceros molares incluidos con col oración de hematoxilina-eosina. Se analizaron 30 biopsias de sacos foliculares de terceros molares superiores e inferiores correspondientes a 21 pacientes con edades comprendidas entre los 17 a 36 años (media: 25,3). De los sacos estudiados 25 (83,3 %) se diagnosticaron como quiste dentígero y 5 (16,7 %) como saco folicular, siendo más frecuente el diagnóstico de quiste dentígero en la zona mandibular. El saco folicular asociado al tercer molar incluido tiene alta capacidad de desarrollar patolo gía odontogénica quística, siendo la más frecuente el quiste dentígero con predilección a la ubicación anatómica en la mandíbula.

To establish the frequency and characteristics of dentigerous cysts associated with follicular sacs of impacted third molars extracted in the oral surgery clinics at the School of Dentistry at Universidad Nacional de Colombia. Quantitative study, a histopathological analysis of 30 follicular sacs of impacted third molars with hematoxylin-eosin staining was performed. 30 biopsies of follicular sacs of upper and lower third molars corresponding to 21 patients aged between 17 and 36 years (mean: 25.3) were analyzed. Of the sacs studied 25 (83.3%) were diagnosed as dentigerous cysts and 5 (16.7%) as follicular sacs, with the diagnosis of dentigerous cysts being more frequent in the mandibular area. The follicular sac associated with impacted third molars has a high capacity to develop cystic odontogenic pathology, being the most frequent the dentigerous cyst with a predilection for the anatomical location in the mandible.

Rol de la cirugía endoscópica en el tratamiento de quistes odontogénicos del hueso maxilar: revisión de la literatura

Los quistes odontogénicos son lesiones óseas, de carácter benigno, la mayoría asintomáticas, que habitualmente corresponden a un hallazgo radiológico. El tratamiento es quirúrgico y está condicionado por factores como localización, tamaño y la afectación de estructuras vecinas. El objetivo es elegir la modalidad de tratamiento que conlleve el menor riesgo de recurrencia, la mínima morbilidad, y al mismo tiempo la erradicación de la lesión. Siguiendo esta premisa han sido abordados, tradicionalmente, con técnicas abiertas con buenos resultados, pero con el advenimiento y desarrollo de la cirugía endoscópica, se empezó a usar esta técnica en forma exclusiva o en forma mixta para la resección de los quistes odontogénicos, logrando similares tasas de éxito, pero con menores complicaciones y morbilidad posoperatoria. Además, presenta una ventaja respecto del seguimiento para las recurrencias, ya que se pueden controlar endoscópicamente en la consulta ambulatoria. El objetivo de esta revisión es describir el desarrollo del rol de las cirugías endoscópicas para el tratamiento de lesiones odontogénicas maxilares.

Odontogenic cysts are benign bone lesions, most of them asymptomatic, which usually constitute a radiological finding. The treatment is surgical and is conditioned by factors such as location, size and involvement of nearby structures. The objective is to choose the treatment mode that presents the lowest risk of recurrence, the minimum morbidity, and at the same time, the eradication of the lesion. Following this premise, the treatment of these lesions has traditionally been approached with open techniques with good results but, with the advent and development of endoscopic surgery, this technique began to be used exclusively or in a mixed form for the resection of odontogenic cysts, achieving similar rates of surgical success, but with fewer complications and postoperative morbidity. It also has an advantage regarding follow-up for recurrences, since patients can be controlled endoscopically in the outpatient clinic. The objective of this review is to describe the development and role of endoscopic surgery for the treatment of maxillary odontogenic lesions.

Presencia de lesiones quísticas en sacos pericoronarios de terceros molares mandibulares / Presence of cystic lesions in pericoronary sacs of mandibular third molars

Introducción: a pesar de que un tercer molar no erupcionado repre- senta un riesgo de formación quística, la práctica clínica desestima el análisis histopatológico de los folículos de dichos molares. Objetivo: identificar la frecuencia de lesiones quísticas en los sacos pericoronarios de terceros molares mandibulares. Material y métodos: estudio des- criptivo, transversal, analítico y observacional, en donde se incluyeron sacos pericoronarios de terceros molares mandibulares para su análisis histopatológico, descripción de características clínico-radiográficas y su asociación con la presencia de cambios histológicos o lesiones quís- ticas. Resultados: se incluyeron 48 muestras de sacos pericoronarios, la histopatología de los sacos pericoronarios mostró que 83.3% tenían algún tipo de alteración: 13 quistes paradentales (27.1%), cuatro quistes dentígeros (8.3%), 12 folículos hiperplásicos (25.0%) y 11 folículos inflamados (22.9%). La presencia de lesiones quísticas en la población fue de 35.4%. Se detectó asociación estadísticamente significativa entre el sexo y la presencia de lesiones quísticas (p = 0.039) y entre el nivel de erupción y la presencia de cambios histológicos (p = 0.046). Con- clusiones: la frecuencia de lesiones quísticas o cambios histológicos en folículos de terceros molares mandibulares es alta, principalmente en molares parcialmente erupcionados o submucosos y sin importar la ausencia de sintomatología o alteraciones radiográficas (AU))

