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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.
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As lesões periapicais inflamatórias (LPIs) são condições patológicas decorrentes de infecções de origem odontogênica, principalmente representadas pelos granulomas periapicais (GPs) e cistos radiculares (CRs). Sua patogênese está associada a mecanismos imunológicos e angiogênicos. O presente estudo, do tipo retrospectivo, teve como objetivo analisar, de forma semiquantitativa, a expressão imuno-histoquímica de ING-4, VEGF e NF-κB em LPIs, e correlacionar o padrão de expressão dessas proteínas. A amostra consistiu de 26 GPs, 17 CRs e 19 cistos radiculares residuais (CRRs). Foram avaliados espessura epitelial e infiltrado inflamatório, e a associação desses achados com o padrão de expressão das proteínas ING-4, VEGF e NF-κB nas LPIs selecionadas. Para a realização da análise estatística, foram utilizados os testes de qui-quadrado, Kruskal-Wallis, Mann-Whitney e correlação de Spearman (p < 0,05). O infiltrado inflamatório exibiu maior intensidade no GP, seguido pelo CR, e por último, o CRR (p < 0,05). Apesar de não haver associação estatisticamente significativa ao associar a expressão de ING-4 nas células inflamatórias do tecido conjuntivo ou cápsula fibrosa entre os grupos de LPIs, o GP e CR evidenciaram, através da média de postos, maior expressão dessa proteína. Não foi evidenciada associação estatisticamente significativa de ING-4 com a intensidade do infiltrado inflamatório. A imunoexpressão de VEGF no núcleo das células inflamatórias do tecido conjuntivo ou cápsula fibrosa exibem associação significativa com as LPIs, que ocorre maior expressão dessa proteína nos cistos (p= 0,002). A maior expressão de NF-κB foi evidenciada nos casos de GPs, tanto a nível nuclear quanto citoplasmático das células inflamatórias (p = 0,005; p = 0,002). Não houve associação estatisticamente significativa quando comparada a expressão de NF-κB entre os cistos, mas a mediana da expressão dessa proteína foi maior para os CRs. Na cápsula fibrosa, a imunoexpressão nuclear e citoplasmática de NF-κB nas células inflamatórias foi superior nas lesões periapicais com intenso infiltrado inflamatório (p < 0,001). Portanto, sugere-se que ING-4, VEGF e NF-κB participam do desenvolvimento das LPIs, e apesar de ocorrer relação diretamente proporcional entre a expressão dessas proteínas, ING-4 não exerceu atividade reguladora na inflamação associada a essas lesões (AU).
Inflammatory periapical lesions (IPLs) are pathological conditions resulting from infections of odontogenic origin, being mainly represented by periapical granulomas (PGs) and radicular cysts (RCs). Its pathogenesis is associated with immunological and angiogenic mechanisms. This retrospective study, semi-quantitative and comparative aimed to analyze the immunohistochemical expression of ING-4, VEGF and NF-κB in IPLs, and to correlate the pattern of expression of these proteins. The sample consisted of 26 were PGs, 17 RCs and 19 residual radicular cysts (RRCs). Epithelial thickness and inflammatory infiltrate were evaluated, and the correlation of these findings with the expression pattern of ING-4, VEGF and NF-κB proteins in selected IPLs. To perform the statistical analysis, the chi-square, Kruskal-Wallis, Mann-Whitney and Spearman correlation tests were used (p < 0.05). The inflammatory infiltrate exhibited greater intensity in the PG, followed by the RC, and finally, the RRC (p < 0.05). Although there was no statistically significant association when associating the expression of ING-4 in inflammatory cells of the connective tissue or fibrous capsule the groups of IPLs, the PG and RC showed higher expression of this protein. There was no statistically significant association between ING-4 and the intensity of the inflammatory infiltrate. Immunoexpression of VEGF in the nucleus of inflammatory cells in the connective tissue or fibrous capsule shows a significant association with IPLs, in which there is greater expression of this protein occurring in cysts (p= 0,002). The highest expression of NF-κB was evidenced in cases of PGs, both at the nuclear and cytoplasmic level of inflammatory cells (p=0,005; p= 0,002). There was no statistically significant association when comparing the expression of NF-κB between the cysts, but the median expression of this protein was expression was higher for the RCs. In the fibrous capsule, nuclear and cytoplasmic NF-κB immunoexpression in inflammatory cells was higher in periapical lesions with intense inflammatory infiltrate (p<0.001). Therefore, it is suggested that ING-4, VEGF and NF-κB participate in the etiopathogenesis of IPLs, and that there is a directly proportional relationship between the expression of these proteins. ING-4 did not exert regulatory activity in the inflammation associated with these lesions (AU).
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Humanos , Masculino , Feminino , Granuloma Periapical/patologia , Cisto Radicular/patologia , NF-kappa B , Fator A de Crescimento do Endotélio Vascular , Ferimentos e Lesões/patologia , Distribuição de Qui-Quadrado , Estatísticas não ParamétricasRESUMO
Abstract: Aldehyde dehydrogenase 1 (ALDH-1) is a marker of stem cells in a variety of diseases, but its role in individuals with chronic inflammatory periapical lesions remains unknown. The aim of this study was to investigate the presence of cells with a stem cell profile based on the immunoexpression of ALDH-1 in periapical granulomas (PGs) and radicular cysts (RCs). A total of 51 cases of periapical lesions (25 PGs and 26 RCs) were subjected to immunohistochemical study. The anti-ALDH-1 antibody was applied using the immunoperoxidase technique. An immunoexpression score (intensity vs. percentage of cells) was used, with the cases being classified as low expression (score: 0 to 4) and high expression (score: 6 to 9). The Chi-square test was used with a 5% level of significance. Immunoexpression of ALDH-1 was detected in all cases of PGs and RCs. In PG cases, the expression was diffuse in connective tissue cells, with most cases exhibiting high expression (n = 18; 69.2%), while in RC cases the expression revealed focal distribution in cells of the capsule and epithelial cells of the cystic lining, with most cases classified as low expression (n = 18; 72%). Significant differences in the expression scores of ALDH-1 were observed in PGs (p = 0.003). The variable expression of ALDH-1 suggests the presence of cells with stem cell profiles in PGs and RCs. These findings suggest that periapical tissues infiltrated by chronic inflammation can recruit important cells for the repair or evolution of periapical lesions.
