[Acute apical abscess and associated factors in patients during the covid-19 pandemic in a health center in Acapulco, Mexico.] / Absceso apical agudo y factores asociados en pacientes durante la pandemia de covid-19 en un centro de salud de acapulco, méxico.

Objective: To estimate the prevalence of acute apical abscess and identify associated factors in patients of a health center from Acapulco, Mexico. Material and methods: Epidemiological study that collected clinical records of patients during the period of october 2021. Sociodemographic and housing information was collected, as well as personal pathological and non-pathological history and a record of the diagnosis of the periapical lesion based on its clinical characteristics issued by the operator on duty. Through multivariate analysis, a factor associated with acute apical abscess was identified with the odds ratio and its 95% confidence interval as estimators of the strength of association with CIETmap statistical software. Results: The 37% (32/87) of patients were diagnosed with the infection. In terms of gender, females were the most affected with a proportion of 56% (18/32). The most common cause was caries with 72% (23/32). The right upper second premolar was the most affected tooth with 25% (8/32). One associated factor was identified, age 36 to 62 years (ORa=3.54; CI95%a=1.27 -16.62). Conclusion: The morbidity rate of the infection was moderate, and it is a common pathology in stomatological emergency consultations, so it is important for the professional in charge of the area to manage it clinically. It will be important to implement oral health education strategies aimed at different age groups to raise awareness of the cariogenic process and its consequences.

A system for automatic classification of endodontic treatment quality in CBCT.

OBJECTIVES: An evaluation of the effectiveness of a new computational system proposed for automatic classification, developed based on a Siamese network combined with Convolutional Neural Networks (CNNs), is presented. It aims to identify endodontic technical errors using Cone Beam Computed Tomography (CBCT). The study also aims to compare the performance of the automatic classification system with that of dentists. METHODS: One thousand endodontically treated maxillary molars sagittal and coronal reconstructions were evaluated for the quality of the endodontic treatment and the presence of periapical hypodensities by three board-certified dentists and by an oral and maxillofacial radiologist. The proposed classification system was based on a Siamese network combined with EfficientNet B1 or EfficientNet B7 networks. Accuracy, sensivity, precision, specificity, and F1-score values were calculated for automated artificial systems and dentists. Chi-square tests were performed. RESULTS: The performances were obtained for EfficienteNet B1, EfficientNet B7 and dentists. Regarding accuracy, sensivity and specificity, the best results were obtained with EfficientNet B1. Concerning precision and F1-score, the best results were obtained with EfficientNet B7. The presence of periapical hypodensity lesions was associated with endodontic technical errors. In contrast, the absence of endodontic technical errors was associated with the absence of hypodensity. CONCLUSIONS: Quality evaluation of the endodontic treatment performed by dentists and by Siamese Network combined with EfficientNet B7 or EfficientNet B1 networks was comparable with a slight superiority for the Siamese Network. CLINICAL RELEVANCE: CNNs have the potential to be used as a support and standardization tool in assessing endodontic treatment quality in clinical practice.

Lesões periapicais de origem não-endodôntica: uma revisão integrativa

O objetivo deste trabalho foi elencar quais são as principais lesões periapicais que não têm origem a partir da necrose pulpar. Para tanto, realizou-se uma revisão integrativa da literatura, com busca nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrievel System Online (MEDLINE) e Bibliografia Brasileira de Odontologia (BBO). Os descritores utilizados foram "doenças periapicais" e "diagnóstico diferencial", combinados com o operador booleano "AND". Foram encontrados 42 artigos que responderam aos critérios de inclusão e exclusão. A análise dos estudos incluídos mostrou que as principais lesões periapicais de origem não endodôntica são o queratocisto odontogênico e o ameloblastoma. Embora a prevalência de lesões periapicais não endodônticas seja baixa, é importante estar atento aos possíveis diagnósticos diferenciais, visto que as lesões que mais apareceram na literatura se tratam de patologias localmente agressivas e potencialmente mutiladoras. Ademais, a conduta do profissional que se depara com qualquer tipo de lesão periapical que apresente comportamento fora dos padrões de normalidade deve ser a realização de biópsia e análise histopatológica.