Introduction: although a non-erupted third molar represents a risk of cystic formation; clinical practice rejects the histopathological analysis of the follicles of said molars. Objective: identify the frequency of the histopathological changes in pericoronary sacs of mandibular third molars. Material and methods: descriptive cross- sectional, observational and analytic study, where pericoronary sacs of mandibular third molars were included for histopathological analysis, description of clinical-radiographic characteristics and their association with the presence of histological changes or cystic lesions. Results: 48 samples of pericoronary sacs were included, the histopathology of the pericoronary sacs showed 83.3% had some type of alteration: 13 paradental cysts (27.1%), four dentigerous cysts (8.3%), 12 hyperplastic follicles (25.0%) and 11 inflamed follicles (22.9%). The presence of cystic lesions in the population was 35.4%. A statistically significant association was detected between sex and the presence of cystic lesions (p = 0.039); and between the level of eruption and the presence of histological changes (p = 0.046). Conclusions: the frequency of cystic lesions or histological changes in mandibular third molar follicles is high, mainly in partially erupted or submucosal molars and regardless of the absence of symptoms or radiographic alterations (AU)

Comparison of CD105 (Endoglin) Expression in Odontogenic Keratocyst and Dentigerous Cyst - An Immunohistochemistry Study

Introduction: Tumors like Odontogenic Keratocyst (OKC), Dentigerous Cyst (DC)and Pyogenic Granuloma are frequently oc- curring in the oral cavity with each of them having relation to angiogenesis. Higher angiogenesis may be associated with increased tissue metabolism, more aggressive biologic behaviour, and increased recurrence and growth rate. Tumor growth is dependent not only on a rise in the number of blood vessels, but also on factors such as protein molecules produced in en- dothelial cells. Microvessel density (MVD), Microvessel area (MVA), Microvessel perimeter (MVP) can predict the growth of the tumour, metastasis and patient’s survival and this value is related to the aggressiveness of the tumour. Aims: The aim of the present study was to determine the angiogenic potential of OKC and DCcompared with normal mucosa using CD 105 marker immunohistochemically. Materials and methods: Immunohistochemical staining was done on 70 paraffin embedded tissue samples. Histopathologi- cally diagnosed cases of OKC, DC and Pyogenic granuloma and healthy gingival tissue samples were retrieved for the study purpose. Results: There was no statistically significant difference in the mean MVD, MVA, MVP values of OKC, DC and pyogenic granu- loma groups. Conclusion: The angiogenic potential was determined in 3 different cases of OKC, Dentigerous Cyst and Pyogenic granuloma in terms of MVD, MVA and MVP and compared to normal mucosa using CD105 marker immunohistochemically.Though the mean values of MVA, MVD, MVP were statistically not significant but was estimated to be higher than the normal mucosa

Epithelial and Stromal Syndecan-1 roles on the biological behavior of Dentigerous cyst, Ameloblastoma and Ameloblastic Carcinoma

Background: Dentigerous cyst diagnosis is simple but several case reports have documented neoplastic changes arising from them. Ameloblastoma is a common benign Odontogenic tumor with an aggressive manner and a high rate of recurrence. Ameloblastic Carcinoma is the malignant counterpart of Ameloblastoma but usually difficult to be distinguished from each other’s. Hence, need for Immunohistochemical markers may help achievement of accurate diagnosis. Objectives: Evaluation of Epithelial and Stromal Syn1 expressions and their roles in tumorigenesis and biological behavior of Dentigerous cyst, Ameloblastoma and Ameloblastic Carcinoma. Methods: Tissue samples comprising of 54 archived histopathologically confirmed cases of (10 Dentigerous cysts, 29 Ameloblastomas and 15 Ameloblastic Carcinoma). The sections were subjected to Immunohistochemical staining according to a standard protocol using antibody to Syn1. Results: Stromal Syn1 expression was higher in Desmolpastic Ameloblastoma than other Conventional Ameloblastoma subtypes. Unicystic Ameloblastoma showed higher Stromal Syn1 than Dentigerous cyst. Ameloblastic Carcinoma showed the highest immune-reactivity to Stromal Syn1 than Conventional Ameloblastoma. While, Epithelial Syn1 immune-reactivity was weak. Conclusions: Desmoplastic Ameloblastoma behaves in a more aggressive manner than other subtypes.Stromal Syn1 are highly expressed in aggressive and malignant odontogenic tumors and could be used together as prognostic predictor tool for odontogenic tumors

