Search Results (50)

Background/Objectives: Vision-language models (VLMs) such as GPT (Generative Pre-Trained Transformer) have shown potential for medical image interpretation; however, challenges remain in generating reliable radiological findings in clinical practice, as exemplified by dental pathologies. This study proposes a Self-correction Loop with Structured Output (SLSO) framework as an integrated processing methodology to enhance the accuracy and reliability of AI-generated findings for jaw cysts in dental panoramic radiographs. Methods: Dental panoramic radiographs with jaw cysts were used to implement a 10-step integrated processing framework incorporating image analysis, structured data generation, tooth number extraction, consistency checking, and iterative regeneration. The framework functioned as an external validation mechanism for GPT outputs. Performance was compared against the conventional Chain-of-Thought (CoT) method across seven evaluation items: transparency, internal structure, borders, root resorption, tooth displacement, relationships with other structures, and tooth number. Results: The SLSO framework improved output accuracy for multiple items compared to the CoT method, with the most notable improvements observed in tooth number identification, tooth displacement detection, and root resorption assessment. In successful cases, consistently structured outputs were achieved after up to five regenerations. The framework enforced explicit negative finding descriptions and suppressed hallucinations, although accurate identification of extensive lesions spanning multiple teeth remained limited. Conclusions: This investigation established the feasibility of the proposed integrated processing methodology and provided a foundation for future validation studies with larger, more diverse datasets. Full article

Background and Clinical Significance: Vascular lesions of the face, particularly arteriovenous malformations (AVM) and mixed hemangiomas (MH), pose significant diagnostic and therapeutic challenges because of their complex anatomy, unpredictable behavior, and high risk of bleeding. Surgical planning should be individualized and often requires a staged approach with meticulous interdisciplinary coordination to ensure patient safety. The presence of a concomitant odontogenic infection further complicates management, as local inflammation may exacerbate vascular instability and increase the risk of life-threatening complications. Local inflammation and infection might cause some life-threatening conditions, especially when an abscess occurs in the area of any vascular lesion. Ensuring that the oral cavity is free from potential odontogenic infections is a particularly important issue in many complex cases, especially in patients treated for oral, head, and neck cancer or in those with other coexisting morbidities affecting the oral and facial regions. Case Presentation: A 72-year-old man was referred for management of a severe odontogenic infection associated with an extensive facial vascular lesion. The patient’s medical history was significant for arterial hypertension and chronic liver dysfunction (CLD) of unclear etiology. Complete blood testing, including coagulation assessment and liver ultrasonography, was performed, with no contraindication to surgery identified. The scope of odontogenic-related infections was scheduled for simultaneous removal during initial surgery. Preparation for surgery included the local application of sclerotherapy agents. Conclusions: Quite often, a routine panoramic radiograph can help in assessing the status of bone and dentition to undertake all necessary treatment. Severe odontogenic disease, including multiple retained roots, periapical infections, and odontogenic cystic lesions in the context of poor oral hygiene, may lead to the occurrence of possible inflammation. In case of any vascular lesion, a careful diagnostic and therapeutic strategy is needed. This case report highlights that maintaining an infection-free oral environment is a critical component of care in patients with complex facial MH and should be regarded as an essential element of overall treatment planning. Full article

Radicular cysts (RCs) represent the most frequent inflammatory cystic lesions of the jaw, typically arising from non-vital teeth. While standard management via enucleation is well-documented, complex cases involving the anterior maxilla present significant surgical challenges due to their proximity to the nasal cavity floor (NCF) and the maxillary sinus floor (MSF). This report provides a comprehensive revision of a clinical case series involving seven patients (ages 17–50) treated with multimodal surgical and regenerative protocols. The patients were stratified into five distinct anatomical risk groups (A–E) based on the integrity of the bony boundaries and the presence of oronasal communications. The treatment strategies combined meticulous cyst enucleation with advanced regenerative techniques, including platelet-rich fibrin (PRF), allogeneic and xenograft bone substitutes, and local flaps such as the buccal fat pad (BFP). The results across all seven cases demonstrated favorable clinical and radiographic outcomes, with no instances of oronasal fistula formation or recurrence during follow-up periods ranging from 12 months to three years. This report emphasizes the necessity of structured anatomical stratification and multimodal planning to ensure scientific precision and surgical predictability in the management of complex maxillary lesions. The differences between approaches towards the nasal cavity and maxillary sinus have to be highlighted. Further studies with larger cohorts are warranted to evaluate the long-term outcomes of different treatment modalities. Full article

