Comparative evaluation of immunohistochemistry, histopathology and conventional radiography in differentiating periapical lesions.
OBJECTIVE
Periapical lesions often present differently on the radiograph resulting in a dilemma in the mind of the dentist to arrive at a final diagnosis. Although, histopathologic diagnosis has been used for confirmation of the true nature of periapical lesion, the concept of transformation of periapical granulomas containing epithelium without cystification into cyst remains controversial. The aim of this in vivo study was to evaluate the efficacy of conventional radiography and histopathology in differentiating periapical lesions in adjunct with immunohistochemical analysis.


OBJECTIVE
Periapical lesions often present differently on the radiograph resulting in a dilemma in the mind of the dentist to arrive at a final diagnosis. Although, histopathologic diagnosis has been used for confirmation of the true nature of periapical lesion, the concept of transformation of periapical granulomas containing epithelium without cystification into cyst remains controversial. The aim of this in vivo study was to evaluate the efficacy of conventional radiography and histopathology in differentiating periapical lesions in adjunct with immunohistochemical analysis.


METHODS
Thirty patients having large periapical radiolucency that do not heal successfully with routine endodontic therapy in relation to either maxillary or mandibular anterior teeth were selected for the study. Intraoral periapical radiographs were obtained and provisional diagnosis of the apical areas were made. Endodontic surgery was performed to enable histopathogical investigation. The histopathological interpretation was done to arrive at a final diagnosis and selected questionable granulomas were subjected for cytokeratin (CK-14) stain.


RESULTS
The histopathological profile of lesions consisted of 66.66% periapical granulomas, 10% cysts, 6.67% abscess and 16.67% granulomas with cystic potential. The radiographic and histopathologic correlation was found in only 30% of these cases. Strong CK-14 expression was observed in all five cases of periapical granuloma with cystic potential.


CONCLUSIONS
The radiographic diagnosis of periapical lesions remains inconclusive. Although histopathologic examination of periapical lesions gives true nature, the precise nature of subsets of periapical granulomas may be achieved with adjunct use of immunohistochemical markers.
Departments of Conservative Dentistry and Endodontics, P M N M Dental College and Hospital, Bagalkot, Karnataka, India.
Prahlad A
PA
Saraf
Departments of Conservative Dentistry and Endodontics, Bharathi Vidyapeeth Deemed University Dental College and Hospital, Wanlesswadi, Sangli, Maharashtra, India.
Sharad
S
Kamat
Departments of Oral and Maxillofacial Pathology, P M N M Dental College and Hospital, Bagalkot, Karnataka, India.
R S
RS
Puranik
Departments of Oral Medicine Diagnosis and Radiology, P M N M Dental College and Hospital, Bagalkot, Karnataka, India.
Surekha
S
Puranik
Departments of Oral and Maxillofacial Surgery, P M N M Dental College and Hospital, Bagalkot, Karnataka, India.
Suma P
SP
Saraf
Departments of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Shimla, Himachal Pradesh, India.
Bhanu Pratap
BP
Singh
Conventional radiography; Cytokeratin-14; Periapical lesions