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Yomtako S, Watanabe H, Kuribayashi A, Sakamoto J, Miura M. Differentiation of radicular cysts and radicular granulomas via texture analysis of multi-slice computed tomography images. Dentomaxillofac Radiol 2024; 53:281-288. [PMID: 38565278 PMCID: PMC11211680 DOI: 10.1093/dmfr/twae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/24/2024] [Accepted: 02/24/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES This study aimed to establish a method for differentiating radicular cysts from granulomas via texture analysis (TA) of multi-slice computed tomography (CT) images. METHODS A total of 222 lesions with multi-slice computed tomography images acquired at our hospital between 2013 and 2022 that were pathologically diagnosed were included in this study. Cases of contrast-enhanced images, severe metallic artefacts, and lesions that were not sufficiently large to be analysed were excluded. The images were chronologically divided into a training group and a validation group. The radiological characteristics were determined. Subsequently, a TA was performed. Pyradiomics software was used for the TA of three-dimensionally segmented volumes extracted from 2 mm slice thickness images with a soft-tissue algorithm. Features that differed significantly between the two lesions in the training group were extracted and used to create machine-learning models. The discriminative ability of these models was evaluated in the validation group using receiver operating characteristic curve analysis. RESULTS A total of 131 lesions, comprising 28 radicular cysts and 103 granulomas, were analysed. Forty-three texture features that exhibited significant variations were extracted. A support vector machine and decision tree model, with areas under the curves of 0.829 and 0.803, respectively, were created. These models showed high discriminative abilities, even for the validation group, with areas under the curve of 0.727 and 0.701, respectively. Both models showed superior performance compared with that of the models based on radiographic findings. CONCLUSION Discriminatory models were established for the TA of radicular cysts and granulomas using CT images.
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Affiliation(s)
- Supasith Yomtako
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- School of Dentistry, Mae Fah Luang University, 333 Mool, Thasud, Muang, Chiang Rai, Thailand
| | - Hiroshi Watanabe
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Ami Kuribayashi
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Junichiro Sakamoto
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Masahiko Miura
- Department of Dental Radiology and Radiation Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
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Mosquera-Barreiro C, Ruíz-Piñón M, Sans FA, Nagendrababu V, Vinothkumar TS, Martín-González J, Martín-Biedma B, Castelo-Baz P. Predictors of periapical bone healing associated with teeth having large periapical lesions following nonsurgical root canal treatment or retreatment: A cone beam computed tomography-based retrospective study. Int Endod J 2024; 57:23-36. [PMID: 37974453 DOI: 10.1111/iej.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/10/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
AIM Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing. METHODOLOGY Seventy-nine patients were treated during the years 2013-2020 with large periapical lesions of endodontic origin (10-15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow-up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi-square test was used for categorical variables, the t-test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables. RESULTS Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p < .001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p > .05). CONCLUSIONS Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision-making process.
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Affiliation(s)
- Carolina Mosquera-Barreiro
- Surgery and medical surgical specialties. International theoretical-practical Master of Endodontics, Dentistry Restorative and Aesthetics, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Ruíz-Piñón
- Surgery and medical surgical specialties. International theoretical-practical Master of Endodontics, Dentistry Restorative and Aesthetics, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Francesc Abella Sans
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, University of Sharjah, College of Dental Medicine, Sharjah, United Arab Emirates
| | - Thilla Sekar Vinothkumar
- Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, Jazan University, Jazan, Saudi Arabia
| | - Jenifer Martín-González
- Endodontic Section, Department of Stomatology, School of Dentistry, University of Sevilla, Sevilla, Spain
| | - Benjamín Martín-Biedma
- Oral Sciences Research Group, Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Castelo-Baz
- Oral Sciences Research Group, Endodontics and Restorative Dentistry Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Krongbaramee T, Wongpattaraworakul W, Lanzel EA, Hellstein JW, Teixeira FB. Retrospective Evaluation of Periradicular Biopsies: An 18-Year Study. J Endod 2023; 49:1457-1463. [PMID: 37543187 DOI: 10.1016/j.joen.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Radiographic findings in periradicular areas are repeatedly associated with infected root canal systems. Although non-odontogenic lesions in teeth are reported to be low, they often mimic periapical pathoses, and consequently, histopathologic examinations after surgical revisions are nurtured. METHODS Biopsies submitted to the College of Dentistry between 2003 and 2021 were reviewed. Clinicopathologic characteristics were collected, including age, sex, medical history, location, sensibility tests, and clinic impressions from each specimen. Histopathologic diagnosis and gross description were also part of our database. RESULTS A total of 72,055 pathology reports were reviewed, of which 10,031 lesions (13.9%) met the criterion of being intraosseous lesions at the periradicular area. Among those 10,031 lesions, 7.94% (n = 796) were of non-endodontic origin, 7153 were documented as non-vital, and 2.36% (n = 169) of these non-vital teeth were diagnosed with a non-endodontic origin. A total of 5707 lesions were obtained from surgeries within the periapical tissues, primarily performed by endodontists (94.02%). Non-endodontic lesions were reported in 1.09% of the cases. Odontogenic keratocyst was the most common non-endodontic diagnosis, followed by nasopalatine duct cyst and benign fibro-osseous lesion, respectively. CONCLUSIONS Pathologic findings of the periradicular tissues are not always from endodontic origin. The probability of encountering non-endodontic lesions is almost 8%. Even in clinically reported teeth with pulp necrosis, 1%-3% of biopsies were confirmed as non-endodontic lesions.
