Utilizing Deep Learning for Diagnosing Radicular Cysts.

OBJECTIVES: The purpose of this study was to develop a deep learning algorithm capable of diagnosing radicular cysts in the lower jaw on panoramic radiographs. MATERIALS AND METHODS: In this study, we conducted a comprehensive analysis of 138 radicular cysts and 100 normal panoramic radiographs collected from 2013 to 2023 at Clinical Hospital Dubrava. The images were annotated by a team comprising a radiologist and a maxillofacial surgeon, utilizing the GNU Image Manipulation Program. Furthermore, the dataset was enriched through the application of various augmentation techniques to improve its robustness. The evaluation of the algorithm's performance and a deep dive into its mechanics were achieved using performance metrics and EigenCAM maps. RESULTS: In the task of diagnosing radicular cysts, the initial algorithm performance-without the use of augmentation techniques-yielded the following scores: precision at 85.8%, recall at 66.7%, mean average precision (mAP)@50 threshold at 70.9%, and mAP@50-95 thresholds at 60.2%. The introduction of image augmentation techniques led to the precision of 74%, recall of 77.8%, mAP@50 threshold to 89.6%, and mAP@50-95 thresholds of 71.7, respectively. Also, the precision and recall were transformed into F1 scores to provide a balanced evaluation of model performance. The weighted function of these metrics determined the overall efficacy of our models. In our evaluation, non-augmented data achieved F1 scores of 0.750, while augmented data achieved slightly higher scores of 0.758. CONCLUSION: Our study underscores the pivotal role that deep learning is poised to play in the future of oral and maxillofacial radiology. Furthermore, the algorithm developed through this research demonstrates a capability to diagnose radicular cysts accurately, heralding a significant advancement in the field.

The roles of stress-induced premature senescence and Akt/FoxO1 signaling in periapical lesions.

OBJECTIVES: There is little knowledge about oxidative stress-induced senescence involvement in apical periodontitis. Here, we explored its molecular mechanism in periapical lesions. METHODS: Ten cases of radicular cysts and five cases of periapical granulomas were randomly selected. Immunohistochemical analysis was performed to detect the expression and correlation between Senescence-associated factor polymerase I and transcript release factor (PTRF) and Akt/FoxO1 signaling. Human periodontal ligament cells (hPDLCs) pretreated with LY294002 were exposed to H2 O2 -induced oxidative stress conditions and then cell proliferation, senescence, apoptosis, and associated signaling were evaluated by EdU labeling, ß-galactosidase assay, RT-qPCR, and western blot analysis, respectively. RESULTS: Polymerase I and transcript release factor and Akt/FoxO1 signaling were more frequently expressed in the radicular cyst than in periapical granulomas. Notably, cells in radicular cysts showed Akt activation, FoxO1 phosphorylation, and cytoplasmic translocation. In vitro, prominent H2 O2 -induced senescence was observed in hPDLCs. LY294002, a PI3K inhibitor, attenuated the expression levels of senescence (Klotho, P16INK4), apoptosis (Bad, Fas), phosphorylated Akt, and phosphorylated FoxO1; however, did not affect cell proliferation. CONCLUSIONS: Our data indicated that senescence is present in clinical periapical lesions, and Akt/FoxO1 signaling is involved in the H2 O2 -induced cellular senescence, which could serve as a potential therapeutic target.

The Prevalence of EBV and KSHV in Odontogenic Lesions.

