Preliminary application of artificial intelligence in the pathological diagnosis of periapical cysts / 口腔疾病防治

Objective@#To study the effect of artificial intelligence in the pathological diagnosis of periapical cysts and to explore the application of artificial intelligence in the field of oral pathology.@*Methods@#Pathological images of eighty-seven periapical cysts were selected as subjects to read, and a neural network with a U-net structure was constructed. The 87 HE images and labeled images of periapical cysts were divided into a training set (72 images) and a test set (15 images), which were used in the training model and test model, respectively. Finally, the target level index F1 score, pixel level index Dice coefficient and receiver operating characteristic (ROC) curve were used to evaluate the ability of the U-net model to recognize periapical cyst epithelium.@*Results @# The F1 score of the U-net network model for recognizing periapical cyst epithelium was 0.75, and the Dice index and the areas under the ROC curve were 0.685 and 0.878, respectively.@*Conclusion@#The U-net network model constructed by artificial intelligence has a good segmentation result in identifying periapical cyst epithelium, which can be preliminarily applied in the pathological diagnosis of periapical cysts and is expected to be gradually popularized in clinical practice after further verification with large samples.

Diverse Roles of Macrophages in Oral Inflammatory and Benign Lesions - A Narrative Review

Background: Macrophages are immune cells with diverse profiles and functions. Macrophages play significant roles in the repair and resolution of inflammatory and reactive lesions. They secrete cytokines and modulate the tissue microenvironment and surrounding cellular responses. Objectives: The present article reviews the histological presentation and role of macrophages in the pathogenesis of oral inflammatory and benign lesion. Materials and Methods: Data was collected by electronic search of databases including PubMed and Google Scholar for Mac- rophages, Periapical Granuloma, Mucocele, and Verruciform Xanthoma. Result: Distinct profiles of macrophages participate in regulation of pathogenesis, lesion size, and resolution of periapical lesions. In trauma-associated reactive or benign lesions, macrophages show phagocytosis and exhibit characteristic foamy his- tological appearance. The immunohistochemical profiles of macrophages aid in identifying the surface receptors and profiles of macrophages in oral lesions. Conclusion: Identifying and understanding macrophage-mediated pathogenesis can help diagnose and develop targeted therapies against various oral lesions.

Abordagem cirúrgica de cisto periapical abscedado na maxila: relato de caso / Surgical approach of absceded periapical cyst in the maxilla: case report / Abordaje quirúrgico de quiste periapical abscedido en la maxila: reporte de caso

O cisto radicular é uma lesão inflamatória associada à necrose pulpar que ocorre frequentemente em maxila. Objetivo: Descrever um caso cirúrgico detalhado de Cisto Periapical Abscedado. Relato de Caso: paciente gênero feminino, 40 anos, hipertensa, diabética Tipo II, compareceu à clínica queixando-se de dor ao ingerir alimentos frios e quentes na região da maxila, lado esquerdo. Ao exame físico, observou-se destruição coronária e presença de fístula na região do elemento dentário 23. Ao exame radiográfico, observou-se uma área radiolúcida ovalada bem circunscrita com halo radiopaco envolvendo a região apical do elemento dentário 23. Frente ao aspecto clínico e radiográfico, foram sugeridas as hipóteses diagnósticas de abscesso periapical crônico, granuloma periapical ou cisto apical abscedado. Foi realizada a exodontia do elemento 23 seguida de enucleação cística. O diagnóstico histopatológico final foi de cisto abscedado. Após 5 meses de evolução observa-se mucosa íntegra e reparo ósseo alveolar. Conclusão: É imprescindível um exame clínico cuidadoso associado ao exame radiográfico e histopatológico para analisar minuciosamente o caso a fim de oferecer ao paciente melhores condutas de tratamento. O diagnóstico de lesões intraósseas associado ao correto tratamento interrompe a evolução do processo patológico, evita danos maiores e restabelece a condição de saúde dos pacientes... (AU)

