Apical Granulomas Research Articles

Эндодонтическое лечение или экстракция: поиск компромисса

The article, using the example of clinical cases from dental practice, analyzes the causes, symptoms and tactics of dental treatment in case of periapical inflammation, an algorithm of instrumental and drug treatment. A tooth caused an apical granuloma or cysts often has to be removed. The aim of endodontic treatment is the prolonged preservation of the tooth as a functional unit of the chewing apparatus, the restoration of the health of periapic tissues and the prevention of autoinfection and sensitization of the body

Correlation Between Proinflammatory Cytokine Expression and Clinical Data in Apical Granuloma

IntroductionThis study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-β, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment. MethodsEighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification. ResultsIFN-γ and TGF-β were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P < .05), and IL-2 and TGF-β (P < .05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P < .05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P < .05). ConclusionIFN-γ and TGF-β were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment.

Tomographic, microbiological and histological characterization of secondary apical periodontitis: case series.

This case series included a tomographic, microbiological, and histopathological description of 15 secondary apical periodontitis (SAP) lesions obtained by apical microsurgery performed in 10 patients to better understand the etiology and pathogenesis of SAP. Preoperative tomographic analyses were performed through Cone beam computerized tomography - Periapical index (CBCT-PAI), and apical microsurgeries were then carried out. The removed apices were used for microbial culturing and for molecular identification using PCR for the detection of 5 strict anaerobic bacteria (P. gingivalis, P. intermedia, P. nigrescens, T. forsythia, and T.denticola) and 3 viruses Herpes simplex viruses (HSV), Cytomegalovirus (CMG) and Epstein-Barr Virus (EBV) by nested PCR. The removed apical lesions were histologically described. Univariate statistical analyses were performed by using STATA MP/16 (StataCorp LLC, College Station, TX, United States). CBCT-PAI analyses revealed PAI 4 and PAI 5 score lesions that involved cortical plate destruction. Eight SAPs were positive by culture, while nine SAP lesions were positive by PCR. Fusobacterium species were the most frequently cultured organisms in 7 SAP lesions, followed by D. pneumosintes in 3. In contrast, by single PCR, T. forsythia and P. nigrescens were detected in 5 lesions, T. denticola in 4 lesions, and P. gingivalis in 2 lesions. Twelve periapical lesions were granulomas, and the remaining three SAP lesions were radicular cysts. In conclusion, this case series study revealed that secondary apical lesions presented tomographic involvement of PAI 3 to 5, and that most SAP lesions were apical granulomas containing anaerobic and facultative microorganisms.

Особенности иммунореактивности организма в постковидном периоде у полиморбидных пациентов с хроническими очагами инфекции ЛОР-органов и полости рта

The high level of morbidity and labor losses among the population during the epidemic of a new coronavirus infection is largely determined by the protracted course of the post-COVID syndrome, which is often complicated by the exacerbation of chronic foci of infection of the upper respiratory tract and oral cavity. Clinical manifestations of a developed immunodeficiency state require an assessment of the characteristics of the body’s immunoreactivity in patients who have undergone COVID-19 in order to develop targeted programs for their immunorehabilitation and prevent manifestations of chronic focal infection, which was the purpose of the study. Immunological examination of 37 patients aged 42 to 60 years (53 ± 3.8 years), 24 women and 13 men, in the post-COVID period with exacerbation of chronic ENT infection (nasopharyngitis, sinusitis, otitis media, laryngitis) and dental pathology (generalized inflammatory periodontal disease, apical granulomas) showed the formation of an immunological imbalance with a quantitative deficiency of T-helpers with a high level of cytotoxic T-lymphocytes and NK cells expressing the alpha chain of the CD8 antigen as well as cytokine-producing NK cells against the background of a pronounced decrease in the resources of alpha and gamma interferon and a high level of Ig E and CIC in the blood. The established immunological prerequisites for comorbid infection, allergization, autoimmunization, and chronic sequel of inflammatory response motivated approaches to the rehabilitation of patients in the post-COVID period and the prevention of activation of chronic foci of infection in the ENT organs and oral cavity through sequential detoxification and immunocorrection. The positive experience of using bioactive preparations of natural origin with a complex detoxifying, immunotropic, antioxidant, and adaptogenic action is presented.

