Selective regenerative management of jaw bone defects after cystectomy of odontogenic cysts: An ambispective cohort study

Аннотация

Objectives: To evaluate the clinical and radiological effectiveness of a selective, defect-based regenerative protocol for jaw bone defects after cystectomy of non-keratocystic odontogenic cysts.

Methods: This single-centre ambispective cohort study included 124 consecutive patients treated between 2019 and 2025. The control group (n = 58) underwent cystectomy with blood-clot healing and primary closure. The protocol group (n = 66) received defect-based reconstruction: advanced platelet-rich fibrin (A-PRF) for contained defects <2 cm³, a bone substitute with PRF for defects of 2–5 cm³, and guided bone regeneration with a resorbable collagen membrane and PRF for defects >5 cm³, cortical perforation or planned implant sites; giant cysts underwent preliminary decompression. The primary outcome was volumetric defect reduction on cone-beam computed tomography (CBCT) at 6 months.

Results: Volumetric reduction at 6 months was 74.8 ± 15.6% in the protocol group versus 58.9 ± 17.4% in controls (p < 0.001), and at 12 months 91.3 ± 8.9% versus 83.7 ± 12.1% (p < 0.001). No benefit was observed for defects <2 cm³ (p = 0.34), whereas the largest benefit was seen for defects >5 cm³ (87.6 ± 9.8% vs 74.2 ± 13.6%; p = 0.001). Postoperative infection decreased from 13.8% to 3.0% (p = 0.044).

Conclusions: Selective, defect-based regeneration accelerated bone healing and reduced infection compared with blood-clot healing, mainly in medium and large or wall-deficient defects. Small contained defects healed comparably without reconstruction; therefore, routine filling of every post-cystectomy cavity is not justified.

Ключевые слова: Bone regeneration; Cone-beam computed tomography; Cystectomy; Guided bone regeneration; Odontogenic cyst; Platelet-rich fibrin