Radicular Cysts Research Articles

Surgical and prosthetic management of an invasive radicular cyst. Ten year follow-up clinical case

Surgical and prosthetic management of an invasive radicular cyst. Ten year follow-up clinical case

The expression of cyclic GMP-AMP synthase in human apical periodontitis: A laboratory investigation.

As a key DNA sensor, cyclic GMP-AMP synthase (cGAS) has emerged as a major mediator of innate immunity and inflammation. Human apical periodontitis has yet to be studied for the presence of cGAS. This investigation was conducted to determine if cGAS is involved in the pathological process of human apical periodontitis. Sixty four human periapical lesions, comprising 20 periapical granulomas and 44 radicular cysts, were employed in this investigation. Healthy gingiva (n=6), dental pulp (n=3), and apical papilla (n=3) were used as control samples. The expression of cGAS in the periapical tissues was discovered using immunohistochemical staining. mRNA-Sequencing and qRT-PCR were utilized to determine the differentially expressed genes (DEGs) associated with DNA-sensing signalling in periapical lesions compared to the healthy control. Immunofluorescence labelling was used to identify the co-expression of cGAS, interleukin-1β, and interleukin-18. A significantly greater expression level of cGAS was discovered in the periapical lesions, with no significant difference between radicular cysts and periapical granulomas. mRNA-Sequencing analysis and qRT-PCR identified differentially expressed mRNA, such as cGAS and its downstream DEGs, between periapical lesions and healthy control tissues. Immunofluorescence labelling further revealed that cGAS, interleukin-1, and interleukin-18 were co-localized. These observations imply that along with the synthesis of interleukin-1 and interleukin-18, cGAS may be involved in the aetiology of apical periodontitis.

RADICULAR CYST : A CASE SERIES WITH REVIEW OF LITERATURE

Radicular cysts are the most common odontogenic cystic lesions of jaws, these are inflammatory in origin. These cysts result from the proliferation of cell rests of Malassez in the periodontal ligament as a consequence of inflammation, following pulpal necrosis of a nonvital tooth. The condition is usually asymptomatic but can result in a slow-growth in the affected region. On radiography the lesion is often seen as a round or oval, well circumscribed radiolucent area involving the apex of the infected tooth. Nonsurgical management should be the treatment of choice of a radicular cyst. However, periapical surgery is often considered, if the lesion is extensive and fails to reply to a nonsurgical approach. The case report is of a 43-year-old male patient with the complaint of swelling in an anterior region of maxilla since past 2 months which was gradually increase in size with no history of any pain or pus discharge. Patient had history of root canal treatment with upper right canine 10 years back. The second case report is of 45-year-old male patient with the complaint of pus discharge from destructed teeth in anterior region since one month. No intraoral and extra oral swelling present. The third case report is of 15 yrs. old male patient with the complaint of pain in upper anterior tooth since 7 days. Patient had history of root canal treatment with right lateral incisor 2 months back. The definitive diagnosis was made based on clinical, radiological and histopathological examination. Both the case reports discusses detailed description of clinical, radiographic, histopathologic features, pathogenesis, and its surgical management.

Conservative approach in the management of infected radicular cyst in the anterior maxilla in a pediatric patient: A case report

Odontogenic cysts are pathological cavities enclosed by fibrous connective tissue and lined with epithelial tissue that develops from odontogenic tissues in the maxilla and mandible's tooth-bearing regions. Trauma or tooth caries is the main cause of radicular cysts or periapical cysts. Pulp necrosis is the outcome of dental caries irritating the pulp cavity. Once the infection has reached the root's tip, it causes periapical periodontitis, which may lead to either a chronic granuloma or an acute abscess. A persistent chronic infection led to the development of a periapical cyst. Radicular cysts are the most prevalent cystic lesions that afflict the jaw. They account for 52% to 68 percent of all cysts affecting the human jaw, making them the most common of all jaw cysts. The paper presents a case report of a 10-year-old pediatric patient who developed a radicular cyst post-trauma and eventually got infected.

Benign Pediatric Jawbone Lesions: A 10-Year Clinical and Radiological Pilot Study

This study aimed at presenting a retrospective longitudinal analysis of the pediatric jaw lesions treated at the Oral and Maxillofacial Surgery Clinic in Cluj-Napoca, Romania, over a timeframe of ten years (2012 to 2022). The clinical and radiological characteristics of the jawbone lesions, the treatment outcome, and the recurrence incidence were described. All consecutive patients aged below 18 years, with histologically diagnosed odontogenic tumors (OTs), nonodontogenic tumors (non-OTs), or odontogenic cysts (OCs) were included. Age, dentition type, clinical symptoms, preoperative and postoperative radiological tests, histological diagnosis, treatment, and follow-up information one year following the diagnoses were all examined. Eighty-two cases were included. The ratio of men to women was 1.15:1, with the mandible predominating by 64.4%. Inflammatory radicular cysts predominated in 31.7% of cases. A total of 42.68% of the patients were asymptomatic. Enucleation was the most frequent surgical technique (45.1%), followed by cystectomies (28%) and marsupialization (14.6%). The overall recurrence rate was 7.3%; the most recurrent histopathological lesion was the odontogenic keratocyst. This study sheds new light on the clinical and radiological characteristics, treatment outcomes, and recurrence rate of juvenile jawbone lesions in children and adolescents. The diagnosis and treatment of jawbone lesions in children and adolescents can be enhanced with the use of epidemiological, clinical, and imagistic information.

Surgical treatment of jaw inflammatory odontogenic cysts in primary teeth: a retrospective analysis

Relevance. Odontogenic cysts in children are the most common bone pathology. The study aimed to conduct a retrospective descriptive analysis of inflammatory odontogenic cysts cases associated with primary teeth in children.Material and methods. The study analysed the medical records of children diagnosed with "radicular cyst associated with a primary tooth" from 2015-2020. We studied the following characteristics, namely, sex, age, location of the process, condition of the teeth in question, surgical treatment techniques and outcome. The data obtained were processed by methods of variational statistics. The Student t-test assessed the significance of differences.Results. The study analysed 60 cases of inflammatory odontogenic cysts in children aged 6 to 13 years. Cysts were more often associated with the primary lower second molars previously treated with the resorcinol-formaldehyde resin therapy. The period from the tooth treatment to the cyst diagnosis was 3 to 5 years. The treatment of cysts applied methods of a gentle and traditional cystotomy. Fifty-one children (85.0%) had follow-up examinations. All children showed bone tissue restoration during the period of 4 to 12 months and spontaneous eruption of permanent teeth in 3-8 months. Only 4 cases (7.8%) required orthodontic correction of permanent teeth position.Conclusion. Primary lower molars, previously treated with resorcinol-formaldehyde resin, are the most common cause of jaw inflammatory odontogenic cysts in children. Low-traumatic surgical methods preserving the follicles of permanent teeth are highly effective (88.2%).

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.

Expression pattern of hypoxia-related genes in odontogenic cysts

ObjectiveThe aim of the present study was to reveal the effects of hypoxia-associated signaling in odontogenic cysts. DesignThe expression levels of genes involved in the hypoxia-associated signaling pathway were determined by quantitative Polymerase Chain Reaction (PCR) method. ResultsAs a result, it was found that phosphatase and tensin homolog (PTEN) expression was low (p = 0.037), and the expression levels of phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) (p = 0.0127), hypoxia inducible factor 1 alpha (HIF1A) (p < 0.001), and HIF1A antisense RNA 1 (HIF1A-AS1) (p = 0.0218) were higher in cyst tissue compared to normal tissue. HIF1A gene expression was found to be significantly altered according to the pathologic subtypes of odontogenic keratocyst, dentigerous cyst, and radicular cyst. ConclusionsOdontogenic cysts were found to have higher expression of HIF1A and HIF1A-AS1, which may be related to the increased hypoxia in these lesions. In addition, PI3K/Akt signaling may be stimulated by increased PIK3CA and decreased PTEN expression, which promote cell survival and support the mechanism of cyst formation.

The MRI characteristics of radicular cysts and granulomas

The MRI characteristics of radicular cysts and granulomas

The magnetic resonance imaging characteristics of radicular cysts and granulomas.

Limited studies have differentiated radicular cysts and granulomas with MRI. Therefore, we investigated the MRI characteristics of the two lesions and clarified features for distinguishing between them. We collected data of 27 radicular cysts and 9 granulomas definitively diagnosed by histopathology and reviewed the fat-saturated T2 weighted, T1 weighted, and contrast-enhanced fat-saturated T1 weighted images. We measured the maximum diameter and apparent diffusion coefficient values of the lesions. We employed Fisher's exact test, the Mann-Whitney U test, and independent t-tests to compare the two lesions and created a decision tree for discriminating between them. There were significant differences between radicular cysts and granulomas with respect to five imaging characteristics-signal intensity of the lesion centre on fat-saturated T2 weighted images; signal intensity, texture, and contrast enhancement of the lesion centre on contrast-enhanced fat-saturated T1 weighted images; and maximum diameter of the lesion. The cut-off diameter for radicular cysts was 15.9 mm. The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.971, 85.2%, and 100%, respectively. From the decision tree analysis, maximum diameter, lesion centre contrast enhancement on contrast-enhanced fat-saturated T1 weighted images, and lesion centre signal intensity on fat-saturated T2 weighted images were important for discriminating between radicular cysts and granulomas.

The prevalence of oral and maxillofacial pathologic lesions in pathology centers of Zanjan (Iran) over a 5-years period (2014-2020)

Background and objectives: The oral and maxillofacial region is exposed to many harmful agents and can be affected by a wide range of reactive, infectious, cystic, precancerous, and neoplastic lesions. This study aimed to determine the prevalence of oral and maxillofacial pathological lesions in pathology laboratories in Zanjan. &#x0D; Method: This retrospective descriptive study was conducted in the period 2014 -2020 by referring to the hospitals and laboratories with pathologists in Zanjan. Information about patients with histopathological lesions of oral and maxillofacial region was extracted, and studied in terms of age, gender, location and histopathological type of lesion. Finally, the collected data were entered into SPSS software version 22 and statistically analyzed (P &lt;0.05).&#x0D; Results: A total of 176 histopathological lesions were investigated. Of them, 120 cases (58%) were female and 74 (42%) were male. The mean age of the patients was 39.4 years. The most prevalent lesion was periapical cyst (14.8%).In terms of tissue involved, the most lesions were related to soft tissue (67%) and in terms of anatomical location, the most lesions were gingival mucosal lesions (35.2%).&#x0D; Conclusion: The prevalence of pathological lesions was higher in females than in males. Soft tissue lesions were more than hard tissue lesions. Gingival mucosal lesions were the most prevalent and lesions of the floor of the mouth and nasal vestibule lesions were the least prevalent ones. Given the histopathologic nature of lesions, periapical cyst was the most prevalent lesion.

The treatment of different odontogenic cysts in children only using acrylic appliance-guided decompression: A long-term clinical study

Aim: Various odontogenic cysts may rarely occur in the jawbones during childhood, including radicular cysts, dentigerous cysts, and odontogenic keratocysts. Treatment for such cysts ranges from conservative approaches to radical surgical procedures. The present study evaluates the effect of the decompression alone method for treating various odontogenic cysts in children.Methods: A retrospective cohort study was performed that included pediatric patients who applied to the pedodontics clinic between 2014 and 2016. Data such as age, gender, anatomical location, reasons for admission, histopathological diagnosis and dimensions of the cysts, and associated teeth were recorded. All odontogenic cysts were treated using the decompression method with an acrylic obturator. All patients were evaluated clinically and radiologically one, three, six, and 12 months after the operation and annually thereafter.Results: As a result of the pathological examination, it was determined that 10 of the 16 odontogenic cysts were dentigerous cysts, 5 were radicular cysts and 1 was an odontogenic keratocyst. The patients consisted of 4 girls and 12 boys, with a mean age of 108.68±21.01 months. The average duration of the decompression was 7.3±1.41 months and the average follow-up was 9.6±2,56 years. In four patients, spontaneous eruption of the impacted permanent teeth was not observed; these were erupted using orthodontic treatment. In two cases of dentigerous cysts, the impacted teeth were extracted and the cyst was enucleated. In the remaining 14 cases, the permanent teeth erupted (spontaneous+orthodontic guided) successfully (87.5%), and the cysts healed completely after decompression treatment. Conclusion: To avoid developmental problems, conservative procedures should be preferred for the treatment of odontogenic cysts in children. Decompression therapy using an acrylic obturator is an effective treatment for odontogenic cysts in pediatric patients; this approach protects and maintains permanent teeth. However, new clinical studies with larger sample sizes are needed to support these results.

Frequency and Demographic Profile of Odontogenic Cysts in Riyadh, Saudi Arabia: Retrospective Multicenter Study.

The study aims to assess the relative frequency, clinicopathological features, treatment, and follow-up of OCs in three tertiary medical centers. OCs were identified from King Abdulaziz Medical City, King Fahad Medical City, and Prince Sultan Military Medical City from January 2010 to December 2021. Three hundred and seventy-two cases of OCs were identified from the archive of three medical centers in Riyadh; one hundred and forty-nine (40%) cases were retrieved from Prince Sultan Military Medical City. The mean age of all OCs was 32 years (range 2-90), with 225 (60.4%) cases occurring in males. There was an almost equal distribution of OCs between the maxilla (47.0%) and the mandible (53.0%). The apical radicular cyst (ARC) accounted for half of the cases, followed by dentigerous cyst (DC) (29.3%) and odontogenic keratocyst (OKC) (14.2%). Enucleation was the most common treatment modality (52.8%), followed by excision (35.0%). Thirteen cases showed recurrence: one ARC, four DCs, and eight OKCs. This is the first large multicenter study of OCs in Riyadh, Saudi Arabia. All three centers showed that ARC was the most common, followed by DC and OKC.

Evaluation of Cone-beam Computed Tomography to differentiate Odontogenic Periapical Cysts and Granulomas

Background: Cone-beam Computed Tomography is a useful diagnostic tools for the detection of odontogenic peripheral cysts and granulomas.&#x0D; Objective: The purpose of the present study was to assess the accuracy of CBCT for diagnosing periapical cyst and granuloma.&#x0D; Methodology: This cross-sectional study was conducted from February 2017 to November 2017. Following inclusion and exclusion criteria consecutive patients who were consult in the department of oral and maxillofacial surgery of Dhaka Dental College Hospital and Bangabandhu Seikh Mujib Medical University for periapical infection was selected. Only those patients showing a periapical lesion of minimum 5 mm size was included in the study subject. Intra-oral periapical radiograph showing criteria was presence of apical radiolucency of 5 mm, corticated borders and displacements of roots. The CBCT images were done for those patients. The following features were documented on CBCT like location at the apex of involved tooth, well defined corticated border, shape is curved or circular, internal structure of lesion is radiolucent, displacement and resorption of the roots of adjacent teeth with a curved outline and perforation of cortical plate. Histopathological specimens were obtained for microscopic examination. The findings of histopathological examinations were correlated with the findings of CBCT.&#x0D; Results: Out of 50 subjects, 41(82.0%) subjects were diagnosed as cyst and 9(18.0%) subjects were as granuloma. Postoperative histopathology revealed 37 out of 41 were cysts and 4 were granulomas. Out of 9 granulomas 3 were cysts and 6 were granulomas. In this study we found the PPV 90.2439 and NPV 66.66. Diagnostic Accuracy was measured by calculating TP, TN and total population. The accuracy was 86%.&#x0D; Conclusion: In conclusion Cone-beam Computed Tomography has high accuracy of CBCT for diagnosing periapical cyst and granuloma.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):171-174

Non surgical management of a large periapical cyst like lesion using metapex, a three year followup - A case report

This case report describes the non - surgical management of a large periapical lesion using Metapex as a intracanal dressing and root canal therapy. Periapical lesions usually develop in non-vital teeth as a result of chronic aggression by the pathogenic microorganisms into the root canal which may appear as radiolucent in periapical radiographs. Treatment of such lesions usually varies from non-surgical and surgical means depending on the individual. In the era of minimally invasive, dentistry, non-surgical endodontic approach has been highly recommended in the periapical healing. This case report shows the healing of large periapical lesion using metapex as intracanal medicament at various time intervals followed by root canal therapy.

Association between Clinical/Radiographic Characteristics and Histopathological Diagnoses of Periapical Granuloma and Cyst.

The aim of this study was to determine the association between clinical/radiographic characteristics and histopathological diagnoses of periapical granuloma and cyst obtained from the teeth treated with endodontic microsurgery. The clinical, radiographic (periapical and cone-beam computed tomography), and histopathological data were collected from patients' dental records of endodontic microsurgery on the teeth with periapical lesions. These lesions were histopathologically diagnosed as either granuloma or cyst, at the Endodontic Clinic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand, from 2016 to 2021 according to inclusion and exclusion criteria. The data were analyzed using bivariate analysis and a multinomial logistic regression at a significance level of p-value less than 0.05. A total of 83 patients (58 females and 25 males) with an average age of 45 to 49.5 years old met the criteria including 68 periapical granulomas (81.9%) and 15 periapical cysts (18.1%). A periapical lesion involving multiple teeth in a periapical radiograph was significantly associated with the histopathological diagnosis of periapical cyst (p < 0.05). Such periapical lesion was six times more likely to be periapical cyst than periapical granuloma. A significant factor for predicting periapical cyst from periapical granuloma was the presence of a periapical lesion with multiple-teeth involvement in a dental radiograph.

Cone Beam-computed Tomography in the Evaluation of Post-operative Bone Healing of Jaw Cysts—A Retrospective Study

Background: Volumetric measurements are used for evaluating dimensions of bone lesions including periapical pathosis, cysts, and tumours, which help to assess the reduction in cystic volume and treatment outcome. Aims: To evaluate the three-dimensional radiographic variation of bone healing over time in jaw cysts after surgical therapy and to check the correlations between these variations. Materials and Method: A retrospective study with 25 pre- and post-treatment Cone Beam-Computed Tomography [CBCT] volumes of patients 18–69 years of age from December 2018 to December 2019 to evaluate the healing process in all three dimensions. These included post-treatment Odontogenic Keratocyst at 44% (n = 11); dentigerous cysts at 36% (n = 9) and Periapical cysts at 20% (n = 5). The post-treatment scans were done after a duration of 6 months, and a 6-point Cone Beam-Computed Tomography Peri-Apical Index (CBCTPAI) scale was used for grading the lesions. Results: SPSS software version 3; Paired t test and Pearson’s coefficient bivariate analysis were utilized to correlate the dependent and the independent variables with a P value of 0.05. The mean difference between pre- and post-operative cystic volume was 22.976 ± 7.809. The mean and standard deviation (SD) done by CBCTPAI scale was 70.728 ± 11.144 for pre-operative cystic measurement and 3.880 ± 0.489 for post-operative cystic volume, with a statistically significant value. A positive significant correlation was found in dependent and independent variables. Conclusions: CBCTPAI helps to assess the reduction in cystic volume and shape of jaw cysts which is essential for immediate and excellent surgical treatment and adequate follow-up.

Radicular cyst management due to endodontic failure – a case study

Radicular cysts, also known as periapical cysts, are the most prevalent cysts affecting both the maxilla and mandible. They arise from epithelial residues in the periodontal ligament as a result of inflammation. In the present case, a 17-year-old male patient reported with pain and swelling in the upper front teeth region for the past 1 year which was diagnosed to be a radicular cyst in relation to 12 which was previously root canal treated. The treatment involved enucleation of the cyst and extraction of 12. The patient has no pain or other symptoms and is currently attending follow-up appointments following the procedure. This case report explains the process and treatment of the radicular cyst in this patient in detail.

Types, Complications, and Prognosis of Inflammatory and Developmental Odontogenic Cyst

In general, odontogenic cysts might have an inflammatory or developmental origin. The review study aims to increase understanding of the various categories of odontogenic cysts by describing their primary characteristics, consequences, treatments, and prognoses of lesions. Different types of developmental odontogenic cysts are the dentigerous cyst, eruption cyst, odontogenic keratocyst (OKC), orthokeratinized odontogenic cyst (OOC), gingival cyst (adult and new-born), lateral periodontal cyst (LPC), glandular odontogenic cyst, and calcifying odontogenic cyst (COC). Periapical or lateral radicular cysts, residual cysts, and paradental cysts are forms of inflammatory odontogenic cysts. The mandible and maxilla are affected by these inflammatory lesions. The most prevalent developmental odontogenic cysts were dentigerous cysts and OKC. Most developmental cysts reported rare recurrence and excellent prognosis except for glandular odontogenic cysts (30 to 55% recurrence) and OKC (30%). Glandular odontogenic cysts, OKC, and COC have the propensity to behave aggressively and recur frequently compared to others. Although most inflammatory cysts are asymptomatic and benign, because of their continuous growth, these lesions have the potential to become destructive because they damage and infect the nearby bone. Malignant transformation has been reported in periapical and residual inflammatory cysts. As a result, they should be properly diagnosed and treated. All inflammatory cysts have a favorable prognosis.

Radicular cyst in primary dentition showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features: An immunohistochemical study

Radicular cyst in primary dentition showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features: An immunohistochemical study