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Dento Maxillo Facial Radiology Feb 2023Limited studies have differentiated radicular cysts and granulomas with MRI. Therefore, we investigated the MRI characteristics of the two lesions and clarified features...
OBJECTIVES
Limited studies have differentiated radicular cysts and granulomas with MRI. Therefore, we investigated the MRI characteristics of the two lesions and clarified features for distinguishing between them.
METHODS
We collected data of 27 radicular cysts and 9 granulomas definitively diagnosed by histopathology and reviewed the fat-saturated weighted, weighted, and contrast-enhanced fat-saturated weighted images. We measured the maximum diameter and apparent diffusion coefficient values of the lesions. We employed Fisher's exact test, the Mann-Whitney test, and independent -tests to compare the two lesions and created a decision tree for discriminating between them.
RESULTS
There were significant differences between radicular cysts and granulomas with respect to five imaging characteristics-signal intensity of the lesion centre on fat-saturated weighted images; signal intensity, texture, and contrast enhancement of the lesion centre on contrast-enhanced fat-saturated weighted images; and maximum diameter of the lesion. The cut-off diameter for radicular cysts was 15.9 mm. The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.971, 85.2%, and 100%, respectively.
CONCLUSIONS
From the decision tree analysis, maximum diameter, lesion centre contrast enhancement on contrast-enhanced fat-saturated weighted images, and lesion centre signal intensity on fat-saturated weighted images were important for discriminating between radicular cysts and granulomas.
Topics: Humans; Radicular Cyst; Magnetic Resonance Imaging; Diffusion Magnetic Resonance Imaging; Granuloma; ROC Curve; Contrast Media
PubMed: 36688723
DOI: 10.1259/dmfr.20220336 -
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 -
Journal of Stomatology, Oral and... Jun 2023The buccal bifurcation cyst (BBC) is an uncommon odontogenic inflammatory cyst affecting the vestibular aspects of the first or second mandibular molar of pediatric...
The buccal bifurcation cyst (BBC) is an uncommon odontogenic inflammatory cyst affecting the vestibular aspects of the first or second mandibular molar of pediatric patients. Its etiopathogenesis is not fully understood, but it is hypothesized that food and detritus impacting buccal periodontal pockets in titled tooth would be responsible for inflammation of the pericoronal tissues, leading to proliferation of epithelial rests and subsequent cystic formation. The true prevalence of the BBC is not known, but it is estimated to be less than 1% of all the inflammatory cysts. Most cases are unilateral but bilateral cases may account for up to 30% of all BBCs, which can generate confusion to unfamiliar clinicians. Maxillary cases are extremely uncommon, and to our knowledge, there are no cases published in the English literature. In this case series, we present five BBC cases; two unilateral, two bilateral, and one affecting the maxilla. We included clinical, imaging, and histopathological information to highlight the different presentations that this cyst might have, with the final aim to aid clinicians in its diagnosis and ultimately, its treatment.
Topics: Humans; Child; Mandibular Diseases; Odontogenic Cysts; Periodontal Pocket; Molar
PubMed: 36565810
DOI: 10.1016/j.jormas.2022.101371 -
PloS One 2022Implant periapical lesion (IPL), as a peri-implant disease originating from implant apex, maintains coronal osseointegration in the early stage. With the understanding...
BACKGROUND
Implant periapical lesion (IPL), as a peri-implant disease originating from implant apex, maintains coronal osseointegration in the early stage. With the understanding to IPL increasingly deepened, IPL classification based on different elements was proposed although there still lacks an overall classification system. This study, aiming to systematically integrate the available data published in the literature on IPL associated with histopathology, proposed a comprehensive classification framework and treatment decision tree for IPL.
METHODS AND FINDINGS
English articles on the topic of "implant periapical lesion", "retrograde peri-implantitis" and "apical peri-implantitis" were searched on PubMed, Embase and Web of Science from 1992 to 2021, and citation retrieval was performed for critical articles. Definite histopathology and radiology of IPL are indispensable criteria for including the article in the literature. The protocol was registered in PROSPERO (CRD42022378001). A total of 509 papers identified, 28 studies were included in this review. In only one retrospective study, 37 of 39 IPL were reported to be at the inflammatory or abscess stage. 27 cases (37 implants) were reported, including acute non-suppurative (1/37, developed to chronic granuloma), chronic granuloma (5/37), acute suppurated (2/37), chronic suppurated-fistulized (6/37), implant periapical cyst (21/37), poor bone healing (2/37), foreign body reaction (1/37). Antibiotics alone did not appear to be effective, and the consequence of surgical debridement required cautious interpretation because of the heterogeneity of lesion course and operation. Implant apicoectomy and marsupialization were predictable approaches in some cases.
CONCLUSIONS
The diversiform nature of IPL in the case reports confirms the need for such histopathological classification, which may enhance the comparison and management of different category.
Topics: Humans; Peri-Implantitis; Retrospective Studies; Radicular Cyst; Suppuration; Granuloma; Decision Trees; Dental Implants
PubMed: 36548276
DOI: 10.1371/journal.pone.0277387 -
BMC Oral Health Dec 2022Radicular cysts arising from primary teeth are rare. Enucleation and marsupialization or decompression are treatment approach to odontogenic cysts. Decompression known...