OBJECTIVES: Odontogenic lesions evolve as a result of altered dental development. This study aimed to evaluate the prevalence and the coinfection of Epstein-Barr virus (EBV) and Kaposi sarcoma-associated herpesvirus (KSHV) in radicular cysts, dentigerous cysts, odontogenic keratocysts, and ameloblastomas. METHODS: Polymerase chain reaction (PCR) was used to analyse 66 cases of odontogenic lesions for the presence of EBV-DNA and KSHV-DNA. These lesions were 15 radicular cysts, 16 dentigerous cysts, 18 odontogenic keratocysts, and 17 ameloblastomas. RESULTS: EBV-DNA was detected in 24 (36.4%) of the studied samples as follows: 6 samples (40.0%) of radicular cysts, 4 (25.0%) of dentigerous cysts, 10 (55.6 %) of odontogenic keratocysts, and 4 (23.5%) of ameloblastomas (P = .168). KSHV-DNA was found in 16 (24.2%) of the studied samples as follows: 1 sample (6.7%) of radicular cysts, 6 (37.5%) of dentigerous cysts, 8 (44.4 %) of odontogenic keratocysts, and 1 (5.9%) of ameloblastomas (P = .001). Additionally, EBV and KSHV were positively correlated in all studied samples (P = .002). CONCLUSIONS: Both EBV and KSHV are found in odontogenic cysts and ameloblastomas. KSHV and EBV are more prevalent in odontogenic keratocysts than in other studied odontogenic lesions. Further, there is a high prevalence of EBV and KSHV coinfection in odontogenic cysts and ameloblastomas.

Multiple Radicular Cysts in an 8-year-old: A Case Report.

Aim: The aim of this article is to report a case of multiple radicular cysts in an 8-year-old. Background: Multiple radicular cysts are an uncommon and rare entity in mixed dentition. Management of these cysts needs careful examination of the present deciduous and erupting permanent dentition. Here, we present a case of multiple radicular cysts in an 8-year-old with no other significant medical history. The treatment approach included removal of the involved deciduous teeth and enucleation of cysts, followed by curettage and the use of Whitehead's varnish. Case description: The patient reported to the department with a chief complaint of pain in the right lower front tooth region and upper left back tooth region for 2 months. There was no relevant medical or dental history. A routine panoramic radiograph was done, which revealed multiple radiolucency. Clinical presentation, radiograph, and aspiration cytology concluded the diagnosis as multiple radicular cysts. The treatment plan for management was the extraction of the teeth involved, followed by enucleation. Whitehead's varnish dressing was placed in the extraction socket. A regular follow-up was done, showing the absence of radiolucency and eruption of permanent teeth. Conclusion: Management of radicular cysts in mixed dentition is challenging. Preserving the vitality of erupting permanent teeth is of utmost importance. Significance: Multiple radicular cysts are an uncommon finding in young children. Proper medical history is important to rule out any syndrome. Correct diagnosis and early management are prognostic factors. How to cite this article: Sharma A, Chhabra A, Sharma I, et al. Multiple Radicular Cysts in an 8-year-old: A Case Report. Int J Clin Pediatr Dent 2023;16(S-3):S317-S320.

Management of radicular cyst associated with primary teeth using decompression: a retrospective study.

BACKGROUND: Radicular cysts arising from primary teeth are rare. Enucleation and marsupialization or decompression are treatment approach to odontogenic cysts. Decompression known to achieve good results in various cysts is widely used in clinic. This study aims to evaluate the efficiency of decompression in reducing radicular cysts associated with primary teeth in children. METHODS: Cases of radicular cysts associated with primary teeth treated by decompression were reviewed in the present study. Clinical information and radiologic data of pre and post decompression were measured and analyzed. RESULTS: Twenty-three patients treated for 25 cysts were included. All lesions with mean initial area 3.66 ± 2.00 cm2 were reduced after decompression time ranging 2 to 10 months. Mean rate of reduction was 0.77 ± 0.44 cm2/mo and large lesions (> 3.5 cm2) had a significantly higher reduction rate compared to smaller ones (< 3.5 cm2) (P < 0.00). All effected succedaneous teeth erupted after treatment at follow-up while 12 (46%) of them had root development problems. CONCLUSIONS: Decompression represents superiority as an effective and less invasive treatment in radicular cysts associated with primary teeth. TRIAL REGISTRATION: This study was retrospectively registered in the Ethics Committee of Ninth People's Hospital Affiliated with Shanghai JiaoTong University School of Medicine (No.SH9H-2022-T158-1).

Deep Learning-Based Microscopic Diagnosis of Odontogenic Keratocysts and Non-Keratocysts in Haematoxylin and Eosin-Stained Incisional Biopsies.

