Incorporating Moldable Demineralized Dentin Matrix into Treatment for a Jaw Cyst

Abstract

The enucleation procedure is a standard treatment for jaw cysts; however, it often results in post-operative bony defects. These defects can lead to serious complications such as the risk of pathologic fracture and delayed wound healing, especially in the case of large cysts where there may be soft tissue dehiscence. Even in the case of smaller cysts, most cystic defects remain visible on postoperative radiographs and can be mistaken for cyst recurrence during follow-up periods. To avoid such complications, the use of bone graft materials should be considered. While autogenous bone is the most ideal graft material as it can be regenerated into functional bone, it has limitations due to the inevitable harvesting surgery. Many tissue engineering studies have been conducted to develop substitutes for autogenous bone. One such material is moldable-demineralized dentin matrix (M-DDM), which can aid in regeneration in cases of cystic defects. This case report highlights a patient who demonstrated the efficacy of M-DDM in bone healing for filling the cystic defect.

Keywords: bone graft surgery; connective tissue graft; demineralized dentin matrix; dentistry; fistula closure.

Figure 1

Initial panoramic X-ray. Pre-operative radiographs revealed a cystic lesion on the left anterior maxilla, and there were two teeth to be extracted: right maxillary first molar and left maxillary third molar, respectively.

Figure 2

Pre- and intra-operative images. Pre-operative radiographs showed a cystic lesion on the left anterior maxilla and dehiscence of the palatal bone. (A) Panoramic X-ray, (B) Sagittal section of CBCT, (C) Axial section of CBCT. (D–G) Intra-operative images. (D) Bone defect with bucco-palatal bony dehiscence after the enucleation of cyst and apicoectomy procedure on the left maxillary lateral incisor. (E) After hydration of M-DDM according to the manufacturer’s instruction, M-DDM obtained a high viscosity that could mold its shape. (F) M-DDM was grafted into the cystic defect. (G) Primary closure with 4-0 vicryl.

Figure 3

Postoperative images. (A) After one week, M-DDM was observed to have been successfully grafted onto the cystic defect in the area of cortical bone loss (arrowhead) and on the alveolar bone above the maxillary left lateral incisor (arrow). (B) M-DDM had healed into the cortico-cancellous complex, resulting in intact bucco-palatal cortical bone (arrowhead) and a significant increase in the thickness of the buccal alveolar bone around the maxillary left lateral incisor (arrow). (C) The axial view of CBCT also showed bone healing with cortical lining on both bucco-palatal contour (arrow). (D) The soft tissue around the maxillary left lateral incisor showed intact healing with sufficient volume.