Intralesional nerve-sparing surgery versus non-surgical treatment for giant cell tumor of the sacrum

BackgroundThere is no standard treatment for giant cell tumors of the sacrum. We compared the outcomes and complications in patients with sacral giant cell tumors who underwent intralesional nerve-sparing surgery with or without (neo-) adjuvant therapies versus those who underwent non-surgical treatment (denosumab therapy and/or embolization).MethodsWe retrospectively investigated 15 cases of sacral giant cell tumors treated at two institutions between 2005 and 2020. Nine patients underwent intralesional nerve-sparing surgery with or without (neo-) adjuvant therapies, and six patients received non-surgical treatment. The mean follow-up period was 85 months for the surgical group (range, 25–154 months) and 59 months (range, 17–94 months) for the non-surgical group.ResultsThe local recurrence rate was 44% in the surgical group, and the tumor progression rate was 0% in the non-surgical group. There were two surgery-related complications (infection and bladder laceration) and three denosumab-related complications (apical granuloma of the tooth, stress fracture of the sacroiliac joint, and osteonecrosis of the jaw). In the surgical group, the mean modified Biagini score (bowel, bladder, and motor function) was 0.9; in the non-surgical group, it was 0.5. None of the 11 female patients became pregnant or delivered a baby after developing a sacral giant cell tumor.ConclusionsThe cure rate of intralesional nerve-sparing surgery is over 50%. Non-surgical treatment has a similar risk of complications to intralesional nerve-sparing surgery and has better functional outcomes than intralesional nerve-sparing surgery, but patients must remain on therapy over time. Based on our results, the decision on the choice of treatment for sacral giant cell tumors could be discussed between the surgeon and the patient based on the tumor size and location.

Inflammatory Response Mechanisms of the Dentine-Pulp Complex and the Periapical Tissues.

The macroscopic and microscopic anatomy of the oral cavity is complex and unique in the human body. Soft-tissue structures are in close interaction with mineralized bone, but also dentine, cementum and enamel of our teeth. These are exposed to intense mechanical and chemical stress as well as to dense microbiologic colonization. Teeth are susceptible to damage, most commonly to caries, where microorganisms from the oral cavity degrade the mineralized tissues of enamel and dentine and invade the soft connective tissue at the core, the dental pulp. However, the pulp is well-equipped to sense and fend off bacteria and their products and mounts various and intricate defense mechanisms. The front rank is formed by a layer of odontoblasts, which line the pulp chamber towards the dentine. These highly specialized cells not only form mineralized tissue but exert important functions as barrier cells. They recognize pathogens early in the process, secrete antibacterial compounds and neutralize bacterial toxins, initiate the immune response and alert other key players of the host defense. As bacteria get closer to the pulp, additional cell types of the pulp, including fibroblasts, stem and immune cells, but also vascular and neuronal networks, contribute with a variety of distinct defense mechanisms, and inflammatory response mechanisms are critical for tissue homeostasis. Still, without therapeutic intervention, a deep carious lesion may lead to tissue necrosis, which allows bacteria to populate the root canal system and invade the periradicular bone via the apical foramen at the root tip. The periodontal tissues and alveolar bone react to the insult with an inflammatory response, most commonly by the formation of an apical granuloma. Healing can occur after pathogen removal, which is achieved by disinfection and obturation of the pulp space by root canal treatment. This review highlights the various mechanisms of pathogen recognition and defense of dental pulp cells and periradicular tissues, explains the different cell types involved in the immune response and discusses the mechanisms of healing and repair, pointing out the close links between inflammation and regeneration as well as between inflammation and potential malignant transformation.

IMPORTANCE OF CORRECT DIAGNOSIS AND TREATMENT OF EXTRA-ORAL FISTULA OF ODONTOGENIC ORIGIN

When properly diagnosed, a cutaneous fistula of dental origin has a favorable therapeutic prognosis. An erroneous diagnosis, however, can lead to inappropriate treatment; also, orocutaneous fistulas occur in about 1% of patients with odontogenic lesions. The objective of this work is to describe the clinical case of a 21-year-old patient with a fistula near the mentalis muscle, who was mistakenly treated for a dermatologic lesion for 8 years. When referred to the stomatology service, an initial radiologic examination found no apparent dental cause. Surgical treatment was then performed under general anesthesia, followed by anatomopathologic examination, with a final diagnosis of apical granuloma, requiring dental removal to eliminate the infection and the fistula. We can conclude that whenever a facial skin lesion is observed, a dental cause must be sought to avoid prescribing the wrong treatment.

Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas.

The aim of this study was to investigate the effectiveness of cone-beam CT (CBCT) findings and gray scale values (GSV) in the differential diagnosis of apical cysts and granulomas. Two independent researchers retrospectively analyzed the CBCT images of 21 teeth and histopathologically diagnosed them as having radicular cysts or apical granulomas. In the CBCT images, apical lesions were evaluated and categorized according to 7 criteria. These criteria were determined as relationship of lesions with dental roots, periphery of the lesion, shape, darker focus in the center, root resorption, displacement in related teeth, and cortical bone perforation. In addition, the minimum and maximum gray scale values of the lesions were measured and compared. There was a statistically significant relationship between histopathological (HP) diagnosis and well-defined cortical border and lesion shape (p = 0.003, p = 0.014, respectively). According to the HP diagnosis, no statistically significant difference was found among other variables (p > 0.05) CONCLUSION: The presence of a well-defined cortical border or partial cortical border is a distinctive criterion for cysts. Additionally, the shape of the lesion was found to be a significant criterion for the separation of the two lesions. The shape of cystic lesions was circular and apical granulomas had a more curved shape. There was no relationship between the histopathological diagnosis of lesions and CBCT gray scale values.

Unilocular radiolucent lesions of the jaws: A retrospective panoramic and cone beam computed tomography evaluation

Background/Aim: The aim of this study was to evaluate and compare the imaging characteristics of common, radiolucent, unilocular, intraosseous lesions of the jaws using both panoramic radiography and cone beam computed tomography (CBCT); also, to evaluate sufficiency of panoramic radiography in determining characteristic features of jaw lesions. Material and Methods: Retrospectively selected images of 57 patients with histopathology results were evaluated by two oral radiologists. The lesions were assessed based on shape, location, borders, relationship with the mandibular canal, presence of destruction of cortical bone, and expansion of cortical bone, and presence of an unerupted tooth related to the lesion. In addition, the widest areas of the lesions were measured. A total of 9 (15.8%) odontogenic keratocysts, 9 (15.8%) apical granulomas, 24 (42.1%) radicular cysts, 12 (21.0%) dentigerous cysts and 3 (5.2%) central giant cell granulomas in 57 patients (20 women, 37 men) with a mean age of 36.93 ± 17.96 years were included. Fifty-seven CBCT and 56 panoramic images of these patients were evaluated. Results: Twenty-nine (50.8%) lesions were in the mandible and 28 (49.2%) in the maxilla. A statistically significant difference was determined for the areas in CBCT images (p=0.007). Conclusions: Panoramic radiography is not as successful as CBCT in demonstrating some characteristics of the lesions, such as expansion and destruction. The area measurements may be beneficial in establishing the differential diagnosis of the lesion.

Differences in Inflammation and Bone Resorption between Apical Granulomas, Radicular Cysts, and Dentigerous Cysts

IntroductionDental cysts can be of inflammatory (radicular cysts) or noninflammatory (dentigerous cysts) origin. Apical periodontitis is a necrosis of the pulp and infection of the root canal causing the development of apical granulomas or radicular cysts. The immunology of granuloma and cyst formation is important because modern root filling materials are immunologically active and can contribute to the resolution of apical granulomas. In contrast, radicular cysts often require apicectomy. A better understanding of the pathophysiology of inflammation and bone resorption in apical periodontitis could be the basis for developing new root filling materials with superior immunomodulatory properties. MethodsForty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray of the 87 consecutive specimens was created, and human leukocyte antigen–DR isotype (HLA-DR)-, CD83-, receptor activator of nuclear factor kappa B ligand–, macrophage colony-stimulating factor (MCSF)-, galectin-3 (Gal3)-, CD4-, and CD8-positive cells were detected by immunohistochemistry. Tissue microarrays were digitized, and the expression of markers was quantitatively assessed. ResultsHLA-DR, CD83, MCSF, and Gal3 expression was significantly (P < .05) higher in radicular cysts compared with apical granulomas. HLA-DR, CD83, MCSF, receptor activator of nuclear factor kappa B ligand, and Gal3 expression in dentigerous cysts was significantly (P < .05) lower than in both periapical lesions (apical granulomas and radicular cysts). CD4 and CD8 infiltration was not statistically different between apical granulomas and radicular cysts. Dentigerous cysts showed a significantly (P < .05) lower T-cell infiltration than apical periodontitis. The CD4/CD8 ratio was not significantly different between the analyzed groups. ConclusionsThe development of radicular cysts in apical periodontitis is associated with an increased expression of myeloid inflammatory markers and bone resorption parameters. Antigen-presenting cells and myeloid cells might be more relevant for the pathogenesis of apical periodontitis than T cells. Increased inflammation might promote the formation of radicular cysts and more pronounced bone resorption.

