Novel recurrence risk stratification of odontogenic keratocysts: A systematic review

• Published in: Oral diseases 2022-10, Vol.28 (7), p.1749-1759
• Main Author: Titinchi, Fadi
• Format: Article
• Language: English
• Subjects: basal cell nevus syndrome; clinico‐pathological conference; Dentition; keratocysts; odontogenic cysts; recurrence; Systematic review; Teeth
• ISSN: 1354-523X; 1601-0825
• DOI: 10.1111/odi.13931

The aim of this study was to identify all clinical, radiological, histopathological, and immunohistochemical features associated with recurrence of odontogenic keratocysts (OKCs) in the literature and formulate a recurrence risk stratification based on these findings. A search was performed in PubMed/Medline, Scopus, Web of Science, Google Scholar and Cochrane databases for clinical and laboratory studies reporting on clinico‐pathological features that led to OKC recurrences for the period 2000 to 2020. Twenty‐three studies were identified and analyzed qualitatively. A total of 2064 OKCs were included of which 439 OKCs were recurrent with a mean follow‐up period of 46.7 months. Significantly associated parameters with OKC recurrence included age (variable age categories), large (>4 cm), multilocular lesions with cortical perforation, association with dentition, presence of daughter cysts, and epithelial budding. Immunohistochemical markers including high Ki67 index and AgNOR count were also implicated. A recurrence risk stratification was formulated based on these findings. Although the level of evidence from the included studies was low, there was considerable evidence that the clinico‐pathological parameters identified were linked with higher OKC recurrence. The surgeon, radiologist, and pathologist should aim to identify these features when making a diagnosis so as to determine the appropriate management regime and prevent recurrences.