Interleukin 17 expression in periapical lesions from elderly patients

OBJECTIVE

To compare the expression of IL-17 in periapical lesions (cysts and granulomas) among elderly individuals and adults. We selected 20 periapical lesions of the elderly (12 granulomas and eight cysts) and 20 periapical lesions of adults (12 granulomas and eight cysts).

MATERIALS AND METHODS

Immunohistochemistry was performed using a specific antibody for IL-17. The slides were subdivided into five high magnification fields and then the images were observed through an optical microscope. According to the number of positive markings for the antibody, grades were given, ranging from 0 to 2.

RESULTS

The results demonstrate that there was no statistical difference when comparing the expression of IL-17 between cysts and granulomas of both groups (study group: cysts 0.7 ± 0.21 × granulomas 0.96 ± 0.58, p = .61; control group: cysts 0.37 ± 0.16 × granulomas 0.31 ± 0.23, p = .27). The comparison between adult (control group) and elderly patients (study group) showed a statistical difference both in cysts (study group: 0.7 ± 0.21 × control group: 0.37 ± 0.16, p = .007) and in granulomas (study group: 0.96 ± 0.58 × control group: 0.31 ± 0.23, p = .0009), in which elderly patients had a higher expression of interleukin 17, in relation to adult patients.

CONCLUSION

We concluded that elderly patients have a higher expression of IL-17 in both cysts and granulomas, when compared to adult patients.

Bilateral dens evaginatus and associated cystic pathology: An unusual case report

Dens evaginatus (DE) presents a clinical conundrum due to its fragility and propensity to cause pulpal and periapical complications. Clinicians should heed the presence of DE during clinical examinations and avoid unnecessary intervention.

Association between Clinical/Radiographic Characteristics and Histopathological Diagnoses of Periapical Granuloma and Cyst

OBJECTIVE

 The aim of this study was to determine the association between clinical/radiographic characteristics and histopathological diagnoses of periapical granuloma and cyst obtained from the teeth treated with endodontic microsurgery.

MATERIALS AND METHODS

 The clinical, radiographic (periapical and cone-beam computed tomography), and histopathological data were collected from patients' dental records of endodontic microsurgery on the teeth with periapical lesions. These lesions were histopathologically diagnosed as either granuloma or cyst, at the Endodontic Clinic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand, from 2016 to 2021 according to inclusion and exclusion criteria. The data were analyzed using bivariate analysis and a multinomial logistic regression at a significance level of p-value less than 0.05.

RESULTS

 A total of 83 patients (58 females and 25 males) with an average age of 45 to 49.5 years old met the criteria including 68 periapical granulomas (81.9%) and 15 periapical cysts (18.1%). A periapical lesion involving multiple teeth in a periapical radiograph was significantly associated with the histopathological diagnosis of periapical cyst (p < 0.05). Such periapical lesion was six times more likely to be periapical cyst than periapical granuloma.

CONCLUSIONS

 A significant factor for predicting periapical cyst from periapical granuloma was the presence of a periapical lesion with multiple-teeth involvement in a dental radiograph.

Frequency and Types of Periapical Radiographic Lesions Associated With Pulpitis in a Tertiary Care Hospital

Objective This cross-sectional study aimed to determine the frequency and types of periapical radiographic lesions (PARLs) associated with pulpitis in patients visiting a tertiary care hospital. Methodology A sample of patients diagnosed with pulpitis, aged 18 years or older, was recruited following a convenient sampling technique. Clinical examinations were conducted to confirm the diagnosis, and radiographic evaluations, including periapical (PA), occlusal, orthopantomogram (OPG), and cone beam computed tomography (CBCT) radiographs were obtained. The radiographs were evaluated for the presence of PA lesions, and the type, size, and location of the lesions were documented. Data were analyzed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA). Results A total of 120 patients (equal gender ratio) with a mean age of 32.6 ± 6.39 years participated in the study. PA views were the most frequently performed radiographic view (86.7%), followed by occlusal views (8.3%). The most prevalent radiographic lesion was the widening of the periodontal ligament (PDL) space (34.2%), followed by PA granuloma (17.5%) and PA cyst (10.8%). The most frequently encountered diagnosis was pulpitis (51.7%), followed by irreversible pulpitis with apical periodontitis (25.8%). Education level, swelling, pus discharge, medicine history, and tooth wear showed statistically significant associations (P ≤ 0.05) with the variables under investigation. Conclusions The most common lesions observed were widening of the PDL space, PA granuloma, and PA cyst. The findings contribute to the local epidemiological and clinical data, enriching the existing database. Understanding the prevalence and characteristics of PA lesions associated with pulpitis can aid in accurate diagnosis and treatment planning for patients with pulpal pathologies.

