MANDİBULAR DENTİJERÖZ KİSTLERİN KONİK IŞINLI BİLGİSAYARLI TOMOGRAFİ GÖRÜNTÜLEME ÖZELLİKLERİ VE KEMİK EKSPANSİYONU İLE İLİŞKİLİ OLABİLECEK GÖRÜNTÜLEME ÖZELLİKLERİ

Yıl 2023, Cilt: 6 Sayı: 3, 323 - 331, 24.10.2023

Gökçen Akçiçek , Leyla Berna Çağırankaya , Nursel Akkaya , Hatice Yağmur Zengin

https://doi.org/10.26650/JARHS2023-1221508

Öz

Amaç: Dentijeröz kist (DK), çenelerde sık görülen kistlerden biri olup teşhis edilmesinde radyografik özellikleri önem taşımaktadır. Bu çalışmanın amacı mandibular DK’lerin konik ışınlı bilgisayarlı tomografi (KIBT) görüntüleme özelliklerini incelemek ve kemik ekspansiyonu ile görüntüleme özellikleri arasındaki olası ilişkileri değerlendirmektir.
Gereç ve Yöntem: Çalışmaya KIBT görüntüsü olan ve patoloji raporu ile tanısı doğrulanan hastalar dahil edilmiştir. KIBT görüntülerinde lezyonun radyografik özelliklerinin yanı sıra, gömülü dişin pozisyonu ve kist-kron ilişkisi de değerlendirilmiştir.
Bulgular: 36 DK’nin %69,4’ünün gömülü dişi etkilediği (%61,1 yer değişikliği, %5,6 rezorpsiyon ve %2,8 yer değişikliği ve rezorpsiyon), %80,6’sının ekspansiyona neden olduğu, %100’ünün kortikal tabakalarda tutuluma neden olduğu (perforasyon ve incelme), %80,6’sının inferior alveolar kanalı etkilediği (%13,9 rezorpsiyon, %11,1 yer değişikliği, %55,6 rezorpsiyon ve yer değişikliği), %65,7’sinin komşu dişi etkilediği (%27,8 rezorpsiyon, %30,6 lamina dura kaybı, %5,6 yer değişikliği ve lamina dura kaybı), gömülü dişlerin %25’inin bukkal/lingual oblik pozisyonda olduğu ve %55,5’inde lateral tip kist-kron ilişkisi olduğu tespit edildi. Ekspansiyon oranı ile gömülü dişe etki (p=0,023) ve komşu dişe etki (p=0,011) arasında istatistiksel olarak anlamlı ilişki saptandı. Ayrıca kist-kron ilişkisi ile gömülü dişin bukkolingual konumu arasında da istatistiksel olarak anlamlı ilişki gözlendi (p=0,031).
Sonuç: Bu çalışmada gömülü dişte rezorpsiyon ve yer değişikliği ile komşu dişte yer değişikliği ve lamina dura kaybının sık olduğu ve bunların DK’lerin ekspansiyon oranı ile istatistiksel olarak ilişkili olduğu bulundu. Bu bulgular ekspansiyonun belirtisi olabileceğinden dikkatlice değerlendirilmelidir.

Anahtar Kelimeler

Konik ışınlı bilgisayarlı tomografi, dentijeröz kist, mandibula

CONE BEAM COMPUTED TOMOGRAPHY IMAGING CHARACTERISTICS OF MANDIBULAR DENTIGEROUS CYSTS AND POSSIBLE IMAGING FEATURES ASSOCIATED WITH BONE EXPANSION

Öz

Objective: Dentigerous cysts (DC) are one of the most common cysts in the jaw, and radiographic features are important for diagnosis. This study aims to evaluate the radiographic features of mandibular DCs on cone beam computed tomography (CBCT) images and investigate the possible associations between the imaging features and bone expansion.
Material and Methods: Patients who had CBCT images with pathologically proven DC within the mandible were included the study. On CBCT images, besides lesion radiographic features, the position of the impacted tooth and cyst-to-crown relationship were also recorded.
Results: Among 36 DCs, 69.4% affected the impacted tooth (61.1% were displaced, 5.6% were resorbed and 2.8% were both displaced and resorbed), 80.6% expanded, 100% had cortical involvement (perforation and thinning), 80.6% affected the inferior alveolar canal (%13.9 resorption, %11.1 displacement, 55.6% resorption and displacement), 65.7% affected the adjacent teeth (27.8% resorption, 30.6% lamina dura loss, 5.6% displacement and lamina dura loss), 25% of impacted tooth position were in buccal/lingual obliquity, and 55.5% had a lateral type cyst-to-crown relationship. There was a statistically significant relationship between the expansion rate and effect on the impacted tooth (p=0.023), between the expansion rate and effect on the adjacent tooth (p=0.011), and between the cyst-to-crown relationship and impacted tooth buccolingual position (p=0.031).
Conclusion: Resorption and displacement of the impacted tooth and resorption, displacement and lamina dura loss of the adjacent tooth were common and statistically related with DCs expansion rates. These imaging features could be a sign of expansion and should be carefully examined.

