# Fresh-Frozen Allogenic Bone Graft Usage in Treatment of an Odntogenic Keratocyst in the Mandible
###### Abstract  
There are many cysts and tumors which might occur in the mandibular and maxillary bones. Their origin can be either odontogenic or non-odontogenic. One of the most common odontogenic cysts is the odontogenic keratocyst (OKC). Its nomenclature and classification have changed many times over years, from a tumor to, finally, a cyst. Nowadays, its treatment has not greatly changed, however, it is related to a potential recurrence rate more than any other cyst of odontogenic origins. OKC size, localization, and possible cortical expansion towards adjacent soft tissues might influence the scope of treatment and possible reoccurrence in time. Each case is quite individual, and after removal of the pathology in some cases there can be a necessity for either bone grafting or any other reconstruction method to restore proper bone continuity. The size and the placement of OKC might influence pathological fracture occurrence or inappropriate healing if the bone cavity after cyst removal is not properly treated. A good healing potential can be achieved with xenograft bone substitutes or allograft fresh-frozen bones. On rare occasions, a titanium plate is used to ensure mandibular stability. In the following case report, an atypical case of a large OKC treated with fresh-frozen bone grafts, supported with collagen barrier material in the anterior mandible with buccal cortical expansion, will be presented. 27 December 20227 December 20  
to grow in the buccolingual diameter, while in the maxillary bones they often grow towards the maxillary sinuses. When present, typical unilocular characteristics might mostly be found. In some cases, multiple OKC (3-10%, the syndromic OKC) are present within the jaw bones. In those particular cases, a basal cell nevus syndrome (nevoid basal cell carcinoma syndrome) should be considered (NNCCS, Gorlin-Goltz syndrome, GGS) [6; 7]. The presence of NBCCS is associated with some genetic coincidence of the patched (PTCH) tumor-suppressor gene. This syndrome is related to the inherited autosomal dominant disorder, which was first described by [PERSON] and [PERSON] in 1960 [6; 7]. OKCs are most commonly found in the 2 nd-3 rd and 6 th decade of life associated with impacted or not mandibular 3 rd molar teeth. A slight male predominance is noted [6; 7; 8; 9]. Its occurrence was related to the presence of dental lamina (odorogenic epithelium) in the alveolus margin in the mandible left from the stages of teeth development. The Serre's remnants and epithelial cell rests (stratified squamous keratinizing epithelium) seem to be most related with OKC occurrence [5; 6; 7; 8; 9; 10]. Because most OKCs grow asymptomatically, they are found accidentally on routine panoramic radiographs. OKC commonly tends to be a cystic or polycystic lesion with clear borders. Its size and shape may vary. On a routine panoramic radiograph (pax), OKC has a characteristic solitary, radiolucent, unilocular, well-defined, expansile lesion with smooth, correlated borders if no cortical expansion is present. It might often be associated with impacted or displaced teeth, mimicking a dentigerous cyst or eruption cyst. They can rarely appear and cause some resorption of tooth apexes or form some mineralized septa within the cyst cavity, which might create more aggressive behavior and mimic ameloblastoma. Cortical expansion is not common or characteristic of OKC but might be considered a radiological sign of local aggressiveness. Occasionally, OKC can be present as a cyst-like lesion, similar to a dentigerous cyst, while rarely it can be more of an expansile solitary unilocular characteristic. Their relationship with dental roots can differentiate from periapical cysts [10; 11; 12; 13; 14]. Some reports describe cases when, during their growth, OKC displaces teeth towards the mandibular angle or within the maxillary sinus.