Association between Cone-Beam Computed Tomography and Histological and Immunohistochemical Features in Periapical Lesions Correlated with Thickened Maxillary Sinus Mucosa

Background and Objectives: Odontogenic sinusitis is a frequently underestimated pathology with fewer symptoms in patients with periapical lesions, periodontal disease, or iatrogenic foreign bodies in the maxillary sinus. The aim of our study was to determine the correlation between maxillary sinusitis and periapical lesions using cone-beam computed tomography (CBCT) imaging and histological and immunohistochemical investigations. Materials and Methods: A total of 1450 initial patients diagnosed with maxillary sinusitis in the Ear-Nose-Throat (ENT) Department, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, Romania, were treated with anti-inflammatory drugs. Of these, 629 still had unresolved symptomatology and were later referred to the Dental Medicine departments for further investigations. Only 50 subjects with periapical lesions in the premolar/molar maxillary area were included in the present study. All the periapical lesions were observed on CBCT and classified using the Periapical Status Index (PSI) and the mean maxillary sinus mucosa thicknesses (MSMT). The enrolled patients underwent surgical procedures with the excision of periapical lesions. The excised samples were submitted to the histological and immunohistochemical investigations. Results: The 50 patients presented periapical lesions of their maxillary teeth in 328 dental units. There was a higher prevalence of periapical lesions in men than in women (chi-square test). We observed a significant difference between the mean MSMT of individuals with periapical lesions compared to those without (p < 0.01). Mean MSMT was 1.23 mm for teeth without periapical lesions and 3.95 mm for teeth with periapical lesions. The histopathological study identified 50% cases with periapical granulomas, 10% cases with periapical granulomas with cystic potential, and 40% cases as periapical cysts. Immunohistochemical stainings showed that CD4+ helper and CD8+ cytotoxic T lymphocytes, along with CD20+ B lymphocytes and CD68+ macrophages, were diffusely distributed in all periapical cysts and in some periapical granulomas, but CD79α+ plasma cells characterized especially periapical granulomas. Conclusions: The current study observed a significant correlation between CBCT maxillary mucosa thickness and type of periapical lesion. Chronic inflammatory lympho-histiocytic infiltrate predominates in periapical lesions, supporting the idea that lesion progression is determined by a humoral-type (CD20+ and CD79α+ B lymphocytes) but also by a cellular-type (CD4+ and CD8+ T lymphocyte population) immune mechanism.

Decompression strategy for critical-sized lesions: A case series and literature review

Critical-sized lesions are defined as the smallest sized intraosseous wound in a particular bone that will not heal spontaneously during the lifetime of that animal. These critical-sized entities pose a unique challenge in endodontics, where these lesions are most likely cystic, with dimensions extending over 10 mm. This paper describes a structured methodology to treat such cases whilst also highlighting inconsistencies and variability between practitioners regarding management of critical-sized lesions. The case series demonstrates that non-surgical root canal therapy followed by surgical decompression may be the treatment of choice for such pathosis. A 16 gauge nasogastric tube was used as a decompression device and sutured to surrounding mucosa. Healing was evaluated using both two- and three-dimensional radiographs. Decompression of critical-sized lesions would appear to be a reliable, conservative and an altogether complete procedure that may not warrant second-stage surgery.

