Lesiones perirradiculares persistentes: revisión narrativa / Persistent periradicular lesions: a narrative review

La persistencia de lesiones perirradiculares luego del tra- tamiento endodóntico es un problema que requiere del clínico un conocimiento cabal de la histofisiología y de la histopato- logía del sistema de conductos radiculares del tejido pulpar y de los tejidos perirradiculares (periodonto y hueso); además de considerar siempre la posible existencia de enfermedades sistémicas que también pueden actuar como factores de in- fluencia. La presencia de bacterias remanentes a posteriori del tratamiento es considerada como una de las causas principales y más frecuentes para la perpetuación de las lesiones perirra- diculares. Sin embargo, existen otros factores causales, como la existencia de conductos laterales o accesorios infectados y no tratados, la reabsorción dentinaria interna, intercomunica- ciones, cul-de-sacs o istmos; que representan áreas de difícil acceso durante la instrumentación e irrigación. Cuando la cau- sa original se localiza en la zona perirradicular, como en los casos de actinomicosis, reacciones a cuerpo extraño, cristales de colesterol (CRCo) y granulomas o quistes con alto conte- nido de CRCo, la indicación más adecuada es el retratamiento y la cirugía periapical como complemento (AU)

The persistence of periradicular lesions after endodontic treatment is a problem that requires the doctor to have a thor- ough knowledge of the histophysiology and histopathology of the root canal system, the pulp tissue and periradicular tis- sues (periodontium and bone); as well as always considering the possible existence of systemic alterations that can also be influencing factors. Persisting bacteria within the root canal system after treatment is one of the major and most frequent causes for the perpetuation of periradicular lesions. Howev- er, there are other possible causal factors such as the exist- ence of untreated lateral or accessory canals, internal dentin resorption, intercommunications, cul-de-sacs or isthmuses; areas that represent a difficulty in access during instrumen- tation and irrigation. If the original cause is located in the periradicular area, in cases like actinomycosis, foreign-body reactions, cholesterol crystals (CRCo) and granulomas or cysts with high content of CRCo, retreatment coupled with periapical surgery is the best approach to treatment (AU)

Relationship between hypertension and periapical lesion: an in vitro and in vivo study

Abstract The aim of this study was to compare potential aspects of periapical lesion formation in hypertensive and normotensive conditions using hypertensive (BPH/2J) and wild-type control (BPN/3J) mice. The mandibular first molars of both strains had their dental pulp exposed. At day 21 the mice were euthanized and right mandibular molars were used to evaluate the size and phenotype of apical periodontitis by microCT. Proteins were extracted from periapical lesion on the left side and the expressions of IL1α, IL1β and TNFα were analyzed by ELISA. Bone marrow stem cells were isolated from adult mice femurs from 2 strains and osteoclast differentiation was evaluated by tartrate-resistant acid phosphatase (TRAP) in vitro. The amount of differentiated osteoclastic cells was nearly double in hypertensive mice when compared to the normotensive strain (p < 0.03). Periapical lesion size did not differ between hypertensive and normotensive strains (p > 0.7). IL1α, IL1β and TNFα cytokines expressions were similar for both systemic conditions (p > 0.05). Despite the fact that no differences could be observed in periapical lesion size and cytokines expressions on the systemic conditions tested, hypertension showed an elevated number of osteoclast differentiation.

Dental complications of herpes zoster: Two case reports and review of literature.

Herpes zoster (HZ) (shingles) results due to reactivation of varicella‑zoster virus. Unusual dental complications like osteonecrosis, exfoliation of teeth, periodontitis, and calcified and devitalized pulps, periapical lesions, and resorption of roots as well as developmental anomalies such as irregular short roots and missing teeth may arise secondary to involvement of 2nd or 3rd division of trigeminal nerve by HZ. Such cases pose both a diagnostic as well as a therapeutic challenge. We report two such rare dental complications of HZ‑spontaneous tooth exfoliation and osteonecrosis of the maxilla in a 70‑year‑old female patient; and multiple periapical pathoses affecting right half of the mandibular teeth in a 45‑year‑old female patient. Both the patients did not have any associated systemic illness. The aim of this paper was to compare the present cases with all the 46 cases of osteonecrosis and 6 cases of multiple periapical pathoses secondary to trigeminal zoster reported in literature till date The article also throws light that the occurrence of such dental complications of HZ is not entirely dependent on the immune status of the host.