The radicular cyst is an inflammatory lesion associated with pulp necrosis that often occurs in the maxilla. Objective: To describe a detailed surgical case of Abscessed Periapical Cyst. Case Report: female patient, 40 years old, hypertensive, type II diabetic, came to the clinic complaining of pain when ingesting cold and hot foods in the left side of the maxilla. On physical examination, coronary destruction and the presence of a fistula in the region of the tooth 23 were observed. The radiographic examination showed a well-circumscribed oval radiolucent area with a radiopaque halo involving the apical region of the tooth 23. In view of the clinical and radiography, the diagnostic hypotheses of chronic periapical abscess, periapical granuloma or abscessed apical cyst were suggested. Element 23 extraction was performed followed by cystic enucleation. The final histopathological diagnosis was an abscessed cyst. After 5 months of evolution, intact mucosa and alveolar bone repair are observed. Conclusion: A careful clinical examination associated with radiographic and histopathological data is essential to systematically analyze the case in order to offer the patient better treatment. The diagnosis of intraosseous lesions associated with the correct treatment interrupts the evolution of the pathological process, avoids further damage and restores the patients' health condition... (AU)

El quiste radicular es una lesión inflamatoria asociada a necrosis pulpar que frecuentemente se presenta en el maxilar. Objetivo: Describir un caso quirúrgico detallado de Quiste Periapical Absceso. Caso Clínico: paciente femenina, de 40 años, hipertensa, diabética tipo II, acudió a la consulta quejándose de dolor al ingerir alimentos fríos y calientes en el lado izquierdo del maxilar. Al examen físico se observó destrucción coronaria y la presencia de una fístula en la región del diente 23. El examen radiográfico mostró un área radiolúcida oval bien delimitada con un halo radiopaco que involucraba la región apical del diente 23. En vista de la clínico y radiográfico, se sugirieron las hipótesis diagnósticas de absceso periapical crónico, granuloma periapical o quiste apical abscesificado. Se realizó la extracción del elemento 23 seguida de enucleación quística. El diagnóstico histopatológico final fue de quiste abscesificado. A los 5 meses de evolución se observa mucosa intacta y reparación del hueso alveolar. Conclusión: Un examen clínico cuidadoso asociado con el examen radiográfico e histopatológico es fundamental para analizar a fondo el caso con el fin de ofrecer al paciente mejores enfoques de tratamiento. El diagnóstico de lesiones intraóseas asociado al correcto tratamiento interrumpe la evolución del proceso patológico, previene mayores daños y restablece el estado de salud de los pacientes... (AU)

Management of periapical lesion with persistent exsudate

Resumo Este relato de caso descreve o tratamento e acompanhamento de um molar inferior em uma jovem de 18 anos com cisto periapical. Assim, torna-se importante saber quais opções devemos tomar diante de uma situação clínica que não podemos resolver pelos métodos convencionais, e quais técnicas e abordagens temos para alcançar o sucesso do tratamento. Este caso mostrou o plano de tratamento e acompanhamento, por meio de imagens de tomografia computadorizada de feixe cônico (TCFC), de um molar inferior previamente tratado com grande abscesso periapical e lesão cística, no qual, a primeira abordagem do plano de tratamento foi fazer o retratamento endodôntico. Durante o preparo químico-mecânico a presença de exsudato purulento intracanal permanente impossibilitou a secagem dos canais, impedindo a obturação do sistema de canais radiculares. Devido a essa situação clínica, foi realizada abordagem cirúrgica com a intenção de reduzir esse exsudato permanente e executar uma técnica de descompressão. Após um ano de acompanhamento, os achados clínicos e radiográficos indicaram processo de reparo.

Abstract This case describes the treatment and follow-up of a mandibular molar in an 18-year-old female with a periapical cyst. Thus, it becomes important to know which options should we take when faced with a clinical situation that we cannot resolve through conventional methods, and which techniques and approaches we have to achieve treatment success. This case showed the treatment plan and follow-up, by the use of CBCT images, from a previously treated mandibular molar with a large periapical abscess and cystic lesion, in which, the first treatment plan approach was to make the endodontic retreatment. During the chemo-mechanical preparation the presence of permanent intracanal purulent exudate made it impossible to dry the canals, impeding obturation of the root canal system. Due to this clinical situation, a surgical approach was performed with the intention of reduce this permanent exudate and to execute a decompression technique. Clinical findings, periapical radiographs and cone beam computed tomographic, indicated almost complete resolution of the radiolucency, after a one-year follow-up.

