Abstract

  Various treatment modalities have been reported for keratocystic odontogenic tumors (KOTs), with different recurrence rates. Enucleation is the complete removal of the cystic lining, but due to the thin and friable lining, the complete removal of KOT become difficult[1].The high recurrence rate after simple enucleation is caused by the presence of retained fragments of lining plus daughter cysts that are left behind [2]. There are adjunctive conservative treatments used with enucleation to decrease the recurrence rate of KOTs. Enucleation with curettage is Additional removal of bone tissue at the periphery by 1 - 2 mm after cyst excision by using curette or rotary instrument[1]. Enucleation with Carnoy's solution After enucleation of KOT,the bone cavity is treated with Carnoy’s solution, The solution penetrates in the cancellous space of the bone in 3 - 5 min by approximately 1.54 mm, fixating and eliminating the remaining tumor cells[3]. Enucleation with liquid nitrogen cryotherapy After removal of the tumor lining, the bone cavity is treated with liquid nitrogen at temperature up to (–196.6°C) [4].Unfortunately, cryotherapy leads to the formation of intracellular and extracellular ice crystals that disrupt normal intracellular osmotic and electrolyte balance, which ultimately causes cell death [5].

Objective: This study aimed at comparing the recurrence rate between enucleation with curettage, enucleation with carnoy's solution and enucleation with liquid nitrogen cryotherapy. Also to show our suggestion that ultrasonic technique can be use as an efficient tool for curettage KOTs.

Materials and Methods: This is a systematic review study. The research sources utilized were PubMed, Google scholar, MEDLINE and Complutense university Library. The keywords which were selected based on Medical Subject Heading (MeSH) terms and PICOS criteria were odontogenic keratocyst, Keratocystic odontogenic tumor AND enucleation OR curettage or Carnoy’s solution or liquid nitrogen cryotherapy And ultrasonic or ultrasound or piezoelectric. For the period from 2001 to 2019. Statistical analyses were performed to compare the recurrence rate between enucleation with curettage, enucleation with carnoy's solution and enucleation with liquid nitrogen cryotherapy

Results: The total number of subjects that underwent Enucleation with curettage, carnoy's solution and liquid nitrogen cryotherapy was 954. In 431 subjects who had enucleation with curettage, 88 subjects had recurrence (19.9%). In 456 subjects who had enucleation with carnoy's solution 36 had recurrence (7,8%). In 67 subjects who had enucleation with liquid nitrogen cryotherapy 5 had recurrence (7,4%).

Conclusion: This systematic review appears that There was no a significant difference in the recurrence rate between enucleation with carnoy's solution group and liquid nitrogen cryotherapy group. However, the higher recurrence rate was for enucleation with curettage. group. In addition, study appears the advantages of ultrasonic technique in surgical field and suggest that ultrasonic technique can be a conservative tool of curettage to minimize the recurrence rate of Keratocystic Odontogenic Tumors.

Keywords: Conservative; Keratocystic; Odontogenic; Tumors

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Citation

Citation: Abdulbadea A Altukroni and Mohammad A Alabduh. “Conservative Treatments of Keratocystic Odontogenic Tumors”.Acta Scientific Dental Sciences 4.2 (2020): 66-74.

Copyright

Copyright: © 2020 Abdulbadea A Altukroni and Mohammad A Alabduh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.