A Report of Two Cases

Background and Objectives: Periapical cystic lesions are a pathology frequently addressed to endodontic specialists. Although their therapy is still not standardized, the treatment should be as conservative as possible and by endodontic means, as they are lesions of endodontic origin. The present case report describes two cases of upper central incisors with large cyst-like periapical lesions, and their one-year follow up. Materials and Methods: Endodontic orthograde treatment was performed under copious irrigation with sodium hypochlorite, in association with calcium hydroxide as an intra-canal medication for both teeth. Root canal filling was achieved in a separate appointment using the continuous wave of condensation technique. A decompression procedure was used in association with endodontic therapy in the second case to reduce the pressure inside the cystic lesion and to allow its drainage, and only because the root canal could not be dried three weeks after medication. Initial cone beam computed tomography (CBCT) investigations, as well as at the one-year follow up, were used to compare the evolution of the lesion. Results: Both cases had a favorable outcome. New bone formation in the periapical region and complete resolution of the lesion was observed at the one-year control in the first case. In the second case, although the lesion was still not completely healed at 12 months, a significant reduction in its size could be observed, showing active signs of healing. Conclusions: Endodontic treatment is the first choice option in the management of teeth with pulpal necrosis and large periapical cystic-like lesions. Decompression is the only surgical procedure recommended when the canals cannot be dried and obturated. Large surgical interventions are unnecessary in cases where endodontic treatment can be performed.

Resolution of a Cystic Endodontic-Periodontal Lesion Utilizing Combined Apicoectomy And Guided Tissue Regeneration: A Case Report

INTRODUCTION

Endodontic-periodontal combined lesions pose a treatment challenge for clinicians, especially when the lesion is persistent and does not show signs of healing after initial endodontic treatment. This case report describes interdisciplinary management of a non-healing combined endodontic-periodontal lesion related to a peri-apical cyst, through a combined approach of apicoectomy and guided tissue regeneration (GTR) with enamel matrix derivative (EMD). Most documented cases have been treated in a sequential manner, with minimal literature present on the effects of a combined approach utilizing EMD for the treatment of these lesions.

CASE PRESENTATION

A 72-year-old male patient presented with an endodontic-periodontal lesion at tooth #31 initially treated with nonsurgical root canal therapy. The lesion was not responsive to initial endodontic treatment. The patient was informed of questionable prognosis, however wished to save the tooth. Tooth #31 was treated via a combination approach of apicoectomy with bioceramic putty retrograde filling, followed by GTR of the defect using allograft, EMD, and resorbable barrier membrane. The lesion was biopsied and diagnosed as a periapical cyst. Clinical and radiographic examination at 1 year showed resolution of lesion, reduction in probing depths, and good bone fill of the defect.

CONCLUSION

Traditionally, endodontic-periodontal lesions, which were not responsive to initial therapy, would be given a questionable prognosis and be extracted. This case demonstrates that non-healing, peri-apical lesions may be cystic in nature and effectively managed utilizing a combined approach, with apicoectomy and GTR with EMD, to produce a stable outcome.

Ultrasound imaging for the differential diagnosis of periapical lesions of endodontic origin in comparison with histopathology - a systematic review and meta-analysis

BACKGROUND

Differentiating periapical lesions is important for treatment planning and subsequent treatment outcome.

OBJECTIVE

To assess the diagnostic accuracy of ultrasound imaging for the differentiation of periapical lesions in comparison with histopathology.

METHODS

PubMed, Scopus, Embase, Web of Science and ProQuest databases were searched for clinical studies published until June 2020 that evaluated the use of ultrasound (US) imaging for differential diagnosis of periapical lesions and used histopathology as the reference standard. Animal studies, laboratory-based studies, reviews and clinical studies not using a reference standard were excluded. Risk of bias (RoB) assessment was performed using a modified Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The random effects model was used for quantitative analysis of the data, and the Deeks test was used for calculating publication bias. Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

