Case #7

A 27-year-old female visited a dental office for a routine check-up and prophylaxis. Radiographic examination revealed a mixed radiolucent-radiopaque lesion in the maxillary incisor area.

A 27-year-old female visited a dental office for a routine check-up and prophylaxis. Radiographic examination revealed a mixed radiolucent-radiopaque lesion in the maxillary incisor area.

Joen Iannucci Haring, DDS, MS

History

The patient denied any history of signs or symptoms associated with the maxillary incisor region. The patient appeared to be in a general good state of health with no significant medical history. The patient`s dental history included regular dental examinations and routine dental treatment. At the time of the dental appointment, the patient was not taking medications of any kind.

Examinations

The patient`s vital signs were all found to be within normal limits. Examination of the head and neck region revealed no enlarged or palpable lymph nodes. Examination of the oral soft tissues revealed no unusual findings, no bony abnormalities were noted, and no tooth anomalies were present.

After a thorough clinical examination, selected periapical films, four bite-wing radiographs, and a panoramic film were ordered. Examination of the maxillary incisor periapical radiograph revealed a mixed radiolucent-radiopaque lesion between the roots of teeth 9 and 10 (see radiograph).

Following the radiographic examination, the teeth adjacent to the lesion were pulp tested for vitality with an electric pulp tester; all teeth tested vital. No expansion or bony changes were noted in the area of the lesion.

Clinical diagnosis

Based on the clinical and radiographic information available, which of the following is the most likely diagnosis?

* lateral periodontal cyst

* central ossifying fibroma

* calcifying odontogenic cyst

* odontoma

* ameloblastoma

Diagnosis

__ calcifying odontogenic cyst

Discussion

The calcifying odontogenic cyst (COC), also known as the Gorlin cyst, is an uncommon lesion of the jaws. Although most experts classify this lesion as a cyst, some prefer to classify it as a neoplasm.

Clinical features

The calcifying odontogenic cyst occurs over a wide age range, and the average age of the affected individual is 33. There is no sex predilection. The calcifying odontogenic cyst occurs with equal frequency in the maxilla and mandible and 65 percent of cases involve the incisor and canine areas.

The calcifying odontogenic cyst is seen in association with an impacted tooth in one-third of the reported cases. Impacted canines are most often involved. The teeth adjacent to this lesion are vital.

The typical calcifying odontogenic cyst measures 2 to 4 centimeters in diameter, although lesions 12 centimeters in diameter have been identified. The smaller lesions are asymptomatic and are usually discovered during routine radiographic examination. The larger lesions may cause a painless swelling and expansion of bone; root resorption and divergence of adjacent teeth may occur.

Radiographic features

The calcifying odontogenic cyst is readily detected on a periapical or panoramic radiograph. When viewed on dental radiographs, the calcifying odontogenic cyst typically appears as a well-circumscribed unilocular radiolucency. This lesion may appear as a radiolucency or as a radiolucency mixed with irregular shaped radiopacities. The degree of radiopacity varies depending on the amount of calcification present.

Diagnosis

A biopsy is necessary to establish the diagnosis of a calcifying odontogenic cyst. The lesion cannot be diagnosed from a radiograph alone. Microscopically, the lesion exhibits en epithelial cyst lining with ghost cells and calcified material.

Treatment

The treatment for the calcifying odontogenic cyst is enucleation. Because the lesion is well-defined, enucleation is relatively easy. The prognosis for an individual with a calcifying odontogenic cyst is very good, and this lesion is unlikely to recur following removal. In addition, there is no evidence of malignant potential.

Joen Iannucci Haring, DDS, MS, is an associate professor of clinical dentistry, Section of Primary Care, The Ohio State University College of Dentistry.

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