BACKGROUND: The goal of the study was to create a histopathology image classification automation system that could identify odontogenic keratocysts in hematoxylin and eosin-stained jaw cyst sections. METHODS: From 54 odontogenic keratocysts, 23 dentigerous cysts, and 20 radicular cysts, about 2657 microscopic pictures with 400× magnification were obtained. The images were annotated by a pathologist and categorized into epithelium, cystic lumen, and stroma of keratocysts and non-keratocysts. Preprocessing was performed in two steps; the first is data augmentation, as the Deep Learning techniques (DLT) improve their performance with increased data size. Secondly, the epithelial region was selected as the region of interest. RESULTS: Four experiments were conducted using the DLT. In the first, a pre-trained VGG16 was employed to classify after-image augmentation. In the second, DenseNet-169 was implemented for image classification on the augmented images. In the third, DenseNet-169 was trained on the two-step preprocessed images. In the last experiment, two and three results were averaged to obtain an accuracy of 93% on OKC and non-OKC images. CONCLUSIONS: The proposed algorithm may fit into the automation system of OKC and non-OKC diagnosis. Utmost care was taken in the manual process of image acquisition (minimum 28-30 images/slide at 40× magnification covering the entire stretch of epithelium and stromal component). Further, there is scope to improve the accuracy rate and make it human bias free by using a whole slide imaging scanner for image acquisition from slides.

Accuracy of computer-aided image analysis in the diagnosis of odontogenic cysts: A systematic review / Precisión del análisis de imágenes asistido por ordenador en el diagnóstico de quistes odontogénicos: una revisión sistemática

Background: This study aimed to search for scientific evidence concerning the accuracy of computer-assistedanalysis for diagnosing odontogenic cysts.Material and Methods: A systematic review was conducted according to the PRISMA statements and consideringeleven databases, including the grey literature. Protocol was registered in PROSPERO (CRD 42020189349). ThePECO strategy was used to define the eligibility criteria and only studies involving diagnostic accuracy were in-cluded. Their risk of bias was investigated using the Joanna Briggs Institute Critical Appraisal tool.Results: Out of 437 identified citations, five papers, published between 2006 and 2019, fulfilled the criteria andwere included in this systematic review. A total of 5,264 images from 508 lesions, classified as radicular cyst,odontogenic keratocyst, lateral periodontal cyst, glandular odontogenic cyst, or dentigerous cyst, were analyzed.All selected articles scored low risk of bias. In three studies, the best performances were achieved when the twosubtypes of odontogenic keratocysts (solitary or syndromic) were pooled together, the case-wise analysis showinga success rate of 100% for odontogenic keratocysts and radicular cysts, in one of them. In two studies, the den-tigerous cyst was associated with the majority of misclassifications, and its omission from the dataset improvedsignificantly the classification rates. Conclusions: The overall evaluation showed all studies presented high accuracy rates of computer-aided systems inclassifying odontogenic cysts in digital images of histological tissue sections. However, due to the heterogeneity ofthe studies, a meta-analysis evaluating the outcomes of interest was not performed and a pragmatic recommendationabout their use is not possible.(AU)

Deep learning object detection of maxillary cyst-like lesions on panoramic radiographs: preliminary study.

OBJECTIVES: This study aimed to examine the performance of deep learning object detection technology for detecting and identifying maxillary cyst-like lesions on panoramic radiography. METHODS: Altogether, 412 patients with maxillary cyst-like lesions (including several benign tumors) were enrolled. All panoramic radiographs were arbitrarily assigned to the training, testing 1, and testing 2 datasets of the study. The deep learning process of the training images and labels was performed for 1000 epochs using the DetectNet neural network. The testing 1 and testing 2 images were applied to the created learning model, and the detection performance was evaluated. For lesions that could be detected, the classification performance (sensitivity) for identifying radicular cysts or other lesions were examined. RESULTS: The recall, precision, and F-1 score for detecting maxillary cysts were 74.6%/77.1%, 89.8%/90.0%, and 81.5%/83.1% for the testing 1/testing 2 datasets, respectively. The recall was higher in the anterior regions and for radicular cysts. The sensitivity was higher for identifying radicular cysts than for other lesions. CONCLUSIONS: Using deep learning object detection technology, maxillary cyst-like lesions could be detected in approximately 75-77%.

