Diagnosis consensus among endodontic specialists and general practitioners: An international survey and a proposed modification to the current diagnostic terminology.

INTRODUCTION: This survey aimed to determine the consensus amongst endodontic specialists in North America and practitioners worldwide to diagnose the pulp and periapical conditions of selected case scenarios encountered in daily practice using the American Association of Endodontists (AAE) pulpal and periapical diagnostic terms. Secondly, an attempt was made to suggest modifications in terms accordingly. METHODOLOGY: A survey designed by two endodontic educators was sent to endodontists in North America and clinicians worldwide through an electronic database. The survey included socio-demographic questions followed by the clinical and radiographic presentations of four clinical scenarios. The participants were then requested to provide the pulpal and the periapical diagnosis of 11 teeth presented in these cases (22 answers in total/participant) using the AAE diagnostic terminology. Cases were designed to include 12 pulpal/periapical conditions as control (non-controversial conditions) and ten so-called controversial conditions. A proportion threshold of 10% was required for any diagnostic term to be reported in this survey. The participants were divided into two groups based on the region of endodontic training and/or practice to 'Specialised North American' or 'International Practitioners,' and their results were statistically compared using chi-squared tests (p < .05). RESULTS: The survey included 421 participants. 74% were endodontists, and 46.1% were amongst the 'Specialised North American' group and 53.9% amongst the 'International Practitioners'. Eleven of 12 control conditions had an almost complete agreement amongst the participants regarding the diagnostic terms selected, ranging between 82% and 96%, with no other diagnostic term exceeding the 10% threshold. All the controversial conditions yielded more than one diagnostic term selected/condition that exceeded the 10% threshold for groups ('Specialised North American' and 'International practitioners'). There were no differences in the diagnostic terms selected between the two groups; however, the weight for each term varied between the groups in some cases. CONCLUSION: There is a lack of consensus amongst clinicians, regardless of their training and region of practice, on the appropriate diagnostic terms to be used in particular clinical conditions. More diagnostic terms and modifications in the current terms may be required to establish a more reliable diagnostic terminology.

Magnificación en la terapia endodóncica mediante el microscopio operatorio / Magnification in endodontic therapy through the operatory microscope

La microendodoncia involucra la visualización a través de un microscopio operatorio de todas las fases del tratamiento de conductos y procedimientos de cirugía apical y correctiva por parte del endodoncista. Existe sobrada evidencia acerca de las mejoras que puede aportar la magnificación al tratamiento; la literatura demuestra que la capacidad del operador mejora si su visión del campo gana claridad y precisión, ambos recursos pueden ser proporcionados por el microscopio operatorio, aunado a que posibilita diagnósticos más certeros junto con mejoras en el pronóstico, lo que permite evitar posibles complicaciones. La calidad de los tratamientos endodóncicos involucra infinidad de factores, cada uno relevante en sí mismo pero, en determinados casos, el microscopio puede significar la diferencia entre un tratamiento exitoso o un fracaso clínico. En la actualidad, se ha convertido en un tema de lo más relevante, por lo que el objetivo del presente trabajo es revisar la literatura con el fin de ayudar al entendimiento basado en evidencia científica de los criterios que determinan la relevancia del uso del microscopio en el ámbito endodóncico (AU)

Microendodontics involves the visualization through an operating microscope of all phases of root canal treatment and apical and corrective surgery procedures by the endodontist. There is plenty of evidence about the improvements that magnification can provide, the literature shows that the operator's ability improves if his vision of the field gains clarity and precision, both resources can be provided by the operating microscope, added to the fact that it enables more accurate diagnoses together with improvements in the prognosis allowing to avoid possible complications. The quality of endodontic treatments involves countless factors, each relevant in itself, but in certain cases the microscope can mean the difference between a successful treatment or a clinical failure. At present, it has become a very relevant topic, so the objective of this work is to review the literature in order to help understand the criteria that determine the relevance of the use of the microscope in the endodontic field based on scientific evidence (AU)

Endosoft: herramienta para el aprendizaje de las patologías pulpares y periapicales / Endosoft: a tool for learning from pulp and periapical diseases