The aim of this study was to list the main periapical lesions that do not originate from pulpal necrosis. An integrative literature review was carried out, with a search in the Latin American and Caribbean Literature in Health Sciences (LILACS), Medical Literature Analysis and Retrievel System Online (MEDLINE) and Bibliografia Brasileira de Odontologia (BBO) databases. The keywords used were "periapical diseases" and "differential diagnosis", combined with the boolean operator "AND". 42 articles were found that met the inclusion and exclusion criteria. The analysis of the included studies showed that the main periapical lesions of non-endodontic origin are the odontogenic keratocyst and the ameloblastoma. Although the prevalence of non-endodontic periapical lesions is low, it is important to be aware of possible differential diagnoses, since the lesions that most appeared in the literature are locally aggressive and potentially mutilating pathologies. In addition, the conduct of the professional who is faced with any type of periapical lesion that presents behavior outside the normal range should be to perform a biopsy and histopathological analysis.

The Potential Clinical Applications of a Microfluidic Lab-on-a-Chip for the Identification and Antibiotic Susceptibility Testing of Enterococcus faecalis-Associated Endodontic Infections: A Systematic Review.

This systematic review evaluated the potential clinical use of microfluidic lab-on-a-chip (LOC) technology in the identification and antibiotic susceptibility testing of E. faecalis in endodontic infections. The search methodology employed in this review adhered to the PRISMA guidelines. Multiple scientific databases, including PubMed/MEDLINE, SCOPUS, and SCIELO, were utilized, along with exploration of grey literature sources. Up to September 2023, these resources were searched using specific keywords and MeSH terms. An initial comprehensive search yielded 202 articles. Ultimately, this systematic review incorporated 12 studies. Out of these, seven aimed to identify E. faecalis, while the remaining five evaluated its susceptibility to different antibiotics. All studies observed that the newly developed microfluidic chip significantly reduces detection time compared to traditional methods. This enhanced speed is accompanied by a high degree of accuracy, efficiency, and sensitivity. Most research findings indicated that the entire process took anywhere from less than an hour to five hours. It is important to note that this approach bypasses the need for minimum inhibitory concentration measurements, as it does not rely on traditional methodologies. Microfluidic devices enable the rapid identification and accurate antimicrobial susceptibility testing of E. faecalis, which are crucial for timely diagnosis and treatment in endodontic infections.

[Maxillary sinus lesions and their association with apical lesions observed by cone beam computed tomography. A retrospective cross-sectional study]. / Lesiones del seno maxilar y su asociación con lesiones apicales observadas por tomografía computarizada de haz cónico. Un estudio transversal retrospectivo.

Introduction: Through cone beam computed tomography, alterations in the maxillary sinuses, such as opacities, space occupation and thickening of the mucosa, can be observed. Some factors contribute to this thickening, standing out among dental factors, periodontitis, apical pathology and endodontic treatments. Objective: To evaluate the association between changes observed in the maxillary sinuses and apical lesions using cone beam computed tomography. Materials and methods: It was a descriptive study with a retrospective and cross-sectional, correlational, field, non-experimental design. The sample consisted of 115 tomographic volumes obtained using Planmeca ProMax 3D Classic equipment (Planmeca, Helsinki, Finland). The presence/absence of endodontic treatment in the present posterior teeth, presence/absence of periapical lesion associated with these teeth, the size of the periapical lesion, presence/absence of alteration in the maxillary sinus and its thickness were evaluated. Results: Apical lesions were observed that averaged a size of 3.32 ± 1.82 mm, and almost half (44.35%) presented between 2 and 4 mm in size. The main alteration of the maxillary sinus that was observed was the thickening of the mucosa (58.26%). The average thickness of the thickening of the sinus mucosa was 3.51 ± 1.78 mm, with 72.17% of the cases with thickening greater than 2 mm. Conclusion: There was an association between the changes observed in the maxillary sinuses and apical lesions. The larger and closer the lesion was to the sinus, the greater the thickening of the sinus mucosa.

Tratamento Endodôntico de Dente com Calcificação Radicular Pós-Trauma: Relato de Caso Clínico / Endodontic Treatment Of Teeth With Post-Trauma Root Calcification: Case Report

