Treatment Modalities and Recurrence Outcomes in Odontogenic Keratocysts: A 24-Year Retrospective Analysis

Background: Odontogenic keratocysts are developmental cysts of the jaws that often remain asymptomatic until they reach considerable size and are most frequently located in the mandibular angle and ramus regions. Due to their high recurrence potential, the optimal treatment approach remains controversial. The aim of this study was to evaluate treatment modalities associated with lower recurrence rates in odontogenic keratocysts. Material and Methods: Patients diagnosed with odontogenic keratocyst between 2000 and 2024 at the Department of Oral and Maxillofacial Surgery, Gazi University, were retrospectively evaluated. Associations between gender, age, lesion localization, histological subtype, treatment modality, and recurrence were analyzed. Statistical analyses were performed using SPSS for Windows (version 27). Results: A total of 291 cases were included, with an overall recurrence rate of 16.2%. The highest recurrence rate was observed in patients treated with enucleation (19.2%), whereas a lower recurrence rate was found in cases treated with marsupialization (5%). No recurrence was observed in patients who underwent resection. A statistically significant association was found between treatment modality and recurrence (p = 0.014). Conclusions: Treatment selection for odontogenic keratocysts should be carefully planned. In the present study, marsupialization was associated with a lower recurrence rate than enucleation in selected cases. However, because of the retrospective design and non-randomized treatment allocation, these findings should be interpreted with caution and should not be considered evidence of a causal relationship. Long-term clinical and radiological follow-up remains essential because of the potential for late recurrence.