• Maxillofacial Plastic and Reconstructive Surgery
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• v.23 no.3
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• pp.232-237
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• 2001

The purpose of this study was to find the clinical features of periapical lesions. A total of 130 periapical lesions which were obtained from biopsy and diagnosed histopathologically as periapical cyst, periapical abscess, and periapical granuloma at the Department of Dentistry in Hanyang University Hospital were throughly analysed according to the distribution and incidence of age, sex, location, and so on. The following results were obtained : 1. Out of 130 periapical lesions, 88 cases(67.7%) were periapical cysts, 30 cases(23.1%) were periapical abscesses, and 12 cases(9.2%) were periapical granulomas. 2. The periapical lesions occurred most frequently in the third decade, and followed by the fourth, fifth, sixth, and second decade. The periapical cysts occurred most frequently in the third decade(26.1%), the periapical granulomas in the fourth decade(33.3%) the periapical abscesses in the sixth decade(26.7%). 3. The periapical lesions were more frequent in men than in women with the ratio of men to women of 1.4 : 1. The radio of men to women of periapical cysts was 1.6 : 1, that of periapical granulomas was 0.5 : 1, and that of periapical abscesses was 1.3 : 1. 4. The periapical lesions were more frequent in maxilla than in mandible with the ratio of 1.2 : 1. The ratio of maxilla to mandible of periapical cysts was 1.5 : 1, that of periapical granulomas was 0.5 : 1, that of periapical abscesses was 1 : 1. 5. The most commonly involved location of the periapical lesions was maxillary anterior teeth(40.8%), and followed by mandibular molars, mandibular premolars, and mandibular anterior teeth and maxillary molars. The most frequent location of the periapical cysts was maxillary anterior teeth(48.9%), that of periapical granulomas was mandibular molars(50.0%), that of periapical abscesses was mandibular molars(40.0%).

• Restorative Dentistry and Endodontics
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• v.20 no.1
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• pp.55-70
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• 1995

Periapical lesions develop as a result of immunopathologic response to irritants from infected root canal systems. Removal of these irritants from the root canal system and sealing the root canal space may induce he31ing of the periapical lesions. 83 periapical lesions diagnosed as periapical abscess, periapical granuloma, chronic nonspecific inflammation, fibrosis and periapical Cyst were evaluated for the distribution of immunoglobulin containing cells. The influence of the state of root canal treatment on the distribution of immunoglobulin containing cells has evaluated. All lesions were divided into a group with no treatment, a group with canal enlargement, a group filled with gutta percha, and a group filled with Vitapex(calcium hydroxide). The distribution of immunoglobulin-containing cells according to the presence of pain and fistula was also evaluated. The following results were obtained. 1. Statistically significant difference in the distribution of immunoglobulin-containing cells among periapical abscess, periapical granuloma, chronic nonspecific inflammation/fibrosis and periapical cyst were found.(Kruskal-Wallis analysis, P<0.05) The number of immunoglobulin-containing cells in fibrosis was remarkably lower than that of periapical abscess, granuloma and cyst. 2. IgM and IgA containing cells were predominantly observed in periapical abscesses and periapical cysts, respectively. 3. All periapical lesions showed a large number of IgG containing cells followed by IgM, IgA and IgE containing cells. 4. There was a decrease in all Ig-containing cells in the group with canal filling compared to groups without treatment or with enlargement. That is, there is a decrease in Ig-containing cells as treatment progresses. 5. No significant correlation existed between the presence of pain and fistula and the distribution of immunoglobulin containing cells in periapical lesions.(t-test) Results appear to support that immune response are actively involved in the development and progress in periapical lesions. The fact that distribution of immunoglobulins differ according to the state of endodontic treatment suggests that root canal treatment may alter the humoral immune response of the periapical lesions.

• Restorative Dentistry and Endodontics
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• v.17 no.1
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• pp.55-68
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• 1992