Non-surgical management of a mutilated maxillary central incisor with open apex and large periapical lesion.

A 24-year-old female patient reported with a mutilated maxillary left central incisor. The coronal tooth structure remaining was very less, discolored, and brittle. She gave history of trauma about 15 years back when the tooth got fractured. An intraoral periapical radiograph revealed an open apex and a large periapical lesion. The case was managed successfully by conservative means using intracanal calcium hydroxide and mineral trioxide aggregate (MTA) apical barrier followed by a fiber post and a core. The final crown restored back esthetics and function. A 6-month follow-up demonstrated a clinically asymptomatic and adequately functional tooth, with radiological signs of healing.

Nonsurgical treatment of periapical lesion associated with type III dens invaginatus using calcium hydroxide: a case report.

Dens invaginatus is a developmental malformation of teeth, probably resulting from an infolding of the papilla during tooth development. It predisposes the tooth to develop caries and periapical pathosis. Root canal therapy may present many problems because of the complex anatomy of the teeth. The purpose of this case report is to describe the endodontic treatment of an Oehlers type III dens invaginatus that perforated into the apical area. Calcium hydroxide powder mixed with normal saline, was used as an intracanal medicament. This eradicated the pathogenic microorganisms in the invagination and preserved the vitality of the tooth, allowing gutta-percha obturation in the invagination.

Uso de cortes semi-seriados no diagnóstico das lesões inflamatórias periapicais / Using of step-serial sections in the diagnosis of periapical inflammatory lesions

A prevalência das patologias periapicais é um assunto de discordância entre investigadores. A variação dos achados pode ser atribuída à falta de padronização do material coletado, a diferentes técnicas de processamento do espécime e aos critérios de diagnóstico histológico utilizados por cada investigador. Este trabalho teve como objetivo re-avaliar casos de abscessos periapicais através de cortes semi-seriados. Foram selecionados casos de diagnóstico histopatológico de abscessos periapicias do Laboratório de Patologia Bucal da FOPUCRS, no período de abril/01 a setembro/2002 (18 meses). Os respectivos blocos de parafina foram localizados no arquivo e três novos cortes semi-seriados (com um espaçamento de 20mm entre cada corte) foram realizados. Os cortes foram corados com hematoxilina e eosina e avaliados por dois examinadores. Dos 23 casos de abscessos diagnosticados por ambos avaliadores, 18 (78,3 porcento) mantiveram o diagnóstico inalterado, enquanto que, cinco (21,7 porcento) alteraram o diagnóstico para cisto. Com base na metodologia empregada nesse experimento, concluímos que a utilização de cortes semi-seriados se faz necessária para o correto diagnóstico das lesões inflamatórias periapicais. Entretanto, a utilização desse recurso não minimizará as diferenças existentes entre os estudos de prevalência das lesões inflamatórias periapicais, uma vez que, ainda existe discrepância de critérios de diagnóstico histopatológicos entre os investigadores

Periapical repair and apical closure of a pulpless tooth using calcium hydroxide--a case report.

A case with a open apex and a large periapical lesion in a 10 year old boy is presented. The lesion formed as a result of necrosis from trauma to a maxillary right central incisor 1 year ago. Apical closure and complete healing of periapical lesion was observed after non-surgical endodontic treatment using calcium hydroxide paste. This report suggests that even large periapical lesions could respond favourably to non-surgical treatment.

Criteria for management of calcific metamorphosis: review with a case report.

Calcific metamorphosis is seen commonly in the dental pulp after traumatic tooth injuries and is characterized by deposition of hard tissue within the root canal space. Opinion differs among practitioners as to whether to treat these cases upon early detection of calcific metamorphosis or to observe them until symptoms or radiographic signs of pulpal necrosis are detected. In this article, the clinical, radiographic, and histopathologic appearance of calcific metamorphosis is described; a review of the literature is presented to address these issues in an attempt to establish sound rationale for treatment. Approximately 3.8% to 24% of traumatized teeth develop varying degrees of calcific metamorphosis. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis. Most of the literature does not support endodontic intervention unless periradicular pathoses is detected or the involved tooth becomes syptomatic. It may be advisable to manage cases demonstrating calcific metamorphosis through observation and periodic examination. A report of a case where in non-surgical endodontic intervention was successfully carried out a patient suffering from calcific metamorphosis with periapical pathoses is also presented.

