Dental Granulomas Research Articles

Evaluation of 3D MRI for early detection of bone edema associated with apical periodontitis.

To detect and evaluate early signs of apical periodontitis using MRI based on a 3D short-tau-inversion-recovery (STIR) sequence compared to conventional panoramic radiography (OPT) and periapical radiographs in patients with apical periodontitis. Patients with clinical evidence of periodontal disease were enrolled prospectively and received OPT as well as MRI of the viscerocranium including a 3D-STIR sequence. The MRI sequences were assessed for the occurrence and extent of bone changes associated with apical periodontitis including bone edema, periradicular cysts, and dental granulomas. OPTs and intraoral periapical radiographs, if available, were assessed for corresponding periapical radiolucencies using the periapical index (PAI). In total, 232 teeth of 37 patients (mean age 62±13.9 years, 18 women) were assessed. In 69 cases reactive bone edema was detected on MRI with corresponding radiolucency according to OPT. In 105 cases edema was detected without corresponding radiolucency on OPT. The overall extent of edema measured on MRI was significantly larger compared to the radiolucency on OPT (mean: STIR 2.4±1.4 mm, dental radiograph 1.3±1.2 mm, OPT 0.8±1.1 mm, P=0.01). The overall PAI score was significantly higher on MRI compared to OPT (mean PAI: STIR 1.9±0.7, dental radiograph 1.3±0.5, OPT 1.2±0.7, P=0.02). Early detection and assessment of bone changes of apical periodontitis using MRI was feasible while the extent of bone edema measured on MRI exceeded the radiolucencies measured on OPT. In clinical routine, dental MRI might be useful for early detection and assessment of apical periodontitis before irreversible bone loss is detected on conventional panoramic and intraoral periapical radiographs.

MUSCLE FUNGAL GRANULOMA DUE TO CLADOSPORIUM SPECIES: A NOVEL SURPRISE

The spectrum of mycotic diseases continue to expand, making it challenging for treatment of infections caused by a diverse array of opportunistic fungi especially in immuno-compromised individuals. The species of Cladosporium implicated in human infections is found as causative agents for infections of the central nervous system, lung, liver, keratitis, and dental granulomas. Involvement of a muscle by a fungal granuloma in an immunocompromised individual by Cladosporium species is very rare and has been never reported before to the best of our knowledge. Below we present a novel case of a 34 year old, Post-transplant Immunocompromised male to have developed a lump within the Triceps Brachii muscle which was found to be a Cladosporium Cladosporioides granuloma and was treated successfully with a multimodal approach of Surgery and Voriconazole anti-fungal therapy.

The Diagnosis and Treatment of a Rare Maxillary Plasmacytoma: a Case Report.

The jaw plasmacytoma is a very rare condition, which its diagnosis is difficult in clinical routine. Up to now, less than 60 cases of jaw plasmacytoma have been reported in the literature. In the present case report, we reported a rare case of jaw plasmacytoma in a 42-year-old female, which was misdiagnosed with dental granuloma and abscess. The diagnosis of plasmacytoma was done by immunohistochemistry (IHC) evaluation following a cone beam computed tomography (CBCT) assessment. The patient was treated with radiotherapy and is disease free after 2 years.

The NFκB Expression on Apical Dental Granuloma: An Immunohistochemistry Analysis.

BackgroundEndodontic treatment on dental caries with dental granuloma on the periapical has the potential to flare. The symptoms of acute flare in dental granuloma are strongly related to the activation of macrophages that produce pro-inflammatory cytokine through nuclear factor kappa B (NFκB). However, the role of NFκB in dental granuloma has not been widely explained.PurposeTo compare NFκB expression in dental granuloma and dental nongranuloma in the periapical of dental caries.MethodsThe periapical lesion of dental granuloma and dental nongranuloma was obtained from patients with dental caries who were subjected to tooth extraction. The periapical lesion was confirmed by periapical radiography and then differentiated by histological and immunohistochemistry by analyzing the NFκB expression.ResultsMost dental granulomas were found in females (66.67%) between the ages 36 and 45 (61.11%). Dental granuloma showed higher NFκB expression compared to dental nongranuloma lesions in tooth caries (p=0.021).ConclusionThe dental granuloma tissue of dental caries showed an increase in NFκB expression. Understanding the role of NFκB might provide additional insights into the process of periapical lesion development.

