Apical Granulomas Research Articles

Apical periodontitis and resorption of the root canal wall.

Abstract The incidence, extent and distribution of root canal wall resorption were studied in 100 extracted human teeth with chronic periapical lesions. Scanning electron microscopy showed that intracanal dentin resorption had occurred in all teeth. There was no difference between teeth with apical granulomas or radicular cysts. The resorption process was generalized and intensive in the apical third of the root canal, whereas the resorption lacunae were more irregularly spread in the middle and cervical thirds of the canal. Intracanal dentin resorption should be taken into account during endodontic treatment, especially when establishing the apical limit of root canal instrumentation.

An apical granuloma with epithelial integument

A chronic periapicalesion—apical granuloma—of the first left maxillary molar, which had rarefied the bony plate and grown into the maxillary sinus, was observed in a 64-year-old white male patient. Light microscopic study of the epon-embedded specimen showed a lesion that had been infiltrated predominantly by mononuclear cells and that had isolated neutrophil-dominated foci. The lesion contained extensive networks and arcades of proliferating epithelium. Unlike the classic granulomas of the periapex, which are generally delimited by a well-developed connective tissue capsule, this particular lesion was lined with epithelial tissue consisting of ciliated columnar and stratified squamous components. While the former seemed to be an extension of the sinus epithelium, the latter appeared to be an outgrowth of the proliferating epithelium encountered within the lesion.

鼻しんのう胞の２例

This report includes two cases of the nasolabila cyst at our hospital.Case 1: A 55-year-old Japanese female visited our hospital on Nov. 14, 1980. She complained of slight swelling of the right side ala of her nose for past 4 months. The area began to swell progressively with oppressive pain. Extirpation of the cyst was carried out with general anesthesia on Jan. 28, 1981. The comparatively thick cyst wall had a soft and elastic consistency. Its fluid was mucous.Microscopic examination revealed cystic lining with stratified columnar ciliated epithelium which included some goblet cells. The wall of the cyst was heavily infiltrate by plasma cells and lymphocytes.Case 2: A 44-year-old Japanese female was seen on Nov. 25, 1982. She complained of pain and swelling of the gingiva of the right first and second incisors. Apical focuses were found by X-ray, however we recognized swelling of the right side ala of her nose. Besides two apical granulomas, we removed a cyst from the right side of the apertura piriformis on the periosteum. Its fluid was mucous.Microscopic examination revealed stratified columnar epithelium with many goblet cells. The wall of the cyst was mildly infiltrated with chronic inflammatory cells.In addition to these two cases, we analyzed 74 cases in 28 years of Japanese literature (1955-1982).

Periapical actinomycosis

Although <i>Actinomyces israelii</i>, the chief etiological agent of human actinomycosis, is a common saprophyte of the oral cavity, periapical actinomycosis is believed to be extremely rare. A recent survey of the literature revealed only 20 cases on record. The purpose of this communication is to document two additional cases and to describe them using light and transmission electron microscopy. Of a total of 45 human spontaneous periapical lesions examined, 2 revealed distinct actinomycotic involvement. Typical "ray fungus" colonies with radiating peripheral filaments could be observed in both specimens. However, in one specimen the colonies were restricted to the apical root canal, but in the other a typical actinomycotic rosette could be observed within the body of the apical granuloma. A few layers of polymorphonuclear leukocytes surrounded the colonies, many of them containing phagocytosed bacteria. Both granulomas contained a mixed infiltrate of mononuclear and polymorphonuclear leukocytes.

Endotoxic activity in periapical lesions

Thirty tissue samples were examined histologically and classified as being inflamed (apical granulomas) or noninflamed (scars or noninflamed cysts). The samples were then homogenized in pyrogen-free water and treated to remove interfering substances. The presence of endotoxin was then determined by means of the Limulus assay; 75 percent of the inflamed tissues were positive for endotoxin, while only 20 percent of the noninflamed tissues contained endotoxin. The presence of endotoxin was thus highly correlated (p = 0.015) with the presence of inflammation in these tissues.