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Objetivo: En los granulomas periapicales, los plasmocitos (PL) participan activamente mediante la liberación de inmunoglobulinas. El propósito de este ensayo fue identificar y contar el número de PL en diferentes períodos de tiempo en lesiones periapicales experimentales en ratas. Materiales y métodos: Mediante la exposición al medio oral de la pulpa de los primeros molares inferiores izquierdos, se indujeron granulomas periapicales en ratas a las que previamente se les suministró anestesia. La pulpa de los primeros molares inferiores derechos no fue expuesta, y estos dientes se utilizaron como control. Los animales fueron eutanasiados a los 10, 30 y 60 días de la exposición. Los maxilares inferiores fueron removidos, y los primeros molares, junto con los tejidos circundantes, se procesaron para su estudio histológico. Se obtuvieron secciones semiseriadas, posteriormente coloreadas con verde de metilo-pironina (VMP). Cada tres secciones, las tres siguientes fueron coloreadas con hematoxilina y eosina (H-E). Los controles también fueron coloreados con H-E. Resultados: Todos los especímenes experimentales coloreados con H-E revelaron la presencia de granulomas periapicales. Luego de la exposición pulpar, el número de PL que reaccionó positivamente al VMP se incrementó de manera progresiva desde el día 10 hasta los días 30 y 60. A pesar de que a los 60 días el número de PL fue ligeramente menor que a los 30 días, no hubo diferencias estadísticamente significativas entre estos dos períodos. Los especímenes del grupo control coloreados con H-E mostraron que los tejidos periapicales se encontraban dentro de los parámetros normales en todos los períodos de observación. Conclusiones: Los resultados de este estudio revelaron que el número de plasmocitos VMP positivos se incrementa progresivamente en función del tiempo transcurrido pero se estabiliza al finalizar el experimento. También sugieren que el empleo de la coloración de VMP es un procedimiento adecuado para la identificación y la cuantificación de plasmocitos en los granulomas periapicales inducidos experimentalmente en ratas (AU)
Aim: Plasma cells (PL) release immunoglobulin in periapical lesions. The purpose of this assay was to identify and count the number of plasmocytes observed in periapical lesions in rats. Materials and methods: By exposing the pulp of the lower left first molars to the oral environment, periapical granulomas were induced in rats previously anesthetized. The pulp of right mandibular first molars was not exposed and these teeth were used as negative controls. The animals were euthanized at 10, 30 and 60 days after pup exposure. The mandibles were removed and specimens of the molar teeth along with the surrounding tissues were prepared for histology. Semi serial sections of the left first molar were stained with methyl green pyronine (MGP). Every three sections, the following three sections were stained with hematoxilyn and eosin (H-E). Negative control samples were stained with H-E. Results: All the H-E stained experimental samples revealed the presence of periapical granulomas. After pulp exposure, the number of PL increased from day 10 to 30 and 60. In the 60-day samples the number of PL was slightly less than that of the 30-day samples, with no statistically significant difference. The H-E stained control samples showed normal periapical tissues in all observation periods. Conclusions: The results of this study revealed that the number of VMP positive PL, increased progressively with time but it was stabilized at the end of the experiment. In addition, the results suggest that the use of VMP stain is a suitable procedure for the identification and counting of PL in experimentally induced periapical granulomas in rats (AU)
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Animais , Ratos , Granuloma Periapical/imunologia , Plasmócitos/imunologia , Inflamação/fisiopatologia , Tecido Periapical , Imunoglobulinas , Fotomicrografia , Técnicas Histológicas , Radiografia Dentária DigitalRESUMO
BACKGROUND: ADAMTS expression can be associated with several inflammatory processes, and has been correlated with tumorigenesis of some neoplasms, but its participation in the development of periapical lesions has not been investigated. Therefore, our objective was to verify the expression of ADAMTS-1, versican and pEGFR in Periapical Granuloma (PG) and in the Radicular Cyst (RC) since they are the most common lesions of the periapex. METHODS: 25 samples of RC and 10 of PG were used. As a control, 10 samples of inflammatory fibrous hyperplasia (IFH) and 10 of dental follicle (DF) were used. The expression of these proteins was investigated using immunohistochemistry. RESULTS: In the epithelium of RC, IFH and DF, the expression of ADAMTS-1 was greater in DF than in RC (p < .001). Versicano showed greater expression in IFH than in RC, DF than in RC (p < .001). pEGFR showed greater expression in IFH and RC than in DF (p < .01 and p < .05, respectively). In connective tissue, ADAMTS-1 expression was greater in PG and RC than in IFH and DF (p < .001). Versicano showed greater expression in PG, RC and IFH compared to DF (p < .001). In pEGFR there was a higher expression in PG when compared to RC, IFH and DF (p < .001). Greater immunostaining occurred in the RC than in the DF (p < .001). CONCLUSIONS: Our results suggest that the studied proteins may participate in the pathogenesis of PG and RC, through the interaction of these proteins, in the remodeling of the ECM (versican) by ADAMTS-1, producing bioactive fragments, which could activate EGFR, contributing to the formation, growth and maintenance of injuries.