Determining the frequency of Epstein-Barr virus (EBV) in two inflammatory lesions of the periapical cyst and dental granuloma

BackgroundOne of the significant problems of Partial root canal therapy is periapical cyst and granuloma. Microorganisms contribute to the creation of periapical lesions, causing chronic illness and dental granuloma. This study aims to determine the effect of Epstein-Barr virus (EBV) on the exacerbation of the disease using the PCR technique. MethodsParaffin tissue samples containing 25 periapical cysts, and 25 dental granulomas underwent DNA extraction. The extracted DNA quality was confirmed by the β-globin component replication using polymerase chain reaction (PCR). Moreover, the samples were evaluated using the nested-PCR technique in terms of the frequency of EBV using dedicated primers. The data analysis was performed using chi-squared, Fischer, and independent t-tests. ResultsEBV was detected in 4% (1/25) of the periapical sample and 4% (1/25) of the 25 dental granuloma samples. Despite the above observations, there was no statistically significant difference in the frequency of EBV between the periapical cyst and dental granuloma samples. ConclusionBased on the results of the study, EBV is likely to affect the pathogenesis or the growth of periapical lesions. Given that there is not a lot of research in this area and the results of the studies are conflicting, the findings attract more research.

Dental Infection of Porphyromonas gingivalis Induces Preterm Birth in Mice.

BackgroundEpidemiological studies have revealed a link between dental infection and preterm birth or low birth weight (PTB/LBW), however, the underlying mechanisms remain unclear. Progress in understanding the associated mechanisms has been limited in part by lack of an animal model for chronic infection-induced PTB/LBW, mimicking pregnancy under conditions of periodontitis. We aimed to establish a mouse model of chronic periodontitis in order to investigate the link between periodontitis and PTB/LBW.MethodsTo establish chronic inflammation beginning with dental infection, we surgically opened mouse (female, 8 weeks old) 1st molar pulp chambers and directly infected with w83 strain Porphyromonas gingivalis (P.g.), a keystone periodontal pathogen. Mating was initiated at 6 wks post-infection, by which time dental granuloma tissue had developed and live P.g. was cultured from extracted tooth root, which serves as a persistent source of P.g. The gestational day (gd) and birth weight were recorded during for P.g.-infected and control mice, and serum and placental tissues were collected at gd 15 to evaluate the systemic and local conditions during pregnancy.ResultsDental infection with P.g. significantly increased circulating TNF-α (2.5-fold), IL-17 (2-fold), IL-6 (2-fold) and IL-1β (2-fold). The P.g.-infected group delivered at gd 18.25 vs. gd 20.45 in the non-infected control (NC) group (p < 0.01), and pups exhibited LBW compared to controls (p < 0.01). P.g. was localized to placental tissues by immunohistochemistry and PCR, and defects in placental tissues of P.g. infected mice included premature rupture of membrane, placental detachment, degenerative changes in trophoblasts and endothelial cells, including necrotic areas. P.g. infection caused significantly increased numbers of polymorphonuclear leukocytes (PMNLs) and macrophages in placental tissues, associated with increased local expression of pro-inflammatory mediators including TNF-α and COX-2. Further placental tissue damage was indicated in P.g. infected mice by decreased CD-31 in endothelial cells, increased expression of 8OHdG, an indicator of oxidative DNA damage, and cleaved caspase-3, a marker of apoptosis. In vitro, P.g. lipopolysaccharide significantly increased expression of COX-2, IL-8 and TNF-α, in HTR-8 trophoblasts in an NF-κB-dependent fashion.ConclusionsOur novel mouse model supports previous epidemiological studies signifying dental infection as predisposing factor for PTB/LBW. We demonstrate PTB and LBW in infected mice, translocation of P.g to placental tissues, increased circulating and local pro-inflammatory markers, and the capability of P.g. LPS to directly induce cytokine production in trophoblasts, in vitro. These findings further underscore the importance of local and systemic infections and inflammation during pregnancy and suggest that prevention and/or elimination of dental infections such as marginal or periapical periodontitis before pregnancy may have a beneficial effect on PTB/LBW.