Twelve articles were included in the systematic review, out of which ten articles were quantitatively assessed. All the articles had a high RoB and concerns regarding applicability in the patient selection domain. For the index test domain, seven articles had low and the remaining five had unclear RoB and concerns regarding applicability. In the reference standard domain, low RoB and concerns regarding applicability were observed for all the articles. The RoB was low in flow and timing domains in all the articles except for one, where it was high. Summary estimates of sensitivity and specificity of US to diagnose periapical granulomas were 0.94 and 0.98, whereas for periapical cysts it was 0.98 and 0.99, respectively. Area under the curve for diagnosis of both periapical granulomas and periapical cysts was 0.99. All the included articles had inherent publication bias. Quality of evidence using GRADE, for sensitivity, was moderate for periapical granulomas and high for periapical cysts, whereas for specificity, it was high for periapical granulomas and low for periapical cysts.

DISCUSSION

The available evidence is considered to be of low quality due to the observational nature of the studies and inherent publication bias.

CONCLUSION

Although the sensitivity and specificity for differentiating periapical cysts and periapical granulomas using US were high, taking the quality of evidence into consideration, it can serve as an additional tool in differential diagnosis of periapical lesions.

Assessment of Constant Periapical Lesions and Their Connection with Endodontic Failures after Apical Microsurgery

Background:

Periapical lesions can be appreciated in the teeth that have underwent root canal treatment leading to more complications. Radiographic as well as histological evaluation is important for definitive diagnosis.

Aim:

The aim of this study was to examine the histology of constant periapical radiolucent lesions that are associated with root canal treated teeth and also to find association between histological findings and radiographic size of lesion as well as existence or nonappearance of a radiopaque lamina.

Materials and Methods:

The study included 60 incisors and canines allotted for apical microsurgery. Two observers studied the diameter of periapical radiolucent lesions and the existence or nonappearance of radiopaque lamina. During apical microsurgery, biopsy specimens were collected and after tissue processing oral pathologist examined the specimen under a light microscope. Histological features of the specimen were taken into consideration, and the diagnosis of abscess, cyst, granuloma, and scar tissue were given. Pearson’s chi-square test was used to study the established relationship between histological diagnosis and lesion size.

Results:

Results indicated that 68.33% of lesions were granulomas, 23.33% were cysts, 5% were abscesses, and 3.33% were scar tissue.

Conclusion:

According to histological results, most of the lesions in this study were granulomas, followed by cysts. Abscesses and scar tissues were rare.

Accuracy of mean grey density values obtained with small field of view cone beam computed tomography in differentiation between periapical cystic and solid lesions

AIM

To determine if small and medium field of view (FOV) cone beam computed tomography (CBCT) adjusted grey density values can be used to distinguish between periapical cystic and solid lesions.

METHODOLOGY

Fifty-seven patients with periapical lesions having retrievable small or medium FOV CBCT images and biopsy samples were included. Two oral and maxillofacial pathologists examined the biopsy samples to provide the gold standard diagnosis of cystic or solid lesion. From the CBCT images, two independent examiners recorded the minimum adjusted grey density value of each lesion twice. Intra-examiner and inter-examiner reliability of the measurements were analysed, and sensitivity, specificity and accuracy of the minimum grey values in distinguishing a solid from cystic lesion were calculated. A receiver operating curve for diagnostic ability of adjusted grey density values to differentiate between periapical cystic and solid lesions was obtained, and the area under the curve (AUC) was calculated.

RESULTS

The intra- and inter-examiner reliability of the grey density values of the lesions and dentine were excellent. The AUC was 0.44 (P-value = 0.45). The adjusted grey density value with the greatest accuracy for differentiating between cystic and solid lesions had an accuracy, sensitivity and specificity of 0.54, 1.00 and 0.075, respectively.

CONCLUSIONS

Small FOV CBCT adjusted grey density values obtained by the device used in the study could not distinguish between periapical cystic and solid lesions. Further developments in CBCT devices are needed to improve the accuracy of grey density measurements.

An Unusual Case of a Large Periapical Cyst Mimicking a Nasopalatine Duct Cyst

This article reports on the management of a large median symmetrical lesion of the anterior palate, which was clinically and radiographically diagnosed as an infected nasopalatine duct cyst. However, histopathology demonstrated it to be a radicular cyst of endodontic origin.

