Differentiation of radicular cysts and radicular granulomas via texture analysis of multi-slice computed tomography images.

OBJECTIVES: This study aimed to establish a method for differentiating radicular cysts from granulomas via texture analysis (TA) of multi-slice computed tomography (CT) images. METHODS: A total of 222 lesions with multi-slice computed tomography images acquired at our hospital between 2013 and 2022 that were pathologically diagnosed were included in this study. Cases of contrast-enhanced images, severe metallic artefacts, and lesions that were not sufficiently large to be analysed were excluded. The images were chronologically divided into a training group and a validation group. The radiological characteristics were determined. Subsequently, a TA was performed. Pyradiomics software was used for the TA of three-dimensionally segmented volumes extracted from 2 mm slice thickness images with a soft-tissue algorithm. Features that differed significantly between the two lesions in the training group were extracted and used to create machine-learning models. The discriminative ability of these models was evaluated in the validation group using receiver operating characteristic curve analysis. RESULTS: A total of 131 lesions, comprising 28 radicular cysts and 103 granulomas, were analysed. Forty-three texture features that exhibited significant variations were extracted. A support vector machine and decision tree model, with areas under the curves of 0.829 and 0.803, respectively, were created. These models showed high discriminative abilities, even for the validation group, with areas under the curve of 0.727 and 0.701, respectively. Both models showed superior performance compared with that of the models based on radiographic findings. CONCLUSION: Discriminatory models were established for the TA of radicular cysts and granulomas using CT images.

Differential diagnosis of cemento-osseous dysplasia and periapical cyst using texture analysis of CBCT.

BACKGROUND: Radiolucencies found at the root apex in patients with cemento-osseous dysplasia (COD) may be mistaken for periapical cysts (PC) of endodontic origin. The purpose of this study was to examine the utility of quantitative texture analysis using cone-beam computed tomography (CBCT) to differentiate between COD and PC. METHODS: Patients who underwent CBCT at Wonkwang University Daejeon Dental Hospital between January 2019 and December 2022 and were diagnosed with COD and PC by clinical, radiologic, and, if necessary, histopathologic examination were included. Twenty-five patients each were retrospectively enrolled in the COD and PC group. All lesions observed on axial CBCT images were manually segmented using the open-access software MaZda version 4.6 to establish the regions of interest, which were then subjected to texture analysis. Among the 279 texture features obtained, 10 texture features with the highest Fisher coefficients were selected. Statistical analysis was performed using the Mann-Whitney U-test, Welch's t-test, or Student's t-test. Texture features that showed significant differences were subjected to receiver operating characteristics (ROC) curve analysis to evaluate the differential diagnostic ability of COD and PC. RESULTS: The COD group consisted of 22 men and 3 women, while the PC group consisted of 14 men and 11 women, showing a significant difference between the two groups in terms of sex (p=0.003). The 10 selected texture features belonged to the gray level co-occurrence matrix and included the sum of average, sum of entropy, entropy, and difference of entropy. All 10 selected texture features showed statistically significant differences (p<0.05) when comparing patients with COD (n=25) versus those with PC (n=25), osteolytic-stage COD (n=11) versus PC (n=25), and osteolytic-stage COD (n=11) versus cementoblastic-stage COD (n=14). ROC curve analysis to determine the ability to differentiate between COD and PC showed a high area under the curve ranging from 0.96 to 0.98. CONCLUSION: Texture analysis of CBCT images has shown good diagnostic value in the differential diagnosis of COD and PC, which can help prevent unnecessary endodontic treatment, invasive biopsy, or surgical intervention associated with increased risk of infection.

Treatment options of periapical cysts of deciduous teeth: report of a case and systematic review of the literature.