A calcificação do canal radicular é um processo que pode ocorrer posteriormente a um traumatismo dentário ou que pode se desenvolver lentamente em decorrência do envelhecimento dentário fisiológico. É caracterizada pela deposição de tecido duro tanto na câmara pulpar como no canal radicular. Essa condição pode ser diagnosticada através de radiografias periapicais e tomografia computadorizada. Em alguns casos, pode estar associada à necrose pulpar e presença de lesão periapical, e o tratamento pode ser considerado bastante complexo. Este relato de caso clínico aborda o tratamento endodôntico do elemento 21, sintomático, com obliteração do canal radicular e necrose pulpar como sequela de um traumatismo dentário. Após a realização de todos os exames, foi dado o diagnóstico de periodontite apical crônica, sendo proposto o tratamento endodôntico convencional. A maior dificuldade encontrada foi a localização da entrada do canal radicular. Inúmeras radiografias foram realizadas a fim de evitar desvios. Somente ao final do terço médio foi possível localizar a entrada do canal radicular e dar prosseguimento ao tratamento, utilizando a técnica coroa-ápice e medicação intracanal à base de hidróxido de cálcio durante as sessões. Foi possível realizar a obturação do canal radicular quando a paciente se mostrou assintomática. Obteve-se sucesso na realização da técnica, e, após a conclusão do caso, foi possível observar remissão dos sintomas. Após um período de acompanhamento de 6 meses e, posteriormente, de 3 anos, foi possível observar cicatrização dos tecidos periapicais

The calcification of the root canal is a process that may occur after a dental trauma or slowly develop due to physiological dental aging. It is characterized by hard tissue deposition on both the pulp chamber and the root canal. Periapical radiography and computed tomography can be used to diagnose this condition. In some cases, it may be associated with pulp necrosis and the presence of periapical injury, and the treatment may be considered to be quite complex. This case report addresses the endodontic treatment of the central incisor, symptomatic, with root canal obliteration and pulp necrosis as a sequela of dental trauma. After all the tests, chronic apical periodontitis was diagnosed, and conventional endodontic treatment was proposed. The most significant difficulty faced was when locating the root canal's entrance. Numerous radiographs were carried out to avoid deviations. The opening of the root canal could only be found at the end of the middle third, so treatment could proceed by using the crown- down technique and intracanal medication based on calcium hydroxide during the sessions. When the patient was asymptomatic, the root canal has been filled. The accomplishment of the technique was successful, and after finishing the case, there was remission of symptoms. After a six-month follow-up period and three years, the healing of the periapical tissues was observed.

Langerhans cell histiocytosis simulating endodontic periapical lesion: Are we prepared to diagnose and manage it? A case report.

Many aggressive non-endodontic radiolucent lesions show very similar clinical and radiographical features to periapical lesions of endodontic origin. Since the treatments of endodontic and non-endodontic lesions differ markedly, a precise diagnosis is imperative. Thus, the present study aimed at presenting a clinical case on the diagnosis and management of a Langerhans cell histiocytosis (LCH) lesion mimicking a periapical lesion of endodontic origin. A 51-year-old male patient was referred to a private dental office due to slight pain from the region of tooth 36. Although no sign of prosthetic or endodontic failure was noted, radiographical examination revealed a radiolucent image with poorly defined borders associated with the periapical region of the tooth. Apicoectomy and bone curettage were then performed and, given the clinical and laboratory features, the definitive diagnosis of solitary eosinophilic granuloma was made. The surgical treatment was sufficient for the remission of the symptoms, and recurrence was not observed. Given the current case, dentists should be aware of LCH lesions as they may mimic endodontic periapical pathoses, leading to misdiagnosis and therapeutic complications. Moreover, alveolar bone lesions may be the first or only sign of LCH in many cases.

Influence of post type on periapical status: a prospective study in a Brazilian population.

OBJECTIVES: This prospective study assessed the effect of post type used to restore endodontically treated teeth in the onset, progression, and remission of periapical lesions. MATERIALS AND METHODS: One hundred and forty teeth (92 patients) were endodontically treated and received a glass fiber post or a cast metal post and a final restoration at a University Clinic by undergraduate students. All patients were followed up for a mean period of 5.1 ± 2.2 years. Periapical Index (PAI) was used for endodontic assessment. Two calibrated and blind examiners assessed the radiographs. The longevity of the endodontic treatment was analyzed using Kaplan-Meier statistics. RESULTS: Of the included teeth, 67.1% received glass fiber posts while 32.9% received cast metal posts. There were 4 endodontic failures, two glass fiber posts with a PAI = 3 in the baseline and PAI = 4 in the last follow-up, and one PAI = 4 in baseline and last follow-up. One cast metal post-failure was PAI = 4 in the baseline and the last follow-up. After 9.4 years, the overall success rate of the endodontic treatment was 97.1% (p = 0.7). CONCLUSIONS: The tested posts presented similar endodontic healing. Precautions taken during endodontic therapy, post cementation, and final restoration are more likely to be responsible for the success of endodontic treatment rather than a specific type of post. Clinical relevance The type of post is not related to the success of the endodontic treatment.