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Affiliation(s)
- Tadkamol Krongbaramee
- Division of Endodontics, Department of Restorative Dentistry & Periodontology, Chiang Mai University, Chiang Mai, Thailand; Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Fabricio B Teixeira
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa.
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Mahasneh SA, Al-Hadidi A, Kadim Wahab F, Sawair FA, Al-Rabab'ah MA, Al-Nazer S, Bakain Y, Nardi C, Cunliffe J. A Cone Beam CT Study on the Correlation between Crestal Bone Loss and Periapical Disease. J Clin Med 2023; 12:jcm12062423. [PMID: 36983422 PMCID: PMC10053371 DOI: 10.3390/jcm12062423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
The aim of this study was to determine whether the degree of bone loss around teeth can be linked to the loss of vitality of adjacent teeth and periapical disease, which necessitates root canal treatments. Three hundred and twenty-one full maxilla cone-beam computed tomography scans were examined. The parameters investigated included the degree of crestal bone loss in relation to the cementoenamel junction, the presence/absence of apical periodontitis, and the presence/absence of root canal treatments. Out of the 2001 teeth examined, 696 (34.8%) showed evidence of crestal bone loss. The degree of crestal bone loss was classified as mild, moderate, or severe. A significant association (p < 0.001) was found between the presence of crestal bone loss around a tooth and root canal treatment of that tooth. It was found that it is more likely for teeth with crestal bone loss to be root canal treated compared to teeth with existing root canal treatment and healthy crestal bone levels. Furthermore, teeth with buccal or lingual crestal bone loss were significantly associated with a higher rate of periapical disease than teeth without crestal bone loss (p < 0.001). CBCT identified the severity of bone loss on all surfaces of the teeth, and the most common presentation was bone loss to the mid-root level. Teeth with crestal bone loss were significantly more likely to be associated with a higher rate of periapical disease. Teeth with crestal bone loss were more likely to be root treated than teeth with healthy crestal bone levels.
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Affiliation(s)
- Sari A Mahasneh
- School of Dentistry, University of Jordan, Amman 11942, Jordan
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Abeer Al-Hadidi
- School of Dentistry, University of Jordan, Amman 11942, Jordan
| | | | - Faleh A Sawair
- School of Dentistry, University of Jordan, Amman 11942, Jordan
| | | | | | | | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Joanne Cunliffe
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester M13 9PL, UK
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Stefopoulos S, Melakopoulos I, Tosios KI, Kerezoudis NP. Calcifying odontogenic cyst resembling clinical signs of vertical root fracture of a maxillary canine. J Am Dent Assoc 2023; 154:65-72. [PMID: 36424213 DOI: 10.1016/j.adaj.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Calcifying odontogenic cyst (COC) can be misdiagnosed as a lesion of endodontic origin when it is in close proximity to the periradicular tissue, and pulp sensibility tests are indispensable for differential diagnosis. However, when the adjacent teeth are necrotic or already endodontically treated, diagnosis becomes challenging. CASE DESCRIPTION In this case report, a maxillary canine with an inadequate root canal treatment was considered as the source of an endodontic infection. Eight months after the retreatment, the patient sought treatment for a buccal intraoral swelling and a deep periodontal pocket and was referred for cone-beam computed tomography with a provisional diagnosis of a vertical root fracture. The tomography revealed an extensive lesion buccally to the roots of the canine and the adjacent vital lateral incisor. An unusual extended external resorption of the root of the vital lateral incisor was also evident. This finding shifted the diagnostic thinking toward a lesion of nonendodontic origin. The lesion was surgically enucleated, and the histopathologic examination confirmed the diagnosis of a COC. PRACTICAL IMPLICATIONS Clinicians always must bear in mind the chance of a nonendodontic lesion masquerading as a lesion of endodontic origin. Cone-beam computed tomography should be considered in cases of doubt or in lesions refractory to endodontic treatment, as it can provide information on the clinicopathologic features of the lesion.
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Rudman J, He J, Jalali P, Khalighinejad N, Woo V. Prevalence of Nonendodontic Diagnoses in Periapical Biopsies: A 6-year Institutional Experience. J Endod 2022; 48:1257-1262. [PMID: 35843357 DOI: 10.1016/j.joen.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The purpose of this study was to identify non-endodontic periapical lesions (NPLs) mimicking endodontic pathosis most frequently encountered by clinicians. METHODS A retrospective study was conducted on biopsies obtained from 2015-2020 at Texas A&M College of Dentistry oral pathology laboratory. The online database was screened for cases submitted as suspected endodontic pathology using specific keywords. Histological diagnoses were collected to determine prevalence of NPLs that were originally thought to be of endodontic origin. The frequency and percentage of endodontic pathology and NPLs were documented. RESULTS Among 6,704 biopsies clinically diagnosed as endodontic lesions, 190 (2.8%) were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocyst (n=70, 36.8%), cemento-osseous dysplasia (n=27; 14.2%), and dentigerous cyst (n=22; 11.6%). Of all NPLs, 3.7% were malignant neoplasms, with the most common diagnosis being squamous cell carcinoma. Of 6,514 endodontic histological diagnoses, the prevalence of periapical granulomas and cysts was 60.2% (n=3,924) and 39.1% (n=2,549), respectively. CONCLUSIONS While most endodontic submissions are likely to be histologically diagnosed as periapical granuloma or cyst, the clinician should be aware that a small portion of these lesions may be non-endodontic in origin and possibly neoplastic in nature. Histopathological evaluation of biopsied specimens is critical to achieve a proper diagnosis to ensure appropriate management of patients.
