Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI)

CASE REPORT ©2021. Published by Ikatan Radiologi Kedokteran Gigi Indonesia

[SUBMISSION] http://jurnal.pdgi.or.id/index.php/jrdi/

COVER LETTER

Dear
Editor-in-Chief
Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI)

Herewith I'm sending the file of our original manuscript entitled as below for consideration of publication in
the Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI) as a full article.

Type of article CASE REPORT

Full title of the

manuscript (English)
Author(s) 1*
First author, 2Second author, 3Third author, ….

Name of the Author(s) should be written in their FULL NAME without any title or degree,
must NOT be abbreviated, and it is sorted in sequence using number in superscript in front of
each author’s name classified on their institutional backgrounds. Put an asterisk (*) and make
the text bold for the corresponding author.
1
Author institution(s) Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Universitas Padjadjaran,
Bandung, Indonesia, 40132
2
Department of Informatics Engineering, Faculty of Engineering, Universitas Surabaya,
Surabaya, Indonesia, 60293

The author's institution should be written completely including the name of the city, country
and postal code in order of the author's number above.
Corresponding Email:
author’s contact
Telephone: (WhatsApp number is preferred if available)

By submitting the manuscript into Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI), all the authors
mentioned above understand that the material(s) presented in this paper neither has not been published
before nor has it been submitted for publication to another scientific journal or being considered for
publication elsewhere. I attest that this work has been approved by all co-authors. All the authors also
understand that if the submitted material is accepted for publication in the journal, they will automatically
transfer the copyright to the publisher and are willing to pay for the author fees.

Signature

(Name of the Main Author)

 Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI)
CASE REPORT ©2021. Published by Ikatan Radiologi Kedokteran Gigi Indonesia
[SUBMISSION] http://jurnal.pdgi.or.id/index.php/jrdi/

TITLE
Panoramic Image Show Post Dredging Ameloblastoma Cyst: A Case Report

ABSTRACT

Objective: This case report aims to present the treatment and outcomes of ameloblastoma using the dredging
technique, an alternative to traditional resection, aimed at minimizing complications while effectively
controlling tumor recurrence.
Case Report: A 23-year-old male, Mr. Darmawan, presented with plexiform ameloblastoma in the right
mandible, experiencing jaw pain and enlargement. He had previously undergone stage I dredging. Physical
examination revealed facial asymmetry and buccal swelling, while imaging showed low bone density and
cortical elevation in the affected area. The dredging method was employed, targeting tumor removal while
preserving adjacent tissues.
Conclusion: The dredging approach demonstrated promising outcomes in ameloblastoma management,
preserving mandible function and reducing complications associated with more invasive techniques.
Radiographic follow-up revealed lesion size reduction and bone density improvement, supporting dredging as
a viable option for younger patients.

Keywords: Ameloblastoma, dredging technique, mandibular tumor, radiographic

INTRODUCTION

Ameloblastoma is a benign odontogenic tumor primarily affecting the mandible, presenting a significant
clinical challenge due to its infiltrative nature and high recurrence potential. While slow-growing,
ameloblastoma has a tendency to invade surrounding tissues, causing considerable structural deformities in
the jaw. The presence of this tumor can greatly impact patients’ quality of life, especially if not managed
optimally from the onset. Previous literature has emphasized that ameloblastoma often requires precise
surgical intervention to prevent recurrence and maintain adequate jaw function.1,2
The standard treatment for ameloblastoma typically involves complete resection of the affected bone
to fully remove the tumor mass. 3,4 However, this approach can lead to complications, especially in young
patients, such as jaw development issues, aesthetic concerns, and unwanted psychological impacts.
Furthermore, radical resection may result in functional problems, including difficulties with chewing and
speaking, making conservative methods like the dredging technique an appealing alternative to mitigate these
negative effects.5,6,7
The dredging technique is a conservative approach aimed at removing the tumor while minimizing
damage to the surrounding healthy tissues. This method is particularly beneficial for patients requiring a more
cautious approach, as it can reduce the risks associated with extensive surgery. 8,9 In cases of ameloblastoma,
this technique has shown promising results with a lower recurrence rate when regular post-operative
monitoring is implemented.10 Studies examining the outcomes of the dredging technique indicate that this
approach can expedite healing and lessen the need for additional reconstructive procedures.11,12
This case report focuses on a 23-year-old male diagnosed with plexiform ameloblastoma in the right
mandible, who previously underwent a first-stage dredging procedure. The patient experienced enlargement
and pain in the right lower jaw several months post-surgery, suggesting potential recurrence or changes in
tissue. This case report examines the selected dredging technique, aimed at preserving healthy tissue while
effectively excising the tumor mass.