Massive radicular cyst involving multiple teeth in pediatric mandible- A case report

Radicular or periapical cysts are one of the most commonly occurring odontogenic cysts of the jaws. The present article reported a case of a 12-year-old female with the chief complaint of swelling and pain on the right lower back tooth region. The radiographic examination revealed the presence of a well-defined radiolucency surrounded by a corticated border with respect to the right mandibular 1^st, 2^nd and 3^rd molar. The case was managed by complete enucleation under general extraction with the extraction of right mandibular 1^st, 2^nd and 3^rd molar. The success of the surgery was apparent by the uneventful healing during the follow-up period and evidence of complete healing after 1-month follow-up. Early diagnosis of the lesion would have lead to a less aggressive treatment plan.

Periapical Cyst and Odontogenic Remnants on Osseous Mandibulectomy Margins: Two Diagnostic Pitfalls

In this article, we describe 2 high-stake diagnostic pitfalls that occurred in a single patient having undergone partial glossectomy and marginal mandibulectomy for invasive squamous cell carcinoma. Margins were grossly uninvolved. Histopathology showed a moderately differentiated squamous cell carcinoma. Microscopic evaluation of margins was challenging, as the inferior osseous margin submitted en face showed spongiotic epithelium with mixed chronic and acute inflammation, representing a periapical cyst after correlation with the gross examination. Another section of the osseous margin showed a small non-atypical epithelial nest, consistent with an odontogenic epithelial rest. We wish to raise awareness of these diagnostic pitfalls as a bone margin with such epithelial foci could be misinterpreted as positive, with serious therapeutic consequences.

Accuracy of computer-assisted image analysis in the diagnosis of maxillofacial radiolucent lesions: A systematic review and meta-analysis

OBJECTIVES

This study aimed to search for scientific evidence concerning the accuracy of computer-assisted analysis for diagnosing maxillofacial radiolucent lesions.

METHODS

A systematic review was conducted according to the statements of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols and considering 10 databases, including the gray literature. Protocol was registered at the International Prospective Register of Systematic Reviews (CRD42018089945). The population, intervention, comparison and outcome strategy was used to define the eligibility criteria and only diagnostic test studies were included. Their risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal tool. Random-effects model meta-analysis was performed and heterogeneity among the included studies was estimated using the I² statistic. The grade of recommendation, assessment, development, and evaluation (GRADE) tool assessed the quality of evidence and strength of recommendation across included studies.

RESULTS

Out of 715 identified citations, four papers, published between 2009 and 2017, fulfilled the criteria and were included in this systematic review. A total of 191 lesions, classified as periapical granuloma and cyst, dentigerous cyst or keratocystic odontogenic tumor, were analyzed. All selected articles scored low risk of bias. The pooled accuracy estimation, regardless of the classification method used, was 88.75% (95% CI = 85.19-92.30). Heterogeneity test reached moderate values (I² = 57.89%). According to the GRADE tool, the analyzed outcome was classified as having low level of certainty.

CONCLUSIONS

The overall evaluation showed all studies presented high accuracy rates of computer-aided diagnosis systems in classifying radiolucent maxillofacial lesions compared to histopathological biopsy. However, due to the moderate heterogeneity found among the studies included in this meta-analysis, a pragmatic recommendation about the use of computer-assisted analysis is not possible.

Role of mast cells in inflammatory and reactive pathologies of pulp, periapical area and periodontium

Mast cells (MCs) have been discovered over 130 years ago; their function was almost exclusively linked to allergic affections. At the time being, it is well known that MCs possess a great variety of roles, in both physiologic and pathologic conditions. In the oral tissues, MCs release different pro-inflammatory cytokines and tumor necrosis factor-alpha that promote leukocyte infiltration in various inflammatory states of the oral cavity. These cells play a key role in the inflammatory process and, as a consequence, their number changes in different pathologic conditions of the oral cavity, such as gingivitis and periodontitis. By understanding the role of MCs in the pathogenesis of different inflammatory diseases of the oral cavity, these cells may become therapeutic targets that could possibly improve the prognosis. Therefore, this review summarizes the current understanding of the role of MCs in various inflammatory pulpal, periapical and periodontal pathophysiological conditions.