AIM: Periapical cysts of primary teeth are pathologic entities which are seldom encountered in the clinical practice. Most frequently, these lesions arise in correspondence with primary teeth presenting previous pulp therapy, severe carious lesions, or a history of previous trauma. The aim of the present study is to systematically review the treatment modalities of periapical cysts of the deciduous, along with the reporting of a clinical case. MATERIALS: A case of periapical cyst treated with marsupialization occurring in an 11-year-old patient is described. A literature search was devised to retrieve studies reporting the treatment of periapical cysts, and involved papers published in the Cochrane Oral Health Group specialist trials, MEDLINE via PubMed, and EMBASE up to March 2023. A total of 39 articles were retrieved. Following title and abstract analysis, 27 articles were selected for full-text analysis, with the final inclusion of 24 articles. CONCLUSION: Periapical cysts of primary teeth present an overall good prognosis irrespective of the treatment option adopted. The performance of a prompt diagnosis appears of utmost importance, as the extraction of the primary teeth involved implies the management of the residual space for the correct positioning of the corresponding permanent teeth.

The clinical outcomes of vital intact teeth close to large cystic lesions of endodontic origin: A prospective clinical study.

AIM: To evaluate the indication of the endodontic treatment for vital intact teeth with the root apex involved in large radicular cystic lesions of endodontic origin. METHODOLOGY: This prospective cohort study enrolled healthy participants with radicular cysts of endodontic origin and with the root apex of vital intact teeth involved in the bone defect, as determined by cone beam computed tomography (CBCT). Thirty-two sound vital teeth were analysed by thermal (TPT) and electric pulp tests (EPT) before surgery (T0) and 1 week (T1), 2 weeks (T2), 3 months (T3) and 6 months (T4) post-surgery. Student's t-test (p < .05) was used to compare the EPT values at baseline and T4. anova (p < .05) was used to analyse the EPT variations for all maxillary and mandibular teeth. McNemar test (p < .05) was used to compare the results according to variation in EPT values gathering by variation, no variation and no response. RESULTS: At T1, 75 and 65.7% of teeth responded positively whilst 25 and 34.3% did not respond to EPT and TPT, respectively. The variation of the EPT values between T0 and T1 was observed for 50.0% of teeth, whilst no variation was noticed in 25.0% of teeth. At T4, 90.6 and 87.5% of teeth responded positively whilst 9.4 and 12.5% did not respond to EPT and TPT, respectively. At T4, variation of the EPT values between T0 and T4 was observed for 28.1%, whilst no variation was noticed in 62.5% of teeth. There were no statistical differences in EPT results between T0 and T4 (p > .05), but significant differences were observed for EPT values between T1 and T4 (p < .05), and between mandibular and maxillary teeth. The pulp sensibility of maxillary teeth worsened after surgery, before reverting progressively to T0 values, whilst no statistically significant differences were observed for mandibular teeth at the different time points. CONCLUSIONS: These data support the inconsistence of the prophylactic endodontic treatment in healthy vital teeth with apex involvement in large cystic lesions of endodontic origin. Post-surgery follow-up with TPT and EPT is recommended to assess pulp status.

A case of radicular cyst on deciduous tooth in a 7-year-old child.

Radicular cysts are the most common cystic lesions in the oral cavity, and have a rare occurrence in the primary dentition. We report a case of radicular cyst of mandible in child by multimodal imaging including panoramic radiography, CT, and MR imaging. A 7-year-old girl presented with swelling and without pain, and hypoesthesia on the right side of the mandible. On clinical examination, an expansive lesion with undulation was found to the buccal cortex of the right side of the mandible. Panoramic radiograph showed a unilocular radiolucency with well-defined margin, displaced tooth, and root resorption in the right mandible. Regarding CT imaging, axial soft tissue algorithm CT and bone tissue algorithm CT showed a low-attenuation internal structure and expansion of the buccal cortex of the right side of the mandible. Three-dimensional-CT showed expansion of the buccal cortex of the right side of the mandible. Multiplanar reformation imaging showed displaced tooth, root resorption, and expansion of the buccal cortex of the right side of the mandible. On T1-weighted image, the expansive lesion showed low signal intensity, and T2-weighted and STIR images revealed high signal intensity. A partial biopsy of the mandibular region was performed. Histopathological diagnosis was radicular cyst caused by apical periodontitis with abscess. This case suggests that multimodal imaging, especially CT and MR imaging, could be effective for evaluating mandibular lesions in child.

Automatic detection and classification of nasopalatine duct cyst and periapical cyst on panoramic radiographs using deep convolutional neural networks.

