Incidental Discovery of Odontogenic Keratocyst in an Edentulous Patient: Importance of Routine Pre-Prosthetic Radiographic Evaluation

Abstract

The most common modality of treatment for completely edentulous patients are conventional removable complete dentures. The protocol for fabrication of complete denture would involve a thorough clinical examination and radiographic investigation. As a routine, unless clinical findings suggest presence of remnant tooth structures, or the patient presents himself with symptoms, the radiographic investigations are overlooked. This case report presents one such situation wherein routine radiographic evaluation of a clinically asymptomatic edentulous individual prior to prosthetic rehabilitation revealed the presence of an odontogenic keratocyst of anterior maxilla substantiating the importance of such routine pre-prosthetic radiographic investigations.

Odontogenic Keratocyst in an Edentulous Patient: Report of an Unusual Case

“…When an OKC is located in the mandible, its center is always above the alveolar canal (NAC) [7,11]. An OKC frequently surrounds the crown of an impacted tooth and is difficult to distinguish radiologically from a dentigerous cyst [6][7][8]11]. It should be noted that more than 50% of OKCs surround the crown of an impacted tooth, in most cases a mandibular third molar [6,8].…”

“…The prevalence of OKCs is higher in men than in women, in individuals aged between 20 and 40 years, and in the Caucasian population of Northern Europe [6]. In 65% to 80% of cases it is located in the region of the mandibular angle [7], and in 33% of the cases it presents in the maxilla [8]. Clinically, OKCs are usually asymptomatic, and their discovery is often fortuitous, mainly during radiological investigations.…”

“…We report here a rare case of an OKC centered on the mandibular right-angle region in a fully edentulous patient who sought (emergency) dental advice because of pain that prevented him from wearing his dentures. Only a very few cases have been described where teeth were missing [8,9]. It is therefore important for practitioners to also include OKCs in the differential diagnosis of cystic lesions in edentulous patients.…”

Rehabilitation of mandibular defects using unconventional approaches: a case series

“…7 Thamizhchelvan et al (2011) documented case of odontogenic keratocyst as an accidental finding in an edentulous maxilla which was rehabilitated using complete denture. 8 A few documented case reports have suggested implant placement in rehabilitation of such defects. 9 However, a recurrence rate of enucleated lesions as described in a retrospective study of 12 years by Karaca et al (2018) was 14.8%.…”

Importance of radiographs in edentulous patients

“…3,4 Even recently few cases of odontogenic pathology like odontogenic keratocyst, have been reported on radiographic examination of edentulous patient, further substantiating the need for pretreatment radiographic screening of edentulous patient. 5 So hereby, with this incidental radiographic discovery of impacted teeth in a complete denture wearer, we would like to urge the general dental practitioner and prosthodontist dealing with diagnosis and treatment planning of edentulous patient to advise routine screening and radiographic examination of edentulous patient, to prevent missed finding, and untoward complication and financial burden to the patient.…”