Histopathologic evaluation of follicular tissues associated with impacted lower third molars

Correlation Between Radiographic and Histopathologic Findings Associated with Unerupted Teeth in Dogs

An association between unerupted teeth and dentigerous cysts is well known,^{1- 4} however little is known about the presence of disease and histopathologic changes in unerupted teeth without radiographic evidence of cyst formation. Forty-two dogs representing 25 breeds, ranging in age from 5 months to 12 years were selected based on radiographic evidence of an unerupted tooth or teeth, either as a primary complaint or incidental finding. Dogs meeting the study criteria were presented to a private dental referral practice within a period of eighteen months from December 2016 through May 2018. Patients were treated with conservative en bloc resection of the unerupted tooth and overlying bone as well as debridement of any cystic structure and biopsy of the samples collected. Radiographs were evaluated using criteria previously established to assess for evidence of a cyst.^{1, 5- 7} A total of 68 unerupted teeth were identified; 63 (92.7%) were mandibular first premolar teeth. Of the 63 unerupted mandibular first premolar teeth, 28 (44.4%) had radiographic evidence of a cystic structure. Histopathology revealed that 21 of 28 (75.0%) had evidence of non-keratinizing stratified squamous epithelium consistent with a cyst lining. Of the remaining 35 of 63 (55.6%) mandibular first premolar teeth with no radiographic evidence of a cyst, 27 (77.1%) had no histologic evidence of epithelium associated with the impacted tooth. Notably however, the remaining 8 of 35 (22.9%) unerupted teeth without radiographic evidence of a cyst did have histologic evidence of non-keratinizing stratified squamous epithelium associated with the impacted tooth.

Histopathological Evaluation of Dental Follicle Associated with Radiographically Normal Impacted Mandibular Third Molars

Introduction

Removal of impacted mandibular third molar is a common procedure performed in oral surgery. Indications for removal of the third molar have generated much discussion in dentistry. The presence of pericoronal pathosis is generally accepted reason for the extraction of impacted mandibular third molars. Radiographic pathology is usually defined as a pericoronal radiolucency measuring about 2.5 mm or larger in any dimension.

Purpose

This study aims to evaluate the histopathologic changes in radiographically normal dental follicles associated with impacted mandibular third molars.

Methods

After extraction of 50 impacted mandibular third molars, dental follicle associated with extracted teeth was placed in 10% formalin solution. Histopathologic examination was done. The type of pathological changes was recorded based on histopathological reports. Patients' gender, age, and radiographic parameters were recorded.

Results

Cystic changes were found in 24% of radiographically normal impacted mandibular third molars. Significant cystic changes were observed in position A vertically impacted lower third molars (ILTMs). Male predominance for cystic change was seen with a male-female ratio of 2:1.

Conclusion

The result of the present study shows that radiographic analysis may not be reliable technique for the diagnosis of cystic changes in ILTM. The presence of cystic changes can be found even in radiographically normal impacted mandibular third molars. Hence, we recommend that impacted mandibular third molars should be removed and histopathological analysis should be conducted on all surgically extracted dental follicles.

Clinician-related factors behind the decision to extract an asymptomatic lower third molar. A cross-sectional study based on Spanish and Portuguese dentists

BACKGROUND

Scientific literature estimates that around 18 to 40 % of asymptomatic third molars are extracted. The aims of the present study were to determine the indications for extraction of asymptomatic lower third molars in a sample of Spanish and Portuguese dentists, and to relate these indications to the clinicians' training and professional experience.

MATERIAL AND METHODS

A survey consisting of 15 cases of asymptomatic lower third molars was emailed to Portuguese and Spanish dentists. The clinicians were asked to assess the level of difficulty of the extractions and to make a reasoned recommendation based on the panoramic radiographs, gender and age of the patients.

RESULTS

381 clinicians filled in the questionnaires. Most of the professionals had over 13 years of clinical experience. The number of Spanish clinicians with postgraduate degrees in Oral Surgery was significantly higher. On average, 42% of respondents recommended extraction of asymptomatic third molars. The indication for extraction was significantly higher among Portuguese dentists. Clinical experience was negatively correlated with the perceived extraction difficulty (p<0.05). The main reason given for extracting was the prevention of pericoronitis, whereas that for not extracting was the absence of a clear indication and the risk of injuring the inferior alveolar nerve.

CONCLUSIONS

The Portuguese dentists were more in favour of removing asymptomatic lower third molars than the Spanish dentists, although the latter had a higher proportion of professionals with postgraduate studies in Oral Surgery.

The importance of histopathologic analysis of pericoronal follicles for the early identification of ameloblastomas

The objective of this study was to discuss the importance of performing histopathological examination of pericoronal follicles as a routine procedure, so as to enable the early identification of odontogenic lesions. We describe two clinical cases with histopathological diagnoses of ameloblastomas who did not show clinical or radiographic signs of disease before microscopic examination.

Incidência de anormalidades histológicas em tecido correspondente ao espaço pericoronário de terceiros molares inclusos e semi-inclusos

INTRODUÇÃO: O Folículo Pericoronário envolve a coroa do germe dental durante seu desenvolvimento. Quando o dente permanece incluso, alterações do folículo podem originar doenças, como cistos e tumores odontogênicos. OBJETIVO: Analisar as alterações histológicas no tecido mole circundante a terceiros molares inclusos e semi-inclusos, independentemente de alterações patológicas aparentes em suas radiografias correspondentes, além de relacionar o diagnóstico histológico com o diagnóstico radiográfico dos casos. MATERIAL E MÉTODO: A partir de terceiros molares extraídos de 26 pacientes, foram analisados espécimes histológicos de folículos pericoronários por dois examinadores calibrados. O diagnóstico histopatológico obtido foi relacionado ao radiográfico, sendo este realizado por meio de radiografias periapicais e, quando necessário, complementado por radiografias panorâmicas. RESULTADO: Dos 37 folículos pericoronários avaliados, 30% mostraram alterações histológicas compatíveis com cistos dentígeros; 51% eram folículos normais, e 19% continham apenas fragmentos de mucosa. Radiograficamente, 100% dos casos demonstraram características de folículos sem alterações. CONCLUSÃO: Esses dados exemplificam que anormalidades podem estar presentes nos tecidos pericoronários sem que haja evidências clínicas e radiográficas. O exame histopatológico provê um diagnóstico mais preciso e deve ser considerado para a construção do diagnóstico definitivo.