Quiste dentígero: correlación de examen imagenológico con diagnóstico de certeza / Dentigerous cyst: corelation between the imaging examination and diagnostic certainty

Se presenta un caso clínico de quiste dentígero, asociado a un tercer molar inferior izquierdo retenido, que concurre a la Cátedra de Diagnóstico por Imáge- nes de la Facultad de Odontología de la Universidad de Buenos Aires. El paciente, de 53 años de edad, es de sexo femenino. Se utiliza la tomografía de haz cónico para diagnosticar presuntivamente dicha patolo- gía. Posteriormente, se realiza biopsia para obtener una muestra y ser enviada para realizar los estudios anatomopatológicos, que corroboran el presuntivo diagnóstico. Basado en lo expuesto, se analiza al quis- te dentígero según ubicación, sexo, edad y maxilar; habiendo realizado una revisión de la literatura (AU)

A clinical case of a dentigerous cyst associated with a retained lower left third molar is presented. The 53-year-old patient is female. Cone beam tomography is used to presumptively diagnose said pathology. Subsequently, a biopsy is performed to obtain a sample and be sent to perform pathological studies that corroborate the presumptive diagnosis. Based on the above, the dentigerous cyst is analyzed according to location, sex, age and maxilla; having carried out a review of the literature (AU)

Quiste dentígero. Revisión de la literatura y reporte de caso / Dentigerous cyst. Literature review and case report

Introducción: el quiste dentígero, también conocido como quiste folicular, es la segunda forma más habitual de los quistes de la región maxilar después del quiste radicular. Tiene una incidencia del 20% con respecto a todos los quistes odontogénicos y se encuentra más en el género masculino entre los 20-40 años. El manejo conservador en lesiones quísticas de gran tamaño es indispensable para evitar defectos óseos o daño a estructuras vecinas. Sin embargo, en lesiones de menor tamaño, la enucleación continúa siendo el tratamiento de elección. Objetivo: presentar un caso clínico de un quiste dentígero y hacer una revisión de la literatura actualizada. Caso clínico: paciente masculino de 23 años que presentó aumento de volumen en zona geniana derecha y, además, en su ortopantomografía se observó una lesión en el sector de los incisivos superiores. Se realizó enucleación de la lesión, cuyo diagnóstico histológico previo fue quiste dentígero y posteriormente se obtiene una correcta regeneración ósea tras un año de seguimiento Conclusión: el manejo del quiste dentígero es variado: puede ir desde la enucleación quirúrgica hasta la descompresión y marsupialización del mismo. No obstante, todos los tratamientos actuales se basan en contrarrestar los factores de expansión quística que permiten a esta lesión alcanzar grandes tamaños intraóseos y poder causar desde rizolisis de dientes adyacentes hasta una asimetría facial como sucedió en este caso clínico.

Introduction: The dentigerous cyst, also known as a follicular cyst, is the second most common form of cysts of the maxillary region after the radicular cyst. It has an incidence of 20% with respect to all odontogenic cysts, it is found more in the male gender between 20-40 years of age. Conservative management of large cystic lesions is essential to avoid bone defects or damage to neighboring structures. However, in smaller lesions, enucleation continues to be the treatment of choice. Objective: To present a clinical case of a dentigerous cyst and to review the updated literature. Clinical case: A 23-year-old male patient who presented increased volume in the right genital area and his orthopantomography showed a lesion in the upper incisor sector. Enucleation of the lesion was performed, whose previous histological diagnosis was dentigerous cyst and later a correct bone regeneration was obtained after one year of follow-up. Conclusion: The management of the dentigerous cyst is varied, it can range from surgical enucleation to decompression and marsupialization. However, all current treatments are based on counteracting cystic expansion factors that allow this lesion to reach large intraosseous sizes and can cause from rhizolysis of adjacent teeth to facial asymmetry, as happened in this clinical case.

