Pericoronal Radiolucency Research Articles

Dentigerous cyst of inflammatory origin—a diagnostic dilemma

Odontogenic cysts commonly encountered in dental practice are the radicular cysts and dentigerous cysts. Apart from the developmental origin of dentigerous cysts, an inflammatory origin has also been suggested. It has been reported that inflammation progressing from the root apex of the deciduous tooth brings about development of the dentigerous cyst around the unerupted permanent tooth. The aim of the present article is to report 4 additional cases of dentigerous cyst believed to be of inflammatory origin and to highlight the diagnostic dilemma in segregating both the entities. The 4 cases were of patients with a mixed dentition with the pathology related to the deciduous tooth present. Radiographically, pericoronal radiolucency was seen attached at the cementoenamel junction of impacted tooth and in continuation with lamina dura of deciduous tooth. Microscopically, the cystic cavity was lined by reduced enamel epithelium like lining, which was hyperplastic to anastomosing in areas in few cases. This study proposes the predicament in accurately diagnosing such cases.

Imaging evalution of the gingival fibromatosis and dental abnormalities syndrome.

The purpose of this study was to evaluate the dentomaxillofacial imaging features of one family affected by the gingival fibromatosis (GF) and dental abnormalities (DA) syndrome. Conventional radiographs (periapical and panoramic) and cone beam CT (CBCT) were performed in nine members of this family: four were affected by the syndrome and five were not. The four affected members demonstrated mild generalized GF in association with DA, including hypoplastic amelogenesis imperfecta, intrapulpal calcifications, delay on tooth eruption and pericoronal radiolucencies in unerupted teeth. None of these oral changes were identified in the five unaffected members. All nine members presented alterations in the paranasal sinuses and mucosal thickening of the maxillary sinus was the most common finding. Family members not affected by the syndrome showed similar alterations in the paranasal sinuses and CBCT was useful to characterize the dentomaxillofacial features of this new syndrome associating GF and DA.

Odontogenic fibroma like lesions: Clinico-pathological considerations

Radiographically enlarged dental follicle is observed in many cases associated with delayed tooth eruption. Pericoronal radiolucencies are seen in neoplasms (odontogenic fibroma), developmental anomalies (regional odontodysplasia), hamartomatous lesions (odontogenic epithelial hamartoma), opercula of third molars, in follicles associated with unerupted third molars, regional odontodysplasia, in dental follicles around impacted teeth of enamel dysplasia with hypodontia syndrome and amelogenesis imperfecta cases with multiple impactions. Interestingly, operculum and the follicle of these lesions histopathologically are identical to odontogenic fibroma (WHO) type. However, the lack of universally accepted clinic-pathological features for such lesions may hinder their recognition. We report a case of regional odontodysplasia wherein (in which) the impacted canine is surrounded by radiolucency measuring about 1.5–2 cm, histopathologic examination of the excised opercula revealed features reminiscent of central odontogenic fibroma (WHO type) with an abundance of odontogenic epithelium and calcifications. The aim of this paper is to discuss various lesions exhibiting histopathological features similar to odontogenic fibroma, as awareness of the clinicopathological features of such lesions is very important to plan proper treatment.

Histopathologic changes in soft tissue associated with radiographically normal impacted third molars

The incidence of impacted or embedded third molars accounts for approximately 98%. Since 1948, there are studies reporting pathological changes in an asymptomatic dental follicle. Controversy still exists for removal of asmptomatic impacted teeth. Hence, this study was performed to histologically evaluate soft tissue pathosis in the pericoronal tissues of impacted third molars with pericoronal radiolucency measuring up to 2.5 mm on orthopantomographs. Forty-one asymptomatic impacted third molars with follicular space of up to 2.5 mm on radiographs were included. The disimpacted teeth and the follicular tissues were obtained for histological examination. Age of the patients ranged from 14 to 25 years. Of 41 tissues evaluated, histopathological reports of 18 follicles were suggestive of dentigerous cyst, two follicles showed odontogenic keratocyst, one follicle each of calcifying epithelial odontogenic cyst, ameloblastoma-like proliferation, odontogenic myxoma and odontogenic fibroma. This study showed 58.5% of asymptomatic cases with definite pathological changes. Hence, thorough clinical and radiographic examination should be carried out for all impacted third molars and the dental follicular tissue should be submitted for histopathological evaluation.