Osler’s node on the thigh, an uncommon location, but a valuable diagnostic aid

A 65-year-old man without any significant past medicalhistory, presented with fever, fatigue and weight loss. Hecomplained of a painful macular violaceous lesion of 2 cm(Fig. 1) located on the left thigh, negative to compression.The remaining physical examination was unremarkableexcept for a slight systolic mitral murmur and conjunctivalhemorrhages.Considering the cutaneous signs although atypical,could be integrated in the Duke minor criteria, we sus-pected a possible endocarditis. Hence, after blood cultures,we started antibiotics using IV amoxicillin (200 mg/kg/day) and gentamycin while scheduling echocardiography.Subsequent laboratory tests confirmed two blood culturespositive for Streptococcus gordonii.Transesophageal echocardiography showed 2 mobilevegetations of 8 and 17 mm on the mitral valve, whichjustified an urgent mitral valve surgery within the next24 h.During the first week after treatment, we observed a fastdisappearance of the cutaneous lesion.The patient recovered after 4 weeks of medical care,followed by removal of a dental granuloma, and is con-sidered healed at 3 years’ follow-up.Is it an Osler’s node or a Janeway lesion? Sir WilliamOsler, in 1893, described the painful sign with his nameassociated ever since. Osler’s nodes are painful and slightlyraised erythematous nodules, from 1 mm to more than1cm[1], commonly located on the pads of the fingers andtoes. Sometimes they are located on the skin of the fore-arms, flank and trunk [2].Then in 1899, Janeway described a different non-tenderlesion found on the palms and soles. The macules, usuallyhemorrhagic, are non-tender, have a variable size, andremain longer than Osler’s nodes [3].Osler’s node on the thigh has never been reportedbefore. Despite some atypical findings, various character-istics of the skin lesion including its size, its shape and itsmarked painful character led us to conclude this was anOsler’s node.Moreover, the histologic findings do not always allowthe physician to distinguish between an Osler’s nodeand a Janeway lesion. Several theories have beenhypothesized for the formation of the cutaneous lesions,and therefore, there is no consensus for specific histo-logic signs. Nowadays septic or bland microemboliseem to explain Osler’s nodes [4] leading sometimes todermal microabscesses with possible isolation of thepathogenic organism from aspirates [5]. However, aphenomenon of an immunologically complex vasculitisis possibility.Osler’s nodes and Janeway lesions might even be theresult of the same process leading to different lesionsaccording to the micro-anatomic site, and the delay inproceeding to biopsy. The virulence of the microorganismresponsible for an acute or subacute infective endocarditismay also play a role in the type of histologicmanifestations.In conclusion, our report suggests that a meticulousphysical examination may allow finding these legendarycutaneous signs that are helpful clues to lead quickly to

Surgical correction of HIV-associated facial lipoatrophy

Surgical correction of HIV-associated facial lipoatrophy

Comparative immunohistochemical and quantitative analysis of inflammatory cells in symptomatic and asymptomatic chronic periapical lesions