Introducción: el empleo de software educativo es una alternativa motivadora en los diferentes escenarios docentes. Objetivo: mostrar la validación del software educativo sobre diagnóstico y tratamiento de enfermedades pulpares y periapicales para su generalización en estudiantes de Estomatología. Material y Métodos: se realizó un estudio de innovación tecnológica o producto terminado digital en la etapa comprendida desde marzo de 2018 a marzo de 2019. Se utilizó la herramienta Mediator v9.0. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético y el sistémico-estructural; y empíricos: la revisión documental y una encuesta a estudiantes y expertos en función de evaluadores externos del producto. Para evaluar la factibilidad del software se utilizó el método de Criterio de Experto y el Criterio de usuario. Las principales variables evaluadas fueron el diseño de las secciones del software, su funcionalidad, cientificidad del contenido, relación de las imágenes con el objetivo del software, así como su uso en la docencia. Resultados: el producto obtenido consta de un texto básico con hipervínculos para acceder a los demás componentes, así como galerías de imágenes y ejercicios de autoevaluación. Según Criterio de Experto la calidad técnica del producto y la calidad del contenido quedaron evaluadas en la categoría Muy Adecuado. Según Criterio de Usuario, la funcionalidad, la motivación individual y los aspectos de diseño fueron evaluados de Bien. Conclusiones: se desarrolló un software educativo que cuenta con recursos variados para el aprendizaje sobre el tema abordado(AU)

Introduction: The use of the educational software is a motivating alternative in different teaching scenarios. Objective: To validate the educational software related to the diagnosis and treatment of pulp and periapical diseases for its generalization in dental students. Material and Methods: A study linked with technological innovation or digital finished product was conducted during the period between March 2018 and March 2019. The tool used was Mediator v9.0. Theoretical methods such as historical-logical, analytical-synthetic, inductive-deductive, and systemic-structural were used; empirical methods, which included the documentary review and a survey, were applied to students and experts as external evaluators of the product. The methods of Expert Judgment and Customer Judgment were used to evaluate the feasibility of the software. The main variables evaluated were the design of software sections, its functionality, scientific content, relationship between the images and the objective of the software and its use in the teaching-learning process. Results: The product obtained is a basic text with hyperlinks to access the rest of the components, image galleries and self-evaluation exercises. According to Expert Judgment, the technical quality of the software and the quality of its content were evaluated as good. According to Customer Judgment, the functionality, self-motivation and design aspects were evaluated as optimal. Conclusions: An educational software with various resources for learning about the topic approached was developed(AU)

The many faces of periapical inflammation.

Dental periapical inflammation is common and can present with a wide variety of symptoms and signs. These include jaw pain and local soft-tissue inflammation, which may be obviously dental in origin; however, the presentation may also be with a painless mass or draining cutaneous sinus, with facial or ear pain or with symptoms of sinusitis, when the dental cause is not clinically obvious. Radiologists are often the first to recognise the dental source of symptoms in these cases. This recognition requires an awareness of the varied manifestations of periapical sepsis and careful systematic review of the teeth and jaws. The causative periapical lesion may be small and subtle, and there is not always a macroscopic defect in the cortical bone between the lesion and surrounding soft-tissue inflammation. The origin of the referral and the initial imaging technique used can vary. Dental periapical inflammation can also be an incidental finding on imaging. In these cases, it should not be mistaken for more sinister pathology and its presence should be conveyed to the referrer so that appropriate dental treatment can be initiated: this is especially important in patients with malignancy in whom radiotherapy is planned. In cases of severe odontogenic soft-tissue sepsis, a review of the airway and major blood vessels is important. We present cases to illustrate the wide range of clinical and radiological manifestations of periapical inflammatory pathology.

The Importance of Obtaining a Pulpal and Periradicular Diagnosis Prior to Restorative Treatment.

Maintaining dental pulp vitality should be among the clinical goals of any restorative treatment. By obtaining a pretreatment pulpal and periradicular diagnosis before performing restorative treatment, the clinician will be better able to proceed with treatment of the pulp, especially if it is exposed during caries excavation. A pretreatment pulpal and periapical diagnosis may be effectively attained by performing five objective clinical tests: pulp sensibility, percussion (which may include bite testing), palpation, periodontal probing/ tooth mobility, and updated radiography. This article provides a description of these five clinical tests and gives an overview of current terminologies used when obtaining a pulpal and periradicular diagnosis.