Dental Apical Inflammation Score (DAIS): Histopathological scoring for the evaluation of the apical inflammatory activity and local bone destruction.

OBJECTIVE: The purpose of this study was to evaluate 210 periapical lesions with a newly created Dental Apical Inflammation Score/DAIS with regard to their inflammatory cell infiltration, bone tissue, epithelium, bacteria and foreign material. STUDY DESIGN: Specimens were obtained from 51 different dental practices over a period of 11 months. These specimens were then sent in for histopathological routine diagnostics. RESULTS: The DAIS classified 81 cases of Type 1 (acute inflammation = low, chronic inflammation = low), 79 cases of Type 2 (acute inflammation = low, chronic inflammation = high), 46 cases of Type 3 (acute inflammation = high, chronic inflammation = low) and 4 cases of Type 4 (acute inflammation = high, chronic inflammation = high). Bone tissue was found in 141 cases, signs for bacterial osteitis in 49 cases, cyst epithelium in 40 cases and foreign material in 27 cases. In 210 cases, cyst epithelium was evident in 27.2 % of Type 1, 15.2 % of Type 2, 8.7 % of Type 3 and in 50 % of Type 4 (p = .019). The 141 cases containing bone tissue showed signs of bacterial osteitis in 16.1 % of Type 1, 29.8 % of Type 2, 77.8 % of Type 3 and in 100 % of Type 4 (p < .001). In 64 cases, Bacteria was evident in 30 % of Type 1, 25 % of Type 2, 55 % of Type 3 and in 100 % of Type 4 (p = .013). CONCLUSION: The DAIS could classify apical lesions with statistically significant differences. Bacterial osteitis in apical lesions was reported for the first time.

Differences in Inflammation and Bone Resorption between Apical Granulomas, Radicular Cysts, and Dentigerous Cysts.

INTRODUCTION: Dental cysts can be of inflammatory (radicular cysts) or noninflammatory (dentigerous cysts) origin. Apical periodontitis is a necrosis of the pulp and infection of the root canal causing the development of apical granulomas or radicular cysts. The immunology of granuloma and cyst formation is important because modern root filling materials are immunologically active and can contribute to the resolution of apical granulomas. In contrast, radicular cysts often require apicectomy. A better understanding of the pathophysiology of inflammation and bone resorption in apical periodontitis could be the basis for developing new root filling materials with superior immunomodulatory properties. METHODS: Forty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray of the 87 consecutive specimens was created, and human leukocyte antigen-DR isotype (HLA-DR)-, CD83-, receptor activator of nuclear factor kappa B ligand-, macrophage colony-stimulating factor (MCSF)-, galectin-3 (Gal3)-, CD4-, and CD8-positive cells were detected by immunohistochemistry. Tissue microarrays were digitized, and the expression of markers was quantitatively assessed. RESULTS: HLA-DR, CD83, MCSF, and Gal3 expression was significantly (P < .05) higher in radicular cysts compared with apical granulomas. HLA-DR, CD83, MCSF, receptor activator of nuclear factor kappa B ligand, and Gal3 expression in dentigerous cysts was significantly (P < .05) lower than in both periapical lesions (apical granulomas and radicular cysts). CD4 and CD8 infiltration was not statistically different between apical granulomas and radicular cysts. Dentigerous cysts showed a significantly (P < .05) lower T-cell infiltration than apical periodontitis. The CD4/CD8 ratio was not significantly different between the analyzed groups. CONCLUSIONS: The development of radicular cysts in apical periodontitis is associated with an increased expression of myeloid inflammatory markers and bone resorption parameters. Antigen-presenting cells and myeloid cells might be more relevant for the pathogenesis of apical periodontitis than T cells. Increased inflammation might promote the formation of radicular cysts and more pronounced bone resorption.

Role of Cytokeratin-7 in the pathogenesis of odontogenic cysts - an immunohistochemical study.