A Novel Conservative Approach Combining "SealBio" and "Surgical Fenestration" for Healing of Large Periapical Cystic Lesions of Endodontic Origin: A Pilot Study

OBJECTIVES

To evaluate the treatment outcome of large periapical cystic lesions treated by combining two novel, conservative approaches, "SealBio" and "Surgical Fenestration".

MATERIALS AND METHODS

Five cases (4M:1F, age range 14-38 years, mean age 24.5 years) of large periapical cystic lesions, diagnosed on clinical and radiographic examination, were included in the study. After informed consent, endodontic treatment was initiated; chemo-mechanical preparation and intra-canal dressing of calcium hydroxide was given. At the next sitting after one week, further disinfection root canals was done by "apical clearing", "apical foramen widening" and irrigation. A cotton pellet was kept in the access cavity. After local anaesthesia, full thickness muco-periosteal flap was reflected and the thinned out bone was removed with bone rongers, a small piece of cystic lining was excised and the cystic cavity was copiously flushed with Betadine solution. The remaining cystic lining was gently curetted and the flap was sutured back. "SealBio" was performed after gentle irrigation with saline and intentional over instrumentation. A calcium sulphate based cement was pushed in the cervical third of the canal and the access opening was sealed with glass ionomer cement. Patient was prescribed antibiotics and anti-inflammatory drugs for 5 days and sutures were removed after 7 days. Patients were followed up clinically and radiographically at regular intervals.

CONCLUSIONS

In this pilot study, treatment outcome after combined technique of "SealBio" and "Surgical fenestration" was found to be highly effective in healing of large periapical cystic lesions. It was simple to perform and very conservative treatment; it required minimal bone removal, obviated the need for complete cyst enucleation, apicectomy and retrograde filling.

M2 macrophages coexist with a Th1-driven profile in periapical cysts

AIM

To evaluate the participation of both Th1 and Th2 responses in periapical cysts by assessing the presence of M2 macrophages, as well as acute IL-1 β, TNF-α and IL-6 cytokines.

METHODOLOGY

Twenty-four cases of periapical cysts were selected. Immuno-expressions of IL-1 β, IL-6, TNF-α and CD163 were analysed in the cystic capsules in both superficial and deeper regions. Data were analysed with paired Wilcoxon test and Spearman correlation coefficient (P ≤ 0.05).

RESULTS

There was a higher expression of IL-1β, IL-6, TNF-α and M2 macrophages in the superficial region (P < 0.001) of cystic capsules. All acute cytokines had significant positive correlations amongst them regardless of the cystic capsule region. Regarding CD163, positive correlations occurred only with TNF-α (P = 0.007; r = 0.537) and IL-6 (P = 0.018; r = 0.478) in the superficial regions of the cystic capsule.

CONCLUSIONS

M2 macrophages participated actively in the inflammatory response of periapical cysts and correlated with the expression of certain acute Th1-related cytokines. This illustrates the coexistence of an acute and chronic Th2-driven immune response in these lesions. Although M2 macrophages favour the healing process, their presence is not sufficient for periapical cyst regression, once an acute active response has occurred due to an infectious stimuli.

Reliability of cone beam computed tomography as a biopsy-independent tool in differential diagnosis of periapical cysts and granulomas: An In vivo Study

Background:

Differential diagnosis of periapical cysts and granulomas is required as their treatment modalities are different.

Aim:

The aim of this study was to evaluate the efficacy of cone beam computed tomography (CBCT) in the differential diagnosis of periapical cysts from granulomas.

Settings and Design:

A single-centered observational study was carried out in the Department of Conservative Dentistry and Endodontics, Dr. R. Ahmed Dental College and Hospital, using CBCT and dental operating microscope.