Periapical lesions are developed as a result of inflammatory response to irritants from root canal system. Clinicians remove these irritants from root canal system and seal the root canal space to induce healing of the periapical lesions. Immunopathologic responses may play an important role in development and progression of periapical lesions and periapical lesions contain immunocompetent cells. The purposes of the present study were to analys and to compare the distribution of the immunocompetent cells in the human periapical lesions according to the stage of endodontic treatment using indirect immunoperoxdase technique. Obtained 94 human periapical lesions were devided into four groups: Group 1 : no endodontic treatment(28 samples) Group 2 : root canal enlarged and irrigated(28 samples) Group 3 : root canal filled(29 samples) Group 4: unknown(9 samples) Monoclonal antibodies to examine target cells were UCHL-1 for T lymphocytes(1 : 200, Dakopatt, Denmark), L26 for B lymphocytes(1 : 200, Dakopatt, Denmark), OPD4 for helper T lymphocytes(l : 200, Dakopatt, Denmark) and alpha-1-antichymotrypsin for macrophages(l : 2000, Dakopatt, Denmark). The following results were obtained : 1. All the periapical lesions studied were infiltrated by T lymphocytes, plasma cells, B lymphocytes, and macrophages. T lymphocytes were more infiltrated than B lymphocytes, and B lymphocytes and macrophages were less infiltrated than T lymphocytes and plasma cells(P<0.05 : Oneway ANOVA test). 2. In untreated group and canal irrigated and enlarged group of all the periapical lesions, helper T lymphocytes were predominently infiltrated(P>0.05 : Oneway ANOVA test). 3. In canal filled groups of all lesions except periapical cyst, plasma cells were predominently infiltrated. But, in canal filled group of periapical cyst, helper T lymphocytes were the predominent cells(P>0.05 : Oneway ANOVA test). The above results shows that the immunologic responses play important role in pathogenesis of periapical lesions and the immunologic response involved undergoes certain changes after endodontic therapy.

• Restorative Dentistry and Endodontics
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• v.17 no.1
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• pp.83-94
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• 1992

This study was executed to measure the biosynthesis of arachidonic acid metabolic products in chronic periapical lesions, to compare the products among periapical granuloma, periapical cyst and chronic periapical abscess, and to understand the pathogensis of chronic periapical lesions. Tissues from 33 chronic periapical lesions of human teeth were enucleated during endodontic surgery. large part of each tissue was contained in liquid nitrogen immediately and the other was examined histologically. In histologically diagnosed 8 cases of periapical granuloma, 9 cases of periapical cyst and 8 cases of chronic periapical abscess. the tissues were homogenatecl and incubated with $_{14}C$-arachidonic acid. Lipid solvent extracts were separated by thin layer chromatography to be analyzed by autoradiography and TLC analyzer. 1. $TXB_2$, 6-keto-$PGF_1{\alpha}$ and $PGE_2$, $LTB_4$, HETEs, and unidentified product which are metabolic products of arachidonic acid were measured in the tissues of chronic peripaical lesions. 2. In all of periapical granuloma, cyst and abscess, the conversion rate of HETEs among all products was the highest(P<0.05), and the percentage of HETEs in total converted products was also the highest(P<0.05). 3. The concentration of each arachidonic acid product was higher in chronic periapical absecss than in periapical granuloma and cyst(P<0.05). The concentration of $TXB_2$ and HETEs in periapical cyst were hight than in periapical granuloma. 4. The relative amounts of total products from lipoxygenase pathway to those from cyclo-oxygenase pathway were about 7 fold in chronic periapical lesions. There was no difference among periapical granuloma, cyst and abscess(P<0.05). The total amount of products from each pathway were higher in chronic periapical abscess than in periapical cyst and granuloma.

• Restorative Dentistry and Endodontics
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• v.11 no.1
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• pp.63-75
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• 1985

This study was designed to identify lymphocytes and to compare the lymphocyte distribution in endoodontically treated periapical lesions with that in endodontically untreated periapical lesions by way of immunohistochemical staining. Twenty-one human dental periapical lesions were obtained, frozened, serially sectioned to $4-5{\mu}$, and stained using the three-stage indirect immunoperoxidase technique and monoclonal antibodies for detecting the presence of B,T lymphocyte and T suppressor cell. Following results were obtained; 1. All of the examined periapical lesions had positive staining for B,T lymphocyte and T suppressor cell. 2. The concentration of T lymphocytes in 18 lesions diagnosed as periapical cyst and granuloma in both groups was greater than that of B lymphocytes and 2 periapical lesions identified as abscess in treated lesions had more positive B lymphocytes than positive T lymphocytes. 3. The average numbers of T,B lymphocytes and T suppressor cells in Endodontically treated lesions were lower than those of untreated lesions, but no statistically significant difference was noted. 4. When the distribution ratios of T lymphocytes to B lymphocytes and T suppressor cells to T lymphocytes were compared in Endodontically treated lesions by the histological aspects of the lesions and at the intervals of the duration after Endodontic treatment, a statistically significant change was not found. 5. The mean values of T lymphocytes, B lymphocytes and T suppressor cells in Endodontically treated lesions were markedly decreased in the specimens obtained at 3 month after Endodontic treatment, but no statistically significant difference was found.