INTRODUCTION: Odontogenic cysts are distinct entities and quite a common occurrence in the jaw bones. These are individual lesions which arise from the same odontogenic apparatus but with varying pathogenesis. Cytokeratins are integral components in tooth development and are expressed across the odontogenic tissues in physiological and pathological states. AIM: To elucidate the role of cytokeratin-7 in the pathogenesis of odontogenic cysts by immunohistochemistry. METHOD: Cytokeratin-7 (CK-7) was assessed in 39 cases of odontogenic lesions retrieved from the archival files which included 15 cases of dentigerous cysts (DC), 12 cases of odontogenic keratocysts (OKC) and 12 cases of radicular cysts (RC) and also 8 cases of control specimens. STATISTICAL ANALYSIS: Results obtained were statistically analyzed using chi-square test to assess the association between different odontogenic cysts used in this study and Cytokeration-7 staining. The difference was considered to be of statistical significance if the p value was ≤ 0.05. RESULTS: CK7 expression was maximum in dentigerous cycts (66.66%) followed by radicular cysts (41.66%) and odontogenic keratocysts (16.6%). On evaluation of staining and expression pattern, highest positivity is shown in dentigerous cysts and the positivity is seen in suprabasal (60%) and superficial layers (40%) whereas radicular cysts and odontogenic keratocysts showed positivity in superficial and spinous layers. CONCLUSION: Cytokeratin-7 expression correlates with the degree of differentiation of the epithelium. So the cysts with a well-differentiated epithelium (RC and DC) express CK-7, while the cysts with a less well-differentiated epithelium (OKC) show slight positivity. Thus it can be useful to differentiate OKC from DC and RC.

Bevacizumab or fibronectin gene editing inhibits the osteoclastogenic effects of fibroblasts derived from human radicular cysts.

Fibronectin (FN) is a main component of extracellular matrix (ECM) in most adult tissues. Under pathological conditions, particularly inflammation, wound healing and tumors, an alternatively spliced exon extra domain A (EDA) is included in the FN protein (EDA+FN), which facilitates cellular proliferation, motility, and aggressiveness in different lesions. In this study we investigated the effects of EDA+FN on bone destruction in human radicular cysts and explored the possibility of editing FN gene or blocking the related paracrine signaling pathway to inhibit the osteoclastogenesis. The specimens of radicular cysts were obtained from 20 patients. We showed that the vessel density was positively associated with both the lesion size (R = 0.49, P = 0.001) and EDA+FN staining (R = 0.26, P = 0.022) in the specimens. We isolated fibroblasts from surgical specimens, and used the CRISPR/Cas system to knockout the EDA exon, or used IST-9 antibody and bevacizumab to block EDA+FN and VEGF, respectively. Compared to control fibroblasts, the fibroblasts from radicular cysts exhibited significantly more Trap+MNCs, the relative expression level of VEGF was positively associated with both the ratio of EDA+FN/total FN (R = 0.271, P = 0.019) and with the number of Trap+MNCs (R = 0.331, P = 0.008). The knockout of the EDA exon significantly decreased VEGF expression in the fibroblasts derived from radicular cysts, leading to significantly decreased osteoclastogenesis; similar results were observed using bevacizumab to block VEGF, but block of EDA+FN with IST-9 antibody had no effect. Furthermore, the inhibitory effects of gene editing on Trap+MNC development were restored by exogenous VEGF. These results suggest that EDA+FN facilitates osteoclastogenesis in the fibrous capsule of radicular cysts, through a mechanism mediated by VEGF via an autocrine effect on the fibroblasts. Bevacizumab inhibits osteoclastogenesis in radicular cysts as effectively as the exclusion of the EDA exon by gene editing.

Apical periodontitis: preliminary assessment of microbiota by 16S rRNA high throughput amplicon target sequencing.