OBJECTIVE: The aim of this study was to evaluate a deep convolutional neural network (DCNN) method for the detection and classification of nasopalatine duct cysts (NPDC) and periapical cysts (PAC) on panoramic radiographs. STUDY DESIGN: A total of 1,209 panoramic radiographs with 606 NPDC and 603 PAC were labeled with a bounding box and divided into training, validation, and test sets with an 8:1:1 ratio. The networks used were EfficientDet-D3, Faster R-CNN, YOLO v5, RetinaNet, and SSD. Mean average precision (mAP) was used to assess performance. Sixty images with no lesion in the anterior maxilla were added to the previous test set and were tested on 2 dentists with no training in radiology (GP) and on EfficientDet-D3. The performances were comparatively examined. RESULTS: The mAP for each DCNN was EfficientDet-D3 93.8%, Faster R-CNN 90.8%, YOLO v5 89.5%, RetinaNet 79.4%, and SSD 60.9%. The classification performance of EfficientDet-D3 was higher than that of the GPs' with accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 94.4%, 94.4%, 97.2%, 94.6%, and 97.2%, respectively. CONCLUSIONS: The proposed method achieved high performance for the detection and classification of NPDC and PAC compared with the GPs and presented promising prospects for clinical application.

[Surgical removal of an atypically large extensive radicular cyst in the mandible: a case report.] / Atypisch grosse radikuläre Zyste. Operative Entfernung einer atypisch grossen ausgedehnten radikulären Zyste im Unterkiefer, ein Fallbericht.

The radicular cyst is the most common odontogenic cyst and is caused by inflammation. It can become atypically large, although the size of the radiographic osteolysis says nothing about the entity of the lesion. This case shows an unusually large multilocular radicular cyst expanding buccally from tooth 46 in a patient with severe autism who can only be treated under general anesthesia. The clinical and radiological picture as well as the intraoperative situation was more indicative of an aggressive cyst or benign tumor. The lesion was surgically completely removed and the teeth 46, 47 and 48 were extracted because of poor compliance and prognosis. Histopathology revealed a radicular cyst. There were no postoperative complications. After eight months, the lesions had almost completely reossified.

Utility of Ultrasonography for Diagnosing and Differentiating Periapical Granuloma from Radicular Cyst.

RATIONALE AND OBJECTIVES: This study aimed to investigate the reliability and accuracy of high-resolution ultrasonography (US) for diagnosing periapical lesions and differentiating radicular cysts from granulomas. MATERIALS AND METHODS: This study included 109 teeth with periapical lesions of endodontic origin from 109 patients scheduled for apical microsurgery. Ultrasonic outcomes were analyzed and categorized after thorough clinical and radiographic examinations using US. B-mode US images reflected the echotexture, echogenicity, and lesion margin, while color Doppler US assessed the presence and features of blood flow of interested areas. Pathological tissue samples were obtained during apical microsurgery and subjected to histopathological examination. Fleiss' κ was used to measure interobserver reliability. Statistical analyses were performed to assess the diagnostic validity and the overall agreement between US and histological findings. The reliability of US compared to histopathological examinations was assessed based on Cohen's κ. RESULTS: The percent accuracy of US for diagnosing cysts, granulomas, and cysts with infection based on histopathological findings was 89.9%, 89.0%, and 97.2%, respectively. The sensitivity of US diagnoses was 95.1% for cysts, 84.1% for granulomas, and 80.0% for cysts with infection. The specificity of US diagnoses was 86.8% for cysts, 95.7% for granulomas, and 98.1% for cysts with infection. The reliability for US compared to histopathological examinations was good (κ = 0.779). CONCLUSION: The echotexture characteristics of lesions in US images correlated with their histopathological features. US can provide accurate information on the nature of periapical lesions based on the echotexture of their contents and the presence of vascularity. It can help improve clinical diagnosis and avoid overtreatment of patients with apical periodontitis.

A deep learning approach for radiological detection and classification of radicular cysts and periapical granulomas.

