Central giant cell granuloma of the jawbones - new insights into molecular biology with clinical implications on treatment approaches

Central giant cell granulomas (CGCG) constitute about 10% of benign jawbone lesions. Approximately one-third of CGCG exhibit local aggressive behavior with bone destruction and a tendency to recur. Cure of patients with aggressive CGCG can be achieved by en bloc resection with clear margins at the possible cost of esthetic, functional and psychological problems, mainly in young patients. It is in these cases where pharmacologic agents are most needed as an alternative treatment approach. Until now, pharmacologic agents for CGCG have been used empirically and, in a small number of cases, with various degrees of success. The purpose of this review is to present the recent findings on the phenotypic profile of the constituent cells in CGCG at the molecular level and discuss the inter-relations among them; to analyze the osteolytic potential concealed in the lesional cells; to provide an evidence-based rationale for the use of pharmacologic agents, and, consequently, to suggest a revised approach for their use.