• Restorative Dentistry and Endodontics
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• 제13권2호
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• pp.283-294
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• 1988

The purpose of this study was to investigate the characteristic features of the cells and tissues of the chronic periapical lesions using light microscope and electron microscope. Fifteen dental periapical lesions were obtained from the patients undergoing periapical surgery. Each specimen was divided into two parts along the tooth axis. One part was routinely processed for histopathologic examinations. 12 periapical lesions were diagnosed as granuloma and 3 periapical specimens as periapical cyst. The other part was fixed in 2.5% glutaraldehyde in 0.1M sodium cacodylate buffer at pH 7.4 and 1% osmic acid in same buffer. They were embedded in Epon 812. The semithin sections were used for the orientation of the lesions and the ultrathin sections were stained conventionally and examined with AEI Corynth 500 electron microscope. The results were as follows. 1. PMN and macrophages, which were dominant cell type, were scattered in small or large numbers throughout the central destructive area of granuloma. In the granulomatous area, plasma cells and lymphoytes were found in significant number and a lot of new capillary formation were revealed. Clefts caused by cholesterol were often seen in the connective tissue. Occasionally foam cells became collected in groups and epithelial proliferation were present. 2. In both granuloma and cyst, some plasma cells contained narrow cisternae of granular endoplasmic reticulum of which was tightly packed with electron dense materials, and other cells exhibited dilated profiles of granular endoplasmic reticulum. 3. In the area where plasma cells and lymphocytes were collected in groups, lymphocytes with well developed nucleolus and profuse cytoplasm were found and differentiating plasma cells were also present. 4. In the epithelial strands of the granulomatous area, epithelial cells contained enlarged endoplasmic reticulum, tonofilaments and ribosoms. Toward the intercellular space epithelial cells protruded a few microvilli. In the intercellular space, exudate-like electron dense materials, most of which was attached to the plasma membrane, appeared. 5. Some foam cells filled with numerous lipid droplets and others had lipid droplets and crystal-like structures. 6. Cyst epithelium consisted of bright cells and dark cells. The former had bright cytoplasm and small amounts of ribosoms, and the latter dark cytoplasm, many ribosoms, mitochondria and elongated microvilli. 7. Epithelial cells near the cyst lumen protruded a lot of long microvilli toward intercellular space and cyst lumen.

• Imaging Science in Dentistry
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• 제52권2호
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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.

• 치과방사선
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• 제20권2호
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• pp.277-287
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• 1990

The purpose of this study was to estimate the diagnostic availability of the common periapical lesions by using computer. The author used a domestic personal computer and rearranged the applied program appropriately with RF (Rapid File), a program to answer the purpose of this study, and then input the consequence made out through collection, analysis and classification of the clinical and radiological features about the common periapical lesions as a basic data. The 256 cases (Cyst 91, Periapical granuloma 74, Periapical abscess 91) were obtained from the chart recordings and radiographs of the patients diagnosed or treated under the common periapical lesions during the past 8 years (1983-1990) at the infirmary of Dental School, Chosun University. Next, the clinical and radiographic features of the 256 cases were applied to RF program for diagnosis, and the diagnosis by using computer was compared with the hidden final diagnosis by clinical and histopathological examination. The obtained results were as follows: 1. In cases of the cyst, diagnosis through the computer program was shown rather lower accuracy (80.22%) as compared with accuracy (90.1 %) by the radiologists. In cases of the granuloma, diagnosis through the computer program was shown rather higher accuracy (75.7%) as compared with the accuracy (70.3%) by the radiologists. 2. In cases of periapical abscess, the diagnostic accuracy was shown 88% in both diagnoses. 4. The average diagnostic accuracy of 256 cases through the computer program was shown rather lower accuracy (81.2%) as compared with the accuracy (82.8%) by the radiologists. 5. The applied basic data for radiographic diagnosis of common periapical lesions by using computer was estimated to be available.