Quiste periapical: diagnóstico y tratamiento / Periapical cyst: diagnosis and treatment

Los quistes periapicales o radiculares representan una de las patologías periapicales más frecuentes dentro del grupo de las lesiones quísticas de los maxilares. Son el resultado de la extensión de proce- sos inflamatorios-infecciosos. Su diagnóstico sigue siendo un desafío para el profesional odontológico, quien debe diferenciarlo de otros procesos inflama- torios periapicales. El objetivo del presente artículo es presentar, apoyado en una revisión de la literatura, el caso clínico de un paciente masculino de 38 años de edad que se presentó a la consulta por leve tume- facción indolora en zona anterosuperior del maxilar. A la inspección se observó borramiento de la región del surco vestibular a nivel de piezas dentarias 1.1, 1.2 y 1.3, de color rojizo con crepitación de la tabla ósea vestibular a la palpación. La tomografía de haz cónico mostró lesión osteolítica, extendida desde zona apical de la pieza dentaria 1.4 hasta zona del elemento dentario 1.1. Se realizó la extirpación de la lesión y api- cectomía. El estudio histológico corroboró el diagnós- tico presuntivo de quiste periapical. Los controles a distancia mostraron buena evolución del tratamiento. Se concluyó en la importancia de realizar un correcto diagnóstico clínico e imagenológico para la selección de un adecuado tratamiento según el caso (AU)

Periapical or radicular cysts represent one of the most frequent periapical pathologies within the group of cystic lesions of the jaws. They are the result of the spread of inflammatory-infectious processes. Its diagnosis continues to be a challenge for the dentist, who must differentiate it from other periapical inflammatory processes. The objective of this article is to present, supported by a review of the literature, the clinical case of a 38-year-old male patient who presented to the consultation due to mild painless swelling in the anterosuperior maxilla. Upon inspection, effacement of the vestibular sulcus region was observed at the level of teeth 1.1, 1.2 and 1.3, reddish in color with crepitation of the buccal bone table on palpation. Cone beam tomography showed an osteolytic lesion that extended from the apical area of tooth 1.4 to area of tooth 1.1. Excision of the lesion and apicoectomy were performed. The histological study corroborated the presumptive diagnosis of periapical cyst. Remote controls showed a good evolution of the treatment. It was concluded on the importance of carrying out a correct clinical and imaging diagnosis for the selection of an adequate treatment according to the case (AU)

Abordagem cirúrgica de cisto periapical infectado em região maxilar: relato de caso / Surgical approach of infected periapical cystin maxillary region: case report

Cistos Periapicais são proliferações dos restos epiteliais de Malassez em decorrência do processo desenvolvimento ou inflamatório devido necrose pulpar. Apresenta-se no início de forma assintomática, e dependendo da sua evolução pode levar a expansão da corticais e reabsorção óssea. Ao exame de imagem se apresentam como uma área radiotransparente bem delimitada, circunscrita por halo radiopaco geralmente associado a região apical de uma ou mais unidades dentárias. O objetivo desse trabalho é relatar abordagem cirúrgica de enucleação e curetagem de um cisto periapical em região maxilar(AU)

Periapical cysts are proliferations of the epithelial remains of Malassez due to the development or inflammatory process due to pulp necrosis. It presents at the beginning asymptomatic, and depending on its evolution may lead to cortical expansion and bone resorption. Imaging studies present as a well-defined radiotransparent area, circumscribed by a radiopaque halo generally associated with the apical region of one or more dental units. The objective of this study is to report a surgical approach of enucleation and curettage of a periapical cyst in the maxillary region(AU)

Enucleation of Odontogenic Cyst with Bone Graft / Enucleación de Quiste Odontogénico con Injerto Óseo

ABSTRACT: Periapical cyst originates from an inflammatory reaction in the body that occurs due to a long-term endodontic aggression. It is more prevalent in caucasian male, during the third decade of life, in the anterior portion of the maxilla. They are commonly radiographic findings, due to their asymptomatic aspect. This study reports a Periapical Cyst in the portion corresponding to teeth 21, 22 and 23, which was treated by enucleation of the cyst, apicoectomy and retrograde root filling with Mineral trioxide aggregate (M.T.A) of teeth 21 and 22, filling of the cyst cavity with xenogeneic bone graft GenOx and a collagen membrane Gen-Derm. Observations after three months show good and rapid bone regeneration, periodontal and periapical health of the teeth involved.