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Granuloma Periapical , Cisto Radicular , Receptores ErbB , Humanos , Imuno-Histoquímica , VersicanasRESUMO
In endodontics, accurate diagnoses are important for the selection of appropriate and successful therapy. Several nonendodontic entities in periapical location may resemble those of inflammatory endodontic origin and impact therapeutic approaches. The aim of this study was to review noninflammatory entities mimicking dentoalveolar abscesses or apical periodontitis and to discuss clinical and pathological features. In this review study, the authenticated search engine in PubMed (MEDLINE) database was used to find articles by using "Nonvital Pulp Dentoalveolar Abscess", "Nonvital Pulp And Apical Periodontitis", "Periapical Abscess", "Chronic Dentoalveolar Abscess", "Chronic Apical Periodontitis", "Periapical Granuloma", And "Radicular Cyst". Each of these predefined keywords were combined with the terms "Misdiagnosed", "Mimicking", "Masquerading", or "Simulating" to search for reported cases indexed from 1978 to 2020. All case reports fulfilling the selection criteria were reviewed to identify radiolucent nonendodontic periapical lesions focused on the questions: "Which pathological entities mimick radiolucent endodontic lesions in periapical location? Based on endodontic clinical parameters, what are the contrasting features?" Out of 426 articles, 111 were relevant to the subject, including a series of cases and case reports. Only well-documented English and recent papers were considered. A total of 30 noninflammatory entities appeared clinically as radiolucent endodontic lesion in periapical location. Lesions simulating chronic apical periodontitis represented 83.3% and dentoalveolar abscess 16.7%. Interestingly, primary malignancies and metastasis counted 43.3% and pain was a typical symptom. Swelling was a noncontributory clinical feature in distinguishing periapical lesions. Lack of pulp response was registered in 68.4% of nonedodontic lesions. A flowchart was generated to summarize clinicopathological aspects of radiolucent nonendodontic entities appearing as dentoalveolar abscesses or apical periodontitis In relation to clinical practice, it is very important for us to note that, a group of pathological entities may simulate radiolucencies of endodontic origin in periapical location, especially malignancies and non-inflammatory odontogenic lesions.
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O desenvolvimento das periodontites apicais está associado à infecção por microrganismos e migração de seus subprodutos através do sistema de canais radiculares para a região periapical, onde induzem uma resposta inflamatória que pode ser visualizada em imagens tomográficas como áreas hipodensas, circunscritas, associadas ao ápice radicular, podendo ou não demonstrar um halo radiopaco circundante. A análise fractal (AF) é um método quantitativo capaz de descrever o padrão estrutural de formas geométricas complexas, sendo expressa numericamente como dimensão fractal (DF). Quanto maior o valor da DF, mais complexa é a estrutura avaliada. O diagnóstico diferencial entre as lesões apicais ainda é dado preferencialmente pelo exame histopatológico. O objetivo do trabalho foi avaliar a AF como método preditor do diagnóstico diferencial entre cistos e granuloma periapicais em exames de tomografia computadorizada de feixe cônico (TCFC). Foram selecionados 12 pacientes, dentre os quais 6 com diagnóstico histopatológico de cisto periapical e 6 com diagnóstico de granuloma periapical, que possuíam exames de TCFC nos bancos de dados analisados. As imagens foram padronizadas e analisadas por meio do software Fiji e a DF de cada lesão foi determinada com o auxílio do plugin BoneJ. O ponto de corte para diferenciação das lesões foi determinado para os dois grupos analisados: grupo I, com número de cortes padrão e grupo II, com número máximo de cortes englobando a lesão. Os resultados evidenciaram que os cistos e granulomas periapicais acometem de forma semelhante ambos os sexos e são mais prevalentes entre a terceira e a sexta décadas de vida. Para o grupo I, o valor de DF para o ponto de corte entre as lesões foi de 2,09 e para o grupo II o valor foi de 2,28, sendo que valores abaixo do ponto de corte apontam para o diagnóstico de cisto periapical. A AF foi considerada como uma ferramenta diagnóstica útil e não invasiva, para distinção entre as periodontites apicais.
The development of apical periodontitis is associated with infection by microorganisms and migration of their subproducts through the root canal system to the periapical region, where they induce an inflammatory response that can be seen on tomographic images as hypodense, circumscribed image, associated with the root apex, which may or may not demonstrate a surrounding radiopaque halo. Fractal analysis (FA) is a quantitative method capable of describing the structural pattern of complex geometric shapes, being expressed numerically as fractal dimension (FD). The higher the DF value, the more complex is the evaluated structure. Differential diagnosis between apical lesions is still preferentially given by histopathological examination. The aim of this study was to assess FA as a differential diagnostic predictor method between periapical cysts and granuloma in cone beam computed tomography (CBCT) exams. Twelve patients were selected, including 6 with a histopathological diagnosis of periapical cyst and 6 with a diagnosis of periapical granuloma, who had CBCT exams in the analysed databases. Images were standardized and analysed using the Fiji software and the FD of each lesion was determined with the aid of the BoneJ plugin. The cutoff point for differentiation of lesions was determined for the two groups analysed: group I with standard number of slices and group II with maximum number of slices encompassing the lesion. The results showed that periapical cysts and granulomas affect both genders similarly and are more prevalent between the third and sixth decades of life. For group I, the FD value for the cutoff point between lesions was 2.09 and for group II the value was 2.28, since values below the cutoff point were representative for periapical cyst. FA was considered a useful and non-invasive diagnostic tool to distinguish between apical periodontitis.