• Restorative Dentistry and Endodontics
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• 제16권1호
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• pp.41-59
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• 1991

This study was performed to elucidate the distribution and correlation of immunoglobulin G subclasses with the degree of inflammation in the experimentally induced rat pulp and periapical pathoses. The pulp exposures were made in 108 mandibular 1st molars of 54 rats and the teeth were left open to the oral environment The animals were sacrified at 3, 7, 15, 30, 60 and 90 days after pulp exposure, and examined microscopically and radiographically Seventy one specimens were routinely sectioned at the thickness of 4 - $6{\mu}$ and stained with Hematoxylin - eosin for histologic examination, with toluidine blue for mast cells, and with the primary antibodies against rat IgG subclasses by using the Avidin - Biotin complex method. The following results were obtained: 1. As the degree of inflammation of rat pulp and periapeces intensified, the number of IgG subclass containing cells per unit area, especially IgG2a and IgG2c, decresased. 2. The IgG2c cells were most predominantly found in the lesions with slight inflammation, IgG1 cells in mild or severe inflammation, and IgG2a cells in moderate inflammation. 3. IgG subclass containg cells were more predominantly observed in the periapical granuloma than periapical abscess or cyst(p<0.01). 4. IgG2a containing cells were predominant in pulp inflammation, IgG1 containing cells in periapical granuloma, IgG2a cells and IgG1 cells in periapical abscess, and IgG2a cells were significantly predominant in periapical cyst. 5. The number of IgG subclass containing cells and mast cells in periapical tissue decreased with time lapse after pulp exposure. And correlation index between mast cells and IgG1, IgG2a, IgG2b was stastically high.

• Restorative Dentistry and Endodontics
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• 제2권1호
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• pp.20-26
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• 1976

Cellulose acetate electrophoresis was used for differential diagnosis of radicular cysts and granulomas. Sixteen periapical lesions were excised from sixteen teeth with radiographic evidence of periapical pathosis, and two normal periodontal tissues were surgically removed from two wisdom teeth. The tissue samples were separated into two parts. Half was prepared for cellulose acetate electrophoresis, and the electrophoretic patterns were scanned with Helena densitometer. The other half was examined histologically, and the histologic diagnoses were then compared with the electrophoretic patterns and with the x-ray findings. The results were the following: 1. The histopathologic results showed the presence of 13 granulomas (81.8%) and 3 cysts (18.3%). 2. An albumin pattern, alpha-globulin pattern, beta-globulin pattern, fibrinogen pattern and gamma-globulin pattern were found in all eighteen cases. 3. All eighteen cases were divided into normal periodontal tissue group, dental granuloma group, and radicular cyst group by the histopathologic diagnosis. The electrophoretic pattern of dental granuloma group and that of normal periodontal tissue group resembled each other. The two groups showed the highest percentage in beta-globulin fraction, and the beta-globulin of dental granuloma group(47.17%) was higher than that of normal periodontal tissue group (40.54%) by 6.63%. On the contrary, beta-globulin fraction of radicular cyst group (28.00%) was much lower than those of the granuloma group (47.17%) and normal periodontal tissue group (40.54%), and alpha-globulin of radicular cyst group (34.16%) was much higher than those of the granuloma group (20.04%) and normal group (19.58%). 4. Five cases (31.3%) of the sixteen periodontal lesions showed different results between histopathologic diagnoses and radiographic findings.

• Restorative Dentistry and Endodontics
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• 제47권1호
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• pp.12.1-12.11
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• 2022

Objectives: This pilot study aimed to establish the interrelationship between collagen and mast cells in periapical granulomas and periapical cysts. Materials and Methods: An observational cross-sectional study was conducted on the paraffin-embedded tissue sections of 68 specimens (34 periapical granulomas and 34 periapical cysts). The specimens were stained with picrosirius to observe collagen fiber birefringence and anti-tryptase antibody to evaluate the mast cell count immunohistochemically. The mean number and birefringence of collagen fibers, as well as the mean number of mast cells (total, granulated, and degranulated), and the mean inflammatory cell density were calculated. The data obtained were analyzed using the Kruskal Wallis test, Mann Whitney U test, and Spearman correlation test (p < 0.05). Results: The mean number of thick collagen fibers was higher in periapical cysts, while that of thin fibers was higher in granulomas (p = 0.00). Cysts emitted orange-yellow to red birefringence, whereas periapical granulomas had predominantly green fibers (p = 0.00). The mean inflammatory cell density was comparable in all groups (p = 0.129). The number of total, degranulated, and granulated mast cells exhibited significant results (p = 0.00) in both groups. Thick cyst fibers showed significant inverse correlations with inflammation and degranulated mast cells (p = 0.041, 0.04 respectively). Conclusions: Mast cells and inflammatory cells influenced the nature of collagen fiber formation and its birefringence. This finding may assist in the prediction of the nature, pathogenesis, and biological behavior of periapical lesions.