• Imaging Science in Dentistry
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• v.52 no.2
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• pp.209-217
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• 2022

Purpose: The aim of this study was, firstly, to determine the concordance of ultrasonographic and histopathological diagnoses in patients in whom apical resection was already indicated. Secondly, this study aimed to determine whether lesions were periapical granulomas or cysts, and to compare them after root canal treatment using ultrasonography and periapical radiographs. Materials and Methods: In the first stage of the study, ultrasonographic and histopathologic diagnoses of 10 lesions were compared. Secondly, the periapical radiographs and ultrasonographic images of 44 lesions were measured. The presence of internal vascularity was determined by ultrasonographic color and power Doppler modes. Follow-up examinations of healing after root canal treatment were performed using ultrasonography and periapical radiographs, and these modalities were compared. Results: In the periapical granuloma and cyst groups, the measurement values decreased for all variables. There was no significant difference in the dimensional changes of lesions between the 2 groups, and ultrasonography and periapical radiographs were compatible. The pre-diagnoses were compared with histopathological diagnoses and were found to be compatible. Conclusion: The ultrasonographic color and power Doppler techniques could be an effective method for diagnosing periapical lesions as cysts or granulomas. After root canal treatment of granulomas and cysts, the dimensional shrinkage and healing patterns appear to be similar. Ultrasonography and periapical radiographs were consistent in terms of dimensional comparisons, and ultrasonography may be an alternative method for follow-up of the healing of periapical lesions.

• Restorative Dentistry and Endodontics
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• v.15 no.2
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• pp.58-76
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• 1990

This study was designed to elucidate the distribution of the immunoglobulins in the experimentally induced rat periapical lesions. The pulp exposure was performed in 80 molars from 40 rats and the animals were sacrificed at 15, 30, 60 and 90 days after the operation and examined and radiographed. Of the 80 samples, 56 samples were routinely sectioned ($4-6{\mu}$ in thickness) and stained with Hematoxylin-Eosin for the light microscopic examination and 50 samples were stained with toluidin blue for mast cells and 50 samples were stained using the Avidin-Biotin horseradish peroxidase for detecting the presence of Ig A, Ig E, Ig M and Ig G containing cells. The following results were obtained : 1. The periapical lesions could be observed in all of 80 teeth by radiogragh (100%) and the periapical lesions were detected in 50 samples of 51 samples by light microscopy (98%). The size of lesions increased with time lapse both by radiograph and by light microscopy(p<0.05). 2. Of the 50 samples, 19 samples were diagnosed as periapical abscesses, 18 as periapical granulomas, 10 as fibrous scar tissues and 3 cysts. 3. After pulp exposure, periapical granulomas were developed mostly in the 15 day group, with time lapse periapical abscesses and fibrous scar tissues increased. 4. In the 50 periapical lesions, the numbers of Ig G containing cell (57.2%) were prominent and the percentage of Ig A, Ig E and Ig M containing cells were 16.4%, 14.7% and 11.8% respectively. The numbers of all classes of immunoglobulin containing cell were highest in the periapical granulomas and lowest in the cysts(p<0.05). 5. The number of the mast cell and immunoglobulin containing cells decreased generally with time lapse after the pulp exposure and Ig A, Ig E, Ig M and Ig G containing cells and mast cells had the high correlation one another(>0.6).

• Restorative Dentistry and Endodontics
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• v.25 no.2
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• pp.193-201
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• 2000