Immediate implantation in a patient with chronic generalized parodontitis and apical granuloma

Relevance. Rehabilitation of patients with moderate to severe generalized periodontitis is a leading problem in periodontology. It was the determination of the prospects for immediate implantation in patients with chronic periodontitis, combined with the pathology of the tooth root and maxillary sinus.Materials and methods. A group of 94 people with periodontitis and chronic odontogenic rhinosinus was observed who underwent sinus surgical treatment, tooth extraction and one-stage implantation with FRP growth factor according to the author's technology.Results. The method showed high efciency on the basis of assessing the clinical, aesthetic result and restoration of bone density after surgery.Conclusions. The developed technology is a promising direction, it allows to combine a high level of sanation of alveolar tissue with the advantages of immediate implantation, prevents bone atrophy, helps reduce the duration of treatment and the number of surgical and orthopedic interventions.

Macrophage phenotypes and Gas6/Axl signaling in apical lesions

Background/purposeMacrophages participate in the periapical inflammation with pro-inflammatory M1 cells and anti-inflammatory M2 cells. Gas6/Axl signal is the responsible pathway for the activation of M1 and polarization of M2. The aim of this study was to compare the number of CD16+ M1 cells, CD206+ M2 cells, and Gas6/Axl expression between apical granulomas and radicular cysts. Materials and methodsTwenty-four cases of granuloma and twenty of cysts were submitted to immunohistochemistry using anti-CD16 and anti-CD206 antibodies for determining M1 and M2 macrophages and investigating the cells with positive Gas6 and Axl expression. ResultsThere were more numerous of M1 macrophages in radicular cysts (175.9 ± 87.7) compared to apical granuloma (116.6 ± 55.8), and M2 macrophages was higher in cysts (204.0 ± 97.6) than granuloma (152.9 ± 64.6). The level of Gas6/Axl expression were similar. There was a significant different in M1 macrophage (P = 0.014) between two diagnosis. In patients with or without root resorption, the number of M1 were 194.6 ± 57.2 compared with 139.1 ± 79.6. The number of M2 were 241.7 ± 81.4 and 164.6 ± 77.1. The expression of Axl was stronger in root resorption patients (191.1 ± 43.6), but the tendency in Gas6 expression was similar. Significant differences were noted in high M2 infiltration and Axl positive lesions. ConclusionIt appears that macrophages associated with significantly higher numbers in radicular cysts than apical granuloma. Meanwhile, macrophages and Axl receptor was intensively expressed in patients with root resorption, related to severe inflammation.

Immunohistochemical analysis of neutrophils, interleukin-17, matrix metalloproteinase-9, and neoformed vessels in oral squamous cell carcinoma.

Tumor-associated neutrophils (TAN), matrix metalloproteinase-9 (MMP-9), interleukin-17 (IL-17), and angiogenesis have been proposed as prognostic biomarkers of malignant tumors. The purpose of this study was to investigate these inflammatory markers as prognostic factors for oral squamous cell carcinoma (OSCC). Specimens of OSCC (n=30), healthy oral mucosa (negative control, n=10), oral leukoplakia (n=10), and apical granuloma with abscess (positive inflammatory controls, n=10) were immunostained for CD66b (neutrophils), MMP-9, IL-17, and CD105 (neoformed microvessels). Semiquantitative (IL-17) and quantitative (CD66b, IL-17, MMP-9, and CD105) analyses were performed. Clinical information (TNM stage, metastasis, recurrence, and survival) and tumor histological grade were also obtained. Positivity for TAN, MMP-9, IL-17, and CD105 was higher in OSCC than in the negative control (P<0.05) and oral leukoplakia, but similar to the positive inflammatory control. Coincident high counts of inflammatory markers (CD66b, MMP-9, IL-17, and CD105) were associated with lymph node metastasis of OSCC. Associations between high numbers of neoformed microvessels and advanced clinical stage and a higher degree of malignancy were also demonstrated. Combined positivity for TAN, MMP-9, IL-17, and CD105 appears to be associated with the metastasis-prone phenotype of OSCC.