OBJECTIVES: Dentists and oral surgeons often face difficulties distinguishing between radicular cysts and periapical granulomas on panoramic imaging. Radicular cysts require surgical removal while root canal treatment is the first-line treatment for periapical granulomas. Therefore, an automated tool to aid clinical decision making is needed. METHODS: A deep learning framework was developed using panoramic images of 80 radicular cysts and 72 periapical granulomas located in the mandible. Additionally, 197 normal images and 58 images with other radiolucent lesions were selected to improve model robustness. The images were cropped into global (affected half of the mandible) and local images (only the lesion) and then the dataset was split into 90% training and 10% testing sets. Data augmentation was performed on the training dataset. A two-route convolutional neural network using the global and local images was constructed for lesion classification. These outputs were concatenated into the object detection network for lesion localization. RESULTS: The classification network achieved a sensitivity of 1.00 (95% C.I. 0.63-1.00), specificity of 0.95 (0.86-0.99), and AUC (area under the receiver-operating characteristic curve) of 0.97 for radicular cysts and a sensitivity of 0.77 (0.46-0.95), specificity of 1.00 (0.93-1.00), and AUC of 0.88 for periapical granulomas. Average precision for the localization network was 0.83 for radicular cysts and 0.74 for periapical granulomas. CONCLUSIONS: The proposed model demonstrated reliable diagnostic performance for the detection and differentiation of radicular cysts and periapical granulomas. Using deep learning, diagnostic efficacy can be enhanced leading to a more efficient referral strategy and subsequent treatment efficacy. CLINICAL SIGNIFICANCE: A two-route deep learning approach using global and local images can reliably differentiate between radicular cysts and periapical granulomas on panoramic imaging. Concatenating its output to a localizing network creates a clinically usable workflow for classifying and localizing these lesions, enhancing treatment and referral practices.

Squamous Cell Carcinoma Arising From Odontogenic Cyst Epithelium or Oral Mucosa Epithelium After Marsupialization of Odontogenic Radicular Cyst in Posterior Mandible?

Squamous cell carcinomas (SCCs) are common malignant tumors in the oral and maxillofacial region. However, SCCs secondary to marsupialization of odontogenic radicular cysts are extremely rare. The authors report an unusual case of a 43-year-old male presented with dull pain in the right molar region of the mandible without numbness of lower lips, who had a long history of smoking, alcohol consumption, and betel nut chewing. Computerized tomography revealed a round well-defined unilocular radiolucent at the apex of lower right premolars, 2 nonvital teeth. The clinical diagnosis was the radicular cyst of the right mandible. The patient was initially treated with root canal therapy of the teeth followed by marsupialization with a mandibular vestibular groove incision. While the patient did not follow the instruction of irrigation of the cyst and had no regular follow-up. The reexamination of computerized tomography indicated a round well-defined unilocular radiolucent at the apex of lower right premolars and filled with a soft tissue without clear boundary with buccal muscles at 31 months follow-up. There were no masses or ulcer around the mandibular vestibular groove incision and the patient had no sign of numbness of lower lips. The clinical diagnosis was the radicular cyst of right mandible with infection. A curettage was performed. However, the pathologic diagnosis was well-differentiated SCC. An extended radical surgical resection including segmental resection of the right mandible was performed. The histopathology was well-differentiated SCC without the cyst epithelium and invasion of bone, which can be distinguished from primary intraosseous SCC. The case indicates that marsupialization performed in patients with a history of smoking, alcohol consumption, and betel nut chewing, has a risk of suffering from oral SCC.

The magnetic resonance imaging characteristics of radicular cysts and granulomas.

OBJECTIVES: Limited studies have differentiated radicular cysts and granulomas with MRI. Therefore, we investigated the MRI characteristics of the two lesions and clarified features for distinguishing between them. METHODS: We collected data of 27 radicular cysts and 9 granulomas definitively diagnosed by histopathology and reviewed the fat-saturated T2 weighted, T1 weighted, and contrast-enhanced fat-saturated T1 weighted images. We measured the maximum diameter and apparent diffusion coefficient values of the lesions. We employed Fisher's exact test, the Mann-Whitney U test, and independent t-tests to compare the two lesions and created a decision tree for discriminating between them. RESULTS: There were significant differences between radicular cysts and granulomas with respect to five imaging characteristics-signal intensity of the lesion centre on fat-saturated T2 weighted images; signal intensity, texture, and contrast enhancement of the lesion centre on contrast-enhanced fat-saturated T1 weighted images; and maximum diameter of the lesion. The cut-off diameter for radicular cysts was 15.9 mm. The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.971, 85.2%, and 100%, respectively. CONCLUSIONS: From the decision tree analysis, maximum diameter, lesion centre contrast enhancement on contrast-enhanced fat-saturated T1 weighted images, and lesion centre signal intensity on fat-saturated T2 weighted images were important for discriminating between radicular cysts and granulomas.

