Absence of radiometric differentiation between periapical cysts and granulomas

Background and Aim:Periapical lesions often present differently on the radiograph resulting in a dilemma in the mind of the dentist to arrive at a final diagnosis. Although, histopathologic diagnosis has been used for confirmation of the true nature of periapical lesion, the concept of transformation of periapical granulomas containing epithelium without cystification into cyst remains controversial. The aim of this in vivo study was to evaluate the efficacy of conventional radiography and histopathology in differentiating periapical lesions in adjunct with immunohistochemical analysis.Aim:Periapical lesions often present differently on the radiograph resulting in a dilemma in the mind of the dentist to arrive at a final diagnosis. Although, histopathologic diagnosis has been used for confirmation of the true nature of periapical lesion, the concept of transformation of periapical granulomas containing epithelium without cystification into cyst remains controversial. The aim of this in vivo study was to evaluate the efficacy of conventional radiography and histopathology in differentiating periapical lesions in adjunct with immunohistochemical analysis.Materials and Method:Thirty patients having large periapical radiolucency that do not heal successfully with routine endodontic therapy in relation to either maxillary or mandibular anterior teeth were selected for the study. Intraoral periapical radiographs were obtained and provisional diagnosis of the apical areas were made. Endodontic surgery was performed to enable histopathogical investigation. The histopathological interpretation was done to arrive at a final diagnosis and selected questionable granulomas were subjected for cytokeratin (CK-14) stain.Results:The histopathological profile of lesions consisted of 66.66% periapical granulomas, 10% cysts, 6.67% abscess and 16.67% granulomas with cystic potential. The radiographic and histopathologic correlation was found in only 30% of these cases. Strong CK-14 expression was observed in all five cases of periapical granuloma with cystic potential.Conclusion:The radiographic diagnosis of periapical lesions remains inconclusive. Although histopathologic examination of periapical lesions gives true nature, the precise nature of subsets of periapical granulomas may be achieved with adjunct use of immunohistochemical markers.

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“…[23] Mortenson et al stated that a lesion greater than 1.5 cm can be safely classified as cyst. [15]…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of immunohistochemistry, histopathology and conventional radiography in differentiating periapical lesions

et al. 2014

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“… • Periapical cyst : Lesions with a layer of stratified squamous epithelium along a surface of sufficient quantity of conjunctive tissue to indicate a delineated cavity and surrounded by a slight fibrous capsule (Patterson et al . 1964, Lalonde & Luebke 1968, Lalonde 1970, Nobuhara & Del Rio 1993, White et al .…”

Section: Methodsmentioning

confidence: 99%

Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption

Vier

Figueiredo

2002

Int Endod J

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In the sample of extracted teeth investigated, 24.5% of the periapical lesions were cysts. Most periapical lesions (84.3%) displayed acute inflammation, whether cystic or not. Periforaminal resorption was present in 87.3% of the cases, and foraminal resorption in 83.2%. Periforaminal and foraminal resorptions were independent entities. There was no association between external root resorption and the nature of the periapical lesions.

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“…As the lesion becomes larger, it is more likely to be a cyst. 2 Cystic transformation occurs owing to inflammatory stimulation of the epithelial rests of Malassez in the periodontal ligament, secondary to a root canal infection, in which the bacteria and their products, that were previously confined to the dental pulp, go beyond the root canal system and reach the periapical tissues. 1,3 Periapical cyst formation seems to be induced by an acute inflammatory reaction, 4 although mononuclear cells are commonly found in the inflammatory infiltrate.…”

Section: Introductionmentioning

confidence: 99%

Correlation between inflammatory infiltrate and epithelial lining in 214 cases of periapical cysts

et al. 2013

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The aim of this study was to evaluate the prevalence of periapical cysts, identify their clinical and microscopic features and correlate their microscopic features with the inflammatory infiltrate present in the lesion site. A total of 214 cases were collected over a 10-year period. Clinical data, including gender, age, race, symptoms and location of the lesion, were recorded. Two independent examiners with no prior knowledge of the patients' clinical data conducted the microscopic evaluations. Statistical analyses were performed using Fisher's or chi-square tests at a 5% level of significance. The results showed that periapical cysts were more prevalent in white women, with a mean age of 35 years, and in the anterosuperior region. The majority of the lesions were lined by atrophic cystic epithelium, which was associated with moderate inflammatory infiltrate in the cystic capsule (p < 0.01), with a diffuse localization pattern (p = 0.03) and absence of neutrophils (p = 0.01). Our findings suggest that periapical cysts lined by atrophic epithelium are related to the presence of moderate mononuclear inflammatory infiltrate.

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Absence of radiometric differentiation between periapical cysts and granulomas

Cited by 38 publications

References 2 publications

Comparative evaluation of immunohistochemistry, histopathology and conventional radiography in differentiating periapical lesions

Comparative evaluation of immunohistochemistry, histopathology and conventional radiography in differentiating periapical lesions

Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption

Correlation between inflammatory infiltrate and epithelial lining in 214 cases of periapical cysts

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