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Affiliation(s)
- Jessica Rudman
- Department of Endodontics, Texas A&M University College of Dentistry, Dallas Texas
| | - Jianing He
- Department of Endodontics, Texas A&M University College of Dentistry, Dallas Texas.
| | - Poorya Jalali
- Department of Endodontics, Texas A&M University College of Dentistry, Dallas Texas
| | | | - Victoria Woo
- Department of Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas Texas
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Progressive fluctuating cervical lymphadenopathy and dental abscess. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:233-235. [PMID: 34893451 DOI: 10.1016/j.anorl.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Guimarães GG, Perez DE, Netto JD, Costa AC, Leonel AC, Castro JF, Pires FR. Nonendodontic periapical lesions: a retrospective descriptive study in a Brazilian population. Med Oral Patol Oral Cir Bucal 2021; 26:e502-e509. [PMID: 33772568 PMCID: PMC8254893 DOI: 10.4317/medoral.24379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background Several nonendodontic diseases can occur in the periapical region, resembling endodontic inflammatory conditions. Therefore, the aim of the present study was to determine the frequency of nonendodontic periapical lesions diagnosed in a Brazilian population.
Material and Methods The files of two Oral Pathology laboratories were reviewed and all cases including at least one clinical diagnosis of endodontic periapical lesions were selected for the study. After initial selection, demographic and clinical data, clinical diagnosis and final diagnosis were reviewed and tabulated. Final diagnosis included endodontic periapical lesions, and benign and malignant nonendodontic periapical lesions. Data were descriptively and comparatively analyzed among the three groups, with a significance level of 5% (p<0.05).
Results Nonendodontic periapical lesions were identified in 208 (19%) out of the 1.125 registries included in the final sample. Benign nonendodontic periapical lesions (200 cases, 18%) were mostly odontogenic keratocysts, ameloblastomas, nasopalatine cysts, dentigerous cysts, glandular odontogenic cysts, and benign fibroosseous lesions. Malignant nonendodontic periapical lesions (8 cases, 1%) included carcinomas, adenocarcinomas, and melanoma. In general, nonendodontic periapical lesions were more common in males and in the posterior mandible (p>0.05).
Conclusions The frequency of nonendodontic periapical lesions was high and, although the general distribution was similar to the results from other populations, some features were probably associated with the profile of the studied populations and to the methods applied in the present study. Knowledge on differential diagnosis of endodontic and nonendodontic periapical lesions is essential to avoid unnecessary treatments and diagnostic delay in routine dental practice. Key words:Differential diagnosis, nonendodontic, periapical lesion, pulp necrosis.
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Affiliation(s)
- G-G Guimarães
- Post graduation Program in Dentistry, Estácio de Sá University Av. Alfredo Baltazar da Silveira, 580 cobertura CEP 22790-701, Recreio dos Bandeirantes, Rio de Janeiro/RJ, Brazil
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Kosanwat T, Poomsawat S, Kitisubkanchana J. Non-endodontic periapical lesions clinically diagnosed as endodontic periapical lesions: A retrospective study over 15 years. J Clin Exp Dent 2021; 13:e586-e593. [PMID: 34188765 PMCID: PMC8223148 DOI: 10.4317/jced.57957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/23/2021] [Indexed: 01/17/2023] Open
Abstract
Background This study aimed to provide the frequency and demographic data of non-endodontic periapical lesions clinically misdiagnosed as endodontic periapical lesions from a Southeast Asian population over a 15-year period.
Material and Methods A retrospective study was conducted from departmental archives between 2005 and 2019. Cases clinically diagnosed as endodontic periapical lesions were retrieved. Then, cases with a histopathological diagnosis of non-endodontic periapical lesion were selected. Demographic data of non-endodontic periapical lesions were recorded. Radiographic features of cases with available radiographs were analyzed.
Results Of 1,566 cases clinically diagnosed as endodontic periapical lesion, 157 cases received a histopathological diagnosis of non-endodontic origin. Eighteen different histopathological diagnoses were identified. The most frequent lesion was dentigerous cyst (n= 51, 32.48%) followed by odontogenic keratocyst (n=31, 19.75%), nasopalatine duct cyst (n=18, 11.46%) and ameloblastoma (n=15, 9.56%). Three cases of malignant tumors, including adenoid cystic carcinoma, mucoepidermoid carcinoma, and metastatic papillary thyroid carcinoma were observed.