Pediatric odontogenic tumors are rare but are frequently overlooked because they often mimic simple cysts on routine radiographic examinations. The radiographic appearance on panoramic imaging and cone-beam computed tomography (CBCT) frequently does not correlate with the true biological nature of these lesions. On CBCT, classic odontogenic tumors often demonstrate mixed radiolucent–radiopaque patterns with ill-defined borders, internal calcifications, septations, or other structural features. The diagnostic challenge arises when an odontogenic tumor mimics a unilateral, well-defined radiolucent area or a cystic lesion with clear borders and no associated tooth displacement, erosion, root resorption, or cortical bone dehiscence. Panoramic radiography has inherent diagnostic limitations but remains widely used for routine dental screening. CBCT provides enhanced three-dimensional assessment and improves diagnostic accuracy in the evaluation of jaw lesions. A marked increase in dental follicle diameter necessitates differentiation between cystic transformation, inflammatory processes, and other odontogenic pathologies. Cortical swelling and bone asymmetry warrant careful evaluation. In this context, an atypical cyst-like lesion detected on routine panoramic radiography prompted a needle aspiration biopsy, which revealed a dry tap and suggested a solid lesion. This prompted CBCT evaluation. Two juvenile cases are presented in which clinical findings, panoramic radiography, and CBCT provided discordant diagnostic impressions of cystic-appearing lesions with well-defined borders and bone expansion. These cases illustrate a diagnostic pathway in which imaging demonstrates a cyst-like appearance with benign radiological features, fine-needle aspiration biopsy reveals the absence of cystic fluid, and histopathology confirms that radiology alone cannot reliably distinguish true cysts from solid odontogenic tumors in pediatric patients. Full article

Background: Ameloblastomas account for roughly 1% of all jaw tumours and cysts, typically manifesting as slow-growing, painless swellings that expand both buccal and lingual cortical plates and may infiltrate adjacent soft tissue, often leading to a delayed diagnosis. These benign tumours, characterized by local invasiveness, originate from epithelial tissues and may develop from dental lamina cell rests, the enamel apparatus, the epithelial lining of odontogenic cysts, or basal epithelial cells of the oral mucosa. Methods: This paper aims to describe the comprehensive and interdisciplinary management of an extensive ameloblastoma in a 16-year-old patient, emphasizing the diagnostic challenges, surgical resection, reconstructive procedures, and subsequent oral rehabilitation. Results: At the eleven-year follow-up, clinical and radiographic examinations showed no signs of tumour recurrence. The patient presented no symptoms, indicating neither pain nor functional impairment. The prosthetic rehabilitation utilizing implant-supported fixed restorations was successfully completed, resulting in satisfactory masticatory function and aesthetics. This case adds to the existing evidence on the management of extensive ameloblastomas by demonstrating successful long-term outcomes following interdisciplinary surgical reconstruction and rehabilitation. Conclusions: The presented case highlights the complexity of restoring the lost tissues and functions, as well as the long-term clinical, functional, and aesthetic outcomes over an eleven-years follow-up period. Full article

Background and Objectives: The aim of this study was to evaluate the radiographic progression of non-surgically managed jaw lesions that remained untreated due to patient deferral or refusal of surgery. Radiographic changes were assessed using two panoramic radiographs obtained at different time points, with a focus on dimensional progression, morphological characteristics, and anatomical involvement. Materials and Methods: A total of 85 non-surgically managed intraosseous cystic and cyst-like jaw lesions were evaluated on two panoramic radiographs obtained at least one year apart. Histopathological confirmation was available for 26 of the lesions (30.6%), while the remaining cases were evaluated radiographically due to the absence of surgical intervention or accessible pathology records. Assessments included localization, size, shape, internal structure, borders, association with non-erupted teeth, root resorption, tooth displacement, involvement of anatomical structures, and cortical changes such as thinning, expansion, or destruction. Nonparametric statistical comparisons were used to assess time-dependent changes and differences between follow-up groups. Results: A total of 57 lesions occurred in the mandible and 28 in the maxilla, predominantly in the posterior regions. The mean vertical/horizontal measurements of the intraosseous lesions was found to be 10.9 ± 4.6 mm/12.2 ± 6.5 mm (Mean ± SD) on the initial panoramic radiographs (Med: 10.0–IQR: 6.50/Med: 12.0–IQR: 8.75) and 14.8 ± 5.3 mm/17.5 ± 8.3 mm (Mean ± SD) on the second panoramic radiographs (Med: 14.5–IQR: 6.75/Med: 16.0–IQR: 10.75), respectively. Both vertical and horizontal dimensions showed a statistically significant increase between the two time points (p < 0.05). Initially, 41 lesions exhibited corticated margins; at follow-up, an additional 33 non-corticated lesions developed cortication. Lesions without corticated margins on the initial images exhibited significantly greater vertical and horizontal growth than those with corticated borders (p < 0.05). Lesions followed for 3–5 years showed significantly greater dimensional changes compared with those observed for shorter or longer intervals (p < 0.05). Lesion shape, internal structure, and multilocularity remained largely stable. Conclusions: Within the limitations of this retrospective study, non-surgically managed jaw lesions showed a tendency to increase in size over time. While the development of corticated borders may be associated with reduced growth activity, panoramic radiography alone is insufficient for definitive assessment, and regular radiographic follow-up should be considered within a broader clinical context. Full article

