Krishnadevaraya College of Dental Sciences and Hospital

Aneurysmal bone cyst (ABC) is rarely a clinical diagnosis on first take; hence, data pertaining to primary ABC assists in differentiating lesions from related pathologies. The cases of primary ABCs were managed by curettage even with extensive cortical plate expansion, whereas secondary ABCs were managed according to primary pathology. The present review retrospectively studies the case reports of primary ABCs affecting the jaws, reported from the year 2000 (the time when USP6 to CDH 11 gene translocation was detected) to date, to identify cases that were diagnostically confirmed with gene analysis. Confirmed primary ABCs of jaws as defined by the World Health Organization (WHO) 2020 classification were included after a thorough literature search. In cases where gene analysis was not done, criteria considered to diagnose as primary ABC (clinical-radiological characteristics and histopathological features) were studied. Recurrence rate and prognosis were analyzed. A male predominance was noted with a ratio of 2:1. The age group between 10 and 20 years and the mandibular posterior region, followed by the temporomandibular joint (TMJ), were mainly affected. Around 22 of 33 cases showed both buccal and lingual cortical plate expansion. Blown-out cortices, fluid levels on magnetic resonance imaging (MRI) or contrast computed tomography (CT), altered blood, and the key histopathological feature of large blood-filled spaces surrounded by fibrovascular septa were the main clues for diagnosis. Around 28 of 33 cases showed giant cells, and 14 of 33 cases showed calcifications/ossifications. Recurrence was noted in 6 of 13 cases treated by curettage. A majority of primary ABCs are believed to exhibit gene mutations; however, genetic analysis was infrequently performed in the reviewed cases. Since the gene analysis may not be feasible in all cases, studies on histopathological analysis and immunohistochemical (IHC) markers to find clues for confirmatory diagnosis are in need.

The aim of the study was to evaluate and compare the cytotoxicity of 25% of neem leaf extract (Azadirachta indica), 20% of guava leaf extracts (Psidium guajava), and 20% of cinnamon extract (Cinnamomum zeylanicum) irrigants at three intervals of time.

Four groups were formed (n = 15), Group 1 (control group) – normal saline solution, Group 2 – 25% of neem extract, Group 3 – 20% of guava extract, and Group 4 – 20% of cinnamon extract. Each group was further divided into three subgroups based on intervals (n = 5). Subgroup A – at 10 min, Subgroup B – at 20 min, and Subgroup C – at 30 min. One hundred microliters of each irrigant was added to 2 mL of the diluted red blood cells suspension obtained from a human volunteer. Hemoglobin (Hb) estimation was done with an automated hematology analyzer after incubating the test samples at 10, 20, and 30 min intervals.

The reduction in the mean Hb values was not statistically significant in the normal saline, guava, and cinnamon groups. However, in the neem extract group, the mean Hb values reduced significantly at P < 0.001. Among the subgroups, Subgroup A (10 min) showed the least cytotoxicity.

In the present study, 20% guava extract had the lowest cytotoxicity and cytotoxicity increased with time. Hence, 20% guava extract can be used as an alternative to conventional irrigants as it has been shown to have the least cytotoxicity.