Conclusions Non-endodontic periapical lesions constituted 10.03% of cases clinically diagnosed as endodontic periapical lesions. Histopathological examinations of non-endodontic periapical lesions revealed a variety of lesions ranging from foreign body reaction, cysts, fibro-osseous lesions, benign tumors and primary or metastatic malignant tumors. Of clinical significance is that some non-endodontic periapical lesions had different treatment modalities and prognoses compared with endodontic lesions. Therefore, dentists must be aware that periapical radiolucent lesions are not always a consequence of pulpal necrosis. Key words:Ameloblastoma, dentigerous cyst, endodontic periapical lesions, non-endodontic periapical lesions, odontogenic keratocyst.
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Affiliation(s)
- Theerachai Kosanwat
- DDS, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Sopee Poomsawat
- DDS, MSc, PhD, Associate Professor, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Jira Kitisubkanchana
- DDS, PhD, Associate Professor, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Atypical presentation of lateral periodontal cyst associated with impacted teeth: two case reports. BMC Oral Health 2021; 21:178. [PMID: 33827538 PMCID: PMC8028169 DOI: 10.1186/s12903-021-01539-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/25/2021] [Indexed: 12/19/2022] Open
Abstract
Background Lateral periodontal cyst (LPC) is an uncommon form of developmental odontogenic cyst. LPC can be suspected when there is a round, well-circumscribed radiolucency, usually of small diameter, along the lateral surface of vital erupted teeth, predominantly in the mandibular premolar region. Histopathological analysis allows LPC to be diagnosed based on its characteristic features such as a thin cuboidal to stratified squamous non-keratinizing epithelium containing epithelial plaques and glycogen-rich clear cells. The aim of this article was to report two cases of atypical LPC associated either with an impacted lower left canine (tooth #33) or with a lower right third molar (tooth #48). Case presentation Case 1: A 56-year-old man was referred to us for an oro-dental assessment. Panoramic radiography revealed an impacted lower left permanent canine (tooth #33) with well-defined radiolucency on its upper cervical margin. A CT scan revealed a pericoronal radiolucency of 5 mm at its widest diameter around the impacted tooth #33. The pericoronal tissue was removed and sent for histopathological examination. The results revealed a lateral periodontal cyst. Satisfactory postoperative healing was achieved at the site. Follow-up at 12 months indicated no recurrence of the lesion. Case 2: A 54-year-old woman consulted with the main issue being pain on the lower right side of the face. Intra-oral examination revealed a vestibular swelling involving the region of the second molar (tooth #47), with obliteration of buccal sulcus. Pocket depth was determined to be 9 mm at the distal of #47. A diagnosis of gingival abscess resulting from chronic periodontitis was made. Panoramic radiography revealed a radiolucent cystic lesion associated with an impacted horizontal lower right third molar (tooth #48), suggestive of a dentigerous cyst. X-rays also revealed alveolar bone resorption on the molar (tooth #47). The cyst was removed along with the third molar and submitted for histopathological diagnosis. The diagnosis was LPC. Follow-up at 18 months indicated no recurrence of the lesion. Conclusion These cases represent atypical presentations of LPC. They provide examples of the differential diagnosis of pericoronal radiolucencies involving an impacted tooth and our observations provide insights regarding the pathogenesis of LPC.
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Pires MD, Martins JNR, Dias GS, Doutel D, Ordinola-Zapata R. Osteosarcoma of the anterior maxilla mimicking a periapical pathology: A case report. AUST ENDOD J 2021; 47:656-663. [PMID: 33604945 DOI: 10.1111/aej.12491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/14/2021] [Accepted: 02/03/2021] [Indexed: 01/24/2023]
Abstract
Osteosarcomas of the jaws (OSJ) are difficult to diagnose, rare malignant lesions, with uncharacteristic radiographic and clinical presentation. Early diagnosis and treatment are essential to improve long-term prognosis. The current report presents a rare case of a primary conventional osteoblastic osteosarcoma of the anterior maxilla in a 25-year-old female. She presented to a private dental clinic after developing pain, facial oedema and palpation tenderness of a mass associated with the upper right lateral incisor. The signs and symptoms mimicked very closely a regular radiolucent and symptomatic periapical pathology, and the definitive diagnosis was only possible through a combination of clinical, radiographic and histopathological findings. The patient was referred to an oncology facility, where she was submitted to radical excision surgery through a hemi-maxillectomy. Although other pathologies are uncommon, the differential diagnosis of lesions compatible with odontogenic periapical pathology should not be neglected.