Anterior lingual mandibular bone depression: differential diagnosis of periapical inflammatory disorders.

Lingual mandibular bone depressions mainly affect the posterior region of the mandible. Depressions in the anterior region are rare, frequently posing difficulties in diagnosis. The aim of this article is to present a case of an anterior lingual mandibular bone depression (ALMBD) that was radiographically superimposed on the roots of anterior teeth. A 43-year-old man was referred for evaluation of a slight depression on the lingual surface of the anterior mandible. The depression was associated with a well-defined radiolucent area superimposed on the roots of the right canine and incisors. All teeth in the area proved to be vital, and cone beam computed tomography (CBCT) revealed a lingual depression in the area. The final diagnosis was an ALMBD, and the patient underwent clinical and radiographic follow-up examinations for 22 months that revealed no alterations in the area. When anterior mandibular radiolucencies are superimposed on the roots of the adjacent teeth, ALMBDs should be considered in the differential diagnosis along with periapical cysts and granulomas. Radiographic and CBCT analyses are useful to avoid unnecessary endodontic and surgical approaches.

Craniofacial and oral alterations in patients with Neurofibromatosis 1.

ABTSRACT: Neurofibromatosis type 1 (NF1) is one of the most common inherited syndromes. The literature on craniofacial alterations associated with NF1 has been limited and partially contradictory. This review is based on literature search and the results of the clinical study "Craniofacial and Oral Alterations and Speech in patients with Neurofibromatosis 1", carried out at the University of Turku and Turku University Hospital, Finland in 2006-2012. By the end of 2012, a total of 110 NF1 patients, 54 female and 56 male patients, were examined.A part of our results confirms pre-existing understanding, a part is contradictory to previous considerations based mainly on case reports, and some are entirely novel. Specifically, our results confirmed that enlargement the mandibular canal is the most common abnormality of the mandible in patients with NF1. It should be noted, however, that this finding does not require treatment. Caries was not a major problem. In fact, it was less frequent in NF1 patients compared to reference population. These findings abrogate some previous perceptions. Novel findings of our project include periapical cemental dysplasia in females; short jaws, a finding which usually does not affect bite; and immunohistological analysis of oral mucosal abnormalities. Pioneering study on speech showed that various deviations were very common: As many as 94% of the participants showed some alterations.To conclude, the awareness of craniofacial alterations common in NF1would help avoiding unnecessary and even harmful involvement, e.g. of periapical cemental dysplasia or enlarged mandibular canal which do not require treatment.

Influence of Hemostatic Agents in the Prognosis of Periapical Surgery: A Randomized Study of Epinephrine versus Aluminum Chloride.

INTRODUCTION: Several variables have been associated with a better prognosis of periapical surgery. The aim of this study was to evaluate the influence of 2 hemostatic agents on the prognosis of periapical surgery at 12 months. METHODS: A prospective study was designed with 2 randomized parallel groups established depending on the hemostatic agent used: epinephrine or aluminum chloride. The analysis of the hemorrhage control was recorded as 0 (no hemorrhage control), 1 (slight but apparent intermittent bleeding persisted after application of the material), or 2 (complete hemorrhage control). At 12 months, periapical lesion healing was determined clinically and radiologically as success, improvement, or failure. RESULTS: Ninety-five patients (67 women and 28 men) with periapical lesions involving a single tooth were enrolled in this study; in 45 teeth, epinephrine was used and in 50 teeth aluminum chloride. In the epinephrine group, 28 teeth were classified as successes, 10 as improvements, and 7 as failures. In the aluminum chloride group, 34 teeth were classified as successes, 11 as improvements, and 5 as failures. No statistically significant difference was found. CONCLUSIONS: The present study found no association between the use of epinephrine or aluminum chloride as hemostatic agents on the prognosis of periapical surgery. The efficacy of hemostatic agents at the time of surgery showed no relationship with the healing outcome.

Mucoepidermoid Carcinoma Mimicking a Lesion of Endodontic Origin.