BACKGROUND
Radicular cysts arising from primary teeth are rare. Enucleation and marsupialization or decompression are treatment approach to odontogenic cysts. Decompression known to achieve good results in various cysts is widely used in clinic. This study aims to evaluate the efficiency of decompression in reducing radicular cysts associated with primary teeth in children.
METHODS
Cases of radicular cysts associated with primary teeth treated by decompression were reviewed in the present study. Clinical information and radiologic data of pre and post decompression were measured and analyzed.
RESULTS
Twenty-three patients treated for 25 cysts were included. All lesions with mean initial area 3.66 ± 2.00 cm were reduced after decompression time ranging 2 to 10 months. Mean rate of reduction was 0.77 ± 0.44 cm/mo and large lesions (> 3.5 cm) had a significantly higher reduction rate compared to smaller ones (< 3.5 cm) (P < 0.00). All effected succedaneous teeth erupted after treatment at follow-up while 12 (46%) of them had root development problems.
CONCLUSIONS
Decompression represents superiority as an effective and less invasive treatment in radicular cysts associated with primary teeth.
TRIAL REGISTRATION
This study was retrospectively registered in the Ethics Committee of Ninth People's Hospital Affiliated with Shanghai JiaoTong University School of Medicine (No.SH9H-2022-T158-1).
Topics: Child; Humans; Radicular Cyst; Retrospective Studies; China; Odontogenic Cysts; Decompression; Tooth, Deciduous
PubMed: 36457003
DOI: 10.1186/s12903-022-02572-w -
Applied Immunohistochemistry &... Feb 2023The aim of this study was to evaluate the immunoexpression of chemokine CXCL12 and its receptor CXCR4 in radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic...
The aim of this study was to evaluate the immunoexpression of chemokine CXCL12 and its receptor CXCR4 in radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs), and to correlate the findings with morphologic parameters of RCs (inflammatory infiltrate and cystic epithelium). Twenty RCs, 20 DCs, and 20 OKCs were submitted to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. RCs and DCs exhibited higher epithelial expression of CXCL12 than OKCs ( P <0.05). The expression of CXCL12 in the fibrous capsule was higher in DCs than in RCs and OKCs ( P <0.05). Higher cytoplasmic expression of CXCR4 was observed in the epithelial lining and fibrous capsule of RCs and DCs compared with OKCs ( P <0.05). In the fibrous capsule, DCs exhibited higher nuclear expression of CXCR4 than OKCs ( P <0.05). No significant differences in the immunoexpression of CXCL12 or CXCR4 were observed according to the morphologic parameters of RCs ( P >0.05). Strong positive correlations were found between cytoplasmic and nuclear expression of CXCR4 in the epithelial lining of RCs and DCs and in the fibrous capsule of all groups ( P <0.05). The results suggest the participation of CXCL12 and CXCR4 in the pathogenesis of RCs, DCs, and OKCs. These proteins may be particularly relevant for the development of odontogenic cysts with less aggressive biological behavior, irrespective of their nature (inflammatory or developmental). In RCs, the expression of CXCL12 and CXCR4 may not be related to the intensity of the inflammatory infiltrate or the status of cystic epithelium.
Topics: Humans; Chemokine CXCL12; Dentigerous Cyst; Odontogenic Cysts; Odontogenic Tumors; Radicular Cyst; Receptors, CXCR4; Signal Transduction
PubMed: 36449693
DOI: 10.1097/PAI.0000000000001093 -
Diagnostics (Basel, Switzerland) Nov 2022The use of cone-beam computed tomography (CBCT) has been increasing in dental practice. This narrative review summarized the relevance and utilizations of CBCT to... (Review)
Review
The use of cone-beam computed tomography (CBCT) has been increasing in dental practice. This narrative review summarized the relevance and utilizations of CBCT to visualize anatomical structures of the maxillary sinus and common pathologies found in the maxillary sinus. The detection/visualization rate, the location and the morphometric characteristics were described. For sinus anatomy, the reviewed features included the posterior superior alveolar artery, sinus pneumatization, sinus hypoplasia, sinus septa, and primary and accessory sinus ostia. For pathology, the following items were reviewed: membrane thickening associated with periapical lesions/periodontal lesions, mucous retention cyst, and antrolith. The visualization and assessment of the maxillary sinus is very important prior to procedures that take place in close proximity with the sinus floor, such as tooth extraction, implant insertion, and sinus floor elevation. Some sinus pathologies may be associated with odontogenic lesions, such as periapical diseases and periodontal bone loss.
PubMed: 36428879
DOI: 10.3390/diagnostics12112819 -
Journal of the American Dental... Jan 2023Calcifying odontogenic cyst (COC) can be misdiagnosed as a lesion of endodontic origin when it is in close proximity to the periradicular tissue, and pulp sensibility...