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Affiliation(s)
| | - Jorge N R Martins
- Faculdade de Medicina Dentaria, Universidade de Lisboa, Lisboa, Portugal
| | | | - Delfim Doutel
- Serviço de Anatomia Patológica (SAP), Instituto Português de Oncologia (IPO), Lisboa, Portugal
| | - Ronald Ordinola-Zapata
- Division of Endodontics, University of Minnesota School of Dentistry, Minneapolis, MN, USA
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Malignant Lesions Mimicking Endodontic Pathoses Lesion: A Systematic Review. J Endod 2020; 47:178-188. [PMID: 32918962 DOI: 10.1016/j.joen.2020.08.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Malignant nonendodontic periapical lesions represent a rare diagnosis, in which few case have been reported about this condition. Due to the low occurrence and little exploration of this subject, serious errors of diagnosis are observed in the oral medicine services. In this sense, the purpose of the present review was to integrate the information on the record published on malignant lesions that mimic endodontic pathoses into a comprehensive analysis of their clinical, radiologic, and histopathologic features. METHODS An online search was made in March 2020 in the following databases: Pubmed, Web of Science, and Scopus. Eligibility criteria included publications having enough clinical, radiologic, and histopathologic information to confirm the diagnosis. Data were assessed descriptively. RESULTS Forty-nine publications from 16 countries comprising 60 cases were included. There is a nearly equal occurrence rate between males and females (male/female ratio is 49.15%/50.84%) with a mean age of 46.56 years. The lesions were more prevalent in the posterior mandibles (40.69%), and, radiographically, they were unilocular radiolucent. Histopathologic analysis showed metastasis (26.67%) as the most prevalent lesion followed by salivary gland malignant disease (25%). CONCLUSIONS The present systematic review revealed several histologic types of malignant periapical lesions that could be mimicking endodontic pathoses. Because these lesions usually do not show clinical or radiologic features of malignant alteration, clinicians should consider these hypotheses in their routine.
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Tsesis I, Krepel G, Koren T, Rosen E, Kfir A. Accuracy for diagnosis of periapical cystic lesions. Sci Rep 2020; 10:14155. [PMID: 32843680 PMCID: PMC7447813 DOI: 10.1038/s41598-020-71029-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/30/2020] [Indexed: 01/16/2023] Open
Abstract
Clinical differentiation between cystic lesions of endodontic and non-endodontic origin is of importance because correct diagnosis may affect treatment decision making. Most radicular cysts are treated with conservative approaches and, therefore, are not surgically removed. The objective of this study was to determine the accuracy of clinical diagnosis of periapical lesions as compared to the histological findings, and to evaluate various associated factors. All biopsy specimens submitted for histological evaluation from 2002 to 2009 were assessed. Only cases of periapical lesions with complete patient data and clinical diagnosis were included. Sensitivity, specificity and accuracy of the clinical diagnosis were calculated and various patient-related factors were evaluated. Of the 4,908 cases, 183 met inclusion criteria. Histologically, there were 171 lesions of radicular cysts and 12 cases of non-endodontic cysts, including OKC and Incisive Canal Cyst. The diagnostic accuracy for clinical diagnosis for radicular cysts was 91.84% and 91.84% for non-endodontic cysts. There was a high accuracy of clinical differentiation between cystic lesions of endodontic and non-endodontic origin. However, some non-endodontic lesions may be incorrectly diagnosed clinically as lesions of endodontic origin. Histological evaluation may be necessary for the correct diagnosis. Further clinical studies are needed to evaluate clinical examination and histological diagnosis of periapical lesions.
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Affiliation(s)
- Igor Tsesis
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Krepel
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Koren
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Rosen
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anda Kfir
- Department of Endodontology, Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Vieira CC, Pappen FG, Kirschnick LB, Cademartori MG, Nóbrega KHS, do Couto AM, Schuch LF, Melo LA, Dos Santos JN, de Aguiar MCF, Vasconcelos ACU. A Retrospective Brazilian Multicenter Study of Biopsies at the Periapical Area: Identification of Cases of Nonendodontic Periapical Lesions. J Endod 2020; 46:490-495. [PMID: 32061420 DOI: 10.1016/j.joen.2020.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to analyze the features of lesions obtained from biopsies at the periapical area of teeth with a radiographic or clinical initial diagnosis of apical periodontitis. METHODS A retrospective study was conducted on biopsies obtained from 1953-2018 at 3 Brazilian oral and maxillofacial pathology centers. Cases of endodontic and nonendodontic periapical lesions (NPLs) with a clinical diagnosis of endodontic pathoses were retrieved. Data regarding patient age, sex, and anatomic location were obtained from patients' records. The frequency and percentage of cases with clinical diagnoses of a periapical cyst, periapical granuloma, or dentoalveolar abscess were recorded, and the final histopathologic diagnosis was documented. RESULTS Among 66,179 oral biopsies, 7246 (10.94%) were clinically diagnosed as periapical disease, 306 (4.22%) of which were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocysts (n = 107, 34.96%) followed by dentigerous cysts (n = 48, 15.68%). The mean age at diagnosis was 39.68 years with a range of 6-80 years. A total of 159 (51.96%) cases occurred in females and 147 (48.03%) in males (female to male ratio = 1.08:1). Most lesions (137, 44.77%) were located in the posterior mandible. CONCLUSIONS A wide variety of histopathologic diagnoses, including benign odontogenic and nonodontogenic cystic and tumorous lesions, infectious diseases, and malignant neoplasms, was reported in the present survey. The features presented in this study were consistent with previous findings reported in the literature.