RESUMEN: El quiste periapical se origina de una reacción inflamatoria que ocurre debido a una agresión endodóntica a largo plazo. Es más frecuente en el varón caucásico, durante la tercera década de la vida, en la porción anterior del maxilar. Son comúnmente hallazgos radiográficos, debido a su aspecto asintomático. En este estudio informamos acerca de un quiste periapical, en la porción correspondiente a los dientes 21, 22 y 23, que se trató mediante enucleación, apicectomía y relleno de raíz retrógrada con agregado de trióxido mineral (MTA) de los dientes 21 y 22, relleno de la cavidad del quiste con injerto óseo xenogénico Gen-Ox y una membrana de colágeno GenDerm. Las observaciones después de tres meses mostraron una buena y rápida regeneración ósea, con conservación de la salud periodontal y periapical de los dientes involucrados.

Tumor odontogénico adenomatoide extrafolicular de localización mandibular / Mandibular extrafollicular adenomatoid odontogenic tumor

Introducción: el tumor odontogénico adenomatoide es un tumor odontogénico benigno compuesto por epitelio odontogénico con estroma fibroso maduro sin participación del ectomesénquima. Representa entre el 2 por ciento y el 7 por ciento de estos tumores. Más del 90 por ciento aparecen antes de los 30 años con tres variantes clínicas: folicular, extrafolicular y periférica. Su aspecto clínico-radiográfico varía y puede ser confundido con otras lesiones quísticas o neoplásicas de la cavidad bucal, por lo que es necesario el diagnóstico anatomopatológico. Objetivo: presentar un caso de un tumor odontogénico adenomatoide extrafolicular mandibular. Presentación del caso: paciente femenina de 12 años de edad, con aumento de volumen asintomático en la encía mandibular del lado izquierdo, sin antecedentes patológicos de interés, de tiempo de evolución no precisado. Al examen físico se observó aumento de volumen de forma redondeada de 1,5 cm que desplazaba la encía mandibular izquierda entre incisivo lateral y canino. La radiografía reveló una lesión radiolúcida unilocular entre 42 y 43 que expandía la cortical ósea. Se detectó ausencia de vitalidad pulpar de estos dientes. Con el diagnóstico clínico de quiste periapical se realizó excisión quirúrgica, se envió la muestra al laboratorio de Anatomía Patológica, y se concluyó el diagnóstico de tumor odontogénico adenomatoide extrafolicular. Conclusiones: el tumor odontogénico adenomatoide, más común en la maxila, puede presentarse en la mandíbula. Los hallazgos clínico-radiográficos semejan otras lesiones odontogénicas como quistes dentígeros, otras neoplasias y lesiones periapicales inflamatorias, siendo el diagnóstico anatomopatológico el concluyente(AU)

Introduction: adenomatoid odontogenic tumor is a benign odontogenic tumor composed of odontogenic epithelium with mature fibrous stroma without ectomesenchymal involvement. It represents between 2 percent and 7 percent of these tumors. More than 90 percent appear before age 30, with three clinical variants: follicular, extrafollicular and peripheral. Its clinical-radiographic aspect may vary, and it may be confused with other cystic or neoplastic lesions of the oral cavity, hence the need for an anatomo-pathological diagnosis. Objective: present a case of mandibular extrafollicular adenomatoid odontogenic tumor. Case presentation: afemale 12-year-old patient presents with asymptomatic left mandibular gum swelling, with no pathological antecedents of interest and an imprecise time of evolution. Physical examination found a round 1.5 cm swelling displacing the left mandibular gum between the lateral incisor and the canine. Radiography revealed a unilocular radiolucent lesion between teeth 42 and 43 expanding the cortical bone. The teeth involved showed no pulpal vitality. Upon reaching a clinical diagnosis of periapical cyst, surgical excision was performed and a sample was submitted to the Anatomical Pathology laboratory. The anatomo-pathological diagnosis was extrafollicular adenomatoid odontogenic tumor. Conclusions: though more common in the maxilla, adenomatoid odontogenic tumors may also occur in the mandible. Clinical and radiological features may be similar to those of other odontogenic lesions, such as dentigerous cysts, other neoplasms and periapical inflammatory lesions; therefore, the final diagnosis should be provided by anatomo-pathological evaluation(AU)

Analysis of the presence and location of mast cells in periapical cysts and periapical granulomas / Análise da presença e localização de mastócitos nos cistos periapicais e granulomas periapicais

