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01-06-2018 | Original Article

Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis

Authors: Mayara Santos de Castro, Clenivaldo Alves Caixeta, Marina Lara de Carli, Noé Vital Ribeiro Júnior, Marta Miyazawa, Alessandro Antônio Costa Pereira, Felipe Fornias Sperandio, João Adolfo Costa Hanemann

Published in: Clinical Oral Investigations | Issue 5/2018

Abstract

Objectives

This manuscript presents a systematic review of the clinicopathologic features and outcomes of conservative surgical treatments for nonsyndromic odontogenic keratocysts (OKCs) and assesses the recurrence rates through a meta-analysis, in order to indicate the best conservative approach.

Materials and methods

PRISMA guidelines for systematic reviews were followed, and the protocol was registered (PROSPERO/Nr.: CRD42017060964). An electronic search was conducted using the PubMed/MEDLINE, Science Direct, Web of Science, Scopus, and The Cochrane Library databases, and relevant articles were selected based on specific inclusion criteria. The PICOS criteria (Population: nonsyndromic patients of any age with OKC, with histopathological diagnosis and minimum follow-up of 12 months; Intervention and Comparison: marsupialization or decompression with or without enucleation, and enucleation alone; Outcome: recurrence rates; Study design: clinical trials, controlled trials, retrospective studies, and case series containing at least 10 cases of OKC) were employed. A pooled odds ratio (OR) was computed through the Mantel-Haenszel test (M-H) with 95% confidence intervals (CI).

Results

One thousand nine hundred OKCs were analyzed; the age of the patients varied from 6 to 90 years (mean of 38.6 years); a male to female ratio of 1.57:1 was observed; 74.5% of the lesions occurred in the mandible; 75.7% of OKCs were unilocular; the association with impacted tooth was reported for 344 OKCs; and the mean follow-up was 60.1 months. One thousand three hundred thirty-one OKCs were treated by conservative surgical treatments, and 261 cases (19.8%) presented recurrence. Nonetheless, minor total recurrence rates were observed after decompression followed by enucleation (11.9%) and marsupialization followed by enucleation (17.8%). In contrast, enucleation alone showed a total recurrence rate of 20.8%.

Conclusion

The results suggest a significant superiority of success for OKC treatments that use decompression followed by enucleation, instead of an initial enucleation (M-H, OR = 0.48; 95% CI = 0.22 to 1.08; P = 0.0163).

Clinical relevance

No consensus exists concerning the best management for OKCs. More aggressive treatments (ostectomy, resection, or use of adjunctive therapies like Carnoy’s solution and liquid nitrogen) can have many disadvantages and risks. Therefore, it is necessary to identify the conservative approach for OKCs that results in a lower recurrence rate.

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Title: Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis
Authors: Mayara Santos de Castro
Clenivaldo Alves Caixeta
Marina Lara de Carli
Noé Vital Ribeiro Júnior
Marta Miyazawa
Alessandro Antônio Costa Pereira
Felipe Fornias Sperandio
João Adolfo Costa Hanemann
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 5/2018
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-017-2315-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Conservative surgical treatments for nonsyndromic odontogenic keratocysts: a systematic review and meta-analysis

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

Clinical relevance

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