Chronic maxillary sinusitis. Differential diagnosis and genesis.

By a careful ENT and oral examination of 111 patients with suspected chronic maxillary sinusitis, the diagnosis was verified in only 56% (62/111). In 29 of these 62 patients (47%) a relation to dental infections was found, periodontitis being as frequent as apical granulomas. In 61% of the patients, in whom the diagnosis chronic maxillary sinusitis could not be verified, dental infections and/or myofascial pain dysfunction syndrome (MPD) were the most common and likely cause of the symptoms. A careful oral examination including dental radiographs is thus important in patients with chronic maxillary sinusitis.

Characterisation of apical granulomas by differential scanning calorimetry

Characterisation of apical granulomas by differential scanning calorimetry

An evaluation of 566 cases of root canal therapy in general dental practice. 1. Diagnostic criteria and treatment details

Clinical findings for 566 cases of root canal therapy, followed up for nine years or less, were analyzed. Women and men were equally represented as patients; most were between 30 and 40 years old. More than 78% of patients had some preoperative pain. The most frequent diagnoses were superimposed infection in an apical granuloma or cyst, or acute pulpitis. Grossman's paste was placed in 67.4% of the treated root canals which were usually filled to the apex of the root as determined by radiographs. This paper shows the follow-up that is possible in a general dental practice.

Studies of periapical status in a medieval population.

The status of the periapical tissue has been investigated in skull materials dating from different periods of time. In these investigations, the bone connected with the root apices has been shown to be destroyed to so great an extent as to make the destruction of bone the most common inflammatory reaction in skeletal material (1). However, the frequencies reported have generally been relatively low in comparison with modern materials, which may be partly explained by the fact that direct inspections without radiography were carried out, in which only the destruction which had penetrated the compactum could be recorded. In the study of exhumed material, there are also special sources of error on account of the occurrence of post-mortem changes, as SWARDSTEDT (11) has pointed out. Attempts have been made to distinguish between different types of pathological changes, such as apical granulomas and cysts, by assessing the radiographic character of the bone destruction in the skull material (1) in the same way as in clinical investigations (10). However, it has proved to be possible to make a reliable differentiation only by a microscopical examination of the soft tissue of the destruction (9). An attempt has also been made to classify the periapical bone destructions in skull material according to size, in the same way as in clinical investigations (11).

Effect of demineralization on stainability of human mast cells in normal periodontal membranes, apical granulomas and radicular cysts.

abstract— The material comprised normal human periodontal membranes, apical granulomas and radicular cysts attached to extracted teeth. Chronically inflamed human gingiva and different rat tissues served as controls. The following demineralizing agents were tested: 5.3% HNO3, 2% formic acid +20% Na‐citrate, 5% EDTA, 10% EDTA+7.5% PVP, 0.05 M EDTA+0.22 M sucrose. Fixation: 4% aqueous solution of basic lead acetate with formalin 1:10 added. The following staining procedures were applied: toluidine blue pH 4.0, astra blue pH 0.2–0.3, naphthol‐esterase‐GBC pH 7.4, and acridine orange in 5% ALSO4, pH 3.4. Demineralization in HNO3, formic acid+Na‐citrate, and 5% EDTA proved unsatisfactory. EDTA+PVP showed valuable staining results, but no secondary fluorescence could be observed after 18 d of exposure to this fluid. The best results were obtained with EDTA+sucrose. Even after 120 d of exposure to this demineralizing agent the human mast cells could be readily demonstrated by all four staining techniques used. In addition, the human mast cells appeared morphologically well preserved.