ABSTRACT Objective: The aim of the present study was to locate mast cells in chronic periapical lesions (granulomas and cysts) by using histochemical techniques and toluidine blue staining. Methods: A quantitative, descriptive, cross-sectional and retrospective research was performed. The sample was obtained from histopathological reports in the archives of the laboratory of surgical pathology of the University of Pernambuco between November 2014 and May 2015. Results: Sixteen cases of granuloma and 21 cases of periapical cysts were selected. The stained slides were analyzed by two examiners at different times, in a double-blind study. Mast cells were found in 13 (61.9%) of the periapical cyst cases, located in the capsule of the lesion. In the periapical granuloma cases, mast cells were found in eight cases (50%), located in the granulation tissue. Conclusion: Mast cells were detected in both cysts and periapical granuloma, located in the capsule and granulation tissue, respectively. Mast cells were more prevalent in periapical cysts than in periapical granuloma.

RESUMO Objetivo: Localizar mastócitos em lesões periapicais (granulomas e cistos) através de técnicas histoquímicas e corante azul de toluidina. Métodos: Uma pesquisa quantitativa, descritiva, transversal e retrospectiva foi realizada. As amostras foram obtidas de documentos histopatológicos nos arquivos do laboratório de patologia cirúrgica da Universidade de Pernambuco entre Novembro de 2014 e Março de 2015. Resultados: Dezesseis casos de granuloma e 21 casos de cistos periapicales foram selecionados. As lâminas coradas foram analisadas por dois examinadores em tempos diferentes, em um estudo duplo-cego. Mastócitos foram encontrados em 13 (61,9%) dos casos de cistos periapicales, localizados na cápsula da lesão. Nos granulomas periapicais, mastócitos foram encontrados em oito casos (50%), localizados no tecido de granulação. Conclusão: Mastócitos foram detectados tanto em cistos quanto em granulomas periapicais, localizados na cápsula e no tecido de granulação respectivamente. Os mastócitos estavam mais presentes nos cistos do que nos granulomas periapicais.

Correlação clínica e histopatológica de cistos e granulomas periapicais / A Clinical and Histopathological Correlation of Periapical Cysts and Granulomas

Cistos e granulomas periapicais estão entre as lesões radiolúcidas mais prevalentes. Porém, há situações em que os padrões clínicos e radiográficos se misturam e, portanto, o estudo histopatológico faz-se necessário para o diagnóstico definitivo. O objetivo deste estudo foi avaliar a correlação clínica e histopatológica no diagnóstico de cistos e granulomas periapicais. Para isso, foram selecionadas amostras obtidas no Laboratório de Patologia Cirúrgica da Faculdade de Odontologia de Pernambuco, FOP/UPE, no período de 11/2005 a 05/2008. Um total de 37 lesões, distribuídas entre cistos e granulomas periapicais, foram incluídas no estudo. Baseadas nos aspectos clínico-radiográfico e transoperatório, cirurgiões-dentistas forneceram hipóteses diagnósticas, as quais foram comparadas aos exames histopatológicos. Achados clínicos revelaram 28 casos (75,7%) de cistos, 4 casos (10,8%) de granulomas, 4 casos (10,8%) com características de ambas lesões, e 1 caso (2,7%) no qual o dentista não forneceu o diagnóstico. Entretanto, os achados histopatológicos revelaram 21 (56,8%) e 16 (43,2%) casos de cistos e granulomas, respectivamente. Os resultados mostraram uma correlação de 45,9% entre os achados para os cistos e de 8,1% para os granulomas. Diante do exposto, a discrepância observada dos achados clínicos quando comparados aos histopatológicos deve ser discutida quanto aos critérios diagnósticos que vêm sendo utilizados atualmente... (AU)