Apical Periodontitis Healing Following Treatment is Impacted by Root Canal Sealer Composition: An in Vivo and in Vitro Investigation

Abstract Objective: To evaluate the periapical healing following root canal treatment in teeth with apical periodontitis (in vivo) and the cytotoxic potential of root canal sealers in vitro. Material and Methods: Apical periodontitis was induced in 60 dogs' teeth and root canals were filled with Sealapex (40 roots), EndoREZ (40 roots), intracanal dressing (20 roots), or left untreated (20 roots). After 30 and 90 days, histopathological analyses were made. In vitro, J774.1 macrophages were stimulated with root canal sealers extracts, cytotoxicity was assessed using lactate dehydrogenase assay, and qRT-PCR was used to analyze TNF-α gene expression. Results: In vivo, smaller apical periodontitis and lower inflammatory cell infiltrate were found in teeth treated with Sealapex compared to EndoREZ. In vitro, EndoREZ was cytotoxic and induced TNF-α gene expression by macrophages differently from Sealapex. Conclusion: Sealapex allowed improved tissue repair following root canal treatment in teeth with apical periodontitis compared to EndoREZ. Synthesis of TNF-α induced by LPS was enhanced by EndoREZ, whereas Sealapex prevented pro-inflammatory gene expression (AU).

ALDH1 expression and potential clinical implications in chronic inflammatory periapical lesions

Abstract: Aldehyde dehydrogenase 1 (ALDH-1) is a marker of stem cells in a variety of diseases, but its role in individuals with chronic inflammatory periapical lesions remains unknown. The aim of this study was to investigate the presence of cells with a stem cell profile based on the immunoexpression of ALDH-1 in periapical granulomas (PGs) and radicular cysts (RCs). A total of 51 cases of periapical lesions (25 PGs and 26 RCs) were subjected to immunohistochemical study. The anti-ALDH-1 antibody was applied using the immunoperoxidase technique. An immunoexpression score (intensity vs. percentage of cells) was used, with the cases being classified as low expression (score: 0 to 4) and high expression (score: 6 to 9). The Chi-square test was used with a 5% level of significance. Immunoexpression of ALDH-1 was detected in all cases of PGs and RCs. In PG cases, the expression was diffuse in connective tissue cells, with most cases exhibiting high expression (n = 18; 69.2%), while in RC cases the expression revealed focal distribution in cells of the capsule and epithelial cells of the cystic lining, with most cases classified as low expression (n = 18; 72%). Significant differences in the expression scores of ALDH-1 were observed in PGs (p = 0.003). The variable expression of ALDH-1 suggests the presence of cells with stem cell profiles in PGs and RCs. These findings suggest that periapical tissues infiltrated by chronic inflammation can recruit important cells for the repair or evolution of periapical lesions.

O preparo do terço cervical e médio na endodontia contemporânea / Preparation of cervical and middle thirds in contemporary endodontics

Introdução: o tratamento endodôntico representa a terapia que trata as doenças pulpares e periapicais. O sucesso desse tratamento pode estar relacionado com o preparo do terço cervical e médio e a sua realização ou não contempla uma das vertentes da Endodontia contemporânea. Objetivo: identificar a prevalência de endodontistas que realizam o preparo cervical e médio, assim como as principais repercussões dentárias causadas por essa etapa, relacionando-as com instrumentos elencados neste estudo. Metodologia: trata ­ se de uma pesquisa observacional transversal que avalia, através de formulário online, a prevalência de endodontistas que realizam o pré-alargamento cervical e médio. O formulário foi enviado entre os dias 1º e 30 de junho de 2021, pela plataforma Google Forms. A amostra foi composta por 102 endodontistas de ambos os gêneros. O formulário apresenta questões de gênero, idade e questionamento sobre tempo de formação e trabalho. Resultados: verificou-se que 93,1% dos entrevistados alegaram realizar o preparo cervical e médio e a maioria, 67 respondentes, não acreditam que ele tem relação com o enfraquecimento dental. Para tal procedimento, a instrumentação rotatória é a mais utilzada com 54,9%. Conclusão: o preparo cervical e médio é uma etapa operatória presente na maioria dos tratamentos endodônticos e sua realização pode estar relacionada com o enfraquecimento dental, no entanto, isso não promove o insucesso do tratamento e, de acordo com os entrevistados, os instrumentos rotatórios são os mais utilizados para essa etapa.