Preservation and demonstration of mast cells in human apical granulomas and radicular cysts.

abstract – The investigation concerns the preservation and demonstration of human mast cells in undemineralized material. The material comprised human apical granulomas and radicular cysts dissected from extracted teeth or obtained by apicoectomy and cyst removal. Chronically inflamed human gingiva, rat tongue, and rat peritoneum served as control tissues. The following fixations were tested: 4% formaldehyde solution buffered to pH 7.2, Newcomer's fluid, and a 4% aqueous solution of basic lead acetate with formalin 1:10 added. The following dyes and fluorochromes were tested: toluidine blue in various concentrations and at various pH values, Astra‐blue, the esterase substrate naphthol‐AS‐D‐chloroacetate in combination with GBC, acridine orange in various concentrations and at various pH values, berberine‐sulfate, and thioflavin T. Abundant mast cells were demonstrated in all granulomas and cysts with at least one of the staining methods tested. A 4% lead acetate solution with formalin added proved the best fixative for the preservation of the human mast cells, whereas staining with Astra‐blue appeared the superior technique for demonstrating the human mast cells. Acridine orange showed the best secondary fluorescence of the fluorochromes tested. The best results with this dye were obtained using a 0.03% solution in 5% AlSO4.

A pathological study on chronic apical lesion with the fluorescent antibody technique

Clinical and laboratory studies have repeatedly indicated the importance of oral bacteria in the initiation and progression of dental caries, periodontal disease and their sequelae, i.e., periapical lesions. However, localization of these bacteria in human tissue especially in the periapical lesion has remained unclear.The present study was made to clarify the localization of cellular components of oral bacteria (Staphylococcus, Streptococcus, Bacterionema, Bacteroides, Fusobacterium and Corynebacterium) with a fluorescent antibody technique and other conventional staining techniques.Of 74 subjects, 41 were diagnosed as apical abscess, 23 as apical granuloma, and 10 as apical cyst by conventional staining methods. By a fluorescent antibody technique, 61 of 74 subjects were fluorescence positive. Of these 61 subjects fluorescein-labeled anti Bacterionema, Corynebacterium, Bacteroides, Staphylococcus, Streptococcus and Fusobacterium sera proved to be fluorescence positive in 54, 53, 40, 38, 35 and 34 subjects, respectively (Table 5). This specific fluorescence was usually observed as a bacterial mass and 1 or in the cytoplasm of macrophages and in polymorphonuclear leukocytes (Fig. 2, 3). These specific fluorescence were usually seen both in the central necrotic area and granulation tissue of apical abscess (Fig. 4, 5, 6), granulation tissue in apical granuloma (Fig. 9), and intercellular space of connective tissue wall in apical cyst (Fig. 11, 12).From the above data, it is indicated that the initiation or the process of chronic apical periodontitis is related with oral bacteria.

The effects of surgical exposures of dental pulps in germ-free and conventional laboratory rats

The purpose of this study was to observe the pathologic changes resulting from untreated experimental pulp exposures in germ-free rats as compared with conventional rats with a normally complex microflora. The pulp tissues of these rats were exposed by drilling through the occlusal surface of the maxillary right first molar with a carbide round bur mounted in a jeweler's spindle-topped hand mandrel. After varying postoperative time intervals (1 to 42 days), the animals were killed and the appropriate tissues were serially sectioned. By the eighth day, vital pulp tissue remained only in the apical half of the roots in the conventional animals. Complete pulpal necrosis with granulomas and abscess formation occurred in all older specimens. Evidence of repair was uniformly lacking. In contrast, no devitalized pulps, apical granulomas, or abscesses were found in the germ-free animals. Dentinal bridging began at 14 days and by 21 and 28 days was complete, regardless of the angle or severity of the exposure. These results, even in the face of gross food impactions, indicate that the presence or absence of a microbial flora is the major determinant in the healing of exposed rodent pulps.