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Affiliation(s)
- Carolina Clasen Vieira
- Department of Semiology and Clinics, Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Geraldo Pappen
- Department of Semiology and Clinics, Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Laura Borges Kirschnick
- Department of Semiology and Clinics, Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariana Gonzalez Cademartori
- Department of Semiology and Clinics, Graduate Program in Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Kaio Heide Sampaio Nóbrega
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Aline Maria do Couto
- Department of Pathology, Postgraduate Program in Oral Pathology, School of Dentistry, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Lauren Frenzel Schuch
- Department of Pathology, Postgraduate Program in Oral Pathology, School of Dentistry, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Leonardo Araújo Melo
- Department of Semiology and Clinics, Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Jean Nunes Dos Santos
- Department of Semiology and Clinics, Diagnostic Center for Oral Diseases, School of Dentistry, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Maria Cássia Ferreira de Aguiar
- Department of Pathology, Postgraduate Program in Oral Pathology, School of Dentistry, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ana Carolina Uchoa Vasconcelos
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Kaur K, Sculley D, Wallace J, Turner A, Ferraris C, Veysey M, Lucock M, Beckett EL. Micronutrients and bioactive compounds in oral inflammatory diseases. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2019. [DOI: 10.1016/j.jnim.2019.100105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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16
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Slusarenko da Silva Y, Stoelinga PJW, Naclério-Homem MDG. The presentation of odontogenic keratocysts in the jaws with an emphasis on the tooth-bearing area: a systematic review and meta-analysis. Oral Maxillofac Surg 2019; 23:133-147. [PMID: 30825057 DOI: 10.1007/s10006-019-00754-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/21/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE This study was conducted in order to gain insight in the actual ratio of odontogenic keratocysts occurring in the tooth-bearing area as compared to the posterior region of the jaws in order to come up with reliable data to base upon a rational treatment policy. METHODS We searched MEDLINE, Web of Science, Scopus, and Cochrane databases for studies reporting on the location of mandibular and maxillary odontogenic keratocysts. All records were independently assessed and a meta-analysis was performed. Risk difference with a confidence interval of 95% of having the lesion in the posterior region versus the tooth-bearing area was the effect measure. P value for the summary effect of < 0.05 was considered statistically significant. RESULTS The 2615 records retrieved were reduced to 34 studies to be qualitatively/quantitatively assessed. The pooled values showed that the difference in the clinical risk of having keratocysts in the posterior region of the mandible and in the tooth-bearing area of the maxilla is 21 and 43%, respectively (P < 0.02 and P < 0.00001). CONCLUSIONS A substantial amount of keratocysts occur in the tooth-bearing area of the jaws, requiring attention.
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Affiliation(s)
- Yuri Slusarenko da Silva
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227, Butantã, São Paulo, 05508-000, Brazil.
| | - Paul J W Stoelinga
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen, The Netherlands
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, Av Prof. Lineu Prestes 2227, Butantã, São Paulo, 05508-000, Brazil
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17
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Mucoepidermoid Carcinoma Mimicking a Lesion of Endodontic Origin. J Endod 2018; 44:1303-1307. [DOI: 10.1016/j.joen.2018.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 01/30/2023]
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18
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Clinicopathological analysis of 232 radicular cysts of the jawbone in a population of southern Taiwanese patients. Kaohsiung J Med Sci 2018; 34:249-254. [DOI: 10.1016/j.kjms.2018.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/07/2017] [Accepted: 01/12/2018] [Indexed: 11/21/2022] Open
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Meschi N, Fieuws S, Vanhoenacker A, Strijbos O, Van der Veken D, Politis C, Lambrechts P. Root-end surgery with leucocyte- and platelet-rich fibrin and an occlusive membrane: a randomized controlled clinical trial on patients’ quality of life. Clin Oral Investig 2018. [DOI: 10.1007/s00784-018-2343-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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de Freitas Silva BS, Yamamoto-Silva FP, Sena-Filho M, Silva Sant’Ana SS, Mariano-Júnior WJ, de Almeida OP, Estrela C. 20-year Follow-up of Recurrent Glandular Odontogenic Cyst Mimicking a Periapical Lesion. J Endod 2017; 43:1915-1920. [DOI: 10.1016/j.joen.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/31/2017] [Accepted: 06/04/2017] [Indexed: 01/08/2023]
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Leandro Santos RS, Ramos-Perez FMDM, Silva GKDA, Rocha AC, Prado JD, Perez DEDC. Odontogenic keratocyst: The role of the orthodontist in the diagnosis of initial lesions. Am J Orthod Dentofacial Orthop 2017; 152:553-556. [PMID: 28962740 DOI: 10.1016/j.ajodo.2017.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022]
Abstract
Odontogenic keratocysts (OKCs) are locally infiltrative odontogenic cysts that are usually diagnosed during routine radiographic examinations. Therefore, it is critical that dental practitioners, in particular orthodontists, recognize and diagnose OKCs to recommend appropriate treatment. This report describes a patient whose OKC was not initially identified during orthodontic pretreatment. In addition, this report discusses the clinical and radiographic features of OKCs, as well as the differential diagnoses of these lesions.