Acute inflammation in horizontal incompletely impacted third molar with radiolucency in the elderly

Although radiolucency has been shown as a risk of infection, the poorly understood effects of aging on radiolucency correlate with acute pericoronitis, which has a high risk of infection extending any complications. We reviewed the records of 346 consecutive patients aged more than 41 years to evaluate whether pericoronal radiolucency below the crown in mandibular horizontal incompletely impacted third molars is related to acute inflammation. The frequency of acute inflammation in teeth with pericoronal radiolucency below the crown was similar to that in teeth without; however, the odds ratio of acute inflammation exhibited in women aged more than 61 years compared to women aged 41-50 years was 9.77 (95% confidence interval [CI]: 1.67-57.29; P < <0.05), and in women aged more than 61 years compared to women aged 51-60 years was 26.25 (95% CI: 2.94-234.38; P < 0.01). The odds ratio of severe acute inflammation exhibited in men aged more than 61 years compared to men aged 41-50 years was 16.67 (95% CI: 1.76-158.27; P < 0.01). These odds ratios indicate an association of acute pericoronitis, including the severe forms of acute inflammation that result from pericoronitis, with pericoronal radiolucency below the crown in the elderly.

Oral anomalies associated with the oculocerebrorenal syndrome of Lowe: Case report with multiple unerupted teeth and pericoronal radiolucencies

The oculocerebrorenal syndrome of Lowe (OCRL) is a rare X-linked recessive disorder, chiefly characterized by ocular involvement, mental retardation, and kidney disease. A literature review is provided, detailing the diversity of oral anomalies associated with the OCRL syndrome. Reported abnormalities include delayed tooth eruption, odontogenic cyst formation, and constricted dental arches. In addition, we present an unusual case of an 18-year-old male affected with the OCRL syndrome and fetal alcohol syndrome. The oral radiographic examination was significant for multiple impacted permanent teeth, many with pericoronal radiolucencies, and an underdeveloped mandible.

Case Reports of a New Syndrome Associating Gingival Fibromatosis and Dental Abnormalities in a Consanguineous Family

Gingival fibromatosis (GF) is characterized by fibrotic enlargement of the gingiva that can be inherited as an isolated trait (named hereditary gingival fibromatosis) or as a component of a syndrome. This article reports one kindred affected by a syndrome characterized by GF associated with dental abnormalities (DA) including generalized thin hypoplastic amelogenesis imperfecta (AI). To characterize the pattern of inheritance and the clinical features, 70 family members were examined. Hematoxylin and eosin staining, immunohistochemistry, and scanning electronic microscopy (SEM) were performed to identify the alterations on gingiva, teeth, and dental follicles. Examination of the family pedigree demonstrated multiple consanguineous first-cousin marriages and an autosomal recessive trait of inheritance. Four members demonstrated mild GF in association with DA, including generalized thin hypoplastic AI, intrapulpal calcifications, delay of tooth eruption, and pericoronal radiolucencies involving unerupted teeth. One of those four patients also had mental retardation (MR). MR as an isolated feature was observed in six members, whereas isolated GF was found in one individual. A combination of gingivectomy and gingivoplasty followed by regular dental procedures were performed in these patients. Histologic examination of the gingival enlargement revealed a dense connective tissue containing myofibroblasts, islands of odontogenic epithelium, and calcified psammomatous deposits, which resembled cementicle-like structures by SEM. Pericoronal lesions also showed calcified psammomatous deposits in association with islands of odontogenic epithelium. Enamel ultrastructure analysis revealed normal surface alternating with irregular and porous areas. To the best of our knowledge, these cases represent a new syndrome within the spectrum of those including GF.

Correlation of the Radiographic and Morphological Features of the Dental Follicle of Third Molars with Incomplete Root Formation

The objective of this study was to determine the correlation of the radiographic and morphological features of the dental follicle of unerupted third molars with incomplete root formation. A cross-sectional study was carried out with 56 patients (105 teeth) aged 13 to 24 years. Panoramic radiography was used to determine the stage of root formation to locate and measure pericoronal radiolucency. The width of the dental follicle ranged from 0.0 to 4.0 mm, the distal face being the one most frequently involved, and stage 7 of root formation showing the highest incidence. An inactive enamel reduced epithelium and inactive epithelium remnant also showed a high incidence. Dense connective tissue showed a high incidence, chronic inflammation was infrequent and calcification was a common finding. There was a significant association between the progression of the rhizogenesis and the transformation of the enamel reduced epithelium into a stratified squamous epithelium. No significant association was found between rhizogenesis and the other morphological findings or between the latter and the width of the pericoronal space. It was concluded that there was no clinically significant correlation between the radiographic and morphological features. Every asymptomatic unerupted third molar should be followed up and the follicular tissue analyzed.

