Management of a Mandibular Odontogenic Keratocyst with Enucleation, Piezotome-Assisted Peripheral Ostectomy, and Platelet-Rich Fibrin-A Case Report.

BACKGROUND/OBJECTIVES: Odontogenic keratocyst (OKC) is a benign yet locally aggressive intraosseous lesion with a high recurrence rate, posing significant challenges for clinical management. This present case report describes a combined surgical management approach for an OKC, involving enucleation with piezotome-assisted peripheral ostectomy, followed by adjunctive application of platelet-rich fibrin (PRF) to the osseous defect. METHODS: A 54-year-old patient presented with a mandibular unilocular radiolucency that was diagnosed histopathologically as an OKC. The lesion was managed using a combined surgical approach involving enucleation and peripheral ostectomy with a piezotome. To optimize healing, PRF was applied to the bone defect. RESULTS: At 18- and 36-month follow-up, the patient demonstrated complete postoperative bone remodeling of the cystic bone defect, with no evidence of recurrence. CONCLUSIONS: This case highlights the low morbidity associated with enucleation and piezotome-assisted peripheral ostectomy, which may be preferable to other aggressive OKC treatment modalities in selected cases. Additionally, PRF use was associated with favorable postoperative healing, with minimal pain, swelling, and inflammation. Radiographic stability at 36 months supports the feasibility of this approach; however, larger studies are needed to compare recurrence risk with other interventions.