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Affiliation(s)
- Raphaela Silva Leandro Santos
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Gleyson Kleber do Amaral Silva
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - André Caroli Rocha
- Department of Stomatology, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - José Divaldo Prado
- Department of Stomatology, A. C. Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Danyel Elias da Cruz Perez
- Department of Clinical and Preventive Dentistry, School of Dentistry, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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El Khateeb SM, Abu-Hammad O, Fadel H, Dar-Odeh N. A Retrospective Analysis of Radiographic Jaw Findings in Young Women; Prevalence and Predictors. J Int Soc Prev Community Dent 2017; 7:22-27. [PMID: 28316945 PMCID: PMC5343679 DOI: 10.4103/2231-0762.200707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/23/2016] [Indexed: 12/20/2022] Open
Abstract
AIMS AND OBJECTIVES To determine the prevalence and types of jaw pathologic findings as detected in panoramic radiographs of a sample of young women attending a teaching hospital in Al Madinah Al Munawarah, Saudi Arabia, and to determine the most important factors that predict the occurrence of jaw pathologic findings. MATERIALS AND METHODS The electronic clinical files of a representative sample of female patients who attended the outpatient dental clinics were retrieved. Patients were aged 18 to 25 years. Types of pathologic radiographic jaw findings and their prevalence were determined through screening of panoramic radiographs. Data were analyzed using the statistical analysis software [SPSS version 21 (IBM Corp.)]. Multiple linear regression was used to explore the significance of some types of dental lesions as predictor variables for the occurrence of jaw pathologic findings. RESULTS A total of 190 patients (mean age, 22.4 ± 2.46 years) were included in the study. Periapical lesions, retained roots, and alveolar bone loss were detected in 53.6%, 24.8%, and 17.4% of the participants, respectively. Other odontogenic abnormalities such as supernumerary and impacted teeth (6.4% and 33.7%, respectively) were also detected. Patients' age was found to be a good predictor for alveolar bone loss and number of periapical lesions (P ≤ 0.05). CONCLUSIONS A high prevalence of periapical lesions, retained roots, and alveolar bone loss was found among a sample of young female dental attendees, as shown by their panoramic radiographs. Further studies are needed to explore potential risk factors for such a noticeable trend of poor oral health, and the needed strategies to counteract this trend.
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Affiliation(s)
- Sara M. El Khateeb
- Department of Oral Medicine, Periodontology, Diagnosis and Oral Radiology, Ain Shams University, Cairo, Egypt
- Department of Basic and Clinical Oral Sciences, Taibah University Dental College and Hospital, Al Madinah Al Munawarah, Saudi Arabia
| | - Osama Abu-Hammad
- Department of Removable Prosthodontics, Faculty of Dentistry, University of Jordan, Amman, Jordan
- Department of Substitutive Dental Sciences, Taibah University Dental College and Hospital, Al Madinah Al Munawarah, Saudi Arabia
| | - Hani Fadel
- Department of Preventive Dental Sciences, Taibah University Dental College and Hospital, Al Madinah Al Munawarah, Saudi Arabia
| | - Najla Dar-Odeh
- Department of Basic and Clinical Oral Sciences, Taibah University Dental College and Hospital, Al Madinah Al Munawarah, Saudi Arabia
- Department of Oral Surgery, Oral Medicine and Periodontics, Faculty of Dentistry, Amman, Jordan
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23
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Huang HY, Chen YK, Ko ECC, Chuang FH, Chen PH, Chen CY, Wang WC. Retrospective analysis of nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions in a population of Taiwanese patients. Clin Oral Investig 2016; 21:2077-2082. [PMID: 27853924 DOI: 10.1007/s00784-016-1997-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/01/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We aimed to evaluate nonendodontic periapical lesions clinically misdiagnosed as endodontic periapical pathoses in a population of Taiwanese patients. MATERIALS AND METHODS Cases (2000-2014) of histopathological diagnoses of nonendodontic periapical lesions were retrieved from all cases with a clinical diagnosis of radicular cyst, apical granuloma, or apical periodontitis in the institution. These cases were regarded as misdiagnosed nonendodontic periapical lesions, of which the types and frequencies, in addition to the demographic data, were determined. RESULTS Four thousand and four specimens were clinically diagnosed as endodontically associated pathoses, of which 118 cases (2.95%) received a histopathological diagnosis of a nonendodontic pathologic entity, the most frequent lesion being keratocystic odontogenic tumor (KCOT, n = 38, 32.20%), followed by fibro-osseous lesion (n = 18, 15.25%), and dentigerous cyst (n = 13, 11.02%). Nine malignant lesions in the periapical area [squamous cell carcinoma (n = 7, 5.93%), adenoid cystic carcinoma (n = 1, 0.85%), and Langerhans cell histiocytosis (n = 1, 0.85%)] were also noted. CONCLUSIONS A wide variety of histopathological diagnoses, including benign odontogenic and non-odontogenic cystic and tumorous lesions and infectious diseases, as well as malignant lesions, was noted in these 118 cases of nonendodontic periapical lesions. Squamous cell carcinoma was the most predominant malignancy of nonendodontic periapical lesions misdiagnosed as apical periodontitis lesions from imaging examination overlooking the clinical findings. CLINICAL RELEVANCE The current data form a useful basis for clinicopathological investigation and educational teaching regarding nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions.
