# Fresh-Frozen Allogenic Bone Graft Usage in Treatment of an Odntogenic Keratocyst in the Mandible
## 2 Case Description
(11) If the patient decides on future dental implant rehabilitation, there is a necessity to improve the bone volume. After considering all of the following topics, a decision was made for GA with GBR. Before the patient was scheduled for oral hygiensation, a necessary evaluation for any active caries/periodontitis and secondary estimation of the vitality of anterior teeth in the mandible was scheduled. The surgery took place under GA and nasotracheal intubation. Presurgical antibiotics included Kefzol 2g (Cefazolin, 1 st class, Sandoz Poland, Warszawa, Poland) with 12 h prior to surgery Frazyparine 5700 IU AXA/0.6 mL prophylaxis (low molecular weight heparin-LMWH) (Mylan, Viatris, Canonsburg, PA, USA). Similar to the biopsy, the 0.1% CHX (chlorexidine gluconate) (Eludril, Pierre-Fabre Oral care, Paris, France) local solution was used. Additionally, the lips and skin surrounding the operating field were scrubbed with FrontOral (BRAUN, Hessen, Melsungen, Germany). [PERSON] sterile Vasculine (Unilever, England) cream was applied to the lips. A local injection of mixed 0.25% solution that consisted of Marcaine-Adrenaline 0.5% (AspenPharma, Braine-I'Alleud, Belgium) with a mixture of Natrium Chlorate 0.9% (Natrium Chloratum 0.9% Fresenius KabiClear, Bad Homburg vor der Hohe, Germany) was used. Before the incision teeth, 41, 31-35 had been removed. Because of their stable position in the alveolar socket and their proper vitality, tooth 42 and tooth 43 were kept. A blade No 15c B ([PERSON], [PERSON], Owlerton Grn, Hillsborough, Sheffield, England) was used for the incision. A modified gingival (envelope) incision through the sockets of removed teeth, followed by two oblique semi-vertical release inisions at the point of 42 and 36, descend far inferiorly from the mucogingival junction towards the alveolar mucosa. Full-thickness mucogeriosteal flaps were raised with Obwegeser Periosteal elevators (Obwegeser 38-630-06-07-38-630-11-07 17.5 cm/6 7/8'', [PERSON], Tuttlingen, Germany) and Obwegeser Soft Tissue Retractor (Obwegeser 38-603-40-07, [PERSON], Tuttlingen, Germany). The entire anterior and left portion of the mandible was exposed. A very thin labially expanded cortical bone with walls dehiscence because of a cyst spread outside of the bone was noted[PERSON] The right mental nerve was exposed, while the left one was [PERSON] into the lesion. The cystic cavity was filled with enormous amounts of keratin mass. An additional bacterial specimen was taken to investigate any possible bacteria present within the lesion. An additional lingual mucoperiosteal flap was raised to improve visualization of the entire cystic cavity. Bone debridement with curettage was performed. The left mental nerve was carefully separated from the cystic mass, along with the left IAN, and their continuity remained good. The additional osteotomy of the entire cavity was done with the usage of Lindeman burr and pear-shaped surgical burr (Aesculap AG, Tuttlingen, Germany). Because the inferior border of the mandible was intact (no pathological fracture as well), along with the lingual wall, there was no necessity for any additional titanium miniplate usage to improve bone stability. The part of the gingival mucosa covering the bone perforation was cut out. The entire bone defect was rinsed with NaCl 0.9% solution Natrium Chloratum 0.9% Fresenius KabiClear, Bad Homburg vor der Hohe, Germany). A secondary osteotomy was performed in the area near the separated nerves, the lingual plate, and within close proximity to the 36 and 42 teeth. The oral cavity was packed with sterile gauze 10 \(\times\) 10 cm (KOMPRI lux S, Zarys Internationa Group, Zabrze, Poland). Following that, a mixture 1:20 solution consisting of Betadine (Braunol, povidonum iodinatum, BRAUN, Hessen, Melsungen, Germany) and -NaCl0. Hoe, Germany) was used to rinse the defect ones again. After careful preparation of the field, 20 mL fresh-frozen bone (FFB) from the bone bank (RCKiK, Katowice, Poland) was first rinsed with 10 mL of NaCl 0.9%.