Limited evidence for use of bone substitutes in treating jaw cysts

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Jaw cysts are common in the maxillofacial area. Enucleation of the cyst and primary watertight closure has been a preferred approach but in recent decades a range of agents have been used. The aim of this review was to compare  the outcomes of simple enucleation and closure in comparison to the use of bone substitutes.

PubMed and Medline and the reference lists of included article were searched. The authors included clinical and preclinical studies with a sample size of N≥5 .The main focus was on data regarding complication rates and bone regeneration.

The overall number of studies included in the review is not provided and the authors presented a qualitative summary of included studies grouped as follows:-

  • Enucleation and primary closure (cystectomy)  without any additional bone substitutes
  • Additional bone substitutes
  • Autologous grafts
  • Allogenic grafts
  • Xenogenic grafts
  • Alloplastic synthetic grafts

They summarised their finding as :-

 Simple cyst enucleation and blood clot healing show low complication rates and sufficient bone regeneration even in large defects. Prospective randomized trials comparing the additional use of filling materials to the “cystectomy” are rare. Currently available data do not indicate the superiority of additional bone grafts.

Concluding that :-

  Enucleation of jaw cysts and primary closure without bone substitutes remains “state of the art” in most cases.

Ettl T, Gosau M, Sader R, Reichert TE. Jaw cysts – Filling or no filling after enucleation? A review. J Craniomaxillofac Surg. 2011 Sep 2. [Epub ahead of print]PubMed PMID: 21890372.

 

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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