Comparison of Curettage and Active Surveillance in the Treatment of Idiopathic Bone Cavities of the Jaw.

BACKGROUND

Idiopathic bone cavities (IBCs) of the jaw may resolve spontaneously, creating controversy over optimal management (curettage vs active surveillance).

PURPOSE: The purpose of this study was to compare lesion control and radiographic bone fill outcomes between curettage and active surveillance for IBCs of the jaw.

STUDY DESIGN, SETTING, SAMPLE: Ambispective cohort study of IBC subjects treated at Peking University School of Stomatology (2008 to 2024).

EXCLUSION CRITERIA: involvement of carious or root canal-treated teeth, use of bone grafts (operative group), or incomplete clinical or imaging data.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The predictor variable was therapeutic approach, grouped into curettage and active surveillance.

MAIN OUTCOME VARIABLE: The main outcome variable was lesion control rate (6 months and overall), calculated as (complete radiographic bone fill + partial radiographic bone fill + no change)/sample size.

COVARIATES: The covariates were demographic characteristics, clinical characteristics and radiographic characteristics.

ANALYSES: Intergroup comparisons were analyzed with χ2 or Fisher's exact test. Lesion control rate was analyzed with Kaplan-Meier curves, and Cox regression assessed the effect of treatment on time to complete radiographic bone fill. P < .05 indicated statistical significance.

RESULTS

The sample was composed of 88 subjects with a mean age of 17.9 (±10.5) years; 34 (38.6%) were male, and the median follow-up was 1 [interquartile range: 0.58 to 2.87] years. There were 47 (53.4%) and 41 (46.6%) subjects treated operatively and nonoperatively, respectively. Six months lesion control rate was 82.1% for the operative group and 89.2% for the nonoperative group (P = .4). Overall lesion control rate was 97.9% for the operative group and 97.6% for the nonoperative group (P = 1). Six months complete radiographic bone fill rate was significantly higher in the operative group than in the nonoperative group (46.2 vs 10.8%, P < .05). No statistically significant difference in the 6 months partial radiographic bone fill rate between the 2 groups (33.3 vs 27.0%, P = .6). Operative costs were higher, with complications observed only in the operative group (4 vs 0).

CONCLUSIONS AND RELEVANCE: Curettage provides significantly faster and higher initial radiographic bone fill rates but incurs greater costs and complication risks. If a nonoperative approach is undertaken, long-term clinical follow-up is required to ensure lesion stability.