Cysts and periapical granulomas are among the most prevalent radiolucent lesions. However, there are situations where the clinical and radiographic patterns are mixed and therefore the histopathological study is necessary for definitive diagnosis. The aim of this study was to evaluate the clinical and histopathological correlation in the diagnosis of periapical cysts and granulomas. For this, samples were selected obtained from histopathological reports of Pathology Laboratory, Faculty of Dentistry of Pernambuco, FOP / UPE, during the period from 11/2005 to 05/2008. A total of 37 lesions distributed among periapical cysts and granulomas, were included in the study. Based on clinical, radiographic and intraoperative lesions, dentists provided diagnostic hypotheses, which were compared to histopathological diagnostic. Clinical findings revealed 28 cases (75.7%) of radicular cysts, 4 cases (10.8%) of granulomas alone, 4 cases (10.8%) with characteristics of both lesions, and 1 case (2.7 %) in which the dentist has not provided the diagnosis. However, the histopathological findings revealed 21 (56.8%) and 16 (43.2%) cysts and granulomas images, respectively. The results showed a 45.9% correlation between the findings for periapical cysts and 8.1% for periapical granulomas. Given the above, the discrepancy observed clinical findings compared to histopathology should be discussed as to the diagnostic criteria that have been used nowadays... (AU)

Anterior stafne bone cyst mimicking periapical cyst: a case report

Stafne bone cyst (SBC) is a bone defect usually located in the posterior portion of the mandible or mandibular angle below the inferior alveolar nerve. The cases of SBC involving multiple anterior tooth apices and penetrating the mandibular bone are extremely rare. Here we present a case of an anterior-positioned SBC mimicking periapical cyst, which penetrated the mandibular bone, with a review of the differential diagnosis.

Quiste periapical con inflamación crónica agudizada / Periapical cyst with acute chronic inflammation

Paciente femenina de 47 años, de piel negra, residente en una comunidad urbana, con antecedente patológico personal de hipertensión arterial sin tratamiento; acudió a consulta de urgencias con una inflamación crónica agudizada del paladar duro derecho. En el examen bucal se observó destrucción total de la corona del diente 12 (Incisivo superior lateral derecho) con aumento de volumen difuso en el paladar. A la vista de una radiografía oclusal, se observó en el ápice del diente en cuestión una zona radiolúcida redondeada de aproximadamente 1,5 cm de diámetro, con una limitación radiopaca. Dicho ápice se encontró intacto, lo cual impresiona un resto radicular del diente 12 con un quiste periapical. Se trata en consulta, se medica y se decide remitir para los servicios de cirugía máxilo facial donde se elimina el quiste, se extrae la cápsula, se le toma muestra, se realiza exodoncia del resto radicular del diente, irrigando con solución y sutura. En próxima consulta la paciente presentó buena evolución y se recibió informe de la biopsia arrojando presencia de varios fragmentos de tejido fibroso con inflamación crónica agudizada con áreas de hemorragia.

A 47 year old female patient of dark skin colour, resident in an urban community that, with PPA of arterial hypertension without treatment; she has an acute chronic inflammation of the right hard palate, the oral examination shows total destruction of the crown on tooth 12 (upper right lateral incisor) with increase of diffuse volume in the palate; visible in an occlusal x-ray, a rounded radiolucyd area of more than 1.5cm of diameter is observed, with a radiopaque limitation in tooth apex in question, and this apex is intact, what impresses a radicular debris of tooth 12 with a periapical cyst. It is decided to be referred to maxillo facial surgery services where the cyst is eliminated, the capsule is extracted, the sample is taken, exodontia of radicular tooth debris is carried out, it is irrigated with solution and it is sutured; in next appointment the patient presents good evolution and a report of the biopsy is obtained resulting: presence of several fragments of fibrous tissue with acute chronic inflammation with bleeding areas.

Mixed Periapical Lesion: An Atypical Radicular Cyst with Extensive Calcifications

The radicular cyst is an inflammatory odontogenic cyst of endodontic origin. Radiographically, the lesion appears as a periapical radiolucent image. This report describes a very rare case of a mixed periapical radiographic image diagnosed as a radicular cyst. A 37-year-old female patient presented a mixed, well-circumscribed image located in the periapical region of the left maxillary central incisor, which presented unsatisfactory endodontic treatment. Microscopic examination revealed a cavity lined by non-keratinized squamous epithelium and extensive calcifications in the cystic lumen and lining epithelium. Diagnosis of radicular cyst with extensive calcifications was established. Endodontic retreatment was performed and no radiographic signs of recurrence were observed 18 months after treatment. Although very rare, a radicular cyst should be considered in the differential diagnosis of a mixed periapical image associated to teeth with pulp necrosis.