Methods:

Forty-five lesions were analyzed using CBCT scans. One evaluator analyzed each CBCT scan for the presence of the following six characteristic radiological features: cyst like-location, shape, periphery, internal structure, effect on the surrounding structures, and cortical plate perforation. Another independent evaluator analyzed the CBCT scans. This process was repeated after 6 months, and inter- and intrarater reliability of CBCT diagnoses was evaluated. Periapical surgeries were performed and tissue samples were obtained for histopathological analysis. To evaluate the efficacy, CBCT diagnoses were compared with histopathological diagnoses, and six receiver operating characteristic (ROC) curve analyses were conducted.

Statistical Analysis Used:

ROC curve, Cronbach's alpha (α) test, and Cohen Kappa (κ) test were used for statistical analysis.

Results:

Both inter- and intrarater reliability were excellent (α = 0.94, κ = 0.75 and 0.77, respectively). ROC curve with regard to ≥4 positive findings revealed the highest area under curve (0.66).

Conclusion:

CBCT is moderately accurate in the differential diagnosis of periapical cysts and granulomas.

Cellular Profile and Expression of Immunologic Markers in Chronic Apical Periodontitis from HIV-infected Patients Undergoing Highly Active Antiretroviral Therapy

INTRODUCTION

This study tested the hypothesis that the inflammatory cell profile (CD3-, CD4-, CD8-, CD20-, and CD68-positive cells) and the expression of immunologic markers (tumor necrosis factor α, interferon-γ, interleukin-6, and interleukin-18) in chronic apical periodontitis are the same between non-HIV-infected patients and HIV-infected patients undergoing highly active antiretroviral therapy (HAART).

METHODS

Thirty-four surgically excised chronic apical periodontitis lesions were sampled from 34 patients (17 HIV-infected and 17 non-HIV-infected). The lesions were extracted from teeth with no previous endodontic treatment. All HIV-infected patients were undergoing HAART. The specimens were submitted to histopathologic and immunohistochemical analyses by using an optical microscope. Immunoexpression was graded into 2 levels, focal to weak and moderate to strong. The χ(2), Fisher exact, and Mann-Whitney tests were used to analyze all significant differences between groups.

RESULTS

Periapical cysts represented 70.6% and 52.9% of the lesions in the HIV-infected and non-HIV-infected groups, respectively; however, no statistically significant difference was observed (P = .481). There were no statistically significant differences between groups for the inflammatory cell profile and for any of the immunologic markers (P > .05).

CONCLUSIONS

There are no statistically significant differences of the cellular profile and expression of immunologic markers in chronic apical periodontitis between non-HIV-infected patients and HIV-infected patients undergoing HAART.

Immunohistochemical study of p53 and proliferating cell nuclear antigen expression in odontogenic keratocyst and periapical cyst

INTRODUCTION

p53 protein is a product of p53 gene, which is now classified as a tumor suppressor gene. The gene is a frequent target for mutation, being seen as a common step in the pathogenesis of many human cancers. Proliferating cell nuclear antigen (PCNA) is an auxiliary protein of DNA polymerase delta and plays a critical role in initiation of cell proliferation.

AIM

The aim of this study is to assess and compare the expression of p53 and PCNA in lining epithelium of odontogenic keratocyst (OKC) and periapical cyst (PA).

MATERIALS AND METHODS

A total of 20 cases comprising 10 OKC and 10 PA were included in retrospective study. Three paraffin section of 4 μm were cut, one was used for routine hematoxylin and eosin stain, while the other two were used for immunohistochemistry. Statistical analysis was performed using Chi-square test.

RESULTS

The level of staining and intensity were assessed in all these cases. OKC showed PCNA expression in all cases (100%), whereas in perapical cyst only 60% of cases exhibited PCNA staining. (1) OKC showed p53 expression in 6 cases (60%) whereas in PA only 10% of the cases exhibited p53 staining. Chi-square test showed PCNA staining intensity was more significant than p53 in OKC. (2) The staining intensity of PA using p53, PCNA revealed that PCNA stating intensity was more significant than p53.

CONCLUSION

OKC shows significant proliferative activity than PA using PCNA and p53. PCNA staining was more intense when compared with p53 in both OKC and PA.