BACKGROUND: Apical periodontitis includes periapical granulomas and radicular cysts, which are histologically distinguished by the absence and the presence of an epithelial lining, respectively. The main cause of apical periodontitis is the bacterial colonization of the root canal space. This research aimed at assessing whether and how periapical granulomas and radicular cysts differ in terms of microbiota using high throughput amplicon target sequencing (HTS) techniques. METHODS: This study included 5 cases of Periapical Granulomas (PGs) and 5 cases of Radicular Cysts (RCs) selected on the base of histology out of 37 patients from January 2015 to February 2016. Complete medical history, panoramic radiograms (OPTs) and histologic records of each patient were assessed. Only lesions greater than 1 cm in diameter and developed in proximity to teeth with bad prognosis were included. The microbiota present in periapical granulomas and radicular cysts thus retrieved was finely characterized by pyrosequencing of the 16S rRNA genes. RESULTS: The core of OTUs shared between periapical granulomas and radicular cysts was dominated by the presence of facultative anaerobes taxa such as: Lactococcus lactis, Propionibacterium acnes, Staphylococcus warneri, Acinetobacter johnsonii and Gemellales. L. lactis, the main OTUs of the entire datasets, was associated with periapical granuloma samples. Consistently with literature, the anaerobic taxa detected were most abundant in radicular cyst samples. Indeed, a higher abundance of presumptive predicted metabolic pathways related to Lipopolysaccharide biosynthesis was found in radicular cyst samples. CONCLUSIONS: The present pilot study confirmed the different microbial characterization of the two main apical periodontitis types and shade light on the possible role of L. lactis in periapical granulomas.

Immunohistochemical Analysis of Galectins-1, -3, and -7 in Periapical Granulomas, Radicular Cysts, and Residual Radicular Cysts.

INTRODUCTION: Galectins play important roles in immunoinflammatory responses, but their participation in the development of periapical lesions remains unclear. This study aimed to evaluate the expressions of galectins-1, -3, and -7 in periapical lesions, correlating them with the intensity of the inflammatory infiltrate and the pattern of the cystic epithelium. METHODS: Twenty periapical granulomas (PGs), 20 radicular cysts (RCs), and 20 residual radicular cysts (RRCs) were submitted to immunohistochemistry using anti-galectin-1, -3, and -7 antibodies. The percentage of immunopositive cells in epithelial and connective tissues was determined. RESULTS: In connective tissue, PGs exhibited higher cytoplasmic/membrane expression of galectins-1 and -7 than RCs and RRCs (P < .05). There was higher nuclear expression of galectin-1 in PGs compared with RCs and RRCs (P < .05). The expression of galectins-1 and -7 in connective tissue was higher in lesions with grade III inflammation (P < .05). No significant differences in galectin-3 immunoexpression were observed for any of the parameters evaluated (P > .05). In the epithelial component, a higher nuclear expression of galectin-7 was detected in RRCs (P < .05), and a higher cytoplasmic/membrane expression of this protein was found in cysts with hyperplastic epithelium (P < .05). Positive correlations were observed between the nuclear and cytoplasmic/membrane expression of galectin-1 in connective tissue (P < .05) as well as between the nuclear and cytoplasmic/membrane expression of galectin-7 in epithelial tissue of cysts (P < .05). CONCLUSIONS: Galectins-1 and -7 may play important roles in the pathogenesis of PGs, RCs, and RRCs. On the other hand, the present results suggest only a minor involvement of galectin-3 in the development of these lesions.

Macrophage polarization differs between apical granulomas, radicular cysts, and dentigerous cysts.

OBJECTIVES: Apical periodontitis can appear clinically as apical granulomas or radicular cysts. There is evidence that immunologic factors are involved in the pathogenesis of both pathologies. In contrast to radicular cysts, the dentigerous cysts have a developmental origin. Macrophage polarization (M1 vs M2) is a main regulator of tissue homeostasis and differentiation. There are no studies comparing macrophage polarization in apical granulomas, radicular cysts, and dentigerous cysts. MATERIALS AND METHODS: Forty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray (TMA) of the 87 consecutive specimens was created, and CD68-, CD11c-, CD163-, and MRC1-positive macrophages were detected by immunohistochemical methods. TMAs were digitized, and the expression of macrophage markers was quantitatively assessed. RESULTS: Radicular cysts are characterized by M1 polarization of macrophages while apical granulomas show a significantly higher degree of M2 polarization. Dentigerous cysts have a significantly lower M1 polarization than both analyzed periapical lesions (apical granulomas and radicular cysts) and accordingly, a significantly higher M2 polarization than radicular cysts. Macrophage cell density in dentigerous cysts is significantly lower than in the periapical lesions. CONCLUSIONS: The development of apical periodontitis towards apical granulomas or radicular cysts might be directed by macrophage polarization. Radicular cyst formation is associated with an increased M1 polarization of infiltrating macrophages. In contrast to radicular cysts, dentigerous cysts are characterized by a low macrophage infiltration and a high degree of M2 polarization, possibly reflecting their developmental rather than inflammatory origin. CLINICAL RELEVANCE: As M1 polarization of macrophages is triggered by bacterial antigens, these results underline the need for sufficient bacterial clearance during endodontic treatment to prevent a possible M1 macrophage-derived stimulus for radicular cyst formation.