Abordagem cirúrgica de cisto periapical abscedado na maxila: relato de caso / Surgical approach of absceded periapical cyst in the maxilla: case report / Abordaje quirúrgico de quiste periapical abscedido en la maxila: reporte de caso

O cisto radicular é uma lesão inflamatória associada à necrose pulpar que ocorre frequentemente em maxila. Objetivo: Descrever um caso cirúrgico detalhado de Cisto Periapical Abscedado. Relato de Caso: paciente gênero feminino, 40 anos, hipertensa, diabética Tipo II, compareceu à clínica queixando-se de dor ao ingerir alimentos frios e quentes na região da maxila, lado esquerdo. Ao exame físico, observou-se destruição coronária e presença de fístula na região do elemento dentário 23. Ao exame radiográfico, observou-se uma área radiolúcida ovalada bem circunscrita com halo radiopaco envolvendo a região apical do elemento dentário 23. Frente ao aspecto clínico e radiográfico, foram sugeridas as hipóteses diagnósticas de abscesso periapical crônico, granuloma periapical ou cisto apical abscedado. Foi realizada a exodontia do elemento 23 seguida de enucleação cística. O diagnóstico histopatológico final foi de cisto abscedado. Após 5 meses de evolução observa-se mucosa íntegra e reparo ósseo alveolar. Conclusão: É imprescindível um exame clínico cuidadoso associado ao exame radiográfico e histopatológico para analisar minuciosamente o caso a fim de oferecer ao paciente melhores condutas de tratamento. O diagnóstico de lesões intraósseas associado ao correto tratamento interrompe a evolução do processo patológico, evita danos maiores e restabelece a condição de saúde dos pacientes... (AU)

The radicular cyst is an inflammatory lesion associated with pulp necrosis that often occurs in the maxilla. Objective: To describe a detailed surgical case of Abscessed Periapical Cyst. Case Report: female patient, 40 years old, hypertensive, type II diabetic, came to the clinic complaining of pain when ingesting cold and hot foods in the left side of the maxilla. On physical examination, coronary destruction and the presence of a fistula in the region of the tooth 23 were observed. The radiographic examination showed a well-circumscribed oval radiolucent area with a radiopaque halo involving the apical region of the tooth 23. In view of the clinical and radiography, the diagnostic hypotheses of chronic periapical abscess, periapical granuloma or abscessed apical cyst were suggested. Element 23 extraction was performed followed by cystic enucleation. The final histopathological diagnosis was an abscessed cyst. After 5 months of evolution, intact mucosa and alveolar bone repair are observed. Conclusion: A careful clinical examination associated with radiographic and histopathological data is essential to systematically analyze the case in order to offer the patient better treatment. The diagnosis of intraosseous lesions associated with the correct treatment interrupts the evolution of the pathological process, avoids further damage and restores the patients' health condition... (AU)

El quiste radicular es una lesión inflamatoria asociada a necrosis pulpar que frecuentemente se presenta en el maxilar. Objetivo: Describir un caso quirúrgico detallado de Quiste Periapical Absceso. Caso Clínico: paciente femenina, de 40 años, hipertensa, diabética tipo II, acudió a la consulta quejándose de dolor al ingerir alimentos fríos y calientes en el lado izquierdo del maxilar. Al examen físico se observó destrucción coronaria y la presencia de una fístula en la región del diente 23. El examen radiográfico mostró un área radiolúcida oval bien delimitada con un halo radiopaco que involucraba la región apical del diente 23. En vista de la clínico y radiográfico, se sugirieron las hipótesis diagnósticas de absceso periapical crónico, granuloma periapical o quiste apical abscesificado. Se realizó la extracción del elemento 23 seguida de enucleación quística. El diagnóstico histopatológico final fue de quiste abscesificado. A los 5 meses de evolución se observa mucosa intacta y reparación del hueso alveolar. Conclusión: Un examen clínico cuidadoso asociado con el examen radiográfico e histopatológico es fundamental para analizar a fondo el caso con el fin de ofrecer al paciente mejores enfoques de tratamiento. El diagnóstico de lesiones intraóseas asociado al correcto tratamiento interrumpe la evolución del proceso patológico, previene mayores daños y restablece el estado de salud de los pacientes... (AU)

Surgical and prosthodontics management of a perforating giant radicular cyst in anterior maxilla: A case report.