Introduction: Endodontic treatment represents therapy that treats pulp and periapical diseases. The success of this treatment may be related to the preparation of the cervical and middle thirds and its realization or not contemplates one of the aspects of contemporary Endodontics. Objective: identify the prevalence of endodontists who perform cervical and middle preparation, as well as the main dental repercussions caused by this stage, relating them to the instruments listed in this study. Methodology: this is a cross-sectional observational study that assesses, through an online form, the prevalence of endodontists who perform cervical and mid-swelling pre-enlargement. The form was sent between June 1st and June 30th, 2021, by the Google Forms platform. The sample consisted of 102 endodontists of both genders. The form presents issues of gender, age and questions about training and work time. Results: it was found that 93.1% of respondents claimed to perform cervical and middle preparation and the majority, 67 respondents, do not believe that it is related to dental weakening. For this procedure, rotary instrumentation is the most used with 54.9%.Conclusion: cervical and middle preparation is an operative step present in most endodontic treatments and its performance ay be related to dental weakening, however, this does not promote treatment failure and, according to respondents, rotary instruments are the most used for this step.

Associação entre a periodontite apical e as doenças cardiovasculares: uma revisão da literatura / Association between apical periodontitis and cardiovascular diseases: a review of the literature

Objetivo: o presente estudo tem como objetivo revisar os dados disponíveis na literatura para verificar se a periodontite apical (PA) é um fator de risco para as doenças cardiovasculares (DCVs). Materiais e Métodos: foi realizada uma busca nas bases de dados do Pubmed e Google Acadêmico sobre a possível associação da PA com o desenvolvimento de problemas cardiovasculares. Após os critérios de seleção, foram incluídos 8 artigos científicos para serem detalhadamente abordados. Revisão de literatura: embora a PA seja um processo inflamatório local, sua patogênese pode influenciar no desenvolvimento de complicações sistêmicas. Partindo do princípio que uma resposta inflamatória localizada é capaz de acarretar à liberação e ativação de mediadores pró-inflamatórios sistêmicos, como as citocinas interleucinas e fatores de necrose tumoral, alguns autores sugerem uma possível associação entre a PA crônica e as DCVs, devido o potencial de surgimento de danos endoteliais e formação de ateromas. Discussão: embora ainda seja questionável a correlação existente entre lesões inflamatórias periapicais e doenças sistêmicas, devido principalmente ao descrédito em que o assunto era tratado no passado e na quantidade limitada de informações conclusivas disponíveis atualmente, os dados revisados neste trabalho propõem que existe uma associação positiva entre a PA e as DCVs, podendo-se verificar uma maior prevalência de PA em pacientes com problemas cardiovasculares. Conclusão: tem-se disponível cientificamente uma quantidade limitada de achados. Portanto, sugere-se a realização de mais pesquisas sobre o tema, objetivando a busca por evidências relevantes e bem fundamentadas sobre esta associação.

Aim: The present study aims to review the data available in the literature to verify whether apical periodontitis (AP) is a risk factor for cardiovascular diseases (CVDs). Materials and Methods: a search was carried out in the databases of Pubmed and Google Scholar about a possible association of AP with the development of cardiovascular problems. After the selection criteria, 8 scientific arti-cles were included to be analyzed in detail. Literature Review: although BP is a local inflammatory process, its pathogenesis can result in the development of systemic complications. Assuming that a localized inflammatory response is capable of causing the release and activation of systemic pro-inflammatory mediators, such as interleukin cytokines and tumor necrosis factors, some automatic effects are a possible association between a chronic AP and CVDs, due to the potential for the emergence of en-dothelial damage and atheroma. Discussion: although the correlation between periapical inflammatory lesions and systemic diseases is still questionable, mainly due to the discredit in which the subject was treated in the past and the limited amount of conclusive information currently available, the data reviewed in this paper propose that there is a positive association between AP and CVDs, with a higher prevalence of AP in patients with cardiovascular problems. Conclusion: a limited amount of findings are scientifically available. Therefore, it is suggested to carry out more research on the subject, aiming the search for relevant and well-grounded evidence on this association

Estado de la enseñanza del diagnóstico de afecciones pulpares y periapicales centrada en el método clínico / Status of the pulp and periapical disorders diagnosis teaching focused on the clinical method