CASE REPORT

The patient, a 23-year-old male named Mr. Darmawan, presented with complaints of jaw enlargement
and persistent pain localized to the lower right mandible, which had been troubling him for approximately two
months. His medical history included an incisional biopsy and a stage I dredging procedure performed in late
2022, resulting in a confirmed diagnosis of plexiform ameloblastoma of the right mandible.
On physical examination, Mr. Darmawan displayed facial asymmetry due to swelling in the buccal area
on the right side, measuring approximately 2 x 1.5 x 0.5 cm. There was no palpable or tender

The size of final manuscript MUST NOT exceed more than 1 MB (megabytes) to be successfully uploaded in our online system,
you may attach the copy of your manuscript and ask for further assistance by sending an e-mail to [email protected] or [email protected]
 Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI)
CASE REPORT ©2021. Published by Ikatan Radiologi Kedokteran Gigi Indonesia
[SUBMISSION] http://jurnal.pdgi.or.id/index.php/jrdi/

lymphadenopathy detected during the examination, indicating an isolated lesion. Intraoral findings showed a
defect in the buccal vestibule near tooth 48, with visible hyperemia in the affected area.
Radiographic assessment was conducted to evaluate the extent and specific characteristics of the
lesion. An orthopantomography (OPG) image showed areas of decreased bone density in the right mandible,
specifically in the edentulous region around teeth 46 to 48. The imaging also highlighted an elevation of the
right inferior mandibular cortex, likely attributed to the previous lesion and dredging procedure. The OPG
further revealed a large, medio-lateral radiolucency with an irregular peripheral pattern, indicative of the
lesion exerting pressure on the right mandibular angle. Bone regeneration was observed within the dredging
cavity, preserving the mandible’s normal structure and functionality.
Due to the recurrence of symptoms and changes in radiographic findings, a follow-up dredging
procedure was considered. The objective was to remove any remaining tumor tissue while minimizing damage
to surrounding bone structures and maintaining mandibular function.
At the three-month post-procedure follow-up, imaging indicated a significant reduction in lesion size,
with improved bone density noted in the treated area. The patient reported reduced pain and swelling,
achieving functional restoration and no evidence of lesion progression or recurrence.

Figure 1. Extraoral view

A B

Figure 2. Intraoral view (A) Occlusion (B)

A B

Figure 3. Panoramic view (A) Control post dredging stage 1 (March 10,2023 (B) Control post dredging stage I
(June 5,2023 (C) Pre-dredging stage 2 (July 21,2023 (D) Control Post-dredging stage 2 (March 25, 2024)

DISCUSSION

The size of final manuscript MUST NOT exceed more than 1 MB (megabytes) to be successfully uploaded in our online system,
you may attach the copy of your manuscript and ask for further assistance by sending an e-mail to [email protected] or [email protected]
 Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI)
CASE REPORT ©2021. Published by Ikatan Radiologi Kedokteran Gigi Indonesia
[SUBMISSION] http://jurnal.pdgi.or.id/index.php/jrdi/