Radicular cyst is the most common type of odontogenic cyst associated with the apex of non-vital teeth. The lining of the radicular cyst usually arises from the epithelial rests of Malassez. These cyst usually persists even after the elimination of microbial load from the root canals. Surgical removal is deemed necessary for the management. For larger lesions extending to the facial or palatal cortical plates, additional regenerative procedures such as bone grafting along with collagen membrane are warranted. This case report describes the surgical and prosthetic management of a giant radicular cyst that was perforating the cortical plates in the anterior maxilla.

Evaluation of CT and MRI Imaging Results of Radicular Cysts, Odontogenic Keratocysts, and Dentigerous Cysts and their Contribution to the Differential Diagnosis.

AIM: This study aimed to evaluate the contribution of the MRI and CT results to the differential diagnosis of histopathologically different odontogenic cysts. BACKGROUND: Odontogenic cysts are commonly seen in the jaw bone and their surgical operations have an important place in the practice of maxillofacial surgery; treatment options for these cysts differ according to their histopathology. Differential results that can be obtained from the radiological evaluations of different cyst groups will allow the surgeon to plan a more accurate approach at the beginning of the operation. In this study, computed tomography (CT) and magnetic resonance imaging (MRI) results of different cyst groups were interpreted together with their histopathological diagnosis. METHODS: CT and MRI results of 17 patients aged between 19-61 were evaluated, whose histopathological diagnosis consisted of 3 radicular cysts (RC), a total of 9 odontogenic keratocysts (OKC) of which 4 were inflamed, and a total of 5 dentigerous cysts (DC) of which one of them was inflammatory. RESULTS: In the CT scan, all cysts showed lytic, a sclerotic surrounding, and showed MRI peripheral enhancement, whereas solid nodular enhancement was only observed in OKCs. Edema and/or air in the surrounding bone medulla was observed in the infected lesions. OKC was heterogeneous, whereas RC and DC were more homogeneous. Diffusion restriction was observed to be frequent in OKCs. The OKCs were ellipsoidal in appearance and were located parallel to the long axis of the bone, and their dimensions were observed to be larger than the other cysts. OKCs may be accompanied by unerupted teeth. Radicular cysts were located perpendicular to the long axis of the bone and were globular in appearance, and their dimensions were smaller and more homogeneous compared to the OKCs. Dentigerous cysts are also accompanied by an unerupted tooth, and their peripheral enhancement is minimal and homogeneous. However, dentigerous cysts can be dense in content and smaller in size, and ellipsoidal localization is more common than OKCs. CONCLUSION: In addition to classic panoramic radiography in the evaluation and differential diagnosis of maxillary and mandibular lesions, CT and MRI evaluations can provide helpful information to the surgeon and pathologist in making the diagnosis and may further help plan the operation.

Surgical enucleation of radicular cyst in endodontically treated primary mandibular molar.

Radicular cysts are most common odontogenic cysts seen in the orofacial region, but not commonly detected in paediatric cases. This case report describes the accidental detection of radicular cyst and its surgical management in an 8-year-old boy in lower left back region of the jaw. The article also gives an insight about radicular cyst from its aetiology to the various other treatment modalities.

[Mucous retention cyst of the alveolar bone radiologically mimicking a radicular cyst: A case presentation.] / Aussergewöhnliche Schleimretentionszyste im Kieferknochen imponiert radiologisch als radikuläre Zyste. Ein Fallbericht.

