Oral Radiology

, Volume 34, Issue 3, pp 251–256 | Cite as

CBCT-based bone quality assessment in decompression of large odontogenic cystic lesions

  • Ling GaoEmail author
  • Wenhao Ren
  • Shaoming Li
  • Jingjing Zheng
  • Lingfa Xue
  • Yaoxiang Xu
  • Qibo Wang
  • Jianzhong Song
  • Zhichao Dou
  • Minzhan Zhou
  • Wenlin Xiao
  • Keqian ZhiEmail author
Original Article



Bone quality comprises bone mineral density and trabecular microstructure. The aim of this study was to explore the effectiveness of cone-beam computed tomography (CBCT) in evaluating bone quality of large odontogenic cystic lesions after decompression using CBCT and BoneJ software, and to determine whether secondary definitive surgery can be guided using CBCT data.


Twenty-seven patients with large odontogenic cystic lesions treated by decompression were evaluated by CBCT. Medical history and perioperative details were analyzed.


The \(\Delta\)CT values for all patients with cystic lesions decreased after decompression, with no differences for age, sex, and histology (p > 0.05). Bone volume fraction and trabecular number of new cancellous bone (0.012%, 0.17/mm3) were lower than those of normal cancellous bone (0.189%, 0.47/mm3) (p < 0.05), while new cancellous bone trabecular separation (11.344 ± 2.556 mm) was stronger than normal cancellous bone trabecular separation (4.833 ± 2.232 mm) (p < 0.05). There were no differences in trabecular thickness between new cancellous bone (3.812 ± 1.593 mm) and normal cancellous bone (4.598 ± 3.573 mm) (p = 0.746). The \(\Delta\)CT values of five patients with favorable osteogenesis were − 72, −86, − 86, −47, and − 55, those of three patients with moderate osteogenesis were − 107, −120, and − 71, and those of two patients with poor osteogenesis were − 165 and − 127 during secondary definitive surgery.


CBCT is considered beneficial for evaluating bone quality of large odontogenic cystic lesions after decompression, while providing potentially useful information for referral to secondary definitive surgery.


CBCT Large odontogenic cystic lesion Bone mineral density Microstructure 


Compliance with ethical standards

Conflict of interest

Ling Gao, Wenhao Ren, Shaoming Li, Jingjing Zheng, Lingfa Xue, Yaoxiang Xu, Qibo Wang, Jianzhong Song, Zhichao Dou, Minzhan Zhou, Wenlin Xiao, and Keqian Zhi declare that they have no conflict of interest.