Quiste dentígero en un primer molar a la edad de 5 años. Informe de caso / Dentigerous cyst in a first molar at the age of 5 years. Case report

RESUMEN El quiste dentígero (QD) es un quiste odontogénico de malformación y origen epitelial,constituye el segundo tipo más común dentro de este grupo y abarca cerca del 20% de todos los quistes encontrados en los maxilares. Radiográficamente el QD se manifiesta como un área radiolúcida unilocular bien definida asociada a la corona de un diente no erupcionado. El QD es considerado una patología rara en niños, por lo cual se decidió presentar el caso de un paciente de 5 años de edad que ha sido atendido en el Servicio de Cirugía Maxilofacial del Hospital Pediátrico Universitario de Cienfuegos "Paquito González Cueto".El paciente fue visto en consulta inicialmente, por presentar aumento de volumen indoloro en la región retromolar inferior izquierda, que tras la exploración clínica y radiográfica sugirió la presencia de un quiste dentígero; quirúrgicamente para realizar la enucleación del mismo, obteniéndose excelentes resultados postoperatorios. En esta ocasión pudimos corroborar que por muy rara que puedan ser algunas entidades, pueden presentarse, por lo que debemos tenerlas presentes al plantear los diferentes diagnósticos diferenciales.

ABSTRACT The dentigerous cyst is an odontogenic cyst of malformation and epithelial origin, being the second most common type of cysts of this group, comprising about 20% of all cysts found in the jaws. Radiographically, it manifests as a well-defined unilocular radiolucent area associated with the crown of a non-erupted tooth. It is considered a rare pathology in children. We present the case of a 5-year-old patient who has been followed up in the Maxillofacial Surgery consultation of the "Paquito González Cueto" University Pediatric Hospital of Cienfuegos, after having undergone surgery to perform the enucleation of a dentigerous cyst.

Tratamiento multidisciplinario en un niño afectado por un quiste dentígero / Multidisciplinaty treatment in a child with dentigerous cyst

Se presenta el caso clínico de un paciente que a los 7 años de edad fue remitido a la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba por presentar un quiste dentígero y displasia fibrosa monostótica. Desde entonces, y durante casi 10 años, el paciente ha sido atendido por un equipo multidisciplinario odontopediátrico, que ha seguido su evolución y ha aplicado diferentes protocolos diagnósticos y terapéuticos; estos últimos han incluido intervenciones quirúrgicas, rehabilitaciones protésicas, quimioterapia, entre otros. Por la complejidad del caso y la poca frecuencia con que aparecen asociadas ambas entidades clínicas en la infancia, se decidió comunicar este artículo al gremio odontológico nacional y extranjero.

The case report of a seven years old child who was referred to Mártires del Moncada Provincial Teaching Stomatological Clinic in Santiago de Cuba, who had a dentigerous cyst and monostotic fibrous displasia is presented. Since then, and almost during 10 years, the patient has been assisted by a multidisciplinary odontopediatric team, which has followed his clinical course and has applied different diagnostic and therapeutic protocols, including surgical procedures, prosthetic rehabilitations, chemotherapy, among others. Due to the case complexity and the frequency with which both clinical entities are associated in childhood, it was decided to publish this work for the national anf foreing odontological community.

Cisto dentígero com transformação ameloblástica / Quiste dentígero con transformación ameloblástica / Dentigerous cyst with ameloblastic transformation

Introdução: O cisto dentígero se origina pela separação do folículo que fica ao redor da coroa de um dente incluso. É o tipo mais comum de cisto odontogênico do desenvolvimento. O seu crescimento é lento, assintomático, e pode atingir grandes dimensões. Objetivo: Relatar um caso clínico cirúrgico de cisto dentígero com transformação ameloblástica, localizado na mandíbula, de paciente, gênero feminino, melanoderma, 14 anos. Caso clínico: Ao exame radiográfico apresentou área radiolúcida unilocular com margem bem definida e esclerótica envolvendo a coroa das unidades 48 e 47. Foi realizada enucleação e curetagem da lesão com exodontia destas unidades sob anestesia local em ambulatório, e aplicada a crioterapia na loja óssea. Encaminhou-se o conteúdo da lesão para exame histopatológico e o diagnóstico de cisto dentígero com transformação ameloblástica foi fechado. Comentários principais: No momento a paciente encontra-se em acompanhamento pós-operatório de 3 anos com neoformação óssea e sem recidivas(AU)

Introducción: El quiste dentígero se origina por la separación del folículo que se queda alrededor de la corona de un diente no erupcionado. Es el tipo más común de quiste odontogénico de desarrollo. Su crecimiento es lento, asintomático y puede alcanzar grandes dimensiones. Objetivo: Reportar un caso quirúrgico de quiste dentígero con transformación ameloblástica. Presentación del caso: Paciente femenina de 14 años, de color de piel negra. La radiografía demostró una radiolucidez unilocular con márgenes bien definidos que envolvían la corona de los dientes 48 y 47. El tratamiento involucró una combinación de enucleación y curetaje de la lesión, exodoncia de los dientes y crioterapia para desvitalizar el hueso circundante. Se realizó el examen histopatológico, luego, se confirmó el diagnóstico de quiste dentígero con transformación ameloblástica. Conclusiones: Al momento de la redacción del reporte la paciente se encontraba en seguimiento posoperatorio de tres años con neoformación ósea y sin recidivas(AU)

