Thank you for giving us the chance to respond to Ide and colleagues’ comments about our article, “Eruption of an impacted canine in an adenomatoid odontogenic tumor treated with combined orthodontic and surgical therapy.” These comments on our research made us search for more data and further clarify some aspects of our research.
Most of the articles on adenomatoid odontogenic tumor (AOT) are case reports, and research studies are fewer. Although there is no consensus for the treatment of AOT, the most common treatment option is enucleation and curettage. We read the articles that Ide et al cited in their letter, and we have seen that in these documented orthodontic treatments for AOT, the authors preferred total excision of the tumor and preserved the teeth. Ide et al also mentioned a report of subtotal excision (marsupialization) with eruption of the teeth. The subtotal excision they mentioned is not true marsupialization. In textbooks, the marsupialization process is described as creating a surgical window in the wall of the cyst, draining the contents, and maintaining continuity between the cyst and the oral cavity. The remaining cystic epithelium is left in situ. This procedure decreases cystic pressure and promotes contraction of the cyst and bone fill.
The marsupialization that we wanted to describe as a treatment option was different. We opened a bone window on the upper side of the tumor. The upper part of the lesion was excised from the bone window border, the inside of the lesion was irrigated, and after recognizing the crown of the teeth, surrounding area was filled with antibiotic gauze. The socket was irrigated with saline solution, and the antibiotic gauze was replaced every other day for 1 week. An obturator was inserted in the window of the lesion, and irrigation was done for 4 months. This technique is usually used for benign cystic lesions.
Although our claim that this case report is the first to report on the eruption of an impacted canine in an AOT treated with combined orthodontics and marsupialization might be controversial, we believe it is not wrong. We think that the marsupialization technique that is used for benign cystic lesions with protection of the involved teeth can be a treatment option for AOT.
Various terms have been used before to describe this tumor, including adenoameloblastoma, ameloblastic adenomatoid tumor, adamantinoma, epithelioma admentinum, and teratmatous odontoma. In 1971, the World Health Organization made the classification of odontogenic tumors and adopted “AOT” as the term for this tumor, which was coined before.
As a result, our success may pave the way for marsupialization for the management of AOT with orthodontic treatment. Further clinical studies are necessary to validate its clinical indications for the management of AOT treatment.
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