Anahtar Kelimeler

Cone beam computed tomography, dentigerous cyst, mandible

Kaynakça

• 1. World Health Organization. Classification of Tumours Editorial Board. Head and neck tumours. Lyon (France): International Agency for Research on Cancer; 2022. WHO classification of tumours series, 5th ed.; vol. 9. https://publications.iarc.fr/ Book-And-Report-Series/Who-Classification-Of-Tumours/WHO-Classification-Of-Head-And-Neck-Tumours-2017 google scholar
• 2. Zhang LL, Yang R, Zhang L, Li W, MacDonald-Jankowski D, Poh CF. Dentigerous cyst: a retrospective clinicopathological analysis of 2082 dentigerous cysts in British Columbia, Canada. Int J Oral Maxillofac Surg 2010;39(9):878-82. google scholar
• 3. Shear M, Speight P. Cysts of the oral and maxillofacial regions. 4th ed. Munksgaard: Blackwell; 2007. pp.59-78. google scholar
• 4. White SC, Pharoah MJ.Oral radiology; principles and interpretation. 5th ed. St. Louis (MO):Mosby;2004. pp.721-974. google scholar
• 5. Terauchi M, Akiya S, Kumagai J, Ohyama Y, Yamaguchi S. An analysis of dentigerous cyst developed around a mandibular third molar by panoramic radiographs. Dent J Basel 2019;7(1):13. google scholar
• 6. Shibata Y, Asaumi J, Yanagi Y, Kawai N, Hisatomi M, Matsuzaki H, et al. Radiographic examination of dentigerous cysts in the transitional dentition. Dentomaxillofac Radiol 2004;33(1):17-20. google scholar
• 7. Lim LZ, Padilla RJ, Reside GJ, Tyndall DA. Comparing panoramic radiographs and cone beam computed tomography: Impact on radiographic features and differential diagnoses. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;17:(18)30888-5. google scholar
• 8. Mao W, Lei J, Lim LZ, Gao Y, Tyndall DA, Fu K. Comparison of radiographical characteristics and diagnostic accuracy of intraosseous jaw lesions on panoramic radiographs and CBCT. Dentomaxillofac Radiol 2021;50(2):20200165. google scholar
• 9. Cardoso LB, Lopes IA, Ikuta CRS, Capelozza ALA. Study between panoramic radiography and cone beam-computed tomography in the diagnosis of ameloblastoma, odontogenic keratocyst, and dentigerous cyst. Craniofac Surg 2020;31(6):1747-52. google scholar
• 10. Suomalainen A, Esmaeili EP, Robinson S. Dentomaxillofacial imaging with panoramic views and cone beam CT. Insights Imaging 2015;6(1):1-16. google scholar
• 11. Kapila SD, Nervina JM. CBCT in orthodontics: assessment of treatment outcomes and indications for its use. Dentomaxillofac Radiol 2015;44(1):20140282. google scholar
• 12. Patel S, Durack C, Abella F, Shemesh H, Roig M, Lemberg K. Cone beam computed tomography in Endodontics - a review. Int Endod J 2015;48(1):3-15. google scholar
• 13. Matzen LH, Schropp L, Spin-Neto R, Wenzel A. Radiographic signs of pathology determining removal of an impacted mandibular third molar assessed in a panoramic image or CBCT. Dentomaxillofac Radiol 2017;46(1):20160330. google scholar
• 14. Suomalainen A, Kiljunen T, Kaser Y, Peltola J, Kortesniemi M. Dosimetry and image quality of four dental cone beam computed tomography scanners compared with multislice computed tomography scanners. Dentomaxillofac Radiol 2009;38(6):367-78. google scholar
• 15. Meng Y, Zhao YN, Zhang YQ, Liu DG, Gao Y. Three-dimensional radiographic features of ameloblastoma and cystic lesions in the maxilla. Dentomaxillofac Radiol 2019;48(6):20190066. google scholar