Avaliaçäo da freqüência e qualidade radiográfica de tratamentos endodônticos em pacientes que procuram atendimento na Faculdade de Odontologia de Säo José dos Campos - UNESP / Assessment of the radiographic frequency and quality of the endodontic treatment in patients of the College of Odontology of Säo José dos Campos - UNESP

Esse trabalho avaliou a presença e a qualidade de tratamentos endodônticos, correlacionando-os com alteraçöes periapicais. Foram avaliados 101 (cento e um) pacientes que procuraram atendimento odontológico na Faculdade de Odontologia de Säo José dos Campos - UNESP. Nestes, foram realizados exames radiográficos completos, com 14 (quatorze) radiografias periapicais cada. As radiografias foram analisadas por três operadores, observando a freqüência dos tratamentos endodônticos, a qualidade radiográfica dos mesmos e a presença de lesäo periapical visível radiograficamente. Canais mal obturados apresentaram 2,5 vezes mais possibilidade de ter lesäo periapical que os bem obturados. Quarenta e oito por cento dos pacientes apresentavam pelo menos um tratamento endodôntico; sendo que 49,5 por cento dos canais tratados apresentaram-se bem preenchidos radiograficamente e 59,2 por cento dos tratamentos foram em dentes anteriores. Faz-se necessário maior atençäo aos cursos de endodontia e conscientizaçäo dos profissionais que exercem a especialidade, visando uma melhor qualidade técnica dos tratamentos endodônticos

Lesöes periapicais crônicas: inter-relacionamento histopatológico, radiográfico e clínico dos insucessos endodônticos / Chronic periapical lesions: inter-relationship histophatologic, radiographic and clinic in endodontic failures

As periapicopatias, decorrentes dos insucessos endodônticos, foram estudadas através dos exames clínico, radiográfico e histopatológico de 150 lesöes periapicais. O estudo inter-relaciona os dados obtidos entre si e com os diagnósticos histopatológicos. Parâmetros como dor, tumefaçäo, fístula, mobilidade dentária, lesäo periodontal, fratura radicular, cirurgia anterior, reabsorçäo radicular, qualidade da obturaçäo dos canais radiculares e fenômenos histopatológicos como reaçäo inflamatória aguda exsudato purulento e fibrosamento säo estudados. Os resultados obtidos foram processados por sistemas informatizados e säo apresentados em tabelas e gráficos. As conclusöes da pesquisa mostraram que nas lesöes periapicais crônicas: a maior incidência foi de granulomas (63,3 por cento), depois os cistos (16,7 por cento); a dor esteve presente em 50 por cento do grupo testado; o diagnóstico final independeu do tamanho das periapicopatias; a tumefaçäo predomina nos granulomas; em todos os tipos e tamanhos de lesöes observaram-se fístula e reabsorçäo radicular; o exame histopatológico é relevante para estabelecer o diagnóstico e análise do processo evolutivo das periapicopatias

Contribución al estudio radiográfico de los cambios en la amplitud de la cámara pulpar asociados a disfunción renal crónica / Radiographic study of changes in the pulp chamber associated with chronic renal failure

Cambios en el lumen de la cámara pulpar se presentan en enfermos renales crónicos en las modalidades englobadas bajo el término "osteodistrofia renal". Este signo lo encontramos tanto en el raquitismo renal, hipofosfatasia e hiperparatiroidismo secundario como en el raquitismo hipofosfatémico resistente a la vitamina D, a éste último se agrega el desarrollo de lesiones periapicales múltiples en piezas aparentemente sanas. Por otra parte, en disfunciones renales graves tratadas con dosis prolongadas de corticoesteroides se presenta el estrechamiento generalizado de la cámara sin la participación comprobada de factores locales o defensivos en el proceso. La osteodistrofia renal ha sido tratada exitosamente en la actualidad. Ello hace que estos pacientes vean aumentadas sus expectativas de vida y por ende, un mayor número solicite atención dental. Constituyendo el examen radiográfico un valioso elemento de diagnóstico, el conocimiento de los signos que caracterizan a este trastorno adquieren cada día mayor interés en el diagnóstico de esta patología. Se presenta una muestra de tres casos clínicos radiográficos para ilustrar este estudio conjuntamente con una revisión bibliográfica sobre el tema