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Journal of Endodontics Sep 2023Bone loss is strongly associated with the immunologic milieu in apical periodontitis (AP). Tertiary lymphoid structures (TLSs) are organized lymphoid cell aggregates...
INTRODUCTION
Bone loss is strongly associated with the immunologic milieu in apical periodontitis (AP). Tertiary lymphoid structures (TLSs) are organized lymphoid cell aggregates that form in nonlymphoid tissues under persistent inflammatory circumstances. To date, there has been no relevant report of TLSs in periapical lesions. This work aimed to investigate the formation and potential function of TLSs in AP.
METHODS
Tissues from human apical lesions (n = 61) and healthy oral mucosa (n = 5) were collected. Immunohistochemistry and multiplex immunofluorescence were used to detect the formation of TLSs. Correlation analyses were performed between clinical variables and TLSs. In addition, immunohistochemistry was used to evaluate the expression of interleukin-1 beta, interleukin-6, receptor activator of nuclear factor kappa-B ligand, and macrophage subsets in the apical lesions.
RESULTS
Periapical granulomas (n = 24) and cysts (n = 37) were identified by histologic evaluation. TLSs, composed of B-cell and T-cell clusters, developed in periapical granulomas and radicular cysts. The CXC-chemokine ligand 13, its receptor CXC-chemokine receptor 5, follicular dendritic cells, and high endothelial venules were localized in TLSs. The quantity and size of TLSs were positively associated with bone loss in AP. Moreover, proinflammatory cytokines and macrophage subsets were also substantially elevated in TLS regions of apical lesions.
CONCLUSIONS
The formation of TLSs in periapical granulomas and cysts was closely associated with persistent immune responses and bone loss in apical lesions. TLSs provide an updated insight into the complicated immune response process in AP.
Topics: Humans; Periapical Granuloma; Tertiary Lymphoid Structures; Ligands; Periapical Periodontitis; Radicular Cyst
PubMed: 37331649
DOI: 10.1016/j.joen.2023.06.006 -
Odontology Jan 2020The purpose of this study was to evaluate computed tomography (CT) findings of radicular cysts with a focus on location, size, and condition of the surrounding bone....
The purpose of this study was to evaluate computed tomography (CT) findings of radicular cysts with a focus on location, size, and condition of the surrounding bone. Subjects comprised 60 men and 86 women (mean age 47.2 years) with histopathologically confirmed radicular cysts who underwent CT examination between 2012 and 2014. Mesiodistal and buccolingual diameters were measured at the location where the lesion appeared to be largest on CT axial images. Of the 146 cases, 103 lesions were in the maxilla and 43 were in the mandible. Mesiodistal diameter of the maxillary lesions was significantly larger than that of the mandibular lesions. However, the ratio of mesiodistal diameter to buccolingual diameter in the mandible was significantly larger than that in the maxilla. Bone expansion was more significant in the maxilla than in the mandible. Mesiodistal and buccolingual diameters in only the maxilla and perilesional sclerotic radiolucency in images of both jaws were significantly associated with the severity of clinical symptoms. The findings suggest that radicular cysts in the maxilla are accompanied by bone expansion in the mesiodistal and buccolingual directions and those in the mandible progress in the mesiodistal direction without bone expansion. Clinical acute symptoms (pain and swelling) are correlated with lesion size in the maxilla; such a correlation is not clear for mandibular lesions, and discovery of mandibular lesions may, therefore, be delayed.
Topics: Female; Humans; Male; Mandible; Maxilla; Middle Aged; Radicular Cyst; Tomography, X-Ray Computed; Tooth
PubMed: 31292814
DOI: 10.1007/s10266-019-00443-5 -
Journal of Indian Society of... 2022Paradental cyst is classified as an inflammatory cyst, and its occurrence in the anterior maxillary region is very rare. Several hypotheses have been put forward on the...
