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Journal of Oral Science & Rehabilitation No. 2, 2016

Journal of Oral Science & Rehabilitation 54 Volume 2 | Issue 2/2016 S p o n t a n e o u s b o n e r e g e n e r a t i o n : A n a l y s i s o f 3 3 6 c a s e s H i s t o l o g i c a l d a t a AccordingtotheWorldHealthOrganizationclas- sification, most of the cysts were odontogenic cysts of inflammatory origin, followed by odon- togenic cysts of unspecified nature; radicular cysts(alsotermedperiapicalcysts);cysticlesions of odontogenic developmental dentigerous (or follicular) nature, unilocular and/or multilocular; unspecified granulationtissue; odontomas; peri- apicalgranulomas;ameloblastomas;keratocysts; nonodontogenicnasopalatineductcysts;inflam- matory residual cysts; and lesions due to other diseases, such as odontogenic fibromas, nonep- ithelial, traumatic and hemorrhagic cysts, sinus polyposis, epulis,fibrous bone dysplasia and oral melanosis.Thediagnosesarereportedin Table2. Discussion Bone reconstruction has been considered an es- sentialrequirementforcompletefunctionalreha- bilitation afterjawsurgery.Although manystud- ieshavesupportedtheuseofdifferentbonegrafts toreducetheriskofjawweakness,14–17 thepresent study showed that spontaneous bone regenera- tion occurred in all of the residual bony defects without the use of anyfilling material. The phys- iological healing process occurred with sponta- neous bone regeneration even in the presence of large residual cystic cavities. The present study suggestedthatthistype ofinterventionwasvery safeandminimallyinvasive,despitetheincreased surgical duration and technical complexity, with a complete recovery of the area occupied by jaw cysts. The bone recovery could be demonstrated with absolute accuracyonlyon CT scan controls, comparingonadigitalizedimagethepreoperative and postoperative bone density. However, the mainlimitationofthepresentstudywastheshort follow-up period. In fact, in orderto confirm data fromthepresentstudy,alongitudinalcontrol(five years after surgery) would be recommended. However, in most cases, patients with cysts inedentulousareasunderwentaCTscanevalua- tion for the following implant-supported pros- thetic rehabilitation.22 Morphometric analysis, similarlyto Chiapasco et al.,14 was not performed because implant stability and survival clinically demonstrated that bone was of a good quality. These results corroborate those of Pradel et al., who concluded that the bone density increased afterenucleation oflarge mandibularcystswith- out using filling material.20 Similar results were obtained by Chiapasco et al.14 The differential diagnosis between odontogenic cysts and ameloblastomas could be attained by analyzing the postoperative recurrence in the short term. Differences such as root resorption ofadjacentteeth mayaidthe clinician inthe pre- operative differential diagnosis. In a radiograph- ic preoperative analysis, ameloblastomas proved tohavearootresorptivepotentialfargreaterthan did othercystic lesions. No recurrencewas noted during the entire follow-up period of the study, although the incidence was about 3%. However, ongoing follow-up examination is required and essential for management. Conclusion Within the limitations of this study, some obser- vations in agreement with current literature can be made. Spontaneous bone regeneration with bonebridgingoutsidetheresidualcystcavitycan occur after surgical removal of large jaw cysts withouttheaidofanygraftingmaterials,accord- ing to evidence-based clinical and radiographic criteria. There was also a reduction ofthe risks of paresthesia and fracture in the mandible, owing to the conservative approach. This will simplify the surgical procedure, decreasing financial and biological costs and reducing the risk of post- operative complications. Competing interests The authorsdeclarethattheyhave nocompeting interests. S p o n t a n e o u s b o n e r e g e n e r a t i o n : A n a l y s i s o f 336 c a s e s

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