Single visit nonsurgical endodontic therapy for periapical cysts: A clinical study

AIMS

The aim of this study was to assess the outcome of single sitting root canal treatment (RCT) of asymptomatic teeth with periapical cysts.

MATERIALS AND METHODS

Ten maxillary anterior teeth showing periapical lesion on the radiograph was further screened by ultrasound with color power Doppler (CPD) for confirmation of a cyst. The average dimension of the lesions ranged from 1.3 to 1.9 cm. Single sitting RCT was performed on all the selected teeth. Postoperative healing was monitored at regular interval of 3 months, 6 months, and 1 year by using subjective feedback, radiograph, and ultrasound with CPD study.

RESULTS

Eight among the ten cases showed either signs of complete healing or healing in progress by the end of 6-12 months.

CONCLUSIONS

It was observed that single sitting nonsurgical endodontic management of asymptomatic teeth with periapical cyst confirmed by ultrasound was successful in selected cases.

A minimally invasive surgical approach for large cyst-like periapical lesions: a case series

Various conservative approaches have been utilized to manage large periapical lesions. This article presents a relatively new, very conservative technique known as surgical fenestration which is both diagnostic and curative. The technique involves partially excising the cystic lining, gently curetting the cystic cavity, performing copious irrigation, and closing the surgical site. This technique allows for decompression and allows the clinician the freedom to take a biopsy of the lesion, as well as perform other procedures such as root resection and retrograde sealing, if required. As the procedure does not perform a complete excision of the cystic lining, it is both minimally invasive and cost-effective. The technique and the concepts involved are reviewed in 4 cases treated with this novel surgical approach.

Distribution of mast cells and macrophages and expression of interleukin-6 in periapical cysts

INTRODUCTION

Mast cells and macrophages are important components of the inflammatory infiltrate found in inflammatory periapical diseases. Several cytokines participate in the mechanisms of inflammation, tissue repair, and bone resorption associated with periapical cysts. The aim of the present study was to evaluate the distribution of mast cells and macrophages and the expression of interleukin-6 (IL-6) in periapical cysts.

METHODS

Thirty periapical cysts were selected for the study, and clinical, demographic, and gross information from the cases was obtained from the laboratory records. Five-micrometer sections stained with hematoxylin-eosin were reviewed for analysis of the microscopic features of the cysts, and 3-μm sections on silanized slides were used for immunohistochemical reactions with anti-tryptase, anti-CD68, and anti-IL-6.

RESULTS

There was no statistically significant difference in the mean number of mast cells and macrophages when comparing superficial and deep regions of the fibrous capsule of the cysts. Mean number of mast cells on the superficial region of the fibrous capsule was higher in cysts showing intense superficial inflammation and exocytosis. Macrophages were more commonly found in areas showing IL-6 expression, and IL-6 was less expressed in deep regions of the fibrous capsule in cysts showing greater gross volume.

CONCLUSIONS

The results reinforced the participation of mast cells and macrophages in the pathogenesis of periapical cysts and suggested that IL-6 is not the major bone resorption mediator in larger periapical cysts.

Gemination of a permanent lateral incisor- a case report with special emphasis on management

The purpose of this case report is to describe the successful endodontic treatment and surgical management of a unesthetic geminated permanent maxillary lateral incisor tooth. Geminated maxillary incisor clinically revealed bifid crown with coronal groove and intraoral periapical radiograph showing radiolucent lesion with sclerotic border. orthograde root canal treatment was performed. surgery was done by reflecting limited thickness mucoperiosteal flap, cyst enucleated, root end resected and retrograde filling done using mineral trioxide aggregate. During the follow up examination, post operative intra oral periapical radiographs revealed healing of periapical lesion. Key words:Gemination, Periapical Cyst, Retrograde Filling. How to cite this article: Sharada H L, Deo B, Briget B. Gemination of a Permanent Lateral Incisor - A Case Report with Special Emphasis on Management. J Int Oral Health 2013; 5(2):55-59.