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Granuloma Periapical , Periodontite Periapical , Cisto Radicular , Fractais , Diagnóstico Diferencial , Tomografia Computadorizada de Feixe CônicoRESUMO
Abstract The aim of this study was to investigate the epidemiological and clinical characteristics of chronic inflammatory periapical diseases in different regions of Brazil and to compare with data from the literature. A multicenter study was carried out in four Brazilian referral centers in oral diagnosis. Histopathological records were reviewed, and all cases diagnosed microscopically as periapical granuloma, radicular cyst, and periapical abscess were included. Demographic and clinical data were collected. Descriptive statistics and Pearson's chi-square test were performed. A total of 10,381 cases of chronic inflammatory periapical diseases were found (13.8% of 74,931 archived specimens) over a period of 65 years. Radicular cysts were the most common lesion (59.9%). Women (56.1%) with a mean age of 37.01 years old (range 13 to 100 ± 14.42) and people of white skin color (59.2%) were the most affected individuals by chronic inflammatory periapical diseases. The lesions were generally asymptomatic (28.1%), located in the maxilla (60.1%), and posterior region (49.8%). The radicular cysts were larger when compared to periapical granulomas (p < 0.001). The disagreement between the clinical and histopathological diagnoses was higher when the final diagnosis was a periapical granuloma (p < 0.001). Chronic inflammatory periapical diseases continue to be common lesions affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst was the most common lesion.
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Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Abscesso Periapical/epidemiologia , Doenças Periapicais/epidemiologia , Granuloma Periapical/epidemiologia , Cisto Radicular/epidemiologia , Brasil/epidemiologia , Doença Crônica , Estudos Multicêntricos como AssuntoRESUMO
Introduction: Apical periodontitis represents a local immune response directed against the progression of microorganisms from the dental pulp to the apical foramen and periapical tissues, which results in bone and dental resorption. The aim of this review is to describe the expression of this group of proteases in apical periodontitis and its modulation during the periapical healing phase following root canal treatment. Literature review: The pathogenesis of apical periodontitis involves degradation of several extracellular matrix components. Matrix metalloproteinases (MMPs) are expressed in response to specific stimuli by resident cells of connective tissue during tissue remodeling and by inflammatory cells that arrive into the surrounding tissues during inflammatory events. MMPs have been reported in apical periodontitis, either experimentally induced or obtained from humans and there is evidence that these enzymes show diff erent expression patterns in granulomas and periapical cysts. Root canal therapy is important for the reduction of periapical inflammation as well as the synthesis of MMPs, especially when using a calcium hydroxide-based dressing. Conclusion: Apical periodontitis show high expression of matrix metalloproteinases and root canal treatment results in less expression of MMPs when compared to untreated apical periodontitis.
Introdução: A lesão periapical representa a resposta imunoinflamatória devido ao aumento do número e progressão de micro-organismos advindos dos canais radiculares contaminados em direção aos tecidos apicais e periapicais, resultando em reabsorção óssea. O objetivo desta revisão será abordar a importância das metaloproteinases da matriz no desenvolvimento das lesões periapicais e sua modulação durante a fase de reparação tecidual depois de instituído o tratamento endodôntico. Revisão da literatura: A patogênese da lesão periapical envolve a degradação progressiva de diversos componentes da matriz extracelular. Dentre as proteases responsáveis pela degradação destes componentes estão as metaloproteinases da matriz (MMPs). Estas proteinases são expressas em resposta a estímulos específicos pelas células residentes do tecido conjuntivo durante o processo de remodelação tecidual e por células inflamatórias que invadem os tecidos durante eventos inflamatórios. As MMPs foram descritas em lesões periapicais experimentais e em humanos e existem evidências de que estas enzimas apresentam padrões de expressões diferentes em granulomas e cistos periapicais. A terapia endodôntica é importante para a redução da inflamação periapical assim como da síntese das MMPs, principalmente quando utilizado um curativo de demora à base de hidróxido de cálcio. Conclusão: As lesões periapicais apresentam alta expressão de metaloproteinases da matriz e o tratamento endodôntico em dentes com lesão periapical resulta em menor expressão de MMPs quando comparado às lesões periapicais não tratadas.
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Humanos , Periodontite Periapical , Metaloproteinases da Matriz , Endodontia , Granuloma Periapical , Cisto RadicularRESUMO
Periapical granuloma is a histological term that refers to the formation of a mass of granulomatous tissue around the apex of a tooth resulting from inflammation and necrosis of the pulp tissue. It consists of an infiltrate of inflammatory cells such as macrophages, plasmocytes and lymphocytes, as well as fibroblasts, collagen fibers and capillaries. Periapical surgery is an alternative for preserving the tooth in the oral cavity in cases where periapical inflammation is persistent even after treatment of root canals. The objective of this study was to report a clinical case in which the surgical technique was used to remove granulomatous lesions from a patient, female, with a history of recurrent periapical abscess without painful symptomatology in the region of the anterior 11,12 and 13 teeth. The histopathological exam demonstrated the presence of a granulomatous tissue with intense inflammatory infiltrate mixed, permeated with lymphocytes and high number of plasmocytes, confirming the diagnosis of periapical granuloma. The treatment was considered successful since the patient remained asymptomatic and there was incorporation of the inorganic bovine bone graft and initiation of bone neoformation in the periapical region.
