# Fresh-Frozen Allogenic Bone Graft Usage in Treatment of an Odntogenic Keratocyst in the Mandible
## 3 Discussion  
The occurrence and presence of odontogenic keratocysts (OKCs) might vary. OKC are most commonly found in the mandible and are less commonly found in the maxillary bones. Because of their local aggressive behavior, many studies on treatment modalities and approaches have been reported. OKC nomenclature is constantly changing, ranging from a cyst (odontogenic keratocyst--OKC) to an odontogenic tumor (keratocyst odontogenic tumor-KCOT). Nowadays, its proper form is OKC, as their treatment is slightly less aggressive but still mostly related to its size, localization, spread towards the cortical bone, and infiltration towards soft tissues [11; 12; 13; 14; 15]. While small bone defects might heal on their own, or sometimes require some guided bone regenerative techniques (GBR), larger ones might require a different approach. For bigger defects, it is advisable to restore bone integrity in one of the known possible methods, especially to gain faster bone healing, decrease possible pathological fracture occurrence, and improve adequate early dental implant rehabilitation. A correlation with the shape and size of OKC influences the type of approach and any possible bone reconstruction used. Secondly, if OKC is in reoccurrence or extends from a cortical layer of the bone, a more radical approach is used. Surgical resection is rarely used,  
Figure 11: Axial CBCT result after bone regeneration. Figure 12: Pre-surgical planning for dental implants. and is reserved for special cases [15; 16; 17; 18]. There are many known treatment possibilities in OKC [15; 16; 17; 18; 19; 20; 21; 22; 23]:  
* surgical enucleation;
* marsupialization followed by enucleation;
* curettage after lesion removal;
* appliance of [PERSON]'s solution fixative (it is a mixture of the following: ethanol, chloroform, and acetic acid) combined with excision and curettage;
* marsupialization, a two-step procedure to reduce the size of OKC then remove it;
* bone osteotomy after curettage and/or enucleation;
* simple excisional biopsy;
* enucleation and cryotherapy (physical method) or Carnoy solution (chemical method);
* application of 5 FU (five-fluoro-uracyl) after enucleation;
* osteotomy with high-speed bone burrs after enucleation/curettage;
* bone resection (only for reoccurrence, large bone defects, and destructions; OKC was unresponsive to treatment);
* combination of methods. After each procedure, a decision should be made on what to do with the bone cavity defect. Some authors advise that bone osteotomy improves local outcomes, while others prefer more conservative approaches. Both approaches do not yet have any consensus. Moreover, the type of surgical or conservative approach influences later possible GBR techniques if necessary. On the other hand, the type of keratinization in the OKCs walls influences its recurrence rate. Histopathological evaluation should include the type of ortho- or parakertainzation within the cyst walls, which is also related to the scope of the radical procedure. Since local aggressiveness is known and reported widely, possible reoccurrence is related to the type of OKC, possible remnants of thin layered cyst membrane or some microcsts, and epithelial islands embedded onto the bone or cyst walls. When treated with chemical or physical methods, the cavity should be easily accessible for those substances so that all of the bony walls will be exposed to Carnoy solution or other substances [20; 21; 22; 23]. Therefore, because of possible remnants of cysts within the bone cavity walls, a wide discussion focused on the best method for OKC removal. This removal is sometimes limited by some vital structures like IAN, the mental nerve, the maxillary sinus, or others [18; 19; 20; 21; 22; 23]. [PERSON] et al. 's study emphasizes that bone osteotomy has a good overall success rate [21]. Despite the method used, each bone cavity can be healed by various methods. Small lesions can be left intact to heal on their own in time, based on blood clots, if the bone cavity is tightly sutured after closure.