Orthokeratinized odontogenic cyst presenting as a periapical lesion

doi:10.1016/S0099-2399(86)80320-X

Journal of Endodontics

Volume 12, Issue 11, November 1986, Pages 539-541

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This article reports a case of a long-standing radiolucency caused by a variant of an odontogenic keratocyst which was interpreted and treated as an endodontic lesion. The case points out the necessity for radiographic recall examinations as part of endodontic therapy. The importance of histological tissue examination and diagnosis is emphasized.

References (3)

BrannonRB
The odontogenic keratocyst: a clinicopathologic study of 312 cases. Part I. Clinical features
Oral Surg
(1976)

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Cited by (7)

Orthokeratinized odontogenic cysts presenting as a periapical lesion: Report of a case and literature review
2014, Journal of Endodontics
Citation Excerpt :
To this end, more studies should be done to clarify the possibility of discovering new biomarkers that will help clinicians and pathologists to clearly differentiate between the various cysts arising in jaws. Our review identified 7 cases of OOC mimicking periapical lesions (9, 10, 24–26), which are presented in Table 1. Our case is unusual for several reasons.
Inflammatory cysts, granulomas, abscesses, and fibrous scars represent most periapical radiolucencies. However, other less common lesions, such as orthokeratinized odontogenic cysts (OOCs), can be found at this region, and they deserve to be discussed because the prognosis for an OOC is different from that expected for the ordinary inflammatory periapical diseases.
An interesting case of OOC associated with a nonvital tooth in a 40-year-old woman is described. After a previous clinical diagnosis of a radicular cyst, the tooth was extracted, and the lesion was enucleated and submitted to microscopy examination.
Because of the detection of an orthokeratinized epithelium lining, a diagnosis of OOC was concluded. After 2 years of periodic follow-up, no signs of recurrence were detected.
The presence of keratin in radicular lesions must be carefully evaluated to eliminate the diagnosis of lesions with more aggressive behavior, such as an OOC or even a keratocystic odontogenic tumor. Hence, histopathologic examination is mandatory to confirm the type of lesion and to differentiate other pathologic conditions, therefore establishing patients' prognoses precisely.
A dentist's dilemma: Nonsurgical endodontic therapy or periapical surgery for teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion
1990, Oral Surgery, Oral Medicine, Oral Pathology
First presented is a brief review of nonsurgical versus surgical treatment of radicular cysts. This is followed by a consideration of the use of radiographs for differential diagnosis of periapical radiolucent lesions. Some of the nonendodontic local and systemic lesions that can occur periapically are then presented. Next examined are the fallibilities of pulp vitality testing methods. The need for histopathologic examination of periapical lesions is the subject of the next discussion. The dentist's dilemma is then examined: should teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion have routine surgical treatment including biopsy or should they be treated nonsurgically and have periodic follow-ups? A possible resolution of this dilemma is the final consideration.
Nonmalignant nonendodontic lesions mimicking periapical lesions of endodontic origin: A systematic review
2022, Journal of Conservative Dentistry
Keratocystic odontogenic tumour arising as a periapical lesion
2014, International Endodontic Journal
Zebra hunt: Clinical reasoning and misdiagnosis
2014, Complications in Endodontic Surgery: Prevention, Identification and Management
Cemento-ossifying mandibular fibroma: A presentation of two cases and rewiev of the literature
2004, Medicina Oral

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¹: Dr. Hancock is assistant base dental surgeon, USAF Hospital, Moody AFB, GA. He completed the USAF Advanced Clinical Dentistry Residency Program in July 1984. Dr. Brown is director of graduate endodontics, Indiana University School of Dentistry, Indianapolis, IN. Dr. hartman is chairman, Department of Oral Pathology, Armed Forces Institute of Pathology, Washington, DC.

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Orthokeratinized odontogenic cyst presenting as a periapical lesion

Oral Surg