Section of Periodontics, UCLA School of Dentistry, Los Angeles, California.
Private Practice Limited to Periodontics and Dental Implants, Poway, California.
Clin Adv Periodontics. 2023 Jun;13(2):77-83. doi: 10.1002/cap.10159. Epub 2021 Apr 13.
Odontogenic fibroma is a rare benign neoplasm of mature fibrous connective tissue with variable amounts of inactive-looking odontogenic epithelium. Few recurrences of central odontogenic fibroma (COF) have been reported in the literature. This manuscript reports the enucleation of a recurrent COF and bone regeneration of the osseous defect with enamel matrix derivative and bone allograft.
A 28-year-old Asian female presented in 2015 with a palatal depression between #10 and 11. The patient previously had an odontogenic fibroma between #10 and 11 removed in 2008. Cone beam computed tomographic evaluation revealed a well-defined, multiloculated radiolucency centered between #10 and 11 that extended from #9-12, and from the alveolar crest to the anterior border and floor of the maxillary sinus. The lesion resulted in splaying of the roots of #10 and 11, external root resorption on #10, loss of crestal and palatal bone cortices, and thinning of labial cortex between #10 and 11. The patient was referred to an oral surgeon for biopsy, and the lesion was diagnosed as odontogenic fibroma. The lesion was enucleated. Enamel matrix derivative was applied to the affected teeth and defect, which was subsequently grafted with bone allograft. At the 5-year follow-up, bone was regenerated to the midroot of #10 and coronal third of #11, with reestablishment of crestal and palatal bone cortices.
CONCLUSION(S): Enucleation of COF and regeneration of the osseous defect with enamel matrix derivative and bone allograft appear to be a viable treatment approach that allows for preservation of contiguous teeth. Why is this case new information? This appears to be the first publication to report on bone regeneration following enucleation of a recurrent odontogenic fibroma. What are the keys to successful management of this case? Graft material provided space maintenance and a scaffold for bone regeneration. What are the primary limitations to success in this case? Loss of the labial bone resulted in a through-and-through defect between 10 and 11 that limited the amount of vertical bone regeneration.
牙源性纤维瘤是一种罕见的良性肿瘤，由成熟的纤维结缔组织和数量不等的静止型牙源性上皮组成。文献中报道中央性牙源性纤维瘤（COF）的复发较少。本文报告了一例复发 COF 的剜除，并使用 enamel matrix derivative 和骨移植物进行骨再生以修复骨缺损。
一位 28 岁的亚洲女性于 2015 年因 10 号和 11 号牙之间的牙槽骨凹陷就诊。该患者曾于 2008 年因 10 号和 11 号牙之间的牙源性纤维瘤而接受治疗。锥形束 CT 评估显示，10 号和 11 号牙之间有一个界限清楚的多房性透光区，从 9-12 号牙延伸，从牙槽嵴到上颌窦的前壁和底部。该病变导致 10 号和 11 号牙的牙根分叉，10 号牙的牙根外部吸收，牙槽嵴和腭骨皮质丧失，以及 10 号和 11 号牙之间的唇侧皮质变薄。患者被转诊给口腔外科医生进行活检，病变被诊断为牙源性纤维瘤。病变被剜除。将 enamel matrix derivative 应用于受影响的牙齿和缺损部位，并用骨移植物进行移植。在 5 年的随访中，10 号牙的根中部和 11 号牙的冠部的骨质得到了再生，牙槽嵴和腭骨皮质得以重建。
中央性牙源性纤维瘤的剜除和使用 enamel matrix derivative 和骨移植物进行骨再生似乎是一种可行的治疗方法，可以保留相邻的牙齿。为什么这个病例是新信息？这似乎是第一篇报道牙源性纤维瘤复发后骨再生的文献。成功治疗这个病例的关键是什么？移植物材料为骨再生提供了空间维持和支架。这个病例成功的主要限制是什么？唇侧骨的丧失导致了 10 号和 11 号牙之间的贯穿性缺损，限制了垂直骨再生的量。