Ameloblastoma is a benign odontogenic tumor that, despite its slow growth, exhibits an infiltrative
nature and high recurrence rate. This makes it a significant clinical challenge, particularly in achieving long-
term optimal outcomes while preserving mandibular function and aesthetics. 13,14 This case is important as it
explores the use of the dredging technique as a conservative approach for managing recurrent ameloblastoma,
especially in young patients where functional and aesthetic impacts are crucial considerations. This technique
presents an appealing alternative to the traditional radical resection, which often leads to complications in
mandibular development and functional integrity.15
In existing literature, the dredging technique has been proposed as a conservative method aimed at
excising tumor tissue while sparing surrounding healthy tissues. 16 Studies have shown that this technique can
offer effective tumor control with a lower risk of recurrence, provided it is followed by stringent postoperative
monitoring. Additionally, this approach has demonstrated benefits in expediting tissue healing and reducing
the need for extensive reconstructive procedures. 17,18 For cases of ameloblastoma, this technique is especially
advantageous for younger patients, where mandibular growth and long-term aesthetic outcomes are
prioritized.19
Theoretically, ameloblastoma is associated with the invasive proliferation of odontogenic epithelium into
surrounding tissues. Literature supports that conservative approaches like dredging can effectively contain
further invasion while preserving healthy structural support. 20,21 While radical resection is often viewed as the
definitive approach for preventing recurrence, it typically carries significant functional impacts, including
speech and mastication difficulties. In the case discussed, the dredging technique offers a means to minimize
such complications, especially for younger patients who require a solution that maintains both function and
aesthetics.22,23,24
Connecting this case to the existing literature, the findings indicate that the dredging technique provides
not only a feasible solution for ameloblastoma management but also demonstrates effectiveness in controlling
tumor growth and reducing recurrence rates without causing substantial mandibular damage. 25,26 This case
supports the conservative approach, adding evidence that dredging could serve as a viable or even preferred
option for certain patients, particularly those who face aesthetic and functional considerations over the long
term.
For future clinical practice, this case provides valuable insights into the potential broader application of
the dredging technique, emphasizing the importance of intensive postoperative monitoring to mitigate
recurrence risks. This technique may offer practitioners a practical, conservative, yet effective treatment
alternative, especially for younger patients who are at risk of similar conditions in the future. This discussion
reinforces the belief that the dredging technique can be a viable method for conservatively managing
ameloblastoma, minimizing long-term complications, and preserving patients’ quality of life.

CONCLUSION

The conclusion of this case report highlights the effectiveness of the dredging method as a conservative
treatment option for recurrent ameloblastoma, especially in younger patients. This approach allows for
optimal tumor control while preserving mandibular function and aesthetics. The study recommends the use of
the dredging technique with routine radiographic monitoring as an alternative to more invasive resection
procedures. For dentists and radiologists, this research underscores the importance of comprehensive
evaluation at every treatment stage to detect early changes and minimize the risk of tumor recurrence.

ACKNOWLEDGMENTS
None

REFERENCES

1. Effiom, O. A., Ogundana, O. M., Akinshipo, A. O. & Akintoye, S. O. Ameloblastoma: current

etiopathological concepts and management. Oral Dis. 24, 307–316 (2018).

2. Petrovic, I. D. et al. Ameloblastomas of the mandible and maxilla. Ear. Nose. Throat J. 97, E26 (2018).

3. Wulansari, D. P., Rahman, F. U. A., Sugianto, I. & Anjani, K. G. Unicystic ameloblastoma of maxillary
sinus masquerading as a large odontogenic cyst: A case report. J. Dentomaxillofacial Sci. 9, 143–145
(2024).

The size of final manuscript MUST NOT exceed more than 1 MB (megabytes) to be successfully uploaded in our online system,
you may attach the copy of your manuscript and ask for further assistance by sending an e-mail to [email protected] or [email protected]
 Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI)
CASE REPORT ©2021. Published by Ikatan Radiologi Kedokteran Gigi Indonesia
[SUBMISSION] http://jurnal.pdgi.or.id/index.php/jrdi/

4. Giraddi, G. B., Arora, K. & Saifi, A. M. Ameloblastoma: A retrospective analysis of 31 cases. J. Oral Biol.
Craniofacial Res. 7, 206–211 (2017).

5. Lovásová, K. et al. A case of giant ameloblastoma: destructive effect on the facial skeleton and soft
tissues of the head and neck. J. Int. Med. Res. 49, 03000605211050185 (2021).

6. Sukmana, B. I. et al. Review of Ameloblastoma Case. Syst. Rev. Pharm. 11, (2020).

7. Ohiro, Y. et al. Modified “Dredging Method” for complicated solid/multicystic ameloblastoma in the
mandible: Report of a case treated by fractionated enucleation. J. oral Maxillofac. surgery, Med.
Pathol. 31, 121–125 (2019).

8. Rahman, A. F. M. S. & Haider, I. A. Ameloblastoma of the jaws: a retrospective observational study of

131 cases at a tertiary level hospital in Bangladesh. J. Dent. Res. Rev. 9, 59–65 (2022).

9. Kakuguchi, W. et al. Application of the dredging method in a case of recurrent ameloblastoma that had
spread over a large region of the mandible. J. Oral Maxillofac. Surgery, Med. Pathol. 32, 44–48 (2020).

10. Tajrin, A. et al. The Recurrence Rate of Oral Benign Lesions which Treated with Dredging and
Obturator. Syst. Rev. Pharm. 11, (2020).