RESUMEN Fundamento: la enseñanza del diagnóstico de las afecciones pulpares y periapicales se enmarca como un contenido esencial del proceso de enseñanza-aprendizaje en la asignatura de Operatoria Clínica, para cumplir las funciones principales declaradas en el perfil profesional del modelo de formación del estomatólogo general en Cuba. Objetivo: determinar el estado actual de la enseñanza del diagnóstico de afecciones pulpares y periapicales en la asignatura de Operatoria Clínica de la carrera de Estomatología. Métodos: investigación observacional, descriptiva y de corte transversal realizada en la Universidad de Ciencias Médicas de Cienfuegos sobre una población conformada por 8 docentes y los 37 estudiantes de tercer año del curso 2017-2018. Se utilizó una guía para observar de forma directa cómo se realiza la enseñanza del diagnóstico de las afecciones pulpares y periapicales y se aplicó una encuesta a profesores y estudiantes con preguntas cerradas. Resultados: se evidenció como fortaleza que predomina la educación en el trabajo como forma organizativa y existen referencias de la enseñanza del método clínico en la carrera de medicina. Se constataron limitaciones en el claustro respecto a las categorías docentes, científicas y años de experiencia; limitado aprovechamiento de la caracterización de los estudiantes y sus resultados así como deficiente aplicación de las acciones esenciales correspondientes a la etapa diagnóstica del método clínico y prevalencia del papel autoritario del docente. Conclusiones: aún existen limitaciones en la enseñanza actual del diagnóstico de las afecciones pulpares y periapicales en la población objeto de estudio.

ABSTRACT Background: the teaching of the pulp and periapical diseases diagnosis is defined as an essential content of the teaching-learning process in the Clinical Operative subject, to fulfill the main functions declared in the professional profile of the general stomatologist training model in Cuba. Objective: to determine the current state of pulp and periapical disorders teaching diagnosis in the Stomatology career Clinical Operative subject. Methods: observational, descriptive and cross-sectional research carried out at the Cienfuegos University of Medical Sciences on a population of 8 teachers and 37 third-year students of the 2017-2018 academic year. A guide was used to directly observe how the teaching of the diagnosis of pulp and periapical diseases is carried out and a survey was applied to teachers and students with closed questions. Results: it was evidenced as a strength that education at work predominates as an organizational form and there are references to the clinical method teaching in the medical career. Limitations were found in the faculty with respect to the teaching and scientific categories and years of experience; limited use of the students characterization and their results as well as deficient application of the essential actions corresponding to the diagnostic stage of the clinical method and prevalence of the teacher authoritarian role. Conclusions: still limitations in the diagnosis of pulp and periapical diseases current teaching of the population under study.

Prevalência de lesão periapical radiolúcida nos pacientes com síndrome de Sjögren primária / Prevalence of radiolucid periapical injury in patients with primary Sjögren syndrome

Introdução: Pacientes com Síndrome de Sjögren Primária (SSP) apresentam maior incidência de cárie dentária. Como consequência da cárie, podem ocorrer lesões periapicais radiolúcidas (LPR). Objetivo: Determinar a prevalência de LPR nos pacientes com SSP e caracterizar radiologicamente os dentes associados às LPR. Métodos: Estudo transversal envolvendo pacientes com SSP, recrutados em uma Clínica de Reumatologia (HUCAM-ES), que foram submetidos, inicialmente, a um questionário socioeconômico e avaliação clínica do fluxo salivar. Posteriormente, radiografias foram obtidas por um sistema digital intrabucal, com posicionador para a técnica periapical do paralelismo. Realizou-se a estatística descritiva por meio da média e desvio-padrão para as variáveis quantitativas, e frequências absoluta e relativa para as variáveis qualitativas. Realizou-se o teste qui-quadrado com IC95% e o teste t de Student para comparação dos pacientes com e sem lesão periapical. Resultados: No total, 24 pacientes fizeram parte do estudo, todos do sexo feminino (20 - 71 anos). O número médio de dentes/paciente foi de 23,3 ± 3,1, com prevalência de LPR dentária de 7,86%. Do total de pacientes, 70,8% tinham pelo menos uma LPR. Na comparação dos dentes com e sem LPR, os dentes com LPR apresentaram maior porcentagem de canal tratado e cárie. Conclusão: De acordo com os resultados, pode-se concluir que as LPR encontradas nos pacientes com SSP são uma condição frequente, principalmente quando associadas a dentes com canal(is) obturado(s) (AU).

