Planning of Large Odontogenic Cysts Treatment Using Panoramic and CBCT Images.

Abstract

Objective: We explored the utility of Cone Beam Computed Tomography (CBCT) and Orthopantomography (OPG) in terms of treatment planning to determine which form of radiography can more reliably assess cyst volume. Methods: 'We evaluated the panoramic and CBCT images of nine patients who consulted our clinic for treatment of large cystic lesions. Overall, 27 images were reviewed and analyzed by 21 oral and maxillofacial surgeons. We asked five questions (detailed in the main text). Results: We evaluated the 189 answers in the questionnaire. The surgeons recommended marsupialization followed by enucleation, marsupialization, and enucleation (70.89 %, 14.28 %, and 14.81 %, respectively). The answers to the reasons of these treatment choices showed that the size of the cysts and relationship with the adjacent anatomical structures are the most effective factors. In after marsupialization challenges, 85.71% of the answers considered that the lesion had shrunk sufficiently to allow enucleation according to OPG's, however, this rate decreased to 42.23% when the same surgeons evaluated the CBCT images of the patients after marsupialization. Ninety-nine percent of the responses reported that CBCT was much more reliable than OPG. Conclusion: In this study, we concluded that OPG imaging method can be used for the diagnosis and followup of cystic lesions, but in order to determine the accuracy of timing, adequacy of new bone formation and whether the cyst has shrunk sufficiently in volume, during the transition from the marsupialization process to the enucleation process, it is necessary to use CBCT imaging method. Further clinical trials should be conducted to define the effects of three dimensions images regarding surgical treatments of different kinds of oral and maxillofacial region cystic lesions.