It has been demonstrated that lymphocytes, plasma cells, macrophages and neutrophil granulocytes represent the predominant cells of the inflammatory lesion of the dental granulomas. Other cells, such as mast cells, eosinophils, dendritic cells comprise minor, but functionally important cell populations. Most of the data considering cells that take part in these processes have been derived from immunohistological studies. This study was undertaken with the aim to determine the phenotype profile of inflammatory cells of dental granulomas using immunohistochemical method in order to study the differences of their quantitative properties and distribution between symptomatic and asymptomatic lesions. The material for the analysis originated from 42 individuals with clinic and radiographic diagnosis of chronic periapical lesions. The tissue was take either during the periradicular surgery, or tooth extraction. Cryostat tissue sections were stained using the alkaline phosphatase-antialkaline phosphatase assay (APAAP). This method is highly valid and sensitive using a panel of specific monoclonal antibodies: CD3, CD4, CD8, CD19, CD38, CD14, CD1a, CD83, CD80, CD86, CD45 and CD123. The composition of the cell population revealed that there was no homogenous and site-specific pattern of the distribution of inflammatory cells. The results of our investigation revealed that the majority of inflammatory cells comprised lymphocytes and plasma cells, followed by subpopulations CD4+, CD8+ and CD14+ cells. Much lower in number were CD80+, CD86+ and CD83+ and CD1a+ cells. There were no statistically significant differences in mean values of inflammatory cells number between symtomatic and asymptomatic lesions, with the exception of CD86+ cells, the number of which was statistically higher in symptomatic lesions. Inflamatory infiltrate cells in dental granulomas are dominated by T- and B-lymphocytes. It points out the complexity of immunopathogenic events in imitiating and progressing of dental granulomas that involve mechanisms of both cellular and humoral immunity. Regarding the quantitative presence of immunocompetent cells in symptomatic and asymptomatic lesions no statistically significant difference was determined unless in mature dendritic cells present in symptomatic lesions.

Immunohistochemical detection of Langerhans cells in dental granulomas and radicular cysts

Dental granulomas (DGs) and radicular cysts (RCs) are chronic periapical lesions frequently involving the jaws. Langerhans cells (LCs) are dendritic cells responsible for the presentation of antigens to T lymphocytes. This study examined the expression of LCs in DG and RCs by immunohistochemical staining. Eighteen cases of DGs and 26 cases of RCs were analyzed using anti-CD1a marker. CD1a-labeled LCs were observed in 11.1% of DGs and in 69.2% of RCs, showing a significant correlation (P < 0.0001; Fisher's test). In DGs, LCs were only observed in granulation tissue, showing discrete immunostaining density. In RCs, LCs exhibited both a round and a dendritic shape in all epithelial layers. Although a correlation was observed between immunostaining density and epithelial thickness, as well as between immunostaining and inflammatory intensity, the differences were not significant in radicular cysts. Langerhans cells provide important insight into the immunopathogenesis of chronic periapical lesions.

Etiopatogenia do cisto radicular. Parte I

As lesões periapicais crônicas decorrem principalmente da infecção dos canais radiculares, devido à doença cárie. Sabese que o processo imuno-inflamatório é a base de formação dos granulomas dentários e cistos radiculares, favorecido pela defesa primária e mediado por células como macrófagos e neutrófilos, ou através de uma defesa específica, mediada por linfócitos e células apresentadoras de antígenos, como as Células de Langerhans. O presente trabalho se propõe a apresentar os aspectos gerais sobre a etiopatogenia dos cistos radiculares, cuja complementação a respeito destas lesões e a avaliação morfológica das mesmas serão objeto da segunda parte deste estudo.

Immunolocalization of interleukin 4, interleukin 6, and lymphotoxin alpha in dental granulomas.

The purpose of this study was to determine the immunolocalization of the interleukin (IL) 4, IL-6, and lymphotoxin (LT) alpha in dental granulomas and correlate their expression with the intensity of the inflammatory infiltrate. Study design Fifteen paraffin specimens of dental granulomas were selected, and the streptavidin-biotin complex stain was used to detect IL-4, IL-6, and LT-alpha. Our results revealed a significant statistical correlation between the intensity of inflammatory infiltrate and the percentage of mononuclear cells positive for IL-4. Moreover, we observed a statistically significant correlation between the frequency of cells expressing IL-6 and LT-alpha. These data suggest that the predominance of a helper T cell subtype 2 response in dental granulomas is correlated with the exacerbation of the inflammatory reaction and its evolution. Moreover, a correlation between the frequency of IL-6-positive and LT-alpha-positive cells suggests that the synergistic activities of these 2 cytokines may be involved in the pathogenesis of this inflammatory condition.