Granuloma periapical é um termo histológico que refere-se à formação de uma massa de tecido granulomatoso ao redor do ápice de um dente, decorrente da inflamação e necrose do tecido pulpar. É constituído por um infiltrado de células inflamatórias como macrófagos, plasmócitos e linfócitos, além de fibroblastos, fibras colágenas e capilares. A cirurgia do periápice é uma alternativa para preservação do dente na cavidade bucal nos casos em que a inflamação periapical é persistente mesmo após tratamento dos canais radiculares. O objetivo desse trabalho é relatar um caso clínico no qual a técnica cirúrgica do periápice foi utilizada para remoção de lesões granulomatosas de uma paciente, do sexo feminino, com histórico de abscesso periapical recidivante sem sintomatologia dolorosa na região dos dentes anteriores superiores 11, 12 e 13. O exame histopatológico demonstrou a presença de um tecido granulomatoso com intenso infiltrado inflamatório misto, permeado com linfócitos e elevado número de plasmócitos, confirmando o diagnóstico de granuloma periapical. O tratamento foi considerado exitoso, visto que a paciente se manteve asintomática e houve incorporação do enxerto ósseo bovino inorgânico e início da neoformação óssea na região periapical.
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Humanos , Feminino , Adulto , Adulto Jovem , Granuloma Periapical , Cirurgia Bucal , Tecido de GranulaçãoRESUMO
INTRODUCTION: The purpose of this study was to analyze the features of lesions obtained from biopsies at the periapical area of teeth with a radiographic or clinical initial diagnosis of apical periodontitis. METHODS: A retrospective study was conducted on biopsies obtained from 1953-2018 at 3 Brazilian oral and maxillofacial pathology centers. Cases of endodontic and nonendodontic periapical lesions (NPLs) with a clinical diagnosis of endodontic pathoses were retrieved. Data regarding patient age, sex, and anatomic location were obtained from patients' records. The frequency and percentage of cases with clinical diagnoses of a periapical cyst, periapical granuloma, or dentoalveolar abscess were recorded, and the final histopathologic diagnosis was documented. RESULTS: Among 66,179 oral biopsies, 7246 (10.94%) were clinically diagnosed as periapical disease, 306 (4.22%) of which were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocysts (n = 107, 34.96%) followed by dentigerous cysts (n = 48, 15.68%). The mean age at diagnosis was 39.68 years with a range of 6-80 years. A total of 159 (51.96%) cases occurred in females and 147 (48.03%) in males (female to male ratio = 1.08:1). Most lesions (137, 44.77%) were located in the posterior mandible. CONCLUSIONS: A wide variety of histopathologic diagnoses, including benign odontogenic and nonodontogenic cystic and tumorous lesions, infectious diseases, and malignant neoplasms, was reported in the present survey. The features presented in this study were consistent with previous findings reported in the literature.
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Granuloma Periapical , Cisto Radicular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Brasil , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
Abstract: The aim of this study was to evaluate macrophage M1 and M2 subpopulations in radicular cysts (RCs) and periapical granulomas (PGs) and relate them to clinical and morphological aspects. M1 macrophages were evaluated by the percentage of CD68 immunostaining associated with the inflammatory cytokine TNF-α, and M2 macrophages, by its specific CD163 antibody. The CD68+/CD163+ ratio was adopted to distinguish between the two macrophage subpopulations. Clinical, radiographic, symptomatology, treatment, and morphological parameters of lesions were collected and a significance level of p = 0.05 was adopted for statistical analysis. The results showed that the CD68+/CD163+ ratio was higher in the RCs (median = 1.22, p = 0.002), and the highest TNF-α immunostaining scores were found in RCs (p = 0.018); in PGs, the CD68+/CD163+ ratio was lower and associated with a greater CD163+ immunostaining (median = 1.02, p <0.001). The TNF-α in cyst epithelium had a score of 3 in 10 cases and predominance of M1 macrophages by CD68+/CD163+ (median = 2.23). In addition, CD68+ cells had higher percentage of immunostaining in smaller RCs (p = 0.034). Our findings suggest that increased CD68 immunostaining associated with TNF-α cytokine in RCs results in a greater differentiation of the M1 phenotype. The higher CD163 immunostaining in PGs results in greater differentiation of the M2 phenotype. Therefore, the inflammatory state promoted by M1 macrophages is related to growth and progression of RCs; on the other hand, the immunomodulatory state of M2 macrophages is related to maintenance of PGs.
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Humanos , Masculino , Feminino , Adulto , Granuloma Periapical/patologia , Cisto Radicular/patologia , Macrófagos/patologia , Valores de Referência , Imuno-Histoquímica , Antígenos de Diferenciação Mielomonocítica/análise , Antígenos CD/análise , Doença Crônica , Fator de Necrose Tumoral alfa/análise , Receptores de Superfície Celular/análise , Estatísticas não Paramétricas , Pessoa de Meia-IdadeRESUMO
Introdução: as periapicopatias inflamatórias de origem endodôntica são as doenças mais frequentes dos ossos maxilares e ocorrem principalmente como consequência da disseminação da infecção endodôntica. Apesar de vários estudos, não existem dados recentes sobre as características epidemiológicas e clínicas dessas lesões envolvendo uma amostra tão grande da população. Objetivo: Investigar as características epidemiológicas e clínicas das periapicopatias inflamatórias de origem endodôntica, incluindo o granuloma periapical, o cisto radicular e o abscesso periapical. Metodologia: foi realizado um estudo retrospectivo e multicêntrico em quatro instituições com centros de referência em diagnóstico oral no Brasil. Todos os registros histopatológicos foram revisados e foram incluídos todos os casos diagnosticados microscopicamente como granuloma periapical, cisto radicular e abscesso periapical. Foram coletados os seguintes dados demográficos e clínicos: sexo, idade e cor da pele dos pacientes, sintomas, duração, tamanho e localização das lesões e concordância entre o diagnóstico clínico e histopatológico. Análises estatísticas descritivas e bivariadas, utilizando o teste Qui-quadrado de Pearson, foram realizadas. Em casos de variáveis com mais de duas categorias, utilizou-se o teste Z para comparação das proporções de colunas e a correção de Bonferroni. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: foram encontrados 10.381 casos de lesões periapicais entre 74.931 espécimes arquivados (13,8%) em 65 anos. Os cistos radiculares foram as lesões mais comuns (59,9%). As lesões periapicais acometeram principalmente mulheres (56,1%), com média de idade de 37,01 anos (13 a 100 ± 14,42 anos) e cor de pele branca (59,2%). As lesões eram geralmente assintomáticas (28,1%), persistindo por mais de um ano (13,3%), com tamanho de até 10 mm (25,2%) e localizadas na maxila (60,1%) e região posterior (49,8%). Os cistos radiculares foram maiores (p < 0,001), com maior ocorrência de sintomatologia (p < 0,027) e maior frequência na região posterior (p < 0,001) em relação aos granulomas periapicais. A possibilidade de discordância entre o diagnóstico clínico e histopatológico foi maior nos granulomas periapicais (p < 0,001). Conclusões: as periapicopatias inflamatórias de origem endodôntica foram comuns em serviços de Patologia Bucomaxilofacial, acometendo principalmente adultos. Isso deve ser uma consequência da carga de cáries não tratadas em dentes permanentes. As mulheres são mais afetadas e o cisto radicular é a lesão mais comum.