Cancer of the oral cavity and pharynx ranks eighth among the top 10 cancer sites in all United States males. Salivary gland tumors (SGTs) are uncommon, and malignancies in SGT are even more uncommon than benign tumors. Intraoral minor SGTs are rare, and when they do occur, the tumor is often benign. The purpose of this report is to present a case of a malignant, intraoral minor SGT mimicking a lesion of endodontic origin. Histopathologic analysis determined the tumor to be a high-grade mucoepidermoid carcinoma. The patient was referred to oral and maxillofacial surgery where it was determined the patient would best be treated by partial maxillectomy. Recall examination at 5 years revealed no recurrent or new disease. Suspicious lesions require histopathological assessment.

Frecuencia de alteraciones pulpares y periapicales en los pacientes atendidos en un hospital de la provincia de Loja ­ Ecuador / Pulp and periapical alterations frequency in the patients attended to al Loja hospital­Ecuador

Las alteraciones pulpares y periapicales, son un conjunto de patologías que afectan a los tejidos pulpar y periapical del diente; constituyen una de las causas por las cuales el paciente acude a consulta. Objetivos: Determinar la frecuencia de enfermedades pulpares y periapicales, de acuerdo al sexo, así como el órgano dentario más afectado; en los pacientes atendidos en el Consultorio Odontológico del Hospital Básico de Catacocha, durante el periodo enero - diciembre 2013. Material y Métodos: Estudio documental, comparativo. La población estuvo constituida por los pacientes que acudieron al servicio de Especialidad de Endodoncia del Hospital. La muestra fue de 330 pacientes, que presentaron enfermedad pulpar, se consideró el primer y segundo diagnósticos. Se procedió a revisión de las historias clínicas del Hospital, partes diarios y sistema CARDEX del Ministerio de Salud Pública del Ecuador para corroborar los datos; previo el respectivo permiso de las autoridades del hospital. Se utilizó la prueba estadística chi cuadrado. Resultados: Se revisaron 330 historias clínicas. Los valores más altos, fueron: Pulpitis 40% (n=90) sexo femenino, pulpitis 40% (n=41) sexo masculino, como primer diagnóstico, y como segundo diagnóstico; Periodontitis apical crónica 34% (n=12) sexo femenino, periodontitis apical crónica 44% (n=7) sexo masculino. El órgano dentario más afectado resultó el primer molar inferior izquierdo 3.6, en el primer diagnóstico; y el diente No. 2.1 en el segundo diagnóstico. Conclusiones: Los tipos de diagnósticos no tienen diferencias significativas, entre varones y mujeres. (AU)

Pulp and periapical alterations are a set of pathologies which affect the pulp and periapical tissues of the tooth. This is one of the causes why patients go to the dentist's office. Objectives: To determine the frequency of pulp and periapical diseases in relation with sex as well as the most affected dental organ in the patients of the Dentist's Office at Basic Hospital in Catacocha during the period JanuaryDecember 2013.Material and Methods: Comparative documentary study. The population was the patients who attended the Hospital Endodontics Specialty service. The sample was 330 patients, who presented the pulp disease. The first and second diagnoses were taken under consideration. In order to confirm the data collected, the clinical histories of the Hospital, the daily reports and the CARDEX system from the Ministry of Public Health of Ecuador, with the previous permission of the Hospital, were compared. The statistic test used was square chi. Results: 330 were taken under consideration. The highest values were: Pulpitis 40% (n=90) feminine sex, Pulpitis 40% (n=41) masculine sex, both at first and second diagnosis; chronic apical Periodontitis 34% (n=12) feminine sex, chronic apical periodontitis 44% (n=7) masculine sex. The most affected dental organ was the first lower left molar 3.6, in the first diagnosis; and tooth number 2.1 in the second diagnosis. Conclusions: The types of diagnosis do not present meaningful differences between men and women. (AU)

Actinomycotic osteomyelitis of palate masquerading periapical pathology: A rare case report.