O cisto radicular é um cisto odontogênico inflamatório de origem endodôntica. Radiograficamente, a lesão se apresenta como uma imagem radiolúcida periapical. Este relato descreve um caso muito raro de uma imagem radiográfica periapical mista diagnosticada como cisto radicular. Uma paciente de 37 anos de idade, do gênero feminino, apresentava uma imagem mista, bem circunscrita, localizada na região periapical do incisivo central superior esquerdo, que apresentava tratamento endodôntico insatisfatório. Avaliação microscópica revelou uma cavidade revestida por epitélio escamoso não-queratinizado e calcificações extensas na cavidade cística e revestimento epitelial. O diagnóstico de cisto radicular com extensas calcificações foi estabelecido. Retratamento endodôntico foi realizado e não foram observados sinais radiográficos de recorrência da lesão após 18 meses de tratamento. Embora muito raro, um cisto radicular deve ser considerado no diagnóstico diferencial de uma imagem periapical mista associada a dentes com necrose pulpar.

Enucleación de quiste periapical simultáneo a la obturación del sistema de conductos radiculares / Periapical cyst enucleation and simultaneous sealing of the root canal system

Introducción: los quistes periapicales representan el tipo más frecuente dentro de los quistes odontogénicos. Su origen está relacionado con una necrosis pulpar y un consecuente estímulo de los restos epiteliales del ligamento periodontal (Malassez). Objetivo: describir un caso clínico de enucleación de quiste periapical simultáneo a la obturación del sistema de conductos radiculares. Presentación del caso: paciente de sexo femenino, 67 años de edad, sin alteraciones sistémicas; buscó atención odontológica por presentar dolor dental y acúmulo de alimentos en la región de molares inferiores del lado izquierdo. Al examen clínico se observó caries extensa en el segundo molar inferior izquierdo con compromiso de furca, ausencia de aumento de volumen vestibular, sin fistula; en la radiografía periapical se evidenció lesión cariosa extensa recidivante en el segundo molar inferior izquierdo, y primer molar inferior izquierdo con tratamiento endodóntico y presencia de área radiolúcida de contornos bien definidos en la región periapical compatible con quiste periapical. El tratamiento estuvo a cargo de un equipo multidisciplinario por lo que se decidió realizar exodoncia del segundo molar inferior izquierdo y cirugía paraendodóntica con enucleación quirúrgica simultánea a la obturación del sistema de conductos radiculares primer molar inferior izquierdo; el examen histopatológico de la muestra extraída comprobó tratarse de un quiste periapical. Se realizó seguimiento radiográfico dos años después y mostró un completo reparo óseo del área afectada. Conclusiones: se concluye que el tratamiento descrito constituye una alternativa válida para la resolución de casos donde la endodoncia convencional es limitada para mantener la función y estética de una pieza dentaria(AU)

Introduction: periapical cysts are the most common odontogenic cysts. Their origin is related to pulp necrosis and the consequent stimulation of epithelial rests of the periodontal ligament (Malassez). Objective: describe a clinical case of periapical cyst enucleation and simultaneous sealing of the root canal system. Case report: a female 67-year-old patient without any systemic alteration sought care for dental pain and accumulation of food in the area of the lower left molars. Clinical examination revealed extensive decay in the lower left second molar with furcation involvement and absence of vestibular volume increase without a fistula. Periapical radiography showed an extensive recurrent carious lesion in the lower left second molar and lower left first molar with endodontic treatment and presence of a radiolucent area of a sharp outline in the periapical region compatible with periapical cyst. Treatment was conducted by a multidisciplinary team, who decided to perform extraction of the lower left second molar and paraendodontic surgery with surgical enucleation and simultaneous sealing of the root canal system in the lower left first molar. Histopathological examination of the specimen removed revealed it was a periapical cyst. Radiographic follow-up conducted two years later showed complete bone repair in the affected area. Conclusions: it is concluded that the treatment described is a valid alternative for the resolution of cases in which conventional endodontics is insufficient to preserve the function and aesthetic appearance of a tooth(AU)

Uveitis manifestaciones secundaria de infección en cavidad bucal: reporte de caso clínico / Uveitis: as a symthom of oral infection: report a case

La uveítis es una patología ocular que se define como la inflamación del tracto uveal del ojo, que pudiera estar asociada a la inflamación de otras estructuras oculares o adyacentes a la cavidad orbitaria, por la proximidad que hay entre los tejidos. En el campo odontológico la uveitis se manifiesta de manera secundaria ante infecciones focales, las cuales se caracterizan por presentar un foco séptico primario, en donde la infección se propaga a otras estructuras del macizo facial. Entre las lesiones que generan un foco infeccioso primario en cavidad bucal, se describen: quiste periapical, granuloma periapical, afecciones pulpares, pericoronaritis y enfermedad periodontal, siendo esta última motivo del caso clínico que se presenta a continuación