Prostaglandins (PGs) and Leukotrienes (LTs) have been implicated in the genesis of pulpal and periapical inflammation. In this study, the relationships among $PGE_2$, 6-keto-PG $F_1{\alpha}$ (a stable metabolite of $PGI_2$) and $LTB_4$ concentrations in inflamed pulp and periapical lesions were discussed. Pulp tissue were obtained in routine endodontic treatment and periapical lesions in periapical surgery after clinical diagnoses were made. These specimens were divided into four groups as normal pulp group (Control group), acute pulpitis group, chronic pulpitis group, and periapical lesion group. Pulp tissue and periapical lesions were stored in liquid nitrogen. The concentration of $PGE_2$, $PGI_2$ and $LTB_4$ were measured with ELISA. The data were analyzed by one-way ANOVA. Significantly higher levels of $PGE_2$, 6-keto-PG $F_1{\alpha}$ a and $LTB_4$ were found in acute pulpitis group than chronic pulpitis group and periapical lesion group(p<0.05). Periapical lesion group showed significantly higher mean concentrations of $PGE_2$ and $LTB_4$ than chronic pulpitis group. In control and chronic pulpitis group, significant higher levels of $PGI_2$ than $PGE_2$ and $LTB_4$ were found. These results suggested that the high levels of $PGE_2$ and $LTB_4$ in periapical lesions may be due to rich endothelium., fibroblast and lymphocyte known as the main producers of $PGE_2$ and $LTB_4$. $PGI_2$ may be thought to one of the most abundant PGs in normal pulp tissue.

• Restorative Dentistry and Endodontics
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• v.18 no.2
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• pp.317-340
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• 1993

This study was designed 1) to compare the distributions of periapical inflammatory cells and 2) to identify lymphocytes and compare the lymphocyte distribution with T lymphocyte subpopulation and then 3) to examine the distribution of cycling cell in human dental periapical lesions. From each of the twenty-five human dental periapical lesions observed one small portion was fixed, embeded in paraffin, sectioned serially and stained with HE. The periapical inflammatory cells were counted to obtain the relative concentration of lymphocyte, plasma cell, macrophage and neutrophil. The large part of each lesion was analysed using Flow cytometer and monoclonal antibodies to obtain the relative concentration of T lymphocyte, B lymphocyte, T'helper cell and T suppressor/cytotoxic cell. In addition to that, seven human dental periapical lesions were examined with DNA analysis to observe the distribution of cycling cell. Following results were obtained: 1. 24 cases of the 32 periapical lesions examined were diagnosed as periapical granuloma and the remaining 8 cases as periapical cyst. Lymphocytes comprised 42.1% of total inflammatory cells in periapical granuloma and 41.8% in periapical cyst. Corresponding percentages for macrophages were 33.8% and 30.3%; for plasma cells, 15.9% and 19.0%; for neutrophils, 8.2% and 8.8%. 2. All of the periapical lesions examined had T lymphocyte, B lymphocyte, T helper cell, T suppressor/cytotoxic cell. And in all cases, T lymphocytes were observed predominantly more than B lymphocytes. 3. In 2 cases of the control group only T lymphocytes were found, and in the remaining 2 cases T lymphocytes were observed predominantly. 4. T helper cells were observed predominantly more than T suppressor/cytotoxic cells in all cases of perapical granulomas. 5. T suppressor/cytotoxic cells were observed predominantly more than T helper cells in 4 cases of periapical cysts (total 5 cases were examined) and only in one case T helper cells were more than T suppressor/cytotoxic cells. 6. In control group, T helper cells were predominant in 2 cases and T helper cells were equivalent to T suppressor/cytotoxic cells in one case. In remaining one case T suppressor/cytotoxic cells were predominant. 7. As the result of DNA analysis, the average proliferating indices of the various groups examined were measured as follows: in the control group 5.45%, in periapical granuloma 6.64%, in periapical cyst 10.1%. The highest index was observed in periapical cyst.

• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.212-221
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• 1999

The periapical response to injury is a complex interaction of inflammatory, immune, neural, vascular and synthetic activity. Nitric oxide(NO), synthesized by nitric oxide synthetase(NOS) from L-arginine, is becoming recognized as an important bio-regulatory molecule in a variety of tissue, but little is known about its possible role in periapical tissue. The purpose of this study was to investigate the expression of nitric oxide synthetase(NOS) in tooth follicle, periapical abscess, granuloma and cyst. The expression of NOS in periapical lesions was evaluated by immunohistochemical staining for $NOS_2$, and $NOS_3$. The immunoreactivity was evaluated by staining intensity, and inflammatory cell infiltration. Correlationship between the periapical lesion in immunoreractivity were statistically analyzed by SPSS. The degree of $NOS_2$ and $NOS_3$ expression in periapical abscess was higher than in any other periapical lesions, and stastically significant. The expression degree of $NOS_2$ and $NOS_3$ was not correlated with periapical abscess and granuloma, but expression of $NOS_2$ showed very significant in periapical cyst. The increased expression of $NOS_2$ and $NOS_3$ was correlated with inflammatory cell infiltration degree of the periapical cyst. These results suggested that NO should play an important role in progress and/or mediation of periapical lesions.