A tomografia computadorizada de feixe cônico no diagnóstico diferencial dos cistos radiculares e granulomas periapicais / Cone beam computed tomography on the differential diagnosis of cysts and periapical granuloma

As patologias mais frequentes na região maxilar e mandibular são as lesões de origem inflamatória, o cisto radicular e o granuloma periapical. O diagnóstico é a base para o tratamento endodôntico e se apoia nos sintomas do paciente, nos exames radiográficos e histológicos que permanecem como o padrão ouro para determinar qual o tipo de lesão periapical. Contudo, a imagem radiográfica sugere como diagnóstico as lesões periapicais sem, no entanto, caracterizar qual o tipo de lesão encontrada. A Odontologia tem sido beneficiada pelos constantes avanços na área da tecnologia de informática. Com esses avanços, no exame da tomografia computadorizada de feixe cônico (CBCT), a lesão pode ser observada na sua total dimensão. Porém, o real potencial em fornecer a distinção entre cistos e granulomas ainda não atingiu a sua plenitude. No entanto, com base em estudos realizados até esta data, a tomografia computadorizada é considerada uma importante ferramenta para o diagnóstico diferencial das lesões periapicais. O principal objetivo desta revisão de literatura é fornecer um panorama sobre o potencial do CBCT como ferramenta para diferenciar os cistos periapicais dos granulomas com base nos estudos mais relevantes até então desenvolvidos (AU).

The most frequent pathologies in maxillary and mandibular region are the lesions of inflammatory origin, radicular cyst, and periapical granuloma. The diagnosis is the basis for endodontic treatment and relies on the patient's symptoms, radiographic and histological examinations that remain the gold standard to determine the type of lesion. However, radiographic images suggest a diagnsosis of periapical lesions without characterizing the lesion. Dentistry has been favored by a continuous progress in computer technology. Using the cone beam computed tomography (CBCT) the lesion can be examined in its full dimension. However, the real potential to provide a distinction between cysts and granulomas has not yet reached its fullness. However, according to the literature, CT scan is considered an important tool for the differential diagnosis of periapical lesions. The main objective of this review is to provide an overview of the potential of CBCT as a tool to differentiate periapical cysts from granulomas, based on relevant previous studies (AU).

Bilateral radicular cyst in mandible: an unusual case report.

A radicular cyst is one of the furthermost everyday odontogenic cysts of the anterior maxilla, not regularly comprehended in youth. They are found mostly at the apices of the tooth (periapical cyst), lateral surface of the roots (lateral radicular cyst) and remains in the jaw after removal of the offending tooth (residual cyst). The radicular cyst has been catalogued as an inflammatory cyst, as an outcome to pulpal necrosis succeeding caries, with a linked periapical inflammatory reaction. They advance sluggishly and asymptomatic lest infected. Because of this they can extent to big dimensions. Many times it is perplexing to segregate radicular cysts from the obligatory pre-existing chronic periapical periodontitis lesions radiographically. Here, we present a rare case with bilateral radicular cyst in relation to first molar of the mandible in a 19-year-old. Orthopantomograph showed a large unilocular radiolucency with a well-defined border in the periapical region of the first molar on the left side extending from the root of the second premolar to the mesial root of the second molar. Correspondingly another well-defined unilocular radiolucency with a well-defined border was seen on the right side of the mandible. Several treatment possibilities are presented for a radicular cyst such as surgical endodontic treatment, extraction of the transgressing tooth, enucleation with primary closure, and marsupialization trailed by enucleation. The patient management comprised surgical enucleation of cystic sac followed by rehabilitation of the same area.

