Implant restoration following removal of an odontogenic keratocyst: A clinical report

Implant restoration following keratocyst: A clinical report Glenn W. Bredfeldt, DDS,a Jose Granado, CDT” West

Side Veterans

Russell

Administration

removal

A. Dixon,

Medical

Center,

Chicago,

andibular defects can be devastating esthetically, functionally, and psychologically. This report describes the restoration of a partially edentulous mandibular defect using osseointegrated dental implants and an iliac crest bone graft. This prosthodontic care was needed because of the removal of an odontogenic keratocyst. Odontogenic keratocysts can occur at any age, but are usually seen under 40 years of age. There is no sex predilection, with the mandible affected almost twice as often as the maxillae. Radiographically, the lesion may appear unilocular or multilocular. Histol’ogically, the lesion consists of a keratin-producing stratified squamous epithelial lining with focal areas of calcification. The lumen may be filled with a straw-colored fluid, or a thicker creamy liquid. Because of the thin friable nature of the cyst wall, complete eradication of the cyst can be difficult. The recurrence rate has been reported as 13 % to 60 % .I, 2 In April 1986, a 44-year-old man complained of pain, tenderness, and discharge from a swelling in the right side

%taff Prosthodontist and Director Program. bStaf7 Oral Surgeon. CCertified Dental Technician.

of General

Practice

Residency

10/l/38207

Fig.

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DDS,

1. Radiograph

MS,b

of an odontogenic and

Ill.

of the mandible. The swelling was of approximately 2 months’ duration, and was gradually enlarging. The past medical history included an appendectomy and a cholecystectomy several years previously. The patient was being treated for peptic ulcer diseases with cimetidine (Tagamet, Smith Kline & French Laboratories, Philadelphia, Pa.), 300 mg, four times per day. The social history included moderate use of alcohol and smoking half a pack of cigarettes per day for 32 years. The patient appeared wellnourished and in good health. Examination revealed normal facial contours. There were multiple carious teeth, some nonrestorable, mild to moderate periodontal disease, and a swelling in the right mandibular buccal vestibule with cortical expansion. Milky exudate could be expressed from a draining fistula on the buccal surface of the swelling. The panoramic radiograph revealed a circumscribed radiolucency, 2.5 to 3 cm in diameter, in the right body of the mandible extending from the right lateral incisor to the second premolars (Fig. 1). The patient was referred to the oral surgery service and was admitted for treatment. In the operating room, the cystic lesion was enucleated and the associated canine and premolars were extracted. Also extracted were the nonrestorable maxillary right second premolar and the lateral incisor and the maxillary left canine and second premolar.

shows large radiolucency.

BREDFELDT,

Fig.

Fig.

2. Final maxillary

3. Mandibular

removable

restorations.

partial

Fig.

denture.

Fig.

6. Two-year

The patient was discharged on the following day. The le&on was reported as a radieular cyst. Following enucleation of the cyst, the patient was referred for prosthodontic care. Treatment recommenda218

Fig.

follow-up

DIXOlri,

4. Implant

prosthesis.

5. Ocelusal

relationship.

AND

GRANADO

radiograph.

tions included fixed maxillary restorations and an implantsupported mandibular prosthesis. In September 1986, while in the course of prosthodontic treatment, the patient again complained of swelling in the right mandible. A secAUGUST

1992

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ODONTOGENIC

KERATOCYST

AND

InlPLANTS

ond examination of the pathologic specimens resulted in a revised diagnosis of odontogenic keratocyst. The patient was returned to the operating room in October 1986, where a wider excision of the lesion was performed. The inferior border of the mandible and inferior alveolar nerve remained intact. However, the mandibular central incisors and right lateral incisor were removed during the second surgery. The mandibular defect created was immediately packed with cancellous bone obtained from the left iliac crest. The postoperative course was uneventful. Maxillary restorations were completed (Fig. Z), and in June 1987 a mandibular removable partial denture (Fig. 3) was placed over the graft site as an interim prosthesis. In February 1989 the patient was admitted for implant placement in the right mandible. Two 17 mm, one 9 mm, and 11 mm IT1 hollow basket cylinder implants (IT1 Implant, Park Dental Research Corp., New York, N.Y.) were placed. Because these implants alre one-stage, the partial

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denture was modified to accommodate the implants without loading. Following osseointegration, an implant supported fixed-detachable prosthesis was inserted in September 1989 (Figs. 4 and 5). The patient is now on regular follow-up and is functioning well with the prosthesis. The Z-year follow-up examination indicated no signs of mobility or inflammation. Radiographs indicate bone levels at the same height as at the initial placement (Fig. 6). REFERENCES 1. Shafer WG, Him MK, Levy BM. A textbook of oral pathology. Philadelphia: WB Saunders Company, 1983:271-3. 2. Bhaskar SN. Synopsis of oral pathology. 7th ed. St. Louis: Mosby Co, 1986:236-g.

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requests

4th ed. The

CV

to:

DR. GLENN W. BREDFELDT DENTAL SERVICE (160) WEST SIDE VA MEDICAL CENTER 820 SOUTH DAMEN AVE. CHICAGO. IL 60612

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