• Restorative Dentistry and Endodontics
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• 제30권1호
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• pp.66-71
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• 2005

치근단 백악질 이형성증은 대부분 하악 전치부에서 발생하는 병소로 시간의 흐름에 따라 3단계의 독특한 방사선 사진상의 변화 양상을 보인다 (방사선 투과성기, 혼합기, 방사선 불투과성기). 특별히 1단계인 방사선 투과성기의 방사선 사진 상의 양상은 치수 괴사로 인해 발생하는 치근단 육종이나 치근단낭과 매우 유사하다. 따라서 이를 감별하기 위해서는 정기적인 방사선 사진 검사와 함께 치수의 생활력을 검사가 매우 중요하다고 할 수 있다. 하지만 본 증례에서는 해당 부위의 치아가 PFG bridge로 수복되어 있는 치수 생확력 검사를 정확하게 할 수 없었다. 또한 병소가 처음에는 하악 전치부에 발생하였으나 뒤이어 하악 견치와 소구치부에서도 연달아 발생한 특이한 소견을 보였다.

• Restorative Dentistry and Endodontics
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• 제11권1호
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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.

• Restorative Dentistry and Endodontics
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• 제42권2호
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• pp.111-117
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• 2017

Objectives: Periapical lesions, including periapical cyst (PC), periapical granuloma (PG), and periapical abscess (PA), are frequently affected by chemical/physical damage during root canal treatment or severe bacterial infection, and thus, the differential diagnosis of periapical lesions may be difficult due to the presence of severe inflammatory reaction. The aim of this study was to make differential diagnosis among PC, PG, and PA under polarizing microscope. Materials and Methods: The collagen birefringence patterns of 319 cases of PC (n = 122), PG (n = 158), and PA (n = 39) obtained using a polarizing microscope were compared. In addition, 6 cases of periodontal fibroma (PF) were used as positive controls. Results: Collagen birefringence was condensed with a thick, linear band-like pattern in PC, but was short and irregularly scattered in PG, and scarce or absent in PA. PF showed intense collagen birefringence with a short, palisading pattern but no continuous band-like pattern. The linear band-like birefringence in PC was ascribed to pre-existing expansile tensile stress of the cyst wall. Conclusions: In this study all PCs (n = 122) were distinguishable from PGs and PAs by their characteristic birefringence, despite the absence of lining epithelium (n = 20). Therefore, the authors suggest that the presence of linear band-like collagen birefringence of the cyst wall aids the diagnostic differentiation of PC from PG and PA.

• Restorative Dentistry and Endodontics
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• 제39권1호
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• pp.63-67
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• 2014

This is a case report of chronic maxillary sinusitis caused by root canal overfilling of Calcipex II (Techno-Dent). A 60 year-old male complained of dull pain in the right maxillary molar area after complicated endodontic treatment using Calcipex II paste and was finally diagnosed with a chronic maxillary sinusitis through a clinical and radiological observation. In the biopsy examination, the periapical granuloma contained a lot of dark and translucent Calcipex II granules which were not stained with hematoxylin and eosin. They were usually engulfed by macrophages but rarely resorbed, resulting in scattering and migrating into antral mucosa. Most of the Calcipex II granules were also accumulated in the cytoplasms of secretory columnar epithelial cells, and small amount of Calcipex II granules were gradually secreted into sinus lumen by exocytosis. However, chronic granulomatous inflammation occurred without the additional recruitment of polymorphonuclear leukocytes (PMNs) and lymphocytes, and many macrophages which engulfed the Calcipex II granules were finally destroyed in the processes of cellular apoptosis. It is presumed that Calcipex II granules are likely to have a causative role to induce the granulomatous foreign body inflammation in the periapical region, and subsequently to exacerbate the chronic maxillary sinusitis in this study.