Efficiency of chronic apical periodontitis treatment with use of Granulotec endodontic sealer

Efficiency assessment of Granulotec (PD) endodontic sealer for root canal permanent obturation in patients with apical granuloma basing on clinical and radiological data. Endodontic treatment of 35 teeth with apical granuloma was performed in 22 patients with root canal obturation by means of lateral condensation with Granulotec sealer. Bone remodeling in periapical area has been estimated in 1, 3, 6 and 8 months with PAI index. Endodontic post-operative pain has been observed in 5 (14.3%) cases of 35, pain duration varied 1 to 5 days, NSAIDs use hasn't been required. During observation period 2 teeth have been excluded from the test group (one case of periapical abscess with sinus tract and one case periapical abscess without sinus tract). In the end of observation period complete bone remodeling was observed in 30 cases, the periapical lesion size significant reduction was achieved in 2 cases, periapical lesion stabilization - in 1 case. The overall success rate was 91.4%. The mean PAI value decreased from 4.2±0.2 to 1.4±0.2. The Granulotec (PD) use for one visit chronic apical periodontitis treatment allows achieving positive results with low complications risk.

Tolerance of brightness and contrast adjustments on chronic apical abscess and apical granuloma interpretation

In digitized radiography techniques, adjusting the image enhancement can improve the subjective image quality by optimizing the brightness and contrast for diagnostic needs. To determine the value range of image enhancement (brightness and contrast) on chronic apical abscess and apical granuloma interpretation. 30 periapical radiographs that diagnosed chronic apical abscess and 30 that diagnosed apical granuloma were adjusted by changing brightness and contrast values. The value range of brightness and contrast adjustment that can be tolerated in radiographic interpretations of chronic apical abscess and apical granuloma spans from -10 to +10. Brightness and contrast adjustments on digital radiographs do not affect the radiographic interpretation of chronic apical abscess and apical granuloma if conducted within the value range.

Retrospective analysis of nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions in a population of Taiwanese patients.

We aimed to evaluate nonendodontic periapical lesions clinically misdiagnosed as endodontic periapical pathoses in a population of Taiwanese patients. Cases (2000-2014) of histopathological diagnoses of nonendodontic periapical lesions were retrieved from all cases with a clinical diagnosis of radicular cyst, apical granuloma, or apical periodontitis in the institution. These cases were regarded as misdiagnosed nonendodontic periapical lesions, of which the types and frequencies, in addition to the demographic data, were determined. Four thousand and four specimens were clinically diagnosed as endodontically associated pathoses, of which 118 cases (2.95%) received a histopathological diagnosis of a nonendodontic pathologic entity, the most frequent lesion being keratocystic odontogenic tumor (KCOT, n=38, 32.20%), followed by fibro-osseous lesion (n=18, 15.25%), and dentigerous cyst (n=13, 11.02%). Nine malignant lesions in the periapical area [squamous cell carcinoma (n=7, 5.93%), adenoid cystic carcinoma (n=1, 0.85%), and Langerhans cell histiocytosis (n=1, 0.85%)] were also noted. A wide variety of histopathological diagnoses, including benign odontogenic and non-odontogenic cystic and tumorous lesions and infectious diseases, as well as malignant lesions, was noted in these 118 cases of nonendodontic periapical lesions. Squamous cell carcinoma was the most predominant malignancy of nonendodontic periapical lesions misdiagnosed as apical periodontitis lesions from imaging examination overlooking the clinical findings. The current data form a useful basis for clinicopathological investigation and educational teaching regarding nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions.

Using Periapical Radiography to Differentiate Periapical Granuloma and Radicular Cysts

Background: The distinction between radicular cysts and apical granulomas is important in treatment decision. Objectives: The current study aimed to differentiate these two lesions based on radiography images. Patients and Methods: The material consisted of 138 radiographs obtained using Kodak E -speed, in patients aged 29 to 47, divided into two groups: 109 granulomas and 29 radicular cysts. Size of radiography images was measured; the tooth then was extracted and examined in pathologist lab. The results were analyzed by SPSS.15 and ROC curve was created to find cut-off point to differentiate periapical granuloma and radicular cysts. Results: Average size of radiography in periapical granuloma was 7.4 mm and for a radicular cyst was 11.1 mm. Cut-off point was 8.2 mm and the area under curve (AUC) was 0.63. Also, the tests were 83% sensitive and 79% specific. Conclusions: Based on 8.2 mm cut-off point could differentiate 83% periapical granulomas and 79% radicular cysts from radiography images.