BACKGROUND
Calcifying odontogenic cyst (COC) can be misdiagnosed as a lesion of endodontic origin when it is in close proximity to the periradicular tissue, and pulp sensibility tests are indispensable for differential diagnosis. However, when the adjacent teeth are necrotic or already endodontically treated, diagnosis becomes challenging.
CASE DESCRIPTION
In this case report, a maxillary canine with an inadequate root canal treatment was considered as the source of an endodontic infection. Eight months after the retreatment, the patient sought treatment for a buccal intraoral swelling and a deep periodontal pocket and was referred for cone-beam computed tomography with a provisional diagnosis of a vertical root fracture. The tomography revealed an extensive lesion buccally to the roots of the canine and the adjacent vital lateral incisor. An unusual extended external resorption of the root of the vital lateral incisor was also evident. This finding shifted the diagnostic thinking toward a lesion of nonendodontic origin. The lesion was surgically enucleated, and the histopathologic examination confirmed the diagnosis of a COC.
PRACTICAL IMPLICATIONS
Clinicians always must bear in mind the chance of a nonendodontic lesion masquerading as a lesion of endodontic origin. Cone-beam computed tomography should be considered in cases of doubt or in lesions refractory to endodontic treatment, as it can provide information on the clinicopathologic features of the lesion.
Topics: Humans; Odontogenic Cyst, Calcifying; Cone-Beam Computed Tomography; Cuspid; Incisor
PubMed: 36424213
DOI: 10.1016/j.adaj.2022.10.005 -
Experimental Oncology Nov 2022Odontogenic cysts and tumors exhibit different degrees of aggressiveness in their biological behavior. There has been evidence that the presence of myofibroblasts (MFs)...
BACKGROUND
Odontogenic cysts and tumors exhibit different degrees of aggressiveness in their biological behavior. There has been evidence that the presence of myofibroblasts (MFs) at the invasion front promotes tumor invasion. Our study is based on the fact that MFs are important in the biological behavior of odontogenic cysts and tumors.
AIM
To assess immunohistochemically expression of alpha-smooth muscle actin (α-SMA) of MFs in odontogenic cysts and tumors and correlate this expression to their biological behavior.
MATERIALS AND METHODS
The archival tissues collected for 1.5 years were obtained from the Department of Oral Pathology & Microbiology, People's Dental Academy, Bhopal (India). A total of 40 cases consisting of 10 cases each of odontogenic keratocysts, radicular cysts, dentigerous cysts and ameloblastomas formed the study group. An immunohistochemical analysis of α-SMA expression and localization was carried out.
RESULTS
Mean MF counts were the highest in odontogenic keratocysts which was followed by ameloblastomas, entigerous cysts and radicular cysts. Weak α-SMA-expression was found in 50% of cases, moderate in 22.5% of cases, and intense - in 10% cases. MFs were arranged in the spindle, focal, or network patterns in 35; 27.5 and 20% of cases, respectively.
CONCLUSION
The analysis revealed that the MFs were distinctly heterogeneous in distribution and pattern of arrangement. This provided persuasive evidence that stroma of these lesions harbor MFs as reflected by α-SMA immunopositive cells.
Topics: Humans; Ameloblastoma; Actins; Immunohistochemistry; Odontogenic Cysts; Odontogenic Tumors; Radicular Cyst; Muscle, Smooth
PubMed: 36325696
DOI: 10.32471/exp-oncology.2312-8852.vol-44-no-3.18676 -
Minerva Dental and Oral Science Oct 2022Lateral periodontal cyst (LPC) and odontogenic keratocystic (OK) are two osteolytic lesions of the jaw with different local invasiveness and percentage of recurrence....
Lateral periodontal cyst (LPC) and odontogenic keratocystic (OK) are two osteolytic lesions of the jaw with different local invasiveness and percentage of recurrence. The aim of this study was to highlight the attention on the differential diagnosis of these lesions that sometimes can have unexpected location and can lead doubts on diagnosis, therapy, and follow-up. A 34-year-old man presented to our department with a complaint of soft pain in the vestibular aspect of left mandibular second premolar and left mandibular first molar. Vital teeth in the left mandible, no mucosal swelling, and no drainage were observed. The CBCT showed a well circumscribed hypodensity area, extending between 3.5 and the apex of mesial root of 3.6. No displacement and no resorption of the roots were notified. Upon clinical and radiographical examination, a provisional diagnosis of LPC was made and enucleation of the lesion and histological examination were planned. Histologically, a cystic wall partially lined by a keratinizing squamous epithelium was observed. Surrounding and within the lesion, there was a chronic inflammatory infiltrate also of granulomatous type and with cholesterol clefts. Based on these findings, the diagnosis of odontogenic keratocystic was done. Radiolucent lesions in the premolar and canine region are frequently clinically and radiographically misdiagnosed. The identification of keratocyst in a location preoperatively favoring a lateral periodontal cyst should be suspected and biopsy must be considered in all cases to establish the nature of the lesion, the best surgical treatment, and the follow-up appointments.
Topics: Humans; Periodontal Cyst; Odontogenic Cysts; Radiography; Bicuspid; Diagnostic Errors
PubMed: 36321623
DOI: 10.23736/S2724-6329.22.04699-X