11. Datarkar, A., Rai, A., Bhawalkar, A. & Jain, A. Clinical outcome following conservative treatment of 58
mandibular ameloblastoma patients: a retrospective study. Oral Maxillofac. Surg. 27, 601–608 (2023).

12. Nowair, I. M. & Eid, M. K. A modified surgical approach for the treatment of mandibular unicystic
ameloblastoma in young patients. J. Cranio-Maxillofacial Surg. 48, 148–155 (2020).

13. Patel, H. et al. Dredging: A conservative surgical approach for treatment of large cystic lesions of the
jaws. Natl. J. Maxillofac. Surg. 13, 430–436 (2022).

14. Regmi, S. et al. Implant Placement in Site of Plexiform Ameloblastoma After Dredging. A Clinical
Report. J. Nepal. Prosthodont. Soc. 4, 116–121 (2021).

15. Srikar, M. V, Sangamesh, N. C. & Vidya, K. C. Marsupialization for the Management of Unicystic
Ameloblastoma-Retrospective Study. Indian J. Public Health 11, 593 (2020).

16. Sadat, S. M. A. & Ahmed, M. ‘ Dredging method’-a conservative surgical approach for the treatment of
ameloblastoma of jaw. J. Bangladesh Coll. Phys. Surg. 29, 72 (2011).

17. Chandima, S., Perera, I., Gunathilake, S., Shanmuganathan, S. & Silva, D. The Profile of Ameloblastoma
and the Status of Routine Clinical Records from a Developing Country Context. margins 15, 42–49
(2019).

18. El-Beialy, W. R. & Galal, N. DREDGING TECHNIQUE FOR KERATOCYSTIC ODONTOGENIC TUMOR: A FIVE-
YEAR FOLLOW-UP OF 28 CASES. Egypt. Dent. J. 63, 1287–1294 (2017).

19. Zhang, Y. et al. Curettage combined with bone cavity opening reduces recurrence of the mandibular
conventional ameloblastoma and effectively preserves the mandible: a retrospective study. BMC Oral
Health 23, 885 (2023).

20. Bukhsh, A. et al. Evaluation, Treatment, Complication and Prognosis of Ameloblastoma. (2023).

21. Dandriyal, R., Gupta, A., Pant, S. & Baweja, H. H. Surgical management of ameloblastoma: Conservative
or radical approach. Natl. J. Maxillofac. Surg. 2, 22–27 (2011).

22. Wadhawan, R., Sharma, B., Sharma, P. & Gajjar, D. Unicystic ameloblastoma in a 23 year old male: A
case report. Int J Appl Dent Sci 2, 87–92 (2016).

23. Wu, K. et al. Clinical evaluation of fenestration decompression combined with secondary curettage for
ameloblastoma of the jaw: retrospective radiographic analysis. BMC Oral Health 22, 443 (2022).

The size of final manuscript MUST NOT exceed more than 1 MB (megabytes) to be successfully uploaded in our online system,
you may attach the copy of your manuscript and ask for further assistance by sending an e-mail to [email protected] or [email protected]
 Jurnal Radiologi Dentomaksilofasial Indonesia (JRDI)
CASE REPORT ©2021. Published by Ikatan Radiologi Kedokteran Gigi Indonesia
[SUBMISSION] http://jurnal.pdgi.or.id/index.php/jrdi/

24. Isobe, K., Morita, K. & Omura, K. Enucleation and repeated dredging treatment for a large ameloblastic
fibroma in growing young patient: Report of a case with difficult treatment planning. Asian J. Oral
Maxillofac. Surg. 23, 96–98 (2011).

25. Shi, S., Liu, Y., Shan, Y., Fu, T. & Zhao, S. Enucleation combined with peripheral ostectomy: its role in
the management of large cystic ameloblastomas of the mandible. J. Cranio-Maxillofacial Surg. 42,
1659–1663 (2014).

26. Gurram, P., Narayanan, P., Chandran, S. & Rathan, A. C. L. Role of Conservative Management in
Treating Ameloblastoma of Jaw Bones: A Review of Literature. J Dent Heal Oral Res 3, (2022).

The size of final manuscript MUST NOT exceed more than 1 MB (megabytes) to be successfully uploaded in our online system,
you may attach the copy of your manuscript and ask for further assistance by sending an e-mail to [email protected] or [email protected]