The significance of recurrent odontogenic keratocysts in bone grafts

A comprehensive literature review identified 10 reported cases of recurrent odontogenic keratocysts (OKCs) in bone grafts. Seven of them were sufficiently documented for further analysis. All except one of the patients had a long history of repeated recurrences. They were all approached via an extraoral route, avoiding a mucosal perforation, when the bone graft was placed after a segmental resection. In three cases, this was also true for the primary treatment. The origin of the recurrences is considered to be the oral mucosa, almost certainly involving the proliferation of epithelial islands or microcysts that were close to the original OKC. A plea is made to avoid segmental or marginal resections for this lesion and to pay attention to possible epithelial islands/microcysts in the overlying attached mucosa in the case where marsupialization is preferred.