Paradental cyst is classified as an inflammatory cyst, and its occurrence in the anterior maxillary region is very rare. Several hypotheses have been put forward on the etiopathogenesis among which the formation of cyst secondary to inflammatory destruction of the periodontium and alveolar bone can be attributed to the present case. A 26-year-old male patient reported with loosened maxillary anterior teeth. After clinical and radiological examination, extraction of teeth #12, #11, #21, and #22 followed with immediate implant placement was planned. During extraction of #21, incidentally, a cyst was noted to be attached to the apices of #21 tooth. Implants were placed at #12, #11, and #22 sites, and socket of #21 was debrided thoroughly, followed by the placement of graft. A histopathological study of the cyst revealed it to be a paradental cyst. The patient was followed up for 6 months, and no recurrence of cystic lesion was noted. When immediate implant placement is being planned, considerations to the periodontal and periapical disease status of the teeth being extracted are crucial to achieve better treatment outcomes.
PubMed: 36582954
DOI: 10.4103/jisp.jisp_625_21 -
Asian Journal of Surgery Dec 2023
Topics: Humans; Periodontal Cyst
PubMed: 37689518
DOI: 10.1016/j.asjsur.2023.08.204 -
Journal of Stomatology, Oral and... Jun 2023To review published cases and case series of the peripheral odontogenic keratocyst (POKC) of the gingiva, report an unusual presentation, and discuss lesional recurrence.
Recurrent peripheral odontogenic keratocyst: Review of the literature and presentation of a novel case initially masquerading as an atypical infected lateral periodontal cyst.
AIM
To review published cases and case series of the peripheral odontogenic keratocyst (POKC) of the gingiva, report an unusual presentation, and discuss lesional recurrence.
MATERIALS AND METHODS
A search of the English language literature for gingival OKCs was conducted. The inclusion of new case yielded a database containing 29 affected patients. Clinical, surgical, radiographic, and histopathologic findings have been summarized.
RESULTS
With available patient demographics, 62.5% were female and 37.5% were male, with an overall mean age at diagnosis of 53.8 years. There was near-equal lesional affinity for the jaws, of which 44.0% occurred in the posterior region, 32.0% anteriorly, and 24.0% overlapped these areas. Twenty-five percent of lesions had a normal color, 30.0% appeared yellow, 20.0% were white, and 10.0% were blue. The majority of lesions were < 1 cm and nearly 42% manifested exudation or fluctuance. Lesional pain was infrequent. Pressure resorption was recorded in 45.8% of cases. Most lesions were managed with conservative surgical modalities. Follow-up information was available in 16 primary cases, of which 5 recurred, signifying a 31.3% recurrence rate, including the featured case, which recurred twice.
CONCLUSION
To reduce recurrence of a gingival OKC, supraperiosteal dissection is advocated. Further, it is advised to follow POKCs for 5-7 years postoperatively, remaining vigilant for subtle clinical manifestations of recurrence. Timely discovery and excision of a POKC of the gingiva may decrease the incidence of a mucogingival defect.
PubMed: 37327876
DOI: 10.1016/j.jormas.2023.101540 -
Nigerian Journal of Clinical Practice Jan 2021Odontogenic cysts develop from the epithelium of dental structures and generally grow slowly. In children and adolescents, cysts usually grow faster than adults and...
BACKGROUND
Odontogenic cysts develop from the epithelium of dental structures and generally grow slowly. In children and adolescents, cysts usually grow faster than adults and require much knowledge for diagnoses and treatments.
AIMS
This study aimed to determine the diagnosis and treatment of odontogenic cysts in different age groups by evaluating the type of lesions, age, gender, and anatomical distribution of odontogenic cysts seen in children and adolescents by cone-beam computed tomography.
MATERIALS AND METHODS
A total of 42 odontogenic cysts (radicular, dentigerous cyst, and odontogenic keratocyst) were determined in children and adolescents aged 7-18 years. Cone-beam computed tomography images of odontogenic cysts were analyzed in terms of types, age, sex, anatomical location, height, width, depth, scalloped borders, lesion shapes, tooth displacement, root resorption, and association with an unerupted tooth.