Uveitis is an eye condition that is defined as inflammation of the uveal tractor and may be associated with inflammation of other ocular structures or adjacent to the orbital cavity, and the proximity between the tissues. In the dental field uveitis manifests itself secondary to focal infections, which are characterized by a primary septic focus, where the infection spreads to other craniofacial structures. Among lesions that produce a primary infection in oral cavity, are described: periapical cyst, periapical granuloma, pulpal disease, and periodontal disease pericoronaritis, the latter being the occasion of the clinical case is presented below

Cisto do ducto nasopalatino: considerações microscópicas e de diagnóstico diferencial / Nasopalatine duct cyst: microscopic and differential diagnosis considerations

Os cistos do ducto nasopalatino são entidades incomuns dos maxilares, mas que podem assemelhar-se clínica e radiograficamente a outras lesões císticas e sólidas da região anterior mediana da maxila. O objetivo deste trabalho foi reportar 4 casos de cisto do ducto nasopalatino buscando discutir suas características microscópicas e de diagnóstico diferencial relevantes na prática clínica odontológica. As informações demográficas, clínicas e imaginológicas foram obtidas a partir dos registros laboratoriais dos pacientes e as lâminas histológicas coradas em hematoxilina e eosina dos 4 casos foram revisadas sob microscopia ótica. Os 4 casos acometeram homens com média de 53 anos de idade e todas as lesões eram assintomáticas. As imagens radiográficas eram radiolúcidas uniloculares, localizadas entre os incisivos centrais superiores e com tamanho médio de 2,0 cm (variando de 1,0 a 4,0 cm). Todos os casos foram tratados através de enucleação cirúrgica e a análise microscópica revelou que 3 dos 4 casos eram revestidos por mais de um tipo de epitélio, sendo o epitélio pavimentoso estratificado não queratinizado o mais comum. Conclui-se que os cistos do ducto nasopalatino acometem usualmente homens adultos, assemelhando-se aos cistos periapicais associados aos incisivos centrais superiores e que devem ser tratados através de procedimentos cirúrgicos conservadores com posterior avaliação microscópica minuciosa do espécime removido.

Nasopalatine duct cysts are uncommon maxillary lesions that can clinically and radiographically resemble other cystic and solid lesions from the maxillary midline area. The aim of this study was to report 4 additional cases of nasopalatine duct cyst focusing on the daily clinical importance of their microscopic and differential diagnosis characteristics. Demographic, clinical and radiographic information was obtained from the patient´s laboratory registries and hematoxilin and eosin stained histological slides from all cases were reviewed under light microscopy. The 4 cases affected males with a mean age of 53 years and all lesions were asymptomatic. Radiographic images were radiolucent and unilocular, between the roots of the upper central incisors measuring a mean of 2,0 cm (ranging from 1,0 to 4,0 cm). All cases were managed through surgical enucleation and microscopic analysis revealed that 3 of the 4 cases were lined by more than one epithelium type, the most common being stratified squamous epithelium. In conclusion, nasopalatine duct cyst usually affect adult males, are similar to periapical cysts associated to upper central incisors, and should be managed by conservative surgical approach followed by careful microscopic evaluation of the surgical specimen.

The relationship of radiographic lesion size and characteristics to diagnosis of periapical cysts and granulomas / 대한치과보존학회지

The purpose of this study was to find out the relationship of radiographic lesion size, gender, age of patients and radiographic character to the diagnosis of periapical cyst and granuloma. The data was collected from 187 periapical lesions of 167 patients who undergone apical surgery at Department of Conservative Dentistry, Seoul National University Dental Hospital from 2003 to 2005. The lesion were surgically removed and send for biopsy to the Oral Pathology Laboratory. From the initial radiograph, lesion size was calculated using PiViewSTAR(R) (INFINITT, Korea) program. The obtained data were statistically evaluated using SPSS (p 0.05). 4. There was a significant correlation between the non-demarcation of the lesion and the incidence of periapical granuloma (p < 0.01).

A Clinical Study of Periapical Lesions