Immunohistochemical features of the granulation tissue structure in the primary and secondary apical periodontitis.

Background The search of criteria of differential enzymatic activity of cyclooxygenase-2 and matrix metalloproteinases immunocompetent cells of granulomas in the primary and secondary apical periodontitis (AP) provides information about the features of lesions of periodontal stromal component, and it can be used as the basis for future therapeutic intervention. Objective. The purpose of this study was to compare the qualitative and quantitative characteristics of the cellular composition of granulation tissue, which formed during primary and secondary apical periodontitis; comparison of morphological characteristics of the structure apical granuloma with immunohistochemical indicators of markers expression of cluster of differentiation CD3, CD4, CD8, CD68, CD138, CD20 and cyclooxygenase-2 and matrix metalloproteinase 9. Methods. The study included 59 patients aged 18 to 50 years with apical periodontitis. Patients were divided into 2 clinical group: 1 – with primary periodontitis and 2 – with secondary periodontitis. For morphological studies using peryapikalnoyi granulation tissue biopsies. Results. Significant differences were found for the fractions of CD4+ T helper cells (p=0,034, r=0,321), CD20+ mature B lymphocytes (p=0,001, r=0,671), CD68+ macrophages (p=0,011, r=0,684) and CD138+ plasma cells (p=0,002, r=0,645). And, also likely decrease in the ratio of CD4+/CD8+ (p=0,002, r=0,645), by reducing the fraction of CD4+ T-helper cells, against reducing the number of leukocytes, expression of MMP-9 (p=0,04, r=0,302) and COX-2 (p=0,013, r=0,321) with secondary apical periodontitis, compared to the primary periodontitis. Conclusion. Disease progression and the beginning of the destruction of bone tissue with the formation of granulation tissue is the result of abnormal immune responses, III and IV type hypersensitivity reactions, with the formation of immune granulomas.

Clinical and Pathohistological Profiles of Chronic Odontogenic Infections with Microvascular Proliferation in Children with Permanent Dentition

The apical periodontitis as an infection is the result of endodontic infections and is manifested when the immunological system of the host is activated from microorganisms which penetrate in to the dental pulp through the root canals. The aim of this study is to compare the clinical diagnosis and the pathohistological identification of chronic odontogenic infections with microvascular proliferation. The study was carried out in University Dental Clinical Center of Kosova in cooperation with Histopathology Departement. In this study were included 36 children between 10 - 15 years old, 20 girls and 16 boys, with permanent dentition and chronic apical changes. After the clinical and x-ray examination, the tooth extraction was done, and then the tissue of periapical region was taken, by the exvaction of the periapical granulomas and the other pathological tissues. From a total of 36 children with chronic apical changes and granulomas, 9 (25.0%) of the children had chronic apical periodontitis, from which 6 (16.67%) of the children did not have microvascular proliferation, 1 (2.78%) child had a medium level of microvascular proliferation and 2 (5.56%) children had signification microvascular changes (proliferation). A total of 6 (16.67%) children had chronic apical periodontitis with a fistula from which 5 (13.89%) children did not have microvascular proliferation and 1 (2.78%) child had a medium level of microvascular proliferation. A total of 5 (13.89%) children had chronic apical periodontitis with parulis, from which 3 (8.33%) children did not have microvascular proliferation, 1 (2.78%) child had a low level of microvascular proliferation and 1 (2.78%) child had severe microvascular proliferation.

English

&nbsp; The periodontium surrounds and supports the teeth and consists of four major components; gingiva, periodontal ligaments, cementum/dentin, and alveolar bone/lamina dura, with collective function of keeping the tooth in position despite varying changes and responses during mastication. A near-normal radiograph of periradicular tissues was used as the basis for evaluation of some common periradicular radiographic pathologies. Apical periodontitis was 70 (58.33%), alveolar abscess 32 (26.66%), and apical granulomas 15 (12.50%). A background anatomy of the periodontium is advocated as a precondition for accurate evaluation of periradicular pathologies. &nbsp; Key words: Periodontium, periradicular, pathology.