RESULTS
There was a significant correlation between odontogenic cyst types and age groups, scalloped borders, lesion shape, tooth displacement, root resorption, and association with an unerupted tooth.
CONCLUSION
When odontogenic cysts seen in children and adolescents are examined with cone-beam computed tomography, the radicular cyst was the most common form and was predominated in the 13-18 years age group and in boys. Differences in terms of scalloped borders, lesion shape, tooth displacement, root resorption, and association with unerupted teeth were noticed. The knowledge of the distribution and properties of odontogenic cysts in pediatric patients will help diagnose the lesions during clinical and radiological examinations and make appropriate treatment planning.
Topics: Adolescent; Adult; Child; Cone-Beam Computed Tomography; Humans; Male; Odontogenic Cysts; Odontogenic Tumors; Radicular Cyst; Retrospective Studies
PubMed: 33473032
DOI: 10.4103/njcp.njcp_46_20 -
Histology and Histopathology Aug 2023Our aim was to investigate how bacterial lipopolysaccharide (LPS) is immunoexpressed in periapical lesions. By surprise we detected Rushton bodies (RBs) whose origin has...
AIM
Our aim was to investigate how bacterial lipopolysaccharide (LPS) is immunoexpressed in periapical lesions. By surprise we detected Rushton bodies (RBs) whose origin has been debatable to be positive for LPS.
METHODOLOGY
Samples of radicular cysts (N=70) were stained in order to identify variations in LPS immunoexpression indicating bacterial background. For immunostaining, we used an anti-LPS antibody from Escherichia coli, and for visualization Horse Radish Peroxidase labeled polymer as the secondary antibody.
RESULTS
RBs showed positivity for LPS in radicular cysts. After collection of radicular cyst samples (70 in total), we noted that all RBs (N=25) histologically detected in tissue samples were positive for LPS. Furthermore, calcification in the cyst capsule showed immunopositivity.
CONCLUSION
We demonstrate for the first time that LPS is present in RBs, indicating that host response to bacteria might be the initial cause of the formation of these hyaline bodies in the cyst epithelium and cyst capsule calcifications.
Topics: Humans; Radicular Cyst; Lipopolysaccharides; Epithelium; Calcinosis
PubMed: 36880590
DOI: 10.14670/HH-18-602 -
Oral Diseases Nov 2020To investigate an association between odontogenic infections (OI) and maxillary sinuses pathologic disorder (MSPD). The distance between the sinus floor and the root...
OBJECTIVE
To investigate an association between odontogenic infections (OI) and maxillary sinuses pathologic disorder (MSPD). The distance between the sinus floor and the root apex of upper posterior teeth was also assessed.
METHODS
Out of 4,402 cone beam computed tomography scans, 230 were selected, and 431 teeth were evaluated regarding the presence of OI: bone loss with furcation involvement, periapical and endodontic-periodontal lesions. The maxillary sinuses were assessed regarding the presence of MSPD, which was considered as mucosal thickening, opacification of the sinus and mucous retention cyst.
RESULTS
There was a significant association between OI and MSPD (p < .001). Periodontal bone loss with furcation involvement, periapical lesions and endodontic-periodontal lesions increased the risk of opacification of the sinuses by 11.6, 34.1 and 228.8 times, respectively. The frequency of the different types of MSP showed not to be associated with a group of teeth or dental root. Conversely, the presence of MSP was associated with a significant shorter distance between the palatine root apex and the sinus floor (p < .001).
CONCLUSION
There is a relationship between infectious process of teeth and MSPD. The proximity between the apex of palatine roots and the maxillary sinus floor showed to be a predisposing factor for MSPD.
