Radiographic reduction following decompression of a dentigerous cyst and an odontogenic keratocyst: A comparative...

Odontogenic cysts are well-known maxillofacial pathologies with variable biological behaviour. Decompression has been widely used as a conservative, structure-preserving management strategy. This report presents a radiographic comparison of reduction patterns following decompression in two individual cases, one dentigerous cyst and one odontogenic keratocyst. Two patients presenting with cystic jaw lesions - one detected during radiographic investigation and the other presenting with progressive swelling - were managed using decompression as the initial treatment. Standardised radiographic measurements were performed, and the Standard Lesion Area Index and Percentage of Reduction were calculated at serial follow-up intervals. The dentigerous cyst demonstrated gradual reduction, achieving 94.4% shrinkage at 12 months and complete radiographic resolution by 44 months, with no radiographic evidence of recurrence. In contrast, the odontogenic keratocyst showed a more rapid initial reduction, with 58% shrinkage at 5 months, followed by a plateau at approximately 90% shrinkage by 24 months and radiographic evidence of recurrence at 44 months. Direct long-term radiographic comparison of dentigerous cyst and odontogenic keratocyst reduction following the same decompression protocol remains limited in the published literature. The literature synthesis indicated that decompression typically requires 8 to 24 months, with dentigerous cysts generally demonstrating more favourable radiographic responses than odontogenic keratocysts. Decompression and marsupialisation are non-definitive approaches, as definitive management requires subsequent enucleation of the lesions. These case-based observations suggest that decompression may be sufficient for selected dentigerous cysts, whereas odontogenic keratocysts require prolonged monitoring and are more likely to necessitate secondary surgical intervention. The findings should be interpreted cautiously in view of the very small number of cases.