One of the most frequent pathologies of jaw bone is a bacteria-induced inflammation at the apices of teeth with subsequent bone resorption that typically presents as a radiolucency in radiographs. Usually, corresponding clinical and radiographic findings correlate and allow for an accurate diagnosis. However, occasionally an unexpected and completely different diagnosis presents as documented in this case report. In a 55-year-old female patient, a radicular cyst was suspected in her right maxillary bone. The treatment plan included a cystectomy as well as apical surgery of the adjacent and root-canal filled teeth 15 and 16. However, the intraoperative finding absolutely did not fit a radicular cyst but rather a mucous retention cyst, as could be confirmed subsequently by histopathology. The diagnosis of a mucous retention cyst within the jaw bone is extraordinary and as such has never been described before in the literature.

Quiste periapical: diagnóstico y tratamiento / Periapical cyst: diagnosis and treatment

Los quistes periapicales o radiculares representan una de las patologías periapicales más frecuentes dentro del grupo de las lesiones quísticas de los maxilares. Son el resultado de la extensión de proce- sos inflamatorios-infecciosos. Su diagnóstico sigue siendo un desafío para el profesional odontológico, quien debe diferenciarlo de otros procesos inflama- torios periapicales. El objetivo del presente artículo es presentar, apoyado en una revisión de la literatura, el caso clínico de un paciente masculino de 38 años de edad que se presentó a la consulta por leve tume- facción indolora en zona anterosuperior del maxilar. A la inspección se observó borramiento de la región del surco vestibular a nivel de piezas dentarias 1.1, 1.2 y 1.3, de color rojizo con crepitación de la tabla ósea vestibular a la palpación. La tomografía de haz cónico mostró lesión osteolítica, extendida desde zona apical de la pieza dentaria 1.4 hasta zona del elemento dentario 1.1. Se realizó la extirpación de la lesión y api- cectomía. El estudio histológico corroboró el diagnós- tico presuntivo de quiste periapical. Los controles a distancia mostraron buena evolución del tratamiento. Se concluyó en la importancia de realizar un correcto diagnóstico clínico e imagenológico para la selección de un adecuado tratamiento según el caso (AU)

Periapical or radicular cysts represent one of the most frequent periapical pathologies within the group of cystic lesions of the jaws. They are the result of the spread of inflammatory-infectious processes. Its diagnosis continues to be a challenge for the dentist, who must differentiate it from other periapical inflammatory processes. The objective of this article is to present, supported by a review of the literature, the clinical case of a 38-year-old male patient who presented to the consultation due to mild painless swelling in the anterosuperior maxilla. Upon inspection, effacement of the vestibular sulcus region was observed at the level of teeth 1.1, 1.2 and 1.3, reddish in color with crepitation of the buccal bone table on palpation. Cone beam tomography showed an osteolytic lesion that extended from the apical area of tooth 1.4 to area of tooth 1.1. Excision of the lesion and apicoectomy were performed. The histological study corroborated the presumptive diagnosis of periapical cyst. Remote controls showed a good evolution of the treatment. It was concluded on the importance of carrying out a correct clinical and imaging diagnosis for the selection of an adequate treatment according to the case (AU)

A Classification-Guided Segmentation Algorithm Based on Deep Learning for Epithelium Segmentation in Histopathological Images of Radicular Cysts.

In histopathological analysis of radicular cysts (RCs), lesions in epithelium can provide pathologists with rich information on pathologic degree, which is helpful to determine the type of periapical lesions and make precise treatment planning. Automatic segmentation and localization of epithelium from whole slide images (WSIs) can assist pathologists to complete pathological diagnosis more quickly. However, the class imbalance problem caused by the small proportion of fragmented epithelium in RCs imposes challenge on the typical automatic one-stage segmentation method. In this paper, we proposed a classification-guided segmentation algorithm (CGSA) for accurate segmentation. Our method was a two-stage model, including a classification network for region of interest (ROI) location and a segmentation network guided by classification. The classification stage eliminated most irrelevant areas and alleviated the class imbalance problem faced by the segmentation model. The results of 5-fold cross validation demonstrated that CGSA outperformed the one-stage segmentation method which was lacking in prior epithelium localization information. The epithelium segmentation achieved an overall Dice's coefficient of 0.722, and intersection over union (IoU) of 0.593, which improved by 5.5% and 5.9% respectively compared with the one-stage segmentation method using UNet.Clinical Relevance- This work presents a framework for automatic epithelium segmentation in histopathological images of RCs. It can be applied to make up for the shortcomings of manual annotation which is labor-intensive, time-consuming and objective.