The main role of panoramic radiography lies in its rapid screening capability and its ability to detect and identify bone lesions, pathologies, and tooth-bearing structures. Since panoramic radiographs are widely used, they provide a good view of the jaw bones, maxillary sinus, and temporomandibular area. However, their major limitation is the reduced ability to accurately assess bone conditions, particularly in evaluating cortical integrity or identifying subtle, nondisplaced, or greenstick-type fracture lines. Other limitations include the presence of artifacts, image distortion, magnification variability, and high sensitivity to patient and film positioning, all of which can compromise image quality and diagnostic confidence. This 2D imaging method is still used worldwide, especially by dentists; however, this type of radiograph can be unpredictable due to structural superimposition and reduced ability to clearly establish, measure, and verify the precise dimensions, boundaries, and areas occupied by selected lesions. Many patients undergo panoramic imaging to assess possible mandibular fractures after trauma or following the removal of cysts, tumors, or impacted teeth. In most cases, the occurrence of a fracture without displacement can be misjudged, omitted, or underestimated. In such cases, either cone-beam computed tomography is performed or a detailed clinical examination before or during surgery, followed by intraoperative assessment, helps identify a possible fracture line, bone bending, mandibular instability, or the potential need for simultaneous prophylactic plating during dental procedures or the use of maxillomandibular fixation. This paper presents the author’s own experience regarding the limitations of panoramic radiographs in estimating bone condition and detecting fracture lines. Therefore, it is essential to highlight the role of prophylactic (preventive) mandibular plating (PMP) or fixation and to clarify when it should be considered. Full article

Dentigerous cysts (DCs), usually linked to unerupted teeth, are the second most common odontogenic cysts. However, synchronous DCs are rarely seen in children without syndromic conditions. This study reports two cases of male children with no systemic illnesses who showed multiple cystic lesions in the jaw. Conventional treatment typically involves enucleation and tooth extraction, which can lead to significant complications, including infection, nerve damage that may cause temporary or permanent numbness, damage to nearby teeth, and, in cases of large cysts, jaw fractures—potentially impacting the child’s quality of life. A conservative decompression method was used, employing custom-made tubes to keep communication between the cystic and oral cavities, thereby lowering intracystic pressure. This approach resulted in complete healing of the lesions and successful eruption of permanent teeth, while safeguarding vital anatomical structures and avoiding more invasive surgery, with an uneventful clinical course. Additionally, 3-year postoperative orthopantomograms are presented, showing complete resolution of the lesions with no recurrence. These results demonstrate the effectiveness of decompression in treating multiple dentigerous cysts in pediatric patients, highlighting its advantages in preserving oral function and aesthetics while reducing surgical risks. Full article

Background/Objectives: Odontogenic keratocysts are benign cysts originating from remnants of the dental lamina, rarely showing peripheral (gingival) localization. In this study, we compiled data on the peripheral variant by reviewing the literature and presenting a new case to establish criteria for accurate differential diagnosis and treatment. Methods: A systematic literature review was conducted following the PRISMA flowchart, leading to the collection of existing data on peripheral odontogenic keratocyst. In addition, we present a new case of a 68-year-old female patient referred to our attention for an asymptomatic swelling of the mandible in the premolar area. Radiographic examination revealed a round radiolucency with well-defined borders located between teeth #4.3 and #4.4, surgically removed and diagnosed as a peripheral (gingival) keratocyst. Results: Including the herein described new case, 37 cases were reviewed from data literature showing occurrence in the mandible (43.2%) and maxilla (46%)—with 10.8% of cases not stated-, with an age range of 14–83 year old, recurrence rate of 12.5–13.6% (total recurrences/total cases) and median follow-up time of 19 months. Conclusions: Data from literature highlights the rarity of odontogenic keratocyst with peripheral (gingival) localization, which can be misleading for differential diagnosis, emphasizing the necessity of histopathological examination as the definitive diagnostic tool for all the cystic lesions of the jaws. The absence of pathognomonic clinical and radiological features, combined with the potential for extraosseous manifestation of odontogenic lesions with high recurrence rates, underscores the importance of complete excision to ensure proper healing and prevent recurrence of odontogenic keratocyst. Full article

