Glandular odontogenic cyst. Report of seven cases.

This study describes the clinical, radiographic and histopathological features of seven glandular odontogenic cysts. These cysts comprised 0.012% of 5800 jaw cysts diagnosed in a 19-year period. There was strong predilection for the mandible (five of the seven cases). Both clinical and radiographic features were nonspecific. The main histological findings were a nonkeratinized, stratified squamous epithelium lining to the cyst cavity which varied in thickness with superficial eosinophilic cuboidal cells and mucous pools within the spinous cell layer. Daughter cysts were found in the wall of 2 cysts. At surgery, most walls were found to be thin and lumen to contain a serous, low viscosity exudate. Because of the high rate of recurrence found in three cases out of the seven after conservative surgical treatment, careful clinical and radiographic follow-up is recommended.

Prevalence of previous endodontic treatment, technical standard and occurrence of periapical lesions in a randomly selected adult, general population.

A random sample of 967 subjects selected from the total population in a Swedish county were examined radiographically regarding prevalence and quality of endodontic treatment and occurrence of periapical lesions. The relationship between the technical standard of endodontic treatment and the occurrence of periapical lesions was also analyzed. Of the selected individuals, 95% attended examination (751 dentate and 169 edentulous individuals). Of the 17,430 teeth examined, 1,492 (8.6%) were endodontically treated. Approximately 70% of the treated root canals were inadequately obturated; 10% showed excess of root filling beyond the apex. The prevalence of periapical lesions was 2.9%, and 24.5% of the endodontically treated roots demonstrated periapical lesions. Root fillings ending more than 2 mm from apex had a significantly lower frequency of periapical lesions than root fillings ending within 2 mm of the apex. No difference in the frequency of periapical lesions was found between properly and improperly obturated root canals. Excess of root filling material beyond the apex was related to a significantly higher frequency of periapical lesions.

Retreatment of endodontic fillings.

Effects of endodontic retreatment on quality of seal and periapical healing were assessed among 660 previously root-filled roots. The roots were divided into either of two groups according to presence or absence of pathologic alterations in the periapical area. The retreatments, which were carried out by dental students, involved a thorough chemomechanical debridement of the root-canal system aiming to control infection. Following a 2-year observation period 556 roots were reexamined clinically and radiographically. The results showed that root-fillings with technical shortcomings could, following retreatment, be markedly improved as regards effectiveness of seal and distance to the apex. A large number of lumina discernible apical to root-filling could also be treated and filled. Seventy-eight percent of the cases with pathologic lesion present periapically prior to retreatment either completely healed or displayed an obvious size-reduction of the process. Retreatments carried out because of technical inadequacies alone were successful in 94% of the cases. It was concluded that renewed endodontic treatment whenever possible is the method of choice when treating defective endodontic fillings complicated with pathologic processes periapically. Apical surgery may be attempted if no signs of healing are apparent following observation.