Histopathological profile of surgically removed persistent periapical radiolucent lesions of endodontic origin.
OBJECTIVE
To determine the types of periapical lesions associated with root filled teeth with persistent periapical pathosis that required surgical treatment based on specific inclusion and exclusion criteria.


METHODS
Periapical lesions from a consecutive clinical sample of 100 patients were examined histopathologically to determine a definitive diagnosis.


RESULTS
Females were more represented (n = 56), the average age was 46.5 years and there were no age differences between gender or lesion type. A diagnosis of periapical granuloma was the most common finding with a similar number present in females (n = 40) and males (n = 37). A cyst was present in 18% of the cases with a majority of females (n = 12) represented in the sample. Evidence of foreign material, with an appearance consistent with endodontic sealer materials, was seen in 25 periapical granulomas, two cysts and one scar. Two periapical scars were seen, one had a history of apicectomy and amalgam root-end filling while the other was associated with extruded root filling material.


CONCLUSIONS
By using defined clinical inclusion and exclusion criteria a predictable clinical diagnosis of a persistent periapical lesion due to endodontic origin can be reliably made. Periapical granulomas and cysts were the most common periapical lesions of endodontic origin associated with persistent periapical pathosis with the overall incidence of periapical cysts similar to previous studies. The presence of endodontic material in a high proportion of periapical lesions suggests a cause-effect association with the inference that clinicians should employ canal preparation techniques that limit apical extrusion of material.
Love
R M
RM
Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand. robert.love@dent.otago.ac.nz
Firth
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001047:Apicoectomy / Q000009:adverse effects; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000601:surgery; D003723:Dental Amalgam / Q000009:adverse effects; D005260:Female; D015745:Granuloma, Foreign-Body / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010482:Periapical Abscess / Q000209:etiology / Q000473:pathology / Q000601:surgery; D010483:Periapical Diseases / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D010484:Periapical Granuloma / Q000209:etiology / Q000473:pathology / Q000601:surgery; D011842:Radicular Cyst / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012184:Retrograde Obturation / Q000009:adverse effects; D012387:Root Canal Filling Materials / Q000009:adverse effects; D012390:Root Canal Therapy / Q000009:adverse effects*; D013524:Surgical Flaps; D055815:Young Adult
D012387:Root Canal Filling Materials; D003723:Dental Amalgam