Differentiation of periapical granulomas and radicular cysts by digital radiometric analysis

It is generally accepted that two of the most commonly seen radiolucencies, the periapical granuloma and the radicular cyst, cannot be differentiated radiographically. The purpose of this investigation was to determine the feasibility of identifying radiometric differences in these two pathologic conditions by analyzing the patterns of the gray-level distributions of digitized radiographic images. Radiographs used in the study had been sent by practitioners to the School of Dentistry with tissue specimens. Radiographs of lesions identified as periapical granulomas and radicular cysts in the mandibular posterior quadrant were included in the study. The radiographs were digitized and regions of interest were drawn to include the lesions. Frequency distributions (histogram) with 256 gray-scale intervals and a cumulative percent histogram were computed. The typical histograms of the dental granulomas had narrower ranges and lower gray-scale values than did cysts. The results of this study indicate that it is feasible to radiometrically differentiate between lesions that are visually indistinguishable on radiographs.

Immunochemical and biological characterization of outer membrane proteins of Porphyromonas endodontalis.

Outer membrane proteins (OMP) of Porphyromonas endodontalis HG 370 (ATCC 35406) were prepared from the cell envelope fraction of the organisms. The cell envelope that had been obtained by sonication of the whole cells was extracted in 2% lithium dodecyl sulfate and then successively chromatographed with Sephacryl S-200 HR and DEAE-Sepharose Fast Flow. Two OMP fractions, OMP-I and OMP-II, were obtained, and their immunochemical properties and induction of specific antibodies were examined. The OMP-I preparation consisted of a major protein with an apparent molecular mass of 31 kDa and other moderate to minor proteins of 40.3, 51.4, 67, and 71.6 kDa, while the OMP-II preparation contained 14-, 15.5-, 27-, and 44-kDa proteins as revealed by sodium dodecyl sulfate-polyacrylamide gel electrophoretic analysis. OMP-I was found to form hydrophilic diffusion pores by incorporation into artificial liposomes composed of egg yolk phosphatidylcholine and dicetylphosphate, indicating that OMP-I exhibited significant porin activity. However, the liposomes containing heat-denatured OMP-I were scarcely active. Spontaneous and antigen-specific immunoglobulin M (IgM)-, IgG-, and IgA-secreting spot-forming cells (SFC) enzymatically dissociated into single-cell suspensions from chronically inflamed periapical tissues and were enumerated by enzyme-linked immunospot assay. In patients with radicular cysts or dental granulomas, the major isotype of spontaneous SFC was IgG. In radicular cysts, the OMP-II-specific IgG SFC represented 0.13% of the total IgG SFC, while the antigen-specific IgA or IgM SFC was not observed. It was also found that none of these mononuclear cells produced antibodies specific for OMP-I or lipopolysaccharide of P. endodontalis.

The effect of indomethacin on experimental dental periapical lesions in rats

The role of prostaglandins in the pathogenesis of dental granulomas and associated bone loss was studied by testing the ability of indomethacin, a potent inhibitor of prostaglandin synthesis, to influence bone resorption in experimentally induced dental granulomas. The cusps of maxillary first molar teeth of Sprague-Dawley rats were ground away, exposing the dental pulps to the oral environment. Daily i.p. injections of 0.1 to 0.2 ml of indomethacin (10 mg per kg) dissolved in 95% ethyl alcohol were administered to one group of the rats while the other group received i.p. injections of 0.1 to 0.2 ml of 95% ethyl alcohol. The rats were killed after 6 wk and specimens of the molar teeth and surrounding jaw bone were taken for routine histopathological processing. The specimens from indomethacin-treated rats demonstrated milder inflammatory changes and a significantly lower degree of periapical alveolar bone resorption. These results support the suggestion that prostaglandins are involved in the events leading to bone resorption in dental periapical lesions.

Josamycin concentrations in human dental granuloma after a single oral administration of josamycin

1. Josamycin concentrations in human serum and dental granuloma after a single oral administration of josamycin (600 mg) were assayed by an agar diffusion (paper disc) method. 2. The mean peak josamycin concentrations in serum and dental granuloma occurred at an identical time, approximately 90 min, and were 0.88 μg/ml and 1.61 μg/g, respectively. 3. The mean concentration ratio of dental granuloma to serum at the peak time was 2.24. 4. Josamycin concentration in dental granuloma at the peak time exceeded MIC 80 for clinically isolated strains of Streptococcus group A, Peptostreptococcus spp., and Bacteroides spp.

Ampicillin concentrations in human dental granuloma after a single oral administration of talampicillin.

Ampicillin concentrations in human serum and dental granulomas of 31 patients were determined after a single oral dose of talampicillin (equivalent to 500 mg of ampicillin) was administered to each. The specimens were taken at 1.5, 2.0, 2.5, 3.0, and 3.5 h after the administration of talampicillin. The mean peak ampicillin concentrations in serum and dental granulomas occurred at identical times, 2.5 h, and were 8.29 micrograms/ml (range, 1.81 to 13.20 micrograms/ml) and 2.94 micrograms/g (range, 1.14 to 7.16 micrograms/g), respectively. The mean dental granuloma/serum ampicillin concentration ratio at the peak time (2.5 h) was 0.42 (range, 0.29 to 0.56). Ampicillin concentrations in dental granulomas exceeded most of the MICs for the bacteria commonly isolated from odontogenic infection.

ヒト歯根嚢胞におけるコラーゲン分解活性

In contrast to odontogenic cysts, radicular cysts, which originate from an epithelium invasion of dental granulomas, are the most common cysts.High animal collagenase and gelatinolytic activity was detected from human radicular cyst fluids and a 4 M urea extract of cyst wall tissues. Collagenase from radicular cysts and cyst fluids were partially purified by gel filtration. Each collagenase showed a molecular weight of 64, 000 and 66, 000.Both collagenases from radicular cysts and cyst fluids were essentially in latent form and were most effectively activated by ρ-amino phenyl mercric acid (APMA).Both collagenases from radicular cysts and cyst fluids were demonstrated to be a typical animal collagenase by the activation and inhibition studies and by analysis of degradation products of collagens.Both APMA activated collagenases broke down type I collagen preferentially to type III collagen, suggesting that the enzymes might originate from polymorphonuclear leukocytes.

In situ characterization of cell infiltrates in human dental periapical granulomas. 3. Demonstration of T lymphocytes.

Cryostat sections of 66 snap-frozen dental periapical granulomas were examined for T lymphocytes by the closed chamber hemadsorption technique using sheep erythrocytes (E) treated with 2-aminoethylisothiouronium bromide hydrobromide (AET) as indicator cells (AET-E). T lymphocytes were also demonstrated by immunofluorescent staining using a rabbit anti-T lymphocyte antiserum. Eighty-six % of the granulomas showed adherence of AET-E, and often a focal AET-E adherence pattern was seen, indicating a localized infiltration of T lymphocytes. Diffuse, moderate binding of AET-E to sections of some granulomas may be due to recirculating T lymphocytes traversing the tissue. The results of the immunofluorescence test parallelled the results obtained in the hemadsorption test. The results show that mononuclear cell infiltrates of periapical dental granulomas usually contain T lymphocytes. Although their pathogenetic function in dental periapical granulomas is still not known, infiltrates of T lymphocytes indicate that cellular immune reactions are involved.

New findings of a lamina densa in relation to plasma cells.

In an ultrastructural study of oral lesions in lichen planus, it was found that some plasma cells have an associated lamina densa. Subsequently, similar appearances have been found in pemphigus vulgaris, in the inflammatory cell infiltrates in dental granulomas and cysts and in a patient with Ehlers-Danlos syndrome. The lamina densa was mainly present adjacent to those parts of the membrane of the plasma cell that were invested with fibrillar connective tissue. The lamina was similar in thickness and electron density to that surrounding Schwann cells and endothelial cells. It is believed that lamina densa has not previously been reported in relation to plasma cells. It is of interest that in all other situations in which lamina densa has been described, the cells are considered to be part of the normal cell population of the tissue, whereas plasma cells are not regarded as part of the resident population of connective tissue.