Introduction: Inflammatory periapical lesions are the most frequent diseases of maxillary bones and occur mainly as a consequence of the dissemination of endodontic infection. Despite several studies, there are no recent data on the epidemiological and clinical characteristics of these lesions involving such a large sample. Objective: To investigate the epidemiological and clinical characteristics of periapical lesions, including periapical granuloma, radicular cyst and periapical abscess. Methodology: A multicenter retrospective study was realized in four institutional reference centers in oral diagnosis in Brazil. Histopathological records were reviewed and included all cases diagnosed microscopically as periapical granuloma, radicular cyst and periapical abscess. Data on patient sex, age, skin color, symptoms, lesion duration, lesion size, lesion location and concordance between clinical and histopathological diagnosis were collected. Descriptive statistics and bivariate analyses using Pearson's Chi-square test were done. A z-test, to compare the column proportions, and Bonferroni correction were used, in the case of variables with more than two categories. P values < 0.05 were considered statistically significant. Results: Were found 10,381 cases of periapical lesions among 74,931 archived specimens (13.8%) in 65 years. Radicular cysts were the most common lesions (59.9%). Periapical lesions affected mainly women (56.1%), with a mean age of 37,01 years (range 13 to 100 ± 14,42) and white-skinned (59.2%). The lesions were generally asymptomatic (28.1%), persisting for more than one year (13.3%), size up to 10 mm (25.2%) and located in the maxilla (60.1%) and posterior region (49.8%). The radicular cysts were larger (p < 0.001), with a higher occurrence of symptomatology (p < 0.027) and higher frequency in the posterior region (p < 0.001) compared to periapical granulomas. The possibility of disagreement between clinical and histopathological diagnosis was higher in periapical granulomas (p < 0.001) than radicular cyst. Conclusions: Endodontic periapical lesions were common in the Bucomaxillofacial Pathology services affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst is the most common lesion.
Assuntos
Granuloma Periapical/epidemiologia , Periodontite Periapical/epidemiologia , Ferimentos e Lesões , Cisto Radicular/epidemiologia , Cárie Dentária , Diagnóstico Bucal , Endodontia , Prontuários Médicos , Epidemiologia , Estudos RetrospectivosRESUMO
Abstract Objective: To present a clinical case of a residual cyst in the right maxillary region with semi-solid content. Main data of the case: 61-year-old patient who comes to consultation for the realization of upper jaw dentures, during the clinical examination a slight facial asymmetry of the right side is observed; radiographic and tomographic examination revealed a radiolucent lesion in the right premolar region. It is diagnosed as a residual cyst and an enucleation is decided; during the surgical procedure a viscous content of yellowish coloration and semi-solid content is observed. Main comments: It is very rare to find residual cysts with semi-solid content, since they generally have purulent or serosanguinous contents.
Resumen Objetivo: Presentar un caso clínico de un quiste residual en la región maxilar derecha, con contenido semisólido. Datos principales del caso: Paciente de 61 años, que acude a consulta para la realización de una prótesis en el maxilar superior, al examen clínico se observa leve asimetría facial del lado derecho; al examen radiográfico y tomográfico se observa lesión radiolúcida en región premolar derecha. Se diagnostica como quiste residual y se decide enucleación, en el procedimiento quirúrgico se observa un contenido viscoso de coloración amarillenta y contenido semisólido. Principales comentarios: Es muy poco común encontrar quistes residuales con contenido semisólido, generalmente son de contenido purulento o serosanguinoso.
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INTRODUCTION: The purpose of this study was to evaluate the expression of cyclooxygenase-2 (COX-2) and tumor necrosis factor alpha (TNF-α) in periapical granuloma (PG) and radicular cyst (RC) samples and to correlate it with the type of lesion, the intensity of the inflammatory infiltrate, and the thickness of the epithelial lining. METHODS: A total of 51 cases of periapical lesions (25 PGs and 26 RCs) were subjected to morphologic analysis and immunohistochemical study. The anti-COX-2 and anti-TNF-α antibodies were applied using the immunoperoxidase technique. Data were analyzed by the Mann-Whitney test, Pearson chi-square test, Fisher exact test, and Spearman correlation. RESULTS: Analysis of the inflammatory infiltrate revealed that 80% of PGs exhibited a grade III infiltrate as opposed to a 19% rate in RCs (P < .001). Morphologic evaluation of the epithelial thickness of RCs revealed the presence of atrophic epithelium in 73% of cases. The majority of PGs had a score of 1 for COX-2 immunoexpression (n = 14, 54%) and a score of 2 for TNF-α expression (n = 16, 64%), whereas in cases of RCs a score of 1 was more prevalent for COX-2 and TNF-α expression (n = 17, 65%). Significant differences in the expression scores of COX-2 and TNF-α were detected in periapical lesions (P < .001). CONCLUSIONS: Based on these findings, we emphasize that RCs and PGs have a similar expression of inflammatory mediators (COX-2 and TNF-α) although the secretion of TNF-α by macrophages and of COX-2 by several cells was higher in PGs, indicating a greater inflammatory response in these lesions.