Introduction: Dentigerous cysts are caused by the separation of the follicle remaining around the crown of unerupted teeth. They are the most common type of developmental odontogenic cyst. Their growth is slow and asymptomatic, and they may reach large dimensions. Objective: Report a surgical case of dentigerous cyst with ameloblastic transformation. Case presentation: A case is presented of a black female 14-year-old patient. Radiography revealed an area of unilocular radiolucency with well-defined margins enveloping the crowns of teeth 48 and 47. Treatment was a combination of enucleation and curettage of the lesion, exodontia of the teeth and cryotherapy to devitalize the surrounding bone. Eventual histopathological examination confirmed the diagnosis of dentigerous cyst with ameloblastic transformation. Conclusions: At the time when the report was written, the patient had been followed up for three years after surgery, showing bone neoformation and no recurrence of the lesion(AU)

Rank, rankl, and opg in dentigerous cyst, odontogenic keratocyst, and ameloblastoma: a meta-analysis

Abstract The aim of this study was to assess and compare RANK, RANKL, and OPG immunoexpression in dentigerous cyst, odontogenic keratocyst, and ameloblastoma. The protocol was registered in PROSPERO (CRD42018105543). Seven databases (Embase, Lilacs, LIVIVO, PubMed, Scopus, SciELO, and Web of Science) were the primary search sources and two databases (Open Grey and Open Thesis) partially captured the "grey literature". Only cross sectional studies were included. The JBI Checklist assessed the risk of bias. A meta-analysis with random effects model estimated the values from the OPG and RANKL ratio reported by the individual studies and respective 95% confidence intervals. The heterogeneity among studies was assessed with I2 statistics. Only nine studies met the inclusion criteria and were considered in the analyses. The studies were published from 2008 to 2018. Two studies presented low risk of bias, while seven studies presented moderate risk. The meta-analysis showed the highest OPG>RANKL ratio for dentigerous cyst (ES=43.3%; 95% CI=14.3-74.8) and odontogenic keratocyst (ES=36.8%; 95% CI=18.8-56.7). In contrast, the highest OPG<RANKL ratio was found for ameloblastoma (ES=73.4%; 95% CI=55.4-88.4) and it was higher in the stromal region compared to the odontogenic epithelial region. The results may explain the aggressive potential of ameloblastoma from the higher OPG<RANKL ratio in this tumor, while it was lower for dentigerous cyst and odontogenic keratocyst.

Resumo O objetivo deste estudo foi avaliar e comparar a imunoexpressão de RANK, RANKL e OPG em cisto dentígero, ceratocisto odontogênico e ameloblastoma. O protocolo foi registrado no PROSPERO (CRD [Oculto]). Sete bancos de dados (Embase, Lilacs, LIVIVO, PubMed, Scopus, SciELO e Web of Science) foram as principais fontes de pesquisa e duas bases de dados (Open Grey e Open Thesis) capturaram parcialmente a "literatura cinza". Apenas estudos transversais foram incluídos. A ferramenta JBI avaliou o risco de viés. Uma metanálise com modelo de efeitos aleatórios estimou os valores da razão OPG e RANKL relatados pelos estudos individuais e seus respectivos intervalos de confiança de 95%. A heterogeneidade entre os estudos foi avaliada por meio do teste I2. Apenas nove estudos preencheram os critérios de inclusão e foram considerados nas análises. Os estudos foram publicados entre 2008 e 2018. Dois estudos apresentaram baixo risco de viés, enquanto sete estudos apresentaram risco moderado. A meta-análise mostrou a maior razão OPG> RANKL para cisto dentígero (ES=43,3%; IC95%=14,3-74,8) e ceratocisto odontogênico (ES=36,8%; IC95%=18,8-56,7). Por outro lado, a maior razão OPG <RANKL foi encontrada para ameloblastoma (ES=73,4%; IC95%=55,4-88,4) e foi maior na região estromal em comparação com a região epitelial odontogênica. Os resultados podem explicar o potencial agressivo do ameloblastoma devido a uma maior proporção OPG <RANKL nesse tumor, enquanto tal proporção foi menor no cisto dentígero e no ceratocisto odontogênico.