Osteomyelitis is an infection that is challenging to manage due to the poor vascularization of bone that favors the proliferation of microorganisms. We report a case of osteomyelitis occurring in endodontically treated teeth in the maxillary palatal region. Clinically and radiographically, it was initially diagnosed as osteomyelitis and was treated accordingly with antibiotics for 1 year with no reported healing. Later, biopsy was done and the findings were consistent with that of chronic osteomyelitis in association with infection by Actinomyces organisms. Thus, the case highlights the rare occurrence of actinomycotic osteomyelitis in maxilla and the importance of biopsy and histopathology which will help in correct diagnosis and rapid resolution through appropriate antibiotic therapy.

O dente tem vitalidade pulpar e tem lesão periapical: critérios para o diagnóstico e condutas / The tooth has pulp vitality and has a periapical lesion: Criteria for diagnosis and treatment

Muitos profissionais ficam confusos quando um dente tem lesão periapical e mantém a vitalidade pulpar. Muitas lesões imitam imagiologicamente as lesões periapicais crônicas inflamatórias e os dentes permanecem com vitalidade pulpar. Sempre devemos lembrar que: 1) dentes com vitalidade pulpar não devem ser abertos sem um diagnóstico prévio das lesões que são portadores; tratamento endodôntico não deve ser aplicado como meio de diagnóstico ou teste terapêutico de lesões periapicais em dentes com vitalidade pulpar. 2) Realizar tratamentos endodônticos em dentes com vitalidade pulpar e com lesões que imitam periapicopatias pode prolongar o tempo de uma abordagem adequada e piorar em muito o prognóstico da lesão. 3) Em dentes com vitalidade pulpar e lesões periapicais de origem a determinar, é muito importante a inter-relação clínica, imagiológica e microscópica para a troca de experiências e conhecimento, visando um diagnóstico seguro e terapêutica eficaz. 4) As lesões relacionadas devem ser mentalizadas ou anotadas para que se aplique sempre frente a dentes com lesões periapicais e com vitalidade pulpar!

Maxillary Osteomyelitis by Actinomyces in a Child / Osteomielitis Maxilar por Actinomyces en un Niño

ABSTRACT: Actinomycosis is a bacterial infection caused by Actinomyces species, which usually affect the soft tissues of the cervicofacial region of adult males. Clinically, it's characterized by a slow-growing indurated mass, especially in the submandibular area. However, in a few cases, the jaws bones can be affected developing osteomyelitis characteristics. The aim of this paper is to report a rare clinical case of Actinomycotic Osteomyelitis affecting the maxilla of a child, involving the maxillary sinus, orbital and zygomatic areas that was treated by the association of antibiotic therapy and surgical debridement. The patient's 2 years follow-up was uneventful and no signs of the lesion recurrence.

RESUMEN: La actinomicosis es una infección bacteriana causada por la especie Actinomyces, que generalmente afecta los tejidos blandos de la región cervicofacial de los hombres adultos. Clínicamente, se caracteriza por una masa endurecida de crecimiento lento, especialmente en la zona submandibular. Sin embargo, en algunos casos, los huesos de las mandíbulas pueden ser afectados desarrollando características de osteomielitis. El objetivo de este trabajo es reportar un caso clínico poco frecuente de osteomielitis actinomicótica que afecta el maxilar de un niño, envolviendo el área del seno maxilar, y zonas orbitales y cigomáticas que fueron tratadas con la asociación de terapia con antibióticos y desbridamiento quirúrgico. El seguimiento del paciente por 2 años ocurrió sin incidentes y sin signos de recidiva de las lesiones.

Fibro-Osseous and Other Lesions of Bone in the Jaws.

Fibroosseous lesions in the jaws have similar histologic and radiographic features. Despite their similarity, management varies significantly. In this article, common fibroosseous lesions and key radiographic features are described. Many of the fibroosseous lesions are diagnosed radiographically, without performing histologic examinations. For some of the fibroosseous lesions, for example, periapical osseous dysplasia, histologic examination is contraindicated. Cherubism and fibrous dysplasia have specific radiographic findings; these conditions can be diagnosed radiographically. Accurate diagnosis conditions is essential; some conditions do not require any intervention, while others require surgical resection. Patient demographics, for example, age, gender, and race, play important roles in diagnosis.

Differentiating early stage florid osseous dysplasia from periapical endodontic lesions: a radiological-based diagnostic algorithm.