Tratamento cirúrgico conservador de cisto radicular de grande extensão: relato de caso com acompanhamento / Conservative surgical treatment of large extension radicular cyst: case report with follow-up

Introdução: os cistos radiculares são as lesões císticas mais comuns nos maxilares. Eles surgem dos Restos Epiteliais de Malassez, presos no ligamento periodontal e podem ser ativados por um processo inflamatório na região pulpar. Geralmente são descobertos em exames radiográficos de rotina, apresentando-se como uma imagem radiolúcida, bem delimitada, envolvendo o periápice de um ou mais dentes. Objetivo: apresentar o tratamento de um extenso cisto radicular, em região de maxila, com acompanhamento de 18 meses. Relato do caso: Paciente do sexo feminino, 49 anos, foi encaminhada para avaliação e tratamento na Clínica Odontológica da Faculdade Sete Lagoas (FACSETE), apresentando lesão extensa em região maxilar anterior direita ao exame radiográfico. Ao exame clínico, observou-se leve assimetria facial e ausência de sintomas dolorosos. Tomografia computadorizada, punção aspirativa e biópsia incisional foram utilizadas para se chegar ao diagnóstico compatível com cisto radicular. Optou-se por uma técnica conservadora, em que foi realizada a descompressão da lesão. Após 05 meses de tratamento, um novo procedimento cirúrgico foi realizado para enuclear o restante da patologia. Conclusão: a descompressão, com utilização de cânula, é um tratamento auxiliar fácil, conservador, eficaz e reduz a morbidade causada por diferentes cistos odontogênicos(AU)

Introduction: root cysts are the most common cystic lesions in the jaw. They arise from the Epithelial Remains of Malassez, trapped in the periodontal ligament and can be activated by an inflammatory process in the pulp region. They are usually discovered in routine radiographic examinations, presenting as a well-defined radiolucent image involving the periapex of one or more teeth. Objective: to present the treatment of an extensive root cyst, in the maxillary region, with a follow-up of 18 months. Case report: A 49-year-old female patient was referred for evaluation and treatment at the Dental Clinic of Faculdade Sete Lagoas (FACSETE), with an extensive lesion in the right anterior maxillary region on radiographic examination. On clinical examination, mild facial asymmetry and absence of painful symptoms were observed. Computed tomography, aspiration puncture and incisional biopsy were used to reach a diagnosis compatible with radicular cyst. We opted for a conservative technique, in which the lesion was decompressed. After 05 months of treatment, a new surgical procedure was performed to enucleate the rest of the pathology. Conclusion: decompression, using a cannula, is an easy, conservative, effective auxiliary treatment and reduces the morbidity caused by different odontogenic cysts.

The Development of Large Radicular Cysts in Endodontically Versus Non-Endodontically Treated Maxillary Teeth.

Background and Objectives: Large radicular cysts of the maxilla present a clinical challenge, as they may cause recurrent infection, severe alveolar bone loss and disruption of the nasal and maxillary sinus floors. The aim of this study was to evaluate the effect of previous root canal treatment on the clinical presentation of large maxillary radicular cysts. Materials and Methods: All cases of radicular cysts treated at the Oral and Maxillofacial Surgery Department of a tertiary public hospital over a period of six years (2012-2018) were evaluated. Histologically confirmed radicular cysts of the maxilla with a maximal dimension of over 15 mm were included. Demographic data of the patients, clinical presentation and radiographic features of the lesions were analyzed. Results: A total of 211 inflammatory cysts were treated in the study period, of these 54 histologically diagnosed radicular cysts in the maxilla were found to have a maximal dimension of over 15 mm. The mean age of patients with large maxillary radicular cysts was 43.3 years, 57.6% of which were male and 42.4% female. The lateral incisor was the most common tooth affected (46.3%). The mean size of the large radicular cysts was 25 mm. Then, 83.8% of the cysts were observed in teeth with previous endodontic treatment. Teeth without endodontic treatment presented clinically with significantly fewer acute symptoms in comparison to teeth with previous endodontic treatment. Conclusions: the vast majority (83.8%) of large maxillary radicular cysts were associated with endodontically treated teeth. Previous endodontic treatment was correlated to increased frequency of clinical symptoms.