J Korean Assoc Oral Maxillofac Surg.  2015 Apr;41(2):109-115. 10.5125/jkaoms.2015.41.2.109.

An alternative treatment option for a bony defect from large odontoma using recycled demineralization at chairside

• Lee J
• Lee EY
• Park EJ
• Kim ES

• KMID: 2189476
• DOI: http://doi.org/10.5125/jkaoms.2015.41.2.109

Abstract

Odontoma is the most common odontogenic benign tumor, and the treatment of choice is generally surgical removal. After excision, bone grafts may be necessary depending on the need for further treatment, or the size and location of the odontoma. Although the osteogenic capacity of a demineralized tooth was verified as early as 1967 by Urist and many other investigators, the cumbersome procedure, including a long demineralization time, may be less than comfortable for clinicians. A modified ultrasonic technology, with periodic negative pressure and temperature control, facilitated rapid and aseptic preparation of demineralized teeth for bone grafts. This approach reduces the demineralization time dramatically (< or =80 minutes), so that the graft material can be prepared chairside on the same day as the extraction. The purpose of this article is to describe two cases of large compound odonotomas used as graft material prepared chairside for enucleation-induced bony defects. These two clinical cases showed favorable wound healing without complications, and good bony support for future dental implants or orthodontic treatment. Finally, this report will suggest the possibility of recycling the benign pathologic hard tissue as an alternative treatment option for conventional bone grafts in clinics.

Keyword

Odontoma; Recycled demineralization

MeSH Terms

Dental Implants
Humans
Odontoma*
Recycling
Research Personnel
Tooth
Transplants
Ultrasonics
Wound Healing
Dental Implants

Figure

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  Fig. 1 Preoperative panoramic radiopraph (A) and computed tomography (CT) scans (B, C) show compound odontoma associated with failure of permanent canine eruption. A. A odontoma is circumscribed by a radiolucent halo underneath an impacted canine (arrows). B. CT scans in axial section show that the alveolar bone was bulged to labial side slightly (arrows). C. CT scans in coronal section show an odontoma with its superior limits invading the floor of the nasal cavity and its posterior limits in the hard palate, and impacted the right maxillary canine above the lesion (arrows).

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  Fig. 2 Intraoral photos during operation. After opening the alveolar bony window (A), demineralized odontoma and tooth block were grafted followed by surgical removal (B), and titanium mesh filled with bone graft and secured into position with screws in the area of the bony defect (C). (a1: an impacted maxillary canine, a2: an odontoma, b1: demineralized odontoma and tooth block, asterisk: titanium mesh)

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  Fig. 3 Postoperative panoramic radiograph showing the titanium mesh in position with demineralized tooth graft materials.

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  Fig. 4 Postoperative panoramic radiograph (A) and computed tomography scans in coronal (B), axial (C) section at 6-months follow-up shows favorable new bone formation and subsequent resorption of graft materials (arrows).

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  Fig. 5 The section in 6-months was stained with H&E staining (A: ×200, B: ×400) and Masson's trichorme staining (C: ×200, D: 400). Osteocytic embedding in graft tooth material (A, arrows), intimate fusion between new bone and graft tooth material (B, a-f) is observed. Osteocytic embedding in graft material with new bone were shown. Embedded osteocyte (C, c; D, a), newly formed bone (C, a,b,d; D, b) were also confirmed in the specimens.

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  Fig. 6 Preoperative panoramic radiopgraph (A) and computed tomography scans (B, C) show a compound odontoma with impacted 3rd molar, contacting above the bony canal of inferior alveolar nerve (left, 4 arrows). Right impacted 3rd molar (right, 3 arrows) was also extracted for the orthodontic treatment.

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  Fig. 7 Postoperative panoramic radiograph at postoperative 1-day (A), and 1-year (B), computed tomography scans (C, D) at 1-year follow-up. Radiographs at 6-months (B-D) showed favorable new bone formation, regularity of alveolar ridge, and higher bony density of graft site. Patient could start orthodontic treatment after 1 month of mass excision. Left: 4 arrows, right: 3 arrows.

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