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Affiliation(s)
- Hsun-Yu Huang
- Department of Dentistry, Ditmanson Medical Foundation Chia-Yi-Christian Hospital, Chia-Yi, Taiwan
| | - Yuk-Kwan Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Edward Cheng-Chuan Ko
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Oral & Maxillofacial Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Fu-Hsiung Chuang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Endodontics, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung, Taiwan
| | - Ping-Ho Chen
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Yi Chen
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wen-Chen Wang
- School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Sullivan M, Gallagher G, Noonan V. The root of the problem: Occurrence of typical and atypical periapical pathoses. J Am Dent Assoc 2016; 147:646-9. [PMID: 27046538 DOI: 10.1016/j.adaj.2016.02.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND A preponderance of periapical radiolucencies are of inflammatory etiology (radicular cysts or periapical granulomas) secondary to pulpal disease. In some instances, however, a suspected periapical inflammatory lesion is not a consequence of pulpal disease but instead represents a lesion of noninflammatory origin. The differential diagnosis for such lesions is broad, ranging from odontogenic cysts and tumors to metastatic disease. As the biological behavior of such lesions is varied, the distinction between inflammatory odontogenic periapical lesions and lesions of noninflammatory origin in a periapical location is critical. METHODS A retrospective study of 5,993 archival periapical biopsies over a span of 15 years from the database of the Oral Pathology Biopsy Service in the Henry M. Goldman School of Dental Medicine at Boston University recorded the incidence of various lesions in a periapical location. RESULTS Of the cases studied, 97.2% represented lesions of inflammatory origin with histopathologic diagnoses as follows: periapical granuloma (60.0%), radicular cyst (36.7%), periapical fibrous scar (0.27 %), and periapical abscess (0.23 %). The remaining 2.8% cases were lesions of noninflammatory origin with histopathologic diagnoses of odontogenic keratocyst (also known as keratocystic odontogenic tumor), benign fibro-osseous lesions, and ameloblastoma. One patient had Langerhans cell disease, and 1 had central giant cell granuloma. CONCLUSIONS Although most periapical specimens biopsied represented expected inflammatory periapical lesions, the biological behavior of underdiagnosed lesions may have considerable consequences for both the patient and the clinician. PRACTICAL IMPLICATIONS This article serves to inform clinicians regarding the diversity of lesions arising in the periapical region of the jaws, to assist in the formulation of differential diagnoses, and to highlight the importance of submission of lesional tissue for histopathologic evaluation and definitive diagnosis when biopsy is clinically indicated.
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Götz C, Reinhart E, Wolff KD, Kolk A. Oral soft tissue infections: causes, therapeutic approaches and microbiological spectrum with focus on antibiotic treatment. J Craniomaxillofac Surg 2015; 43:1849-54. [PMID: 26358301 DOI: 10.1016/j.jcms.2015.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/30/2015] [Accepted: 08/07/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Intraoral soft tissue infections (OSTI) are a common problem in dentistry and oral surgery. These abscesses are mostly exacerbated dental infections (OIDC), and some emerge as postoperative infections (POI) after tooth extraction (OITR) or apicoectomy (OIRR). The main aim of this study was to compare OIDC with POI, especially looking at the bacteria involved. An additional question was, therefore, if different antibiotic treatments should be used with OSTI of differing aetiologies. The impact of third molars on OSTI was evaluated and also the rates of POI after removal of third molars were specified. MATERIAL AND METHODS Patient data was collected from the patients' medical records and the results were statistically evaluated with SPSS (SPSS version 21.0; SPSS, IBM; Chicago, IL, USA). The inclusion criterion was the outpatient treatment of a patient with an exacerbated oral infection; the exclusion criteria were an early stage of infiltration without abscess formation; and a need for inpatient treatment. RESULTS Periapical exacerbated infections, especially in the molar region were the commonest cause of OIDC. In the OITR group, mandibular tooth removal was the commonest factor (p=0.016). Remarkably, retained lower wisdom teeth led to significant number of cases in the OITR group (p=0.022). CONCLUSIONS In our study we could not define differences between the causal bacteria found in patients with OIDC and POI. Due to resistance rates we conclude that amoxicillin combined with clavulanic acid seems to be the antibiotic standard for exacerbated intraoral infections independent of their aetiology.
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Affiliation(s)
- Carolin Götz
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Klaus-Dietrich Wolff), Technische Universität München, Klinikum Rechts der Isar, Ismaningerstraße 22, 81675 München, Germany.
| | - Edeltraud Reinhart
- Department of Oral and Maxillofacial Surgery, Julius-Maximilians-Universität Würzburg, 97070 Würzburg, Germany
| | - Klaus-Dietrich Wolff
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Klaus-Dietrich Wolff), Technische Universität München, Klinikum Rechts der Isar, Ismaningerstraße 22, 81675 München, Germany
| | - Andreas Kolk
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Dr. Klaus-Dietrich Wolff), Technische Universität München, Klinikum Rechts der Isar, Ismaningerstraße 22, 81675 München, Germany
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26
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Treatment of a Large Radicular Cyst. J Craniofac Surg 2015; 26:e454-5. [PMID: 26079122 DOI: 10.1097/scs.0000000000001635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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