BACKGROUND: Osseous dysplasia (OD) is the most common fibro-osseous lesion of the jaw affecting the periapical region. Early stages of OD can resemble periapical radiolucencies, thus mimicking the radiological aspects of an endodontic pathology. Such radiolucent lesions affecting previously decayed or treated teeth are even more complex to interpret. CASE PRESENTATION: The aim of this paper is to report a case-series of representative clinical situations describing the radiological features and illustrating the diagnostic workup of patients with florid osseous dysplasia (FOD). Emphasis is given to the endodontic implications of such periapical bone disease and the complexity of accurate diagnosis in the context of endodontic retreatment. We then propose a practical radiological-based diagnostic algorithm to assist the clinician in the diagnostic of OD periapical lesions. CONCLUSION: Periapical lesions may be confused with bone diseases such as osseous dysplasia, especially in the radiolucent initial stage. Knowledge of clinical features associated with a careful reading of cone beam CT images, such as fine opacities within the hypodense periapical lesion, may help determine the right diagnostic.

Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion.

Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.

Actinomycosis is not Frequent in the Periapex But is a Persistent Lesion

Abstract Periapical actinomycosis caused by a gram-positive anaerobic pathogen characterizes a typical extra-radicular infection. This study determined the frequency and correlated the content of bacteria colonies with the of periapical actinomycosis size. The study comprised a total of 218 periapical lesions (PL) (cysts, granulomas or abscess). The specimens embedded in paraffin were sliced into 4-µm sections and stained with hematoxylin-eosin, Gram, Periodic Acid-Schiff (PAS) and Grocott's stain. The presence of bacterial colonies composed of filamentous structures labeled with the histochemical stains were described as Actinomyces, and for each case, the bacterial colonies were counted and measured. The correlation between the number and size of bacterial colonies and the size of PL was tested using Pearson's adjusted correlation coefficient. From 218 PL, bacterial colonies were identified in 64 biopsies. Seven cases (0.3%) fulfill the criteria for diagnosis of periapical actinomycosis. All of cases were therapy-resistant and did not showed periapical repair after 12 months of follow-up. Periapical surgery or dental extraction was performed. The correlation test indicated no correlation between the number of bacterial colonies and the lesion size (p=0.752, r=-0.148). However, a larger bacterial colony size generally resulted in a larger periapical lesion (P=0.000, r=0.657). The frequency of periapical actinomycosis was low, and this lesion should be included in the differential diagnosis of PL. The size of the Actinomyces colonies seemed to contribute to increase the size of the periapical lesion.

Resumo A actinomicose periapical causada por um patógeno anaeróbio Gram positivo caracteriza uma infecção extra-radicular típica. Esse estudo determinou a frequência e correlacionou o conteúdo das colônias bacterianas com o tamanho das actinomicoses periapicais. O estudo compreendeu um total de 218 lesões periapicais (LPs) (cistos, granulomas ou abscessos). Os espécimes embebidos em parafina foram cortados em secções de 4-µm e corados com hematoxilina-eosina, Gram, ácido periódico de Schiff (PAS) e coloração de Grocott. A presença de colônias bacterianas compostas por estruturas filamentosas marcadas com os corantes histoquímicos foram descritas como Actinomyces, e para cada caso, as colônias bacterianas foram contadas e mensuradas. A correlação entre o número e tamanho das colônias bacterianas e o tamanho das LPs foi testado usando o coeficiente de correlação ajustado de Pearson. De 218 LPs, colônias bacterianas foram identificadas em 64 biópsias. Sete casos (0,3%) preencheram os critérios para o diagnóstico de actinomicose periapical. Todos os casos foram resistentes à terapia e não mostraram reparo periapical após 12 meses de acompanhamento. Cirurgia periapical ou extração dental foi realizada. O teste de correlação indicou nenhuma correlação entre o número de colônias bacterianas e o tamanho da lesão (p=0.752, r=-0.148). Entretanto, uma maior colônia bacteriana geralmente resultou em uma maior lesão periapical (p=0.000, r=0.657). A frequência de actinomicose periapical foi baixa e esta lesão deve ser incluída no diagnóstico diferencial das LPs. O tamanho das colônias de Actinomyces pareceu contribuir para o aumento no tamanho da lesão periapical.

