Conservative surgical approach for mandibular odontogenic keratocyst associated with guided tissue regeneration: a case report

Resumen

Odontogenic keratocyst (OKC) is a cystic lesion with locally aggressive behavior and high recurrence rates, making treatment decisions complex. Conservative approaches have been proposed to preserve oral structures; however, few cases have reported their association with bone reconstruction. This report describes a pediatric case of extensive mandibular OKC managed conservatively with associated bone regeneration. An 11-year-old female patient presented with a radiographic finding of an extensive asymptomatic intraosseous lesion in the right mandible. Incisional biopsy and decompression device placement were performed, with initial diagnosis of dentigerous cyst. After six months, the device was replaced by a smaller one to promote bone neoformation. Nine months later, a second surgery was performed with device removal, extraction of teeth 47 and 48, and lesion enucleation. Histopathology confirmed OKC. At 28 months postoperatively, recurrence adjacent to the right first molar was detected, and a new conservative procedure was carried out, incorporating bone grafting with sticky bone. The patient was followed up for six months, showing absence of recurrence and graft healing. Despite initial misdiagnosis and multiple surgeries, conservative management preserved the stomatognathic system and avoided ablative procedures. Postoperative follow-up enabled early detection of recurrence and timely intervention associated with bone reconstruction.