Human rights statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Bux P, Lisco V. Ectopic third molar associated with a dentigerous cyst in the subcondylar region: report of case. J Oral Maxillofac Surg. 1994;52:630–2.CrossRefPubMedGoogle Scholar
  2. 2.
    Ziccardi VB, Eggleston TI, Schneider RE. Using fenestration technique to treat a large dentigerous cyst. J Am Dent Assoc. 1997;128:201–5.CrossRefPubMedGoogle Scholar
  3. 3.
    Pogrel MA. Decompression and marsupialization as a treatment for the odontogenic keratocyst. Oral Maxillofac Surg Clin N Am. 2003;15:415–27.CrossRefGoogle Scholar
  4. 4.
    Bataineh AB, al Qudah M. Treatment of mandibular odontogenic keratocysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86:42–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Williams TP, Connor FA Jr. Surgical management of the odontogenic keratocyst: aggressive approach. J Oral Maxillofac Surg. 1994;52:964–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Enislidis G, Fock N, Sulzbacher I, Ewers R. Conservative treatment of large cystic lesions of the mandible: a prospective study of the effect of decompression. Br J Oral Maxillofac Surg. 2004;42:546–50.CrossRefPubMedGoogle Scholar
  7. 7.
    Gao L, Wang XL, Li SM, Liu CY, Chen C, Li JW, et al. Decompression as a treatment for odontogenic cystic lesions of the jaw. J Oral Maxillofac Surg. 2014;72:327–33.CrossRefPubMedGoogle Scholar
  8. 8.
    Seeman E, Delmas PD. Bone quality—the material and structural basis of bone strength and fragility. N Engl J Med. 2006;354:2250–61.CrossRefPubMedGoogle Scholar
  9. 9.
    Cullum ID, Ell PJ, Ryder JP. X-ray dual-photon absorptiometry: a new method for the measurement of bone density. Br J Radiol. 1989;62:587–92.CrossRefPubMedGoogle Scholar
  10. 10.
    Kalender WA, Felsenberg D, Genant HK, Fischer M, Dequeker J, Reeve J. The European Spine Phantom—a tool for standardization and quality control in spinal bone mineral measurements by DXA and QCT. Eur J Radiol. 1995;20:83–92.CrossRefPubMedGoogle Scholar
  11. 11.
    Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8:1558–64.CrossRefPubMedGoogle Scholar
  12. 12.
    Doube M, Klosowski MM, Arganda-Carreras I, Cordelieres FP, Dougherty RP, Jackson JS, et al. BoneJ: free and extensible bone image analysis in ImageJ. Bone. 2010;47:1076–9.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Marker P, Brondum N, Clausen PP, Bastian HL. Treatment of large odontogenic keratocysts by decompression and later cystectomy: a long-term follow-up and a histologic study of 23 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;82:122–31.CrossRefPubMedGoogle Scholar
  14. 14.
    Pogrel MA, Montes DM. Is there a role for enucleation in the management of ameloblastoma? Int J Oral Maxillofac Surg. 2009;38:807–12.CrossRefPubMedGoogle Scholar
  15. 15.
    Reichart PA, Philipsen HP, Sonner S. Ameloblastoma: biological profile of 3677 cases. Eur J Cancer B Oral Oncol. 1995;31B:86–99.CrossRefPubMedGoogle Scholar
  16. 16.
    Yang L, Li F, Cao M, Chen H, Wang X, Chen X, et al. Quantitative evaluation of maxillary interradicular bone with cone-beam computed tomography for bicortical placement of orthodontic mini-implants. Am J Orthod Dentofac Orthop. 2015;147:725–37.CrossRefGoogle Scholar
  17. 17.
    Cortes AR, Correa L, Arita ES. Evaluation of a maxillary sinus floor augmentation in the presence of a large antral pseudocyst. J Craniofac Surg. 2012;23:e535–e7.CrossRefPubMedGoogle Scholar
  18. 18.
    Kobayashi K, Shimoda S, Nakagawa Y, Yamamoto A. Accuracy in measurement of distance using limited cone-beam computerized tomography. Int J Oral Maxillofac Implants. 2004;19:228–31.PubMedGoogle Scholar
  19. 19.
    Loubele M, Guerrero ME, Jacobs R, Suetens P, van Steenberghe D. A comparison of jaw dimensional and quality assessments of bone characteristics with cone-beam CT, spiral tomography, and multi-slice spiral CT. Int J Oral Maxillofac Implants. 2007;22:446–54.PubMedGoogle Scholar
  20. 20.
    Pinsky HM, Dyda S, Pinsky RW, Misch KA, Sarment DP. Accuracy of three-dimensional measurements using cone-beam CT. Dentomaxillofac Radiol. 2006;35:410–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Zhao Y, Liu B, Han QB, Wang SP, Wang YN. Changes in bone density and cyst volume after marsupialization of mandibular odontogenic keratocysts (keratocystic odontogenic tumors). J Oral Maxillofac Surg. 2011;69:1361–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Anavi Y, Gal G, Miron H, Calderon S, Allon DM. Decompression of odontogenic cystic lesions: clinical long-term study of 73 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112:164–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Roze J, Babu S, Saffarzadeh A, Gayet-Delacroix M, Hoornaert A, Layrolle P. Correlating implant stability to bone structure. Clin Oral Implants Res. 2009;20:1140–5.CrossRefPubMedGoogle Scholar
  24. 24.
    Hohlweg-Majert B, Pautke C, Deppe H, Metzger MC, Wagner K, Schulze D. Qualitative and quantitative evaluation of bony structures based on DICOM dataset. J Oral Maxillofac Surg. 2011;69:2763–70.CrossRefPubMedGoogle Scholar
  25. 25.
    Aranyarachkul P, Caruso J, Gantes B, Schulz E, Riggs M, Dus I, et al. Bone density assessments of dental implant sites: 2. Quantitative cone-beam computerized tomography. Int J Oral Maxillofac Implants. 2005;20:416–24.PubMedGoogle Scholar

Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Oral Maxillofacial Surgery, Key Laboratory of Oral Clinical MedicineThe Affiliated Hospital of Qingdao UniversityQingdaoChina
  2. 2.Department of ImplantologyThe Affiliated Hospital of Qingdao UniversityQingdaoChina
  3. 3.Department of StomatologyThe Affiliated Hospital of Qingdao UniversityQingdaoChina
  4. 4.Department of Oral Maxillofacial Surgery, Stomatological Hospital, College of MedicineXi’an Jiaotong UniversityXi’anChina

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