Guía de práctica clínica cirugía periapical, indicaciones y técnica quirúrgica / Periapical surgery clinical practice guide, indications and surgical technique

Esta GPC en Cirugía periapical tiene como objetivos proporcionar recomendaciones basadas en la evidencia científica, con la finalidad de mejorar la calidad asistencial y unificar los criterios de actuación en relación a las indicaciones y técnicas de aplicación en Cirugía Periapical de los profesionales sanitarios en el ámbito de la Odontología.

Expression of cytokeratins in epithelialized periapical lesions.

OBJECTIVE: This study attempted to clarify whether differential immunocytokeratin expression occurs in cystic and epithelialized noncystic lesions. STUDY DESIGN: From January 2003 to June 2004, periapical surgery was carried out on 70 teeth, collecting 70 histologic samples. Serial sections of original histologic slices were prepared for immunostaining. The antibodies used were against cytokeratins CK7, AE1, AE3, AE1-3, and CAM52. The intensity of staining was evaluated as follows: 0 = no cells stained; 1 = weak staining (11%-25%); 2 = moderate staining (26%-75%); and 3 = intense staining (>or=76%). RESULTS: Ten epithelized granulomas and 6 cysts were included. Intense staining was seen for AE1 and AE1-3 in the 2 types of lesion; staining with AE3 was moderate for epithelized granulomas and cysts. CK7 demonstrated a light reactivity in the outermost epithelial layer. CAM52 showed weak staining for the epithelized granuloma and moderate for the cyst. CONCLUSIONS: Cysts and epithelized granulomas presented the same cytokeratin expression, though with marked differences in distribution and degree of staining of cytokeratins. This immunochemical technique is interesting for the determination of the histologic type and the prognosis, but may not be clinically practicable.

The post-endodontic periapical lesion: histologic and etiopathogenic aspects.

Apical periodontitis is produced in the majority of cases by intraradicular infection. Treatment consists in the elimination of the infectious agents by endodontia. Even when carrying out a correct cleansing and filling of canals, it is possible that periapical periodontitis will persist in the form of an asymptomatic radiolucency, giving rise to the post-endodontic periapical lesion. The chronic inflammatory periapical lesion is the most common pathology found in relation to alveolar bone of the jaw. From the histological point of view, it can be classified as chronic periapical periodontitis (periapical granuloma), radicular cyst, and as scar tissue. The most frequent is the periapical granuloma, constituted by a mass of chronic inflammatory tissue, in which isolated nests of epithelium can be found. The radicular cyst is characterized by the presence of a cavity, partially or wholly lined by epithelium. Scar tissue is a reparative response by the body, producing fibrous connective tissue. The aim of this study is to review and update the etiopathogenic and histological aspects of chronic post-endodontic periapical lesions.