• 16. Khojastepour L, Khaghaninejad MS, Hasanshahi R, Forghani M, Ahrari F. Does the Winter or Pell and Gregory classification system indicate the apical position of impacted mandibular third molars? J Oral Maxillofac Surg 2019;77(11):2222.e1-9. google scholar
• 17. Neville BW, Damm DD, Allen CM, Bouquot JE. Odontogenic cysts and tumors. In: Oral and maxillofacial pathology. 3rd ed. China: Elsevier; 2009.p.678-740. google scholar
• 18. Açıkgöz A, Uzun-Bulut E, Özden B, Güngüz K. Prevalence and distribution of odontogenic and nonodontogenic cysts in a Turkish Population. Med Oral Pathol Oral Cir Bucal 2012;17(1):e108-15. google scholar
• 19. Henien M, Sproat C, Kwok J, Beneng K, Patel V. Coronectomy and dentigerous cysts: a review of 68 patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123(6):670-4. google scholar
• 20. Avril L, Lombardi T, Ailianou A, Burkhardt K, Varoquaux A, Scolozzi P, et al. Radiolucent lesions of the mandible: a pattern-based approach to diagnosis. Insights Imaging 2014;5(1):85-101. google scholar
• 21. Borghesi A, Nardi C, Giannitto C, Tironi A, Maroldi R, Di Bartolomeo F, et al. Odontogenic keratocyst: imaging features of a benign lesion with an aggressive behavior. Insights Imaging 2018;9(5):883-97. google scholar
• 22. Ikeshima A, Tamura Y. Differential diagnosis between dentigerous cyst and benign tumor with an embedded tooth. J Oral Sci 2002;44(1):13-7. google scholar
• 23. Lin HP, Wang YP, Chen HM, Cheng SJ, Sun A, Chiang CP. A clinicopathological study of 338 dentigerous cysts. J Oral Pathol Med 2013;42(6):462-7. google scholar
• 24. Main DM. Follicular cysts of mandibular third molar teeth: radiological evaluation of enlargement. Dentomaxillofac Radiol 1989;18(4):156-9. google scholar
• 25. Akçiçek G, Çağirankaya LB, Akkaya N. Dentigerous Cyst: Evaluation of the cyst-to-crown relationship and other imaging features on cone beam computed tomography images [in Turkish]. Selcuk Dent J 2019;6(4):135-40. google scholar
• 26. Borras-Ferreres J, Sanchez-Torres A, Aguirre-Urizar JM, Gay-Escoda C. Dentigerous cyst with parietal and intracystic calcifications: a case report and literature review. J Clin Exp Dent 2018;10(3):e296-9. google scholar
• 27. Shimizu M, Ogawa D, Okamura K, Kawazu T, Chikui T, Yoshiura K. Dentigerous cysts with calcification mimicking odontogenic tumors: differential diagnosis by CT. Oral Radiol 2015;31(1):14-22. google scholar
• 28. Martinelli-Klay CP, Martinelli CR, Martinelli C, Macedo HR, Lombardi T. Unusual imaging features of dentigerous cyst: A case report. Dent J (Basel) 2019;7(3):76. google scholar
• 29. Perez A, Lenoir V, Lombardi T. Dentigerous cysts with diverse radiological presentation highlighting diagnostic challenges. Diagnostics (Basel) 2022;12(8):2006. google scholar
• 30. Lee JH, Kim SM, Kim HJ, Jeon KJ, Park KH, Huh JK. Characteristics of bony changes and tooth displacement in the mandibular cystic lesion involving the impacted third molar. J Korean Assoc Oral Maxillofac Surg 2014;40(5):225-32. google scholar
• 31. Kauke M, Safi AF, Grandoch A, Nickenig HJ, Zoller J, Kreppel M. Volemtric analysis of keratocystic odontogenic tumors and non-neoplastic jaw cysts-comparison and its clinical relevance. J Craniomaxillofac Surg 2018;46(2):257-63. google scholar
• 32. Apajalahti S, Hagström J, Lindqvist C, Suomalainen A. Computerized tomography findings and recurrence of keratocystic odontogenic tumor of the mandible and maxillofacial region in a series of 46 patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111(3):e29-37. google scholar