Mandible cemento-osseous dysplasia (COD) can be found mostly associated with dental roots and tooth-bearing anatomical structures. A variety of odontogenic cysts and tumors might have similar appearances. A lesion in the jaw bone not associated with dental roots with a cyst-like appearance might suggest a non-odontogenic lesion, an empty bone cavity, an osseous, fibrous, or fibro-osseous lesion, or a traumatic bone cyst (TBC). A radiolucent irregular bone cavity without clear borders always requires improved diagnostics in cone-beam computed tomography (CBCT) as well as a revision and a biopsy in some cases. When there is some bone swelling and asymmetry on radiological evaluation, followed by extra-cortical spread, and the lesion has irregular borders with thickening or atypical calcifications, a biopsy should be performed. COD and TBCs can be found mostly associated with dental roots, but sometimes they are not associated with tooth-bearing jaw structures and might cause some diagnostic problems, especially if they resemble an empty radiolucent cystic-like lesion in an atypical location. Regardless of the type of lesion, a bone revision and a biopsy are important. When a sufficient amount of a sample is removed and evaluated, this can greatly improve the final diagnosis. The authors present an interesting case of a lesion accidentally found in a routine panoramic radiograph used for screening before scheduled orthodontic treatment. Full article

Background: Hospital-based data can complement registry estimates for cranio-maxillofacial (CMF) oncology, particularly in under-reported regions. We aimed to describe the institutional case-mix of CMF tumor diagnoses, standardized to ICD-10 sites, and to quantify trends using visit-normalized indicators. Methods: We conducted a retrospective, observational, single-center, hospital-based study of diagnosis-level encounters (2012–2016). Diagnoses were recoded to ICD-10 and restricted to CMF sites (lip, oral cavity, major salivary glands, oropharynx/hypopharynx, nasal cavity/middle ear, paranasal sinuses, eye/adnexa). The primary indicator uses a strict CMF set (malignant CMF codes plus D00.0 and D14.1); odontogenic cysts and non-neoplastic jaw lesions (K09–K10) were excluded, while benign CMF neoplasms are reported descriptively for site distributions. Results: We identified 2729 malignant CMF diagnoses over 2012–2016, peaking in 2014 (n = 751) and lowest in 2016 (n = 367). The combined malignant rate (per 1000 total visits) was 30.6, 43.9, 52.6, 34.4, and 26.7 for 2012→2016. The proportion of malignancies within the strict CMF set was 99.2%, 97.3%, 97.9%, 96.8%, and 95.1%, respectively (overall 97.4%). The most frequent malignant sites cumulatively were the palate (n = 416), parotid gland (n = 376), floor of mouth (n = 344), gingiva (n = 282), and mouth, unspecified (n = 179). Conclusions: After ICD-10 recoding and restriction to CMF sites, malignant tumors predominated within the institutional, diagnosis-level case-mix, with a 2014 peak followed by a decline. These indicators are case-mix monitors and not population incidences; interpretation should consider coding practices and service-mix changes across years. Full article

The jaw bones can manifest various cysts and tumors of different origins and etiologies. Any bone lesions lacking any potential odontogenic origin might require more accurate diagnostics, adequate investigation, and careful patient anamnesis. In cases of sharply demarcated radiolucency or mixed radiolucent–radiopaque radiological appearance lesions, they can sometimes extend between the displaced tooth roots or cause their resorption. The scope of cortical bone in radiographic studies might have a different status, and lesions can spread outside of the bone. If no odontogenic feature is present, an additional blood examination for bone markers and calcium–phosphate markers is useful to establish any endocrine-related pathologies. In the primary hyperparathyroidism (PHP), bone blood markers and bone scintigraphy are very useful to establish the possible occurrence of brown tumor. On the other hand, in central giant cell granuloma (CGCG), only a direct tumor lesion biopsy might confirm the diagnosis, where in microscopic evaluation, mostly fibroblasts and secondary cells have multinucleated giant cells along with some accessory cells like macrophages, dendrocytes, and other endothelial cells. Because both lesions can have similar clinical and radiological appearances and unclear borders, with different shapes, sizes, and symptoms, it is quite important to compare both clinical and radiological patient characteristics. The authors aim to present how radiological studies alone can easily lead to lesion misdiagnosis. They also aim to emphasize how local treatment methods without advanced microsurgical reconstruction can, in some cases, improve patient outcomes. Full article