Clinicopathological study of jaw cysts in southeast region of Turkey.

OBJECTIVE: The purpose of this retrospective study was to analyze clinic and radiologic features and the prevalence of jaw cysts in southeast region of Turkey. MATERIALS AND METHODS: This study was carried out in 149 cysts of the jaw diagnosed among 407 individuals who were taken biopsy in our department from October 2008 to December 2012. All cysts were treated by enucleation, marsupialization, or combination, and all cases were histologically examined. RESULTS: One-hundred-and-forty-eight cases were classified odontogenic, one was non-odontogenic. There were 89 cysts (59.7%) in men, 60 (40.3%) in women. The mean age was 32.72 years. We found 80 cysts (35 F, 45 M) in the maxillary and 69 (28 F, 41 M) in mandible. It is observed that 94 were radicular cysts (63%), 40 were dentigerous cysts (26.9%), 9 were odontogenic keratocysts (OKC) (6.1%), 5 were residual radicular cysts (3.4%), and 1 was nasopalatine cyst (0.6%). In radicular cysts, 56 of them (59.5%) were located in the anterior region of the jaws; 18 dentigerous cysts and 2 OKCs were found in the posterior region of mandible. Clinically, the chief complaint of patients was expansion and pain. Radiographically, scalloping of the lesion between the teeth was found in 1 case, root resorption was seen in 3 cases, and displacement of the teeth and follicles was observed in 16 cases. CONCLUSIONS: We found similar prevalence of jaw cysts that reported in the literature, in which most odontogenic cysts (OCs) were inflammatory origin.

Higher expression of galectin-3 and galectin-9 in periapical granulomas than in radicular cysts and an increased toll-like receptor-2 and toll-like receptor-4 expression are associated with reactivation of periapical inflammation.

INTRODUCTION: Cysts and periapical granulomas are inflammatory reactions that develop in response to periapical infection by microbial species in dental root canal. It is known that toll-like receptors (TLRs) are pathogen recognition molecules and that galectins are lectins that can be associated with the inflammatory process, stimulating or inhibiting the immune system. The objective of this study was to evaluate the in situ expression of TLRs and galectins in radicular cysts and periapical granulomas. METHODS: We analyzed 62 cases (30 radicular cysts, 27 periapical granulomas, and 5 control cases). Indirect immunohistochemistry was used to evaluate the expression of TLRs (TRL-2 and TLR-4) and galectins (Gal-3 and Gal-9). RESULTS: The expression of Gal-3 and Gal-9 was significantly higher in periapical granulomas and radicular cysts than in the control group. Similarly, both Gal-3 and Gal-9 were expressed significantly more in periapical granulomas than in radicular cysts. The expression of TLR-2 was significantly higher in periapical granulomas and radicular cysts than in the control group, and it was also significantly higher in radicular cysts with sinus tract than in the cases without sinus tract. Furthermore, the expression of TLR-4 was significantly higher in the cases of periapical granulomas with sinus tract than in the cases without sinus tract. CONCLUSIONS: Gal-3/Gal-9 and TLR-2/TLR-4 expression in the periapical granulomas and radicular cysts is associated with reactive periapical inflammation. Pathobiology of periapical disease is a very complex interplay of many bioactive molecules involved in immunoinflammatory responses. Up-regulation of these bioactive molecules might be an important modulator of inflammatory periapical lesions.

An unusual case report of bilateral mandibular radicular cysts.

A radicular cyst is one of the most common odontogenic cysts of anterior maxilla, not commonly seen in adolescence. Here, we present a rare, atypical case, of bilateral radicular cysts of the mandibular posterior region in a 13-year-old girl. The patient management comprised surgical enucleation of cystic sac under general anesthesia followed by rehabilitation of the same area. The purpose of this article is to lay emphasis on the pedodontist's role in early diagnosis and treatment of such lesions.