Introduction: Patients with Primary Sjögren Syndrome (PSS) have a higher incidence of dental caries. As a conse- quence, radiolucent periapical lesions (RPL) may appear. Objective: To determine the prevalence of RPL in patients with PSS and to radiologically characterize the teeth associated with RPL. Methodology: Cross-sectional study involving patients with PSS, recruited at the Rheumatology Clinic (HUCAM-ES), who were initially submitted to a socioeconomic questionnaire and clinical evaluation of salivary flow. Subsequently, radiographs were obtained by a digital intraoral system with positioner for the periapical parallelism technique. Descriptive statistics were calculated by the mean and standard deviation for quantitative variables, and absolute and relative frequencies for qualitative variables. Chi-square test with 95% CI and Student t test were applied to compare patients with and without periapical lesion. Results: Over-all, 24 patients participated in the study and all were females (20-71 years). The mean number of teeth per patient was 23.3±3.1, with prevalence of dental RPL of 7.86%. Among all patients, 70.8% had at least one RPL. When comparing teeth with and without RPL, teeth with RPL showed higher percentage of treated canal and caries. Conclusion: According to the results, it can be concluded that RPL in patients with PSS is a frequent condition, especially when associated with teeth with obturated root canals (AU).

Malignant Lesions Mimicking Endodontic Pathoses Lesion: A Systematic Review.

INTRODUCTION: Malignant nonendodontic periapical lesions represent a rare diagnosis, in which few case have been reported about this condition. Due to the low occurrence and little exploration of this subject, serious errors of diagnosis are observed in the oral medicine services. In this sense, the purpose of the present review was to integrate the information on the record published on malignant lesions that mimic endodontic pathoses into a comprehensive analysis of their clinical, radiologic, and histopathologic features. METHODS: An online search was made in March 2020 in the following databases: Pubmed, Web of Science, and Scopus. Eligibility criteria included publications having enough clinical, radiologic, and histopathologic information to confirm the diagnosis. Data were assessed descriptively. RESULTS: Forty-nine publications from 16 countries comprising 60 cases were included. There is a nearly equal occurrence rate between males and females (male/female ratio is 49.15%/50.84%) with a mean age of 46.56 years. The lesions were more prevalent in the posterior mandibles (40.69%), and, radiographically, they were unilocular radiolucent. Histopathologic analysis showed metastasis (26.67%) as the most prevalent lesion followed by salivary gland malignant disease (25%). CONCLUSIONS: The present systematic review revealed several histologic types of malignant periapical lesions that could be mimicking endodontic pathoses. Because these lesions usually do not show clinical or radiologic features of malignant alteration, clinicians should consider these hypotheses in their routine.

Chronic inflammatory periapical diseases: a Brazilian multicenter study of 10, 381 cases and literature review

Abstract The aim of this study was to investigate the epidemiological and clinical characteristics of chronic inflammatory periapical diseases in different regions of Brazil and to compare with data from the literature. A multicenter study was carried out in four Brazilian referral centers in oral diagnosis. Histopathological records were reviewed, and all cases diagnosed microscopically as periapical granuloma, radicular cyst, and periapical abscess were included. Demographic and clinical data were collected. Descriptive statistics and Pearson's chi-square test were performed. A total of 10,381 cases of chronic inflammatory periapical diseases were found (13.8% of 74,931 archived specimens) over a period of 65 years. Radicular cysts were the most common lesion (59.9%). Women (56.1%) with a mean age of 37.01 years old (range 13 to 100 ± 14.42) and people of white skin color (59.2%) were the most affected individuals by chronic inflammatory periapical diseases. The lesions were generally asymptomatic (28.1%), located in the maxilla (60.1%), and posterior region (49.8%). The radicular cysts were larger when compared to periapical granulomas (p < 0.001). The disagreement between the clinical and histopathological diagnoses was higher when the final diagnosis was a periapical granuloma (p < 0.001). Chronic inflammatory periapical diseases continue to be common lesions affecting mainly adults. This should be a consequence of the burden of untreated caries in permanent teeth. Women are more affected and radicular cyst was the most common lesion.

Differentiation of periapical granuloma from radicular cyst using cone beam computed tomography images texture analysis.