Transmigrant impacted mandibular canines: A retrospective study of 15 cases

Transmigration of mandibular canines across the midline is rare. The authors describe the clinical and radiologic characteristics of patients with transmigrant impacted mandibular canines. The authors conducted a retrospective observational study of 14 patients with transmigrant canines. They diagnosed transmigrant canines in all of the patients on the basis of the clinical and radiological findings, and they obtained the data from the patients' case histories and panoramic radiographs. They considered a canine to be transmigrant when one-half or more of its length crossed the mandibular midline. There were 15 transmigrated canines in 14 patients aged 16 to 60 years. Primary canines were present in 10 cases. One case involved a pericoronal infection, two involved supernumerary teeth, one was associated with an odontoma, and in two a pericoronal radiolucency was seen that was compatible with a follicular cyst. Treatment consisted of surgical extraction for eight patients, and periodic clinical and radiologic follow-up visits for six patients. Radiographic examination is necessary to diagnose impacted transmigrant canines, among other anomalies. Surgical extraction is the treatment of choice for patients with transmigrant canines involving associated pathology. In some cases, the management of asymptomatic impaction can be limited to periodic clinical and follow-up visits. The absence of the permanent canine within the arch beyond the normal time of eruption suggests the presence of an impacted canine. A transmigrant canine may develop an associated pathology.

Early soft tissue pathosis associated with impacted third molars without pericoronal radiolucency

Objectives. This study was performed to histologically evaluate soft tissue pathosis in pericoronal tissues of impacted third molars that did not exhibit pathologic pericoronal radiolucency. Study design. One hundred impacted third molars without evidence of abnormal pericoronal radiolucency (follicular space <2.0 mm) were removed for reasons other than participation in this study, and the pericoronal tissues were submitted for histopathologic examination. Specimens were fixed and processed routinely and were stained with hematoxylin and eosin before independent evaluation by each of 2 oral pathologists. A subset of both diseased and healthy tissues underwent additional evaluation for the presence of proliferating cell nuclear antigen (PCNA) for assessment of cellular activity. Results. Of the specimens submitted, 34% showed squamous metaplasia suggestive of cystic change equivalent to that found in dentigerous cysts. Soft tissue pathosis was significantly higher in patients over 21 years of age ( P = .001). Five of 8 diseased specimens demonstrated PCNA uptake, whereas none of 10 healthy specimens were PCNA positive. Conclusions. These findings suggest that radiographic appearance may not be a reliable indicator of the absence of disease within a dental follicle. We conclude that the incidence of soft tissue pathologic conditions is higher than generally assumed from radiographic examination alone. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:402-6)

PERICORONAL RADIOLUCENCIES WITH AND WITHOUT RADIOPACITIES

Pericoronal radiolucencies are common entities of the jaws that account for about 15% to 20% of all biopsy specimens. They are usually slow-growing, benign entities that involve odontogenic epithelium and the crown of a nonerupting tooth. Many lesions develop early in life and are detected during routine radiographic examination. Others are found in later years when a patient presents with a slow-growing swelling. The dentist is often the first provider to encounter these conditions. Thus, he or she must be familiar with their appearance and understand the proper management required.

歯原性嚢胞から発生したと考えられる下顎骨中心性癌の１例

This is a case report of a patient with an intraosseous carcinoma of the mandible. The patient was a 49-year-old female with a chief complaint of right mandibular angle swelling. The right retromolar pad was tender and slightly swollen, whereas the overlying mucosa was intact. The orthopantomograph revealed an impacted wisdom tooth with an associated pericoronal radiolucency. The clinical diagnosis was an odontogenic cyst. The impacted wisdom tooth was therefore removed and marsupialization was performed. The histological diagnosis was an infected dentigerous cyst. Three months later, her right mandibule became swollen again. The histological diagnosis was hyperplasia of the lining epithelium with severe dysplasia. However, this time we hiopsied the deep sites of the cavity, and obtained a pathological diagnosis of squamous cell carcinoma.These results indicated that the lesion was an intra-osseous squamous cell carcinoma arising from an odontogenic cyst.