Gorlin-Goltz syndrome (GGS) is also known as Nevoid basal cell carcinoma syndrome (NBCCS). In the most common manifestation, GGS is diagnosed based on multiple cysts in the jaw bones, namely OKCs (odontogenic keratocysts). Other features might include major and minor clinical and radiological criteria to confirm this syndrome. Quite commonly, BCCs (basal cell carcinomas), bifid ribs, palmar and plantar pits, and ectopic calcification of the falx cerebri can be found in the majority of patients. Currently, the mutation of the PTCH1 gene seems to be responsible for GGS occurrence, while the male-to-female ratio is 1:1. The following radiological study based on OPGs and CBCT confirmed multiple cystic lesions in jaw bones, confirmed to be OKCs in the histopathological evaluation with an occurrence of numerous skin BCC lesions. In cases of most oral OKC cystic lesions, either surgical removal, curettage, or enucleation with or without any bone grafting can be used with a good amount of success. Rarely, some stable bone osteosynthesis procedures have to be carried out to avoid pathological bone fractures after cyst removal. A special consideration should include the temporomandibular joint. TMJ surgery and the replacement of the joint with an alloplastic material can be performed to improve biting, chewing, proper mouth opening, and maintain good patient occlusion. The authors want to present how effective and simple a standard dental panoramic radiograph combined with CBCT is and how it is suitable for GGS detection. They also want to underline how a standard TMJ prosthesis can be used as an alternative to a custom-made prosthesis. Full article

Background/Objectives: Odontogenic cysts are pathological cavities lined by cells arising from odontogenic epithelial cells, occurring mostly on the tooth-bearing areas of the jaws. It is common to find that the apices of the teeth around the cyst are within the cyst’s cavities due to its expansion. This study aims to assess the outcome of cyst enucleation on the associated teeth, specifically the latter’s responsiveness after cyst enucleation. Methods: This retrospective study examined a sample of patients who had been previously treated for odontogenic cysts from 1 January 2000 to 31 December 2021. A list of patients was obtained and included whether they met the imposed inclusion criteria. The data collected included the patients’ preoperative and postoperative electric pulp testing readings and their timings. Results: In total, 77 individual teeth from 19 patients were included after meeting the inclusion/exclusion criteria. Overall, 57 out of the 77 (74%) teeth were responsive following long-term follow-up. Among the 57 teeth with a positive response, 8 teeth were initially non-responsive and regained their responsiveness after a period of time. Pulp responsiveness recovery was seen even 300 days after surgery. Conclusions: It is not certain that a tooth with apices involved in a cyst cavity will be non-vital following enucleation. It is recommended that these teeth be reassessed for a minimum of 10 months postoperatively before proceeding with root canal treatment. Full article

This case study highlights the use of cinematic rendering (CR) in preoperative planning for the excision of a cyst in the oral and maxillofacial region of a 60-year-old man. The patient presented with a firm, non-tender mass in the right cheek, clinically suspected to be an epidermoid cyst. Conventional imaging, including dental magnetic resonance imaging (MRI) protocols, confirmed the lesion’s size, location, and benign nature. CR reconstructions, combining advanced algorithms and novel skin presets, allow for the generation of highly realistic, three-dimensional visualizations from conventional imaging datasets. CR provided an enhanced, detailed depiction of the lesion within its anatomical context, significantly improving spatial understanding for surgical planning. The surgical excision was performed without complications, and histological analysis confirmed the diagnosis of a benign epidermoid cyst with no evidence of dysplasia or malignancy. This case demonstrates the potential of CR to refine preoperative planning, especially in complex anatomical regions such as the face and jaw, by offering superior visualization of superficial and deep structures. Thus, the integration of CR into clinical workflows has the potential to lead to improved diagnostic accuracy and better surgical outcomes. Full article