Assuntos
Ciclo-Oxigenase 2/metabolismo , Imuno-Histoquímica/métodos , Mediadores da Inflamação/metabolismo , Granuloma Periapical/metabolismo , Tecido Periapical/metabolismo , Cisto Radicular/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Ciclo-Oxigenase 2/genética , Feminino , Expressão Gênica , Humanos , Macrófagos/metabolismo , Masculino , Granuloma Periapical/patologia , Tecido Periapical/patologia , Cisto Radicular/patologia , Fator de Necrose Tumoral alfa/genéticaRESUMO
The aim of this study is present a surgical solution of the case of endodontic root canal failure caused by overfilling, with a history of endodontic retreatment and aesthetic rehabilitation with porcelain veneers. Patient C.F.P.L, 50 years old, female, was looking for treatment complaining of pain. Previous endodontic treatment was reported on tooth 11, and root canal retreatment after 6 months due to the persistence of painful symptomatology. Later, the patient carried out aesthetic rehabilitation with porcelain veneers, and approximately 6 months later the vitro pain related to the tooth 11 occurred again. Radiographic and tomographic images showed obturation of the root canal of the tooth 11 associated with diffuse hypodense area in the periapical region, with overextended endodontic material. The probable clinical diagnosis was symptomatic traumatic apical periodontitis, and apical surgery was proposed as treatment plan. After infiltrative anesthesia, a Newmann incision and split flap were performed, followed by osteotomy with micro-chisel and curettage of the lesion. An apicectomy was performed with Zecrya drill, followed by retro cavity with diamond ultrasonic tip and retrograde obturation with white MTA. After 2 years of follow-up bone neoformation and absence of symptomatology were observed, tooth in function and preservation of aesthetic rehabilitation harmony. Apical surgery is a therapeutic alternative with favorable prognosis for the treatment of endodontic failure, provided that it is correctly indicated and with a wellexecuted surgical protocol. (AU).
O objetivo deste estudo é apresentar a resolução cirúrgica de um caso de insucesso endodôntico ocasionado pela sobre obturação do canal radicular, com histórico de retratamento endodôntico e reabilitação estética com facetas cerâmicas. Paciente C.F.P.L, 50 anos, gênero feminino, procurou atendimento odontológico queixando-se de dor. Foi relatado tratamento endodôntico prévio no dente 11, e retratamento do canal radicular após 6 meses devido à persistência de sintomatologia dolorosa. Posteriormente, a paciente passou por reabilitação estética com facetas cerâmicas e, aproximadamente 6 meses após, houve o reaparecimento de dor espontânea relacionada ao dente 11. As imagens radiográficas e tomográficas revelaram obturação do canal radicular do dente 11 associado à área hipodensa difusa na região periapical, com extravasamento de material obturador. O diagnóstico clínico provável foi de periodontite apical sintomática traumática, e plano de tratamento proposto uma cirurgia parendodôntica. Posterior a anestesia infiltrativa, realizou-se incisão do tipo Newmann e retalho dividido, seguido de osteotomia com micro cinzel e curetagen da lesão. A apicectomia foi realizada com broca Zecrya, seguida da confecção da retrocavidade com ponta ultrassônica diamantada e obturação retrógrada com MTA branco. Após 2 anos de proservação foi observada neoformação óssea e ausência de sintomatologia, dente em função e preservação da harmonia da reabilitação estética. A cirurgia parendodôntica é uma alternativa terapêutica com prognóstico favorável para o tratamento do insucesso endodôntico, desde que corretamente indicada e com protocolo cirúrgico bem executado. (AU).
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INTRODUCTION: The aim of the present study was to compare the immunoexpression of CD34, intercellular adhesion molecule-1 (ICAM-1), and podoplanin and the presence of mast cells with clinical, demographic, radiologic, and histologic features from periapical granulomas, periapical cysts, and residual cysts. METHODS: Thirty-one lesions (5 granulomas, 15 periapical cysts, and 11 residual cysts) were selected. Histologic sections in silanized slides were used for the immunohistochemical reactions. The analysis of the images was performed by using an optical microscope, and data were analyzed with 5% significance (P < .05). RESULTS: Cysts presented atrophic and hyperplastic epithelium in 11 cases (35.5%) and 15 cases (48.8%), respectively (P > .05). The intensity of the inflammatory infiltrate was similar when comparing the 3 groups (P > .05). CD34 and podoplanin expression and the presence of mast cells were similar when comparing the 3 groups; ICAM-1 expression was more intense in granulomas than cysts (P < .05). There were no statistically significant differences associated with the expression of the evaluated markers according to the intensity of the inflammatory infiltrate. CONCLUSIONS: There were no differences in the expression of CD34 and podoplanin and in the presence of mast cells when the 3 groups were compared. ICAM-1 expression was more common in periapical granulomas.