Langerhans Cell Histiocytosis Mimicking Periapical Pathology in a 39-year-old Man.

Langerhans cell histiocytosis (LCH) is a clonal neoplastic proliferation of Langerhans-type dendritic cells, with more than 50% of cases of LCH seen in children younger than 15 years of age. The most common clinical presentation of LCH is solitary or multiple bony lesions. The jaws are affected in approximately 10%-20% of cases, with a strong predilection for the mandible. The maxilla is involved in only 1% of head and neck cases. When the jaws are involved, lesions of LCH may mimic periapical pathology as seen in patients requiring endodontic therapy or bone loss as seen in periodontal disease. We report the case of a 39-year-old man with LCH involving the posterior maxilla. This is a rare presentation of LCH with respect to both location and patient age. Clinicians should consider LCH when developing a differential diagnosis of an apical radiolucency of vital teeth or teeth that fail to respond to endodontic therapy and be aware of its clinical and radiographic mimics.

20-year Follow-up of Recurrent Glandular Odontogenic Cyst Mimicking a Periapical Lesion.

Periapical lesions usually are caused by root canal infection; nevertheless, other pathologies may eventually involve the tooth apex, making the correct diagnosis more difficult. Glandular odontogenic cysts (GOCs) are uncommon and, despite their cystic nature, may present an aggressive behavior and a high recurrence rate. This report describes a recurrent GOC mimicking a periapical lesion that was followed up for 20 years. A 45-year-old woman described tooth discomfort for several years in the anterior region of the mandible that was not exacerbated during eating or occlusion. Clinical examination revealed no signs of swelling, redness, or inflammation in the gingival or surrounding soft tissue. Nevertheless, periapical radiography showed a well-defined large radiolucent lesion in the periapical region of teeth #22, #23, #24, and #25. The pulp test confirmed that all these teeth were vital. An incisional biopsy was performed, and with the histopathological diagnosis of an odontogenic cyst, the lesion was enucleated surgically. After recurrence, the extensive periapical multilocular lesions were again surgically removed. Based on the microscopic findings, the final diagnosis was GOC. One year later, there were no signs of recurrence. GOCs associated with the root apex may mimic periapical inflammatory diseases. Clinical, radiographic, and histopathological findings are essential for the diagnosis of inconclusive radiolucent findings in the periapical region. Biopsy specimens should be sent to a specialized oral pathology laboratory.

Retrospective analysis of nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions in a population of Taiwanese patients.

OBJECTIVE: We aimed to evaluate nonendodontic periapical lesions clinically misdiagnosed as endodontic periapical pathoses in a population of Taiwanese patients. MATERIALS AND METHODS: Cases (2000-2014) of histopathological diagnoses of nonendodontic periapical lesions were retrieved from all cases with a clinical diagnosis of radicular cyst, apical granuloma, or apical periodontitis in the institution. These cases were regarded as misdiagnosed nonendodontic periapical lesions, of which the types and frequencies, in addition to the demographic data, were determined. RESULTS: Four thousand and four specimens were clinically diagnosed as endodontically associated pathoses, of which 118 cases (2.95%) received a histopathological diagnosis of a nonendodontic pathologic entity, the most frequent lesion being keratocystic odontogenic tumor (KCOT, n = 38, 32.20%), followed by fibro-osseous lesion (n = 18, 15.25%), and dentigerous cyst (n = 13, 11.02%). Nine malignant lesions in the periapical area [squamous cell carcinoma (n = 7, 5.93%), adenoid cystic carcinoma (n = 1, 0.85%), and Langerhans cell histiocytosis (n = 1, 0.85%)] were also noted. CONCLUSIONS: A wide variety of histopathological diagnoses, including benign odontogenic and non-odontogenic cystic and tumorous lesions and infectious diseases, as well as malignant lesions, was noted in these 118 cases of nonendodontic periapical lesions. Squamous cell carcinoma was the most predominant malignancy of nonendodontic periapical lesions misdiagnosed as apical periodontitis lesions from imaging examination overlooking the clinical findings. CLINICAL RELEVANCE: The current data form a useful basis for clinicopathological investigation and educational teaching regarding nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions.