Periapical Radiolucent Lesions Research Articles

Microbial flora of root canal–treated teeth associated with asymptomatic periapical radiolucent lesions

This study aimed to investigate the composition of microflora in endodontically treated teeth associated with asymptomatic periapical lesions in southern Chinese patients. Twenty-four teeth which had received nonsurgical root canal treatment more than 4 years previously, and which presents an acceptable coronal restoration with a periapical radiolucent area, were re-treated nonsurgically. Bacteriological samples were obtained after removal of the old root canal filling. The samples were inoculated on enriched trypticase soy agar and four selective media for incubation at 37 degrees C in both a carbon dioxide-enriched atmosphere and anaerobically. Eighteen teeth that had received gutta-percha root canal fillings were grouped for analysis, 12 (66.7%) of which contained cultivable microorganisms. The total colony forming units per ml of transport medium ranged from 0 to 2.3 x 10(5). The number of bacterial genera recovered ranged between 0 and 6, with facultative gram-positive cocci being the most prevalent group of bacteria isolated. Facultative anaerobic bacteria were present in all, whereas strict anaerobic bacteria were found in 3 out of the 12 teeth with positive growth. The size of the periapical rarefaction did not show any relationship with the quantity of microorganisms recovered. Coagulase-negative staphylococci, streptococci and Pseudomonas aeruginosa were most frequently isolated in this group of patients. The possible origin of these organisms is discussed.

Hemangioma of the Mandible Presenting as a Periapical Radiolucency

A case of an hemangioma of the mandible in a 53-yr-old female patient is presented. The lesion was removed, and no atypia or mitotic cells were found. The excision was curative, and the overall prognosis was excellent. A differential diagnosis of radiolucent periapical lesions of the mandibular symphysis is presented.

Persistent periapical radiolucencies of root-filled human teeth, failed endodontic treatments, and periapical scars

Objective. This report describes 6 cases that demonstrate persistent periapical radiolucent lesions after conventional root canal treatment. Study Design. Six teeth that had conventional root canal treatment or re-treatment with nonresolving periapical radiolucencies underwent periapical surgery. Biopsies were obtained and analyzed descriptively by correlative light and transmission electron microscopy for general features and microbial findings. Results. Three findings were identified: periapical lesions with persisting infection in the apical root canal system (2 cases); a cyst (1 case); and periapical healing by scar tissue formation (2 cases). Conclusions. These results confirm previous observations that associated factors in the failure of endodontic treatment include persistent intraradicular infection and periapical cysts. In addition, unresolved periapical radiolucencies may occasionally be due to healing by scar tissue, which may be mistaken as a sign of failed endodontic treatment. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:617-27)

Infiltrate of chronic lymphocytic leukemia appearing as a periapical radiolucent lesion

This report presents a case of a mandibular premolar with a vital pulp and a periapical radiolucent lesion in a patient with a history of chronic lymphocytic leukemia. Biopsy of the lesion revealed an infiltrate of chronic lymphocytic leukemia in the mandible, which is quite rare. This lesion may have portended a worsening of the patient's condition and downgrading of her prognosis.

Asymptomatic Periapical Radiolucent Lesion Found in an Area of Previous Trauma

The case of an anterior mandibular radiolucent area, which unexpectedly yielded salivary gland tissue, is described. Salivary gland depressions in the posterior mandible are readily recognized because of their almost pathognomonic radiographic appearance. A salivary gland inclusion in the anterior mandible in the proximity of teeth may create a diagnostic dilemma where superimposed periapical pathosis is present. The clinical importance lies in the recognition and appropriate treatment of the lesion. For the anterior salivary gland inclusion, a biopsy and a microscopic examination provide the most reliable diagnosis.

A dentist's dilemma: Nonsurgical endodontic therapy or periapical surgery for teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion

First presented is a brief review of nonsurgical versus surgical treatment of radicular cysts. This is followed by a consideration of the use of radiographs for differential diagnosis of periapical radiolucent lesions. Some of the nonendodontic local and systemic lesions that can occur periapically are then presented. Next examined are the fallibilities of pulp vitality testing methods. The need for histopathologic examination of periapical lesions is the subject of the next discussion. The dentist's dilemma is then examined: should teeth with apparent pulpal pathosis and an associated periapical radiolucent lesion have routine surgical treatment including biopsy or should they be treated nonsurgically and have periodic follow-ups? A possible resolution of this dilemma is the final consideration.

Comparison of prophylactic and on-demand diflunisal for pain management of patients having one-visit endodontic therapy

To determine whether the posttreatment prophylactic use of diflunisal (Dolobid 500) would be more effective than the on-demand use of diflunisal in reducing endodontic posttreatment pain, the current open-label, randomized study was undertaken. After one-visit nonsurgical endodontic therapy, 100 patients with asymptomatic teeth having either vital-inflamed pulp, pulpal necrosis, or pulpal necrosis with periapical radiolucent lesion were randomly given either prophylactic diflunisal (two tablets immediately at the conclusion of the visit, then four tablets to be taken in the schedule of one every 8 to 12 hours for pain if needed) or on-demand diflunisal (same dosage schedule; pills to be taken only if needed). The outcome showed that compared to the on-demand usage, the posttreatment prophylactic administration of diflunisal resulted in a statistically significant reduction in the number of episodes of endodontic posttreatment pain that required analgesic intervention. It appears from the results of this study that the posttreatment prophylactic use of diflunisal is significantly more effective than the on-demand usage of diflunisal in reducing endodontic posttreatment pain for one-visit endodontic therapy with all types of originally asymptomatic endodontic conditions. Further studies are necessary to determine whether pretreatment prophylactic deflunisal would be more effective, and also the effectiveness of prophylactic diflunisal in reducing posttreatment pain in presenting symptomatic cases and for cases treated in multiple visits.

A comparison of erythromycin and cefadroxil in the prevention of flare-ups from asymptomatic teeth with pulpal necrosis and associated periapical pathosis

In a previous study by our group with patients having asymptomatic teeth with pulpal necrosis and an associated periapical radiolucent lesion (PN/PL), it was shown that prophylactic administration of penicillin V or erythromycin (high-dose, 1-day regimen) resulted in a low incidence of flare-up (mean = 2.2%) and a low incidence of swelling and pain not associated with flare-up. No hypersensitivity responses occurred, and gastrointestinal side effects were found primarily with the erythromycins. To ascertain whether a single-dose administration of a long-acting 1-gm tablet of the cephalosporin antibiotic cefadroxil would result in a similar outcome, the present study was undertaken with 200 patients having quiescent PN/PL. The patients were randomly given either cefadroxil or erythromycin (base or stearate). Evaluations of flare-up were done 1 day, 1 week, and 2 months after endodontic treatment. A 2.0% flare-up incidence was found, with no statistically significant differences for cefadroxil (1.0%), stearate (2.0%), or base (4.0%). No hypersensitivity responses occurred. Gastrointestinal side effects were found primarily with the erythromycins (19.0%). The results showed that a 1-gm, single-dose regimen of cefadroxil was as effective as erythromycin and penicillin in preventing flare-ups and serious sequelae. A comparative analysis of the data from our first study (no peritreatment antibiotics) and the pooled data from our last three investigations (including the current trial) showed that peritreatment antibiotic coverage significantly reduced flare-ups and serious sequelae after endodontic treatment of asymptomatic PN/PL ( p < 0.001).

A prospective randomized trial on efficacy of antibiotic prophylaxis in asymptomatic teeth with pulpal necrosis and associated periapical pathosis

A recent study from aprivate endodontic practice compared “prophylactic” antibiotic (high-dose, 1-day) regimens of penicillin V and erythromycin (base or stearate) for patients who had asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL). A 2.2% flare-up incidence was found, with no statistically significant differences for penicillin (0.0%), base (2.9%), and stearate (3.8%). No hypersensitivity responses occurred, and gastrointestinal side effects were found were found primarily with the erythromycins (12.4%). To ascertain whether or not similar results would occur with student operators in a dental school clinic population, the current study was undertaken. One-hundred ninety-five patients with quiescent PN/PL were randomly given either penicillin V or erythromycin (base or stearate). A 2.6% flare-up incidence was found, with no statistically significant differences for penicillin (3.1%), base (1.5%), and stearate (3.1%). No hypersensitivity responses occurred, and GI side effects were found primarily with the erythromycins (17.7%). As can be seen, the results were very similar to those of the recent endodontic practice study. Hence, it can be concluded that the results of the previous endodontic practice study were not unique to any one clinician or method. A comparison was also made between the “prophylactic” penicillin group of the current study and the placebo control group of our previous dental scholl clinic, student operator study (in which the methods, population, and regimen were almost identical to those of the current study). The results showed that the “prophylactic” penicillin group had significant fewer flare-ups and non-flare-up-associated swelling and pain that did the placebo group. In view of these findings and those from studies from the literature in which “prophylactic” anbiotics were not used, it is our opinion that the antibiotic regimens used in the current study should be a component of clinical endodontic therapy for quiescent PN/PL.

Prophylactic penicillin versus penicillin taken at the first sign of swelling in cases of asymptomatic pulpal-periapical lesions: A comparative analysis

In order to ascertain whether the time of administration of an antibiotic affects the occurrence of flare-ups and non-flare-up-associated swelling and pain, an analysis of components of two prospective endodontic studies on patients having asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL) was done. In the first study, prophylactic penicillin was used. In the second study, penicillin (or erythromycin for patients allergic to penicillin) was taken by the patient at the first sign of swelling (patient controlled). For the patient-controlled group, as compared to the prophylactic penicillin group, there was statistically significantly more (1) incidence of flare-ups ( p < 0.05); (2) non-flare-up-associated swelling ( p < 0.001); (3) non-flare-up-associated pain ( p < 0.05); (4) combined moderate and severe pain ( p < 0.05); (5) combined incidence of flare-ups and swelling ( p < 0.001); (6) combined incidence of flare-ups and pain ( p < 0.01); and (7) combined incidence of flare-ups and both swelling and pain ( p < 0.001). There were statistically significantly fewer instances of (1) no patient post-treatment problems ( p < 0.001) and (2) combined mild pain and no patient post-treatment problems ( p < 0.001). Hence, for asymptomatic teeth with PN/PL, it appears that prophylactic antibiotics are preferable to antibiotics taken by the patient at the first sign of swelling.

Maintenance of pulp vitality following surgical removal of a symptomatic cementoma

A case is described of cementoma in the mandibular incisor area, accompanied by moderate symptomatology. An excisional biopsy was performed and the neurovascular supply to all of the mandibular incisors was apparently severed. Follow-up revealed that the lateral incisor pulps underwent necrosis with resulting periapical radiolucent lesions. Endodontic therapy in these teeth was completed successfully. The central incisor pulps, however, remained vital throughout the follow-up period of about 2 yr.

A prospective randomized trial comparing periapical instrumentation to intracanal instrumentation in cases of asymptomatic pulpal-periapical lesions

To clarify the divergent viewpoints with respect to method of instrumentation in asymptomatic teeth with pulpal necrosis and associated periapical radiolucent lesions (PN/PL), this prospective study was undertaken. The subjects were 106 patients with quiescent cases of PN/PL. Alternately, 53 had periapical instrumentation and 53 had intracanal instrumentation. Prophylactic antibiotics were not administered but the patients were told to take an antibiotic at the first sign of swelling. Flare-ups, non-flare-up-associated swelling and pain, and cases in which there were no postoperative problems were evaluated at 1-day, at 1 week, and at 2 months. A 6.6% incidence of flare-up was found with no statistically significant difference between periapical instrumentation (7.5%) and intracanal instrumentation (5.7%). A 27.4% incidence of swelling was found with no statistically significant difference between periapical instrumentation (24.5%) and intracanal instrumentation (30.2%). A 43.4% incidence of pain was found, with no statistically significant difference between periapical instrumentation (39.6%) and intracanal instrumentation (47.2%). When moderate pain and severe pain were combined, the incidence was 21.7%, with no statistically significant difference between periapical instrumentation (15.1%) and intracanal instrumentation (28.3%). An incidence of patients having no postoperative problems of 41.5% was found, with no statistically significant difference between periapical instrumentation (47.2%) and intracanal instrumentation (35.8%). When flare-ups were combined with swelling, the incidence was 34.0%, with no statistically significant difference between periapical instrumentation (32.1%) and intracanal instrumentation (35.8%). When flare-ups were combined with pain, the incidence was 50.0%, with no statistically significant difference between periapical instrumentation (47.2%) and intracanal instrumentation (52.8%). When flare-ups were combined with both swelling and pain, the incidence was 77.4%, with no statistically significant difference between periapical instrumentation (71.7%) and intracanal instrumentation (83.0%). When non-flare-up-associated mild pain was combined with the category of no postoperative problems, the incidence was 63.2%, with no statistically significant difference between periapical instrumentation (71.7%) and intracanal instrumentation (54.7%). A sign test analysis of the nine previous categories showed that periapical instrumentation was significantly better than intracanal instrumentation (8/9; p < 0.001). A review of similar cases showed that patients with whom periapical instrumentation was used had significantly better periapical healing than patients in whom the apex could not be negotiated. Hence, for patients with PN/PL without symptoms, it appears that periapical instrumentation is preferable to intracanal instrumentation.

Healing of a massive maxillary lesion

An unusually large radiolucent periapical lesion was treated successfully in spite of a considerable lack of cooperation on the part of the patient. An unusually large radiolucent periapical lesion was treated successfully in spite of a considerable lack of cooperation on the part of the patient.