Assuntos
Antígenos CD34/metabolismo , Molécula 1 de Adesão Intercelular/metabolismo , Mastócitos/metabolismo , Glicoproteínas de Membrana/metabolismo , Doenças Periapicais/metabolismo , Granuloma Periapical/metabolismo , Cisto Radicular/metabolismo , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Mastócitos/patologia , Pessoa de Meia-Idade , Doenças Periapicais/patologia , Granuloma Periapical/patologia , Tecido Periapical/metabolismo , Tecido Periapical/patologia , Cisto Radicular/patologia , Estudos Retrospectivos , Adulto JovemRESUMO
Las imágenes radiolúcidas periapicales que involucran dientes primarios traumatizados se pueden confundir entre sí y dar lugar a diagnósticos erróneos y tratamiento. Por lo tanto, es importante identi-ficar las características radiográficas de las imágenes radiolúcidas periapicales en los incisivos prima-rios traumatizados, principalmente debido al hecho de que la superposición de imágenes se produce en esta región. Además, es frecuente observar la expansión del folículo haciendo que el diagnóstico radiográfico sea aún más difícil. El objetivo de este estudio fue describir, a través de una revisión de la literatura, las características radiográficas de las imágenes periapicales asociadas con los incisivos primarios traumatizados.
Periapical radiolucencies involving traumatized primary teeth can be confused with each other and lead to misdiagnosis and treatment. Therefore, it is important to identify radiographic characteristics of periapical radiolucent images in traumatized primary incisors, mainly due to the fact that overla-pping of images occurs in this region. Besides, it is frequent to observe follicle expansion making the radiographic diagnosis even more difficult. The objective of this study was to describe, through a literature review, the radiographic characteristics of periapical images associated with traumatized primary incisors.
As radioluscências periapicais envolvendo dentes decíduos traumatizados podem ser confundidas entre si e levar a um erro de diagnóstico e tratamento. Por isso, é importante identificar características radiográficas de imagens radiolúcidas periapicais em incisivos decíduos traumatizados, principalmente pelo fato que nesta região ocorre sobreposição de imagens e, é frequente observar expansão do folículo, dificultando ainda mais o diagnóstico radiográfico. O objetivo deste trabalho foi descrever através de uma revisão de literatura as características radiográficas de imagens periapicais associadas a incisivos decíduos traumatizados.
Assuntos
Granuloma Periapical , Dente Decíduo , Radiografia Dentária , Cisto Radicular , Traumatismos Dentários , Saco Dentário , Serviço de Acompanhamento de Pacientes , Germe de Dente , Necrose da Polpa Dentária , Erros Médicos , Diagnóstico BucalRESUMO
INTRODUCTION: Galectins play important roles in immunoinflammatory responses, but their participation in the development of periapical lesions remains unclear. This study aimed to evaluate the expressions of galectins-1, -3, and -7 in periapical lesions, correlating them with the intensity of the inflammatory infiltrate and the pattern of the cystic epithelium. METHODS: Twenty periapical granulomas (PGs), 20 radicular cysts (RCs), and 20 residual radicular cysts (RRCs) were submitted to immunohistochemistry using anti-galectin-1, -3, and -7 antibodies. The percentage of immunopositive cells in epithelial and connective tissues was determined. RESULTS: In connective tissue, PGs exhibited higher cytoplasmic/membrane expression of galectins-1 and -7 than RCs and RRCs (P < .05). There was higher nuclear expression of galectin-1 in PGs compared with RCs and RRCs (P < .05). The expression of galectins-1 and -7 in connective tissue was higher in lesions with grade III inflammation (P < .05). No significant differences in galectin-3 immunoexpression were observed for any of the parameters evaluated (P > .05). In the epithelial component, a higher nuclear expression of galectin-7 was detected in RRCs (P < .05), and a higher cytoplasmic/membrane expression of this protein was found in cysts with hyperplastic epithelium (P < .05). Positive correlations were observed between the nuclear and cytoplasmic/membrane expression of galectin-1 in connective tissue (P < .05) as well as between the nuclear and cytoplasmic/membrane expression of galectin-7 in epithelial tissue of cysts (P < .05). CONCLUSIONS: Galectins-1 and -7 may play important roles in the pathogenesis of PGs, RCs, and RRCs. On the other hand, the present results suggest only a minor involvement of galectin-3 in the development of these lesions.
Assuntos
Galectina 1/metabolismo , Galectina 3/metabolismo , Galectinas/metabolismo , Doenças Periapicais/patologia , Granuloma Periapical/patologia , Cisto Radicular/patologia , Humanos , Doenças Periapicais/metabolismo , Granuloma Periapical/metabolismo , Tecido Periapical/metabolismo , Tecido Periapical/patologia , Cisto Radicular/metabolismoRESUMO
Abstract Objective: This study evaluated the expression of pro-inflammatory (IL-1β, IL-6, IFN-γ and TNF-α) and anti-inflammatory (IL-4 and TGF-β) cytokines in apical periodontitis lesions. Correlations between these cytokines and clinical and cone-beam computed tomographic (CBCT) data were also assessed. Material and Methods: Apical periodontitis lesions' data were obtained from 27 patients subjected to periradicular surgery. Specimens were processed for histopathologic and immunohistochemical analysis. Sections were evaluated according to the amount of positive staining for each antibody. Expression levels of the target mediators were compared with clinical and CBCT data. Results: Twenty lesions were diagnosed as granuloma and 7 as cyst. In granulomas, IL-4 expression was significantly higher than IL-6 (p=0.001) and TNF-α (p=0.001). There was a significant relationship between high levels of TNF-α and lesions <5 mm (p=0.017). In cysts, IL-6 expression was significant lower than IL-4 (p=0.001) and IFN-γ (p=0.004). There was a significant relationship between high levels of TGF-β and endodontic treatment performed ≤4 years before (p=0.045). In general, IL-4 was the most expressed mediator in both cysts and granulomas. Conclusions: There was a balance between the expression of pro-inflammatory and anti-inflammatory cytokines associated with the chronic periradicular inflammatory process. TNF-α and TGF-β were related to some clinical and CBCT data.