Topics: Causality; Cone-Beam Computed Tomography; Humans; Maxillary Sinus; Paranasal Sinus Diseases; Sinus Floor Augmentation
PubMed: 32531831
DOI: 10.1111/odi.13481 -
International Endodontic Journal Aug 2024Apical periodontitis is an inflammatory disorder triggered by an immune response to bacterial infection, leading to the periapical tissue damage and alveolar resorption....
AIM
Apical periodontitis is an inflammatory disorder triggered by an immune response to bacterial infection, leading to the periapical tissue damage and alveolar resorption. However, the underlying mechanisms driving this process remain elusive, due to the complex and interconnected immune microenvironment within the local lesion site. In this study, the influence of Nlrp3 inflammasome-mediated immune response on the apical periodontitis was investigated.
METHODOLOGY
RNA sequencing, immunohistochemistry and ELISA assay were performed to investigate the activation of Nlrp3 inflammasome signalling pathways in the human periapical tissues, including radicular cysts, periapical granulomas and healthy oral mucosa. A mouse model of apical periodontitis was established to study the role of Nlrp3 knockout in periapical bone resorption and Treg cell stability, and the underlying mechanism was explored through in vitro experiments. In vivo Treg cell adoptive transfer was performed to investigate the effects of Treg cells on the progression of apical periodontitis.
RESULTS
Our findings find that the hyperactivated Nlrp3 inflammasome is present in human periapical lesions and plays a vital role in the immune-related periapical bone loss. Using a mouse model of apical periodontitis, we observe that Nlrp3 deficiency is resistant to bone resorption. This protection was accompanied by elevated generation and infiltration of local Treg cells that displayed a notable ability to suppress RANKL-dependent osteoclast differentiation. In terms of the mechanism of action, Nlrp3 deficiency directly inhibits the osteoclast differentiation and bone loss through JNK/MAPK and NF-κB pathways. In addition, Nlrp3 induces pyroptosis in the stem cells from apical papilla (SCAPs), and the subsequent release of cytokines affects the stability of Treg cell in periapical lesions, leading indirectly to enhanced bone resorption. In turn, adoptive transfer of both Nlrp3-deficient and wild-type Treg cells effectively prevent the bone erosion during apical periodontitis.
CONCLUSIONS
Together, our data identify that the Nlrp3 inflammasome modulates the Treg cell stability and osteoclastogenesis in the periapical inflammatory microenvironment, thus determining the progression of bone erosion.
Topics: NLR Family, Pyrin Domain-Containing 3 Protein; T-Lymphocytes, Regulatory; Animals; Periapical Periodontitis; Mice; Humans; Inflammasomes; Disease Models, Animal; Alveolar Bone Loss; Signal Transduction; Mice, Knockout; Periapical Granuloma; Radicular Cyst; Mice, Inbred C57BL
PubMed: 38441141
DOI: 10.1111/iej.14062 -
Cureus Nov 2023In dentistry, bone regeneration in areas following tooth loss, the removal of a tumor or cyst, and craniofacial surgery can be accomplished by using bone grafts. Many... (Review)
Review
In dentistry, bone regeneration in areas following tooth loss, the removal of a tumor or cyst, and craniofacial surgery can be accomplished by using bone grafts. Many biocompatible materials have been employed for bone regeneration in dentistry; however, all these bone graft materials come with various drawbacks. Therefore, there is a growing demand for natural, cost-effective, and biocompatible plant-based bone grafts. This review explores the emerging field of phytogenic elements in bone restoration and their specific applications in dentistry. The review focuses on key phytogenic compounds, such as algae-based and plant-based bone substitutes, delineating their roles in bone regeneration in dental bone defects. It also highlights the existing challenges associated with phytogenic grafts, such as limited bioavailability and high-dose toxicity. This calls for increased research into compatible, affordable carriers and a broader spectrum of studies to determine the most effective phytogenic solutions in dental regenerative medicine.
PubMed: 38046714
DOI: 10.7759/cureus.48175