Clinical, radiographic and histological evaluation of chronic periapical inflammatory lesions

Abstract

The aim of the present study was to comparatively evaluate the clinical, radiographic and histological aspects of chronic inflammatory periapical lesions. One hundred and sixty-four lesions of human teeth, independent of age, race and sex, were evaluated by clinical, radiographic and histological analyses conducted after surgical endodontic treatment. Our results showed that there was uniformity in the interference factors on the evolution of periapical healing such as the apical biofilm and/or endogenous (cholesterol crystals) or exogenous (extruded endodontic materials that are indigestible or of difficult digestion) foreign bodies and that some cysts are reversible with endodontic treatment. We conclude that it is difficult for the clinician to adjust parameters defining a diagnosis of chronic inflammatory periapical lesions. UNITERMS: Endodontics; Periapical cysts; Chronic inflammatory lesions.O objetivo deste estudo foi realizar uma avaliação comparativa entre os aspectos clínico-radiográficos e histopatológicos das lesões periapicais inflamatórias crônicas. Através deste, foram avaliadas 164 lesões inflamatórias crônicas periapicais provenientes de dentes de indivíduos, independendo de idade, raça e sexo. Foram encaminhados casos condizentes com periodontite apical crônica e processo cístico inflamatório avaliados através do exame clínico-radiográfico. Após procedimento cirúrgico, a análise histopatológica foi realizada. Os resultados clínico-laboratoriais foram submetidos à análise estatística. Os resultados mostraram que há constância de fatores de interferência na evolução do processo reparatório periapical representados com ênfase pelo biofilme microbiano apical e/ou por corpos estranhos tanto endógenos como os critais de colesterol quanto exógenos como os materiais endodônticos extravasados indigeríveis ou de difícil digestão; e que alguns processos císticos são passíveis de reversão com o tratamento endodôntico. Nesta pesquisa pode-se observar que é difícil para o clínico ajustar parâmetros definindo a hipótese diagnóstica das lesões periapicais inflamatórias crônicas.

A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses

“…These data did not surprise us because of the same pathogenic process they have. [ 53 ] According to the International Classification of Diseases for Dentistry and Stomatology classification, which is an extensive classification of the diseases of the digestive system based on the originated tissues, periapical granuloma and radicular cyst are in the same subcategory as “disease of the pulp and periapical tissues.” The products of pulpal infection initiate an inflammatory response and stimulate the proliferation of the rests of Malassez in the periapical granuloma and the epithelial cell mass enlargement leads to cyst formation. Most radicular cysts are small, but they can reach a large size.…”

Comparative analysis of accuracy of diagnosis of chronic periapical lesions made by clinical and histopatological examination

“…In a study that included 227 chronic periapical lesions, histopathological analysis confirmed the incidence of radicular cysts and periapical granulomas to be 84.1% and 15.9%, respectively [7]. Another clinical study, which encompassed 164 patients with chronic periapical process, established the presence of radicular cysts in 54.88% cases and periapical granulomas in 45.12% cases [8]. The results were obtained using histopathological examination.…”

“…Furthermore, out of 17 clinical diagnoses of radicular cyst, 71% were accurate, whereas 29% were wrong diagnoses [9]. Brazilian authors, who compared clinical and histopathological diagnosis, reported levels of correlation between clinical and histopathological diagnosis of periapical granuloma and radicular cyst to be 61.97% and 76.27%, respectively [8]. Mortenson (1970) classified chronic periapical lesions into the following groups [1]:…”

Periodontitis Apical: Caracterización Histológica y Morfométrica de Quistes Radiculares y Granulomas Periapicales

“…En la identificación y diagnóstico de las lesiones periapicales, se han señalado varios métodos de comprobada eficacia, siendo la radiografía periapical la más utilizada (de Paula-Silva et al, 2009). Sin embargo, para el diagnóstico diferencial de estas lesiones, el análisis radiográfico por sí sólo no es concluyente debido a diversos factores que dificultan el diagnóstico, entre ellos, las distintas lesiones osteolíticas de características similares, variabilidad en las características de granulomas y quistes radiculares, y limitaciones de visualización radiográfica bidimensional (Cotti et al, 1999;Lia et al, 2004;de Paula-Silva et al). Çalıs¸kan et al señalan que para llegar a una confirmación diagnóstica definitiva, es necesario el análisis histopatológico de las biopsias de estas lesiones y la correlación con los hallazgos clínicos y radiográficos (Ricucci & Bergenholtz, 2004;García et al, 2007).…”