The interrelationship of pulp and periodontal disease

In order to ascertain whether or not a relationship exists between periodontal and pulpal lesions, eighty-five teeth with periodontal lesions were examined histologically. Prior to extraction, subjective symptoms and the results of clinical tests were recorded. In addition, a medical and dental history was elicited. In many teeth a profusion of lateral and accessory canals and foramina were found, especially in the bifurcation and trifurcation regions of molars. Where the roots were fused with cementum, accessory canals were frequently seen. The pulps of only five teeth (6 per cent) were found to be uninvolved. Atrophic pulps were found in twenty-three teeth (27 per cent). The pulps were inflamed in forty-two teeth (49 per cent) and totally necrotic in fifteen teeth (18 per cent). These observations appeared to indicate that periodontal lesions produced a degenerative effect on the pulps of the involved teeth. In order to separate the effects of caries or operative procedures in the pulps of those teeth with periodontal involvements, we examined thirty-two periodontally involved teeth in which there was no evidence of caries or restorations. Among this group, twelve teeth (37 per cent) had pulps exhibiting various degrees of atrophy and twelve teeth (37 per cent) had inflammatory pulp lesions. In three teeth the pulps were completely necrotic. Further analyses indicated that pulps subjected to a combination of pulp and periodontal irritants showed a greater incidence of inflammatory reactions than those subjected to operative procedures alone. Pulp lesions were found to have an effect on the severity of the periodontal lesion. Inflammation of the periodontal membranes from inflamed and necrotic pulps was readily spread through lateral canals and accessory foramina, especially in molars. Also, extensive apical granulomas caused resorption of the crest of the interradicular alveolar ridge. Thus, retention of these teeth could be accomplished only through combined endodontic and periodontal therapy. Pain in periodontally involved teeth was also investigated. Atrophy or inflammation of the pulp was responsible for the greatest incidence of pain. The pain incidence appeared to increase when caries or restorations were present. Thermal responses in teeth with periodontal lesions increased significantly when the pulps were found to be inflamed, but there was no correlation between the type of pulp inflammation and a specific thermal test. The patients' complaints relating to pain on thermal stimuli were not found to be reliable indicators of the state of the pulp in periodontally involved teeth.

Why an apical granuloma does not heal: F. Prader. Schweiz. Monatschr. f. Zahnh. 2: 111, 1952

Why an apical granuloma does not heal: F. Prader. Schweiz. Monatschr. f. Zahnh. 2: 111, 1952

Case report of the relief of frontal headaches associated with the presence of a malposed supernumerary tooth and two apical granulomas

A young man was referred for dental consultation with the complaint of persistent frontal headaches. After the removal of a malposed supernumerary tooth and root resections of both maxillary lateral incisors, the headaches disappeared. The headaches, which ceased after the operation, could have been due to the chronic pulpitis in the two lateral incisors and also might have been caused by the supernumerary tooth which, in an attempt to erupt, might have produced pressure on the branches of the dental nerve plexus. During the surgical procedure, the apex of the maxillary incisor tooth was interfered with and gave a nonvital response to the Kriser pulp tester. After fifteen months, however, this tooth gave a vital response, and we can assume that there must have been some regeneration of nerve tissue.

TUMORS OF THE NOSE AND THE THROAT

<h3>TUMORS OF THE NOSE AND ACCESSORY SINUSES</h3> Bogdasarian and Stout¹report a case of neurilemmoma of the nasal septum in a man 42 years old. The tumor was easily removed by a nasal snare. A review of the literature disclosed no case of tumor of a nerve sheath on the nasal septum. Sooy²states that in the differential diagnosis of a cystic lesion occurring laterally in the nasal floor and the maxilla four conditions must be considered. Two of these conditions, peridontal cyst, resulting from apical granuloma, and dentigerous cyst, are dental in origin. The other two, globulomaxillary cyst and nasoalveolar cyst, are of fissural origin. The author presents a discussion of each type of cyst together with 5 case reports. Four cases of sarcoid of the nose are reported by Fletcher.³Medical treatment of sarcoid is said to be ineffective. In 2 of the reported cases the lesions was