OBJECTIVE: This study aimed to investigate the use of texture analysis for characterization of radicular cysts and periapical granulomas and to assess its efficacy to differentiate between both lesions with histological diagnosis. METHODS: Cone beam computed tomography (CBCT) images were obtained from 19 patients with 25 periapical lesions (14 radicular cysts and 11 periapical granulomas) confirmed by biopsy. Regions of interest were created in the lesions from which 11 texture parameters were calculated. Spearman's correlation analysis was performed and adjusted with Benjamini-Hochberg false discovery rate procedure (FDR <0.005). RESULTS: The texture parameters used to differentiate the lesions were assessed by using a receiver operating characteristic analysis. Five texture parameters were predictive of lesion differentiation for eight positions: angular second moment; sum of squares; sum of average; contrast; correlation. CONCLUSION: Texture analysis of CBCT scans distinguishes radicular cysts from periapical granulomas and can be a promising diagnostic tool for periapical lesions. CLINICAL SIGNIFICANCE: Texture analysis can be used in diagnostic and treatment monitoring to provide supplementary information.

Tratamiento no quirúrgico de lesión periapical de gran tamaño: Reporte de caso / Non-surgical Therapeutics of large size periapical injury: Clinical case report

Resumen Se describe un caso clínico sobre una mujer de 21 años de edad la cual sufrió trauma dental a los 6 años que comprometió al incisivo superior izquierdo lo cual con el tiempo generó o se formó una gran lesión periapical en esta región. Radiográficamente se observa la formación incompleta de la raíz, las paredes del conducto radicular delgadas, y una extensa lesión periapical. Se realizó el desbridamiento químico-mecánico con limas K y se ejecutó la desinfección del conducto radicular con clorhexidina al 2%. El conducto se deja medicado con hidróxido de calcio (Vitapex®), el cual se reemplaza periódicamente con dicho material hasta los nueve meses, finalmente se obtura con Biodentine®. Se da seguimiento al caso a través de cuatro años, pasando por blanqueamiento interno, carilla de resina hasta llegar a poste intra radicular con corona completa de porcelana en lo concerniente al aspecto estético. En cuanto a la lesión periapical de gran tamaño, se llega a observar por medio de tomografías, disminución de la lesión al mínimo y genera cicatrización ósea. En relación con la observación clínica hay desaparición de la fístula y ausencia de sintomatología.

Abstract This report describes a clinical case involving a 21-year-old woman, who suffered dental trauma at age 6, compromising left tooth 2.1. On time she developed a large periapical injury in this area. Radiographically, incomplete root formation, thin walls of the root canal, and extensive periapical damage is clearly shown. Chemo- mechanical debridement was performed with K files and disinfection of the root canal using 2% chlorhexidine. The root canal was left medicated with calcium hydroxide (Metapex), which was replaced periodically until 9 months. Finally, the root canal was completely sealed with Biodentine. The case had a follow up for over four years and concerning esthetical aspects, through this period of time an internal whitening, resin veneer, intra radicular post and complete crown were provided. Regarding the considerable periapical injury, tomography shows that it has been drastically reduced and generated bone healing. Clinical observations also show that the fistula and symptomatology disappeared.

A Retrospective Brazilian Multicenter Study of Biopsies at the Periapical Area: Identification of Cases of Nonendodontic Periapical Lesions.

INTRODUCTION: The purpose of this study was to analyze the features of lesions obtained from biopsies at the periapical area of teeth with a radiographic or clinical initial diagnosis of apical periodontitis. METHODS: A retrospective study was conducted on biopsies obtained from 1953-2018 at 3 Brazilian oral and maxillofacial pathology centers. Cases of endodontic and nonendodontic periapical lesions (NPLs) with a clinical diagnosis of endodontic pathoses were retrieved. Data regarding patient age, sex, and anatomic location were obtained from patients' records. The frequency and percentage of cases with clinical diagnoses of a periapical cyst, periapical granuloma, or dentoalveolar abscess were recorded, and the final histopathologic diagnosis was documented. RESULTS: Among 66,179 oral biopsies, 7246 (10.94%) were clinically diagnosed as periapical disease, 306 (4.22%) of which were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocysts (n = 107, 34.96%) followed by dentigerous cysts (n = 48, 15.68%). The mean age at diagnosis was 39.68 years with a range of 6-80 years. A total of 159 (51.96%) cases occurred in females and 147 (48.03%) in males (female to male ratio = 1.08:1). Most lesions (137, 44.77%) were located in the posterior mandible. CONCLUSIONS: A wide variety of histopathologic diagnoses, including benign odontogenic and nonodontogenic cystic and tumorous lesions, infectious diseases, and malignant neoplasms, was reported in the present survey. The features presented in this study were consistent with previous findings reported in the literature.