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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 9  »  Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption
Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption
Results.



Histopathology.
The results are presented in Tables 1-5. Analysis was completed in a total of 102 specimens, as two were lost during preparation. The degree of agreement amongst the observers concerning the diagnosis of the periapical lesions gave a Kappa coefficient of 0.96 (IC 95% ј 0.82-1.0).
Periapical granulomas was not a common finding. A1 lesions (granuloma and periapical abscess score1) comprised only11.8%of the sample (Table 1).The most prevalent histological diagnosis was the lesions classified as A2 (noncystic periapical abscess scores 2 and 3) (Fig.1), which comprised 63.7% of the sample (Table 1).
Periapical cysts represented 24.5% of the sample. Just four (3.9%) periapical cysts presented with no or small abscess cavities (Fig. 2). Amongst the 25 cysts analysed, 21 (84%) had large abscess cavities. The abscessed areas were associated with an epithelial component resulting in disorganization and discontinuity. The greater the severity of the abscess, the bigger the epithelial disintegration observed. In other cases, the cavities of the abscesses were situated mainly on the connective tissue adjacent to the epithelial layer (Fig. 3).
There were cases where focal areas of neutrophils were absent within the cyst epithelium in one histological section, but the following section often revealed a defined abscess in that site. Disregarding the cystic characteristic of the lesions and by just analysing the presence of an abscess, we were able to observe that 86 lesions (84.3%) had abscess cavities that occupied a large area. Just 16 lesions (15.7%) were free from or contained only microcavities of acute inflammatory cells (Table 2).

Table 1. Prevalence of different periapical lesions.

Prevalence of different periapical lesions

Table 2. Periapical lesions of minor and major severity of abscess.

Periapical lesions of minor and major severity of abscess
A1-noncystic lesions with absence or with a small degree of abscess.
A2-noncystic lesions with high degree of abscess.
B1-cystic lesions with absence or with a minimum degree of abscess.
B2-cystic lesions with high degree of abscess.

Resorption.
Only 12.7% of the samples were free of periforaminal resorption and 16.8% showed integrity of the foraminal surroundings (Table 3). From all the samples, 72.6% had periforaminal resorption, reaching more than 1/ 4th of the area around the foramen (Fig. 4). Moreover, in 42.2% of these cases, the resorption included more than half of this area (Fig. 5). When foraminal resorption occurred, 58.4% of the samples were affected in more than 1/4 of their perimeter (Fig. 6), and 28.7% in more than half (Fig.7). Just 8.9%of the samples had no resorption (Table 4).
From Table 4, it is clear that the pattern of periforaminal resorption did not depend on the pattern of foraminal resorption or vice-versa. An apex may present with substantial periforaminal resorption, without alteration to the foramen. The apical foramen may be resorbed, even if the zone that surrounds it had an intact cementum structure. However, the resorption could occur both in a periforaminal and foraminal location and to different degrees.
By associating the presence of periforaminal and foraminal resorption, we were able to perceive that 49.5% of the apices had resorption in more than 1/4th of the examined area, and in more than half in 22.8% of cases (Table 4) (Fig.7). The lacunae of resorption were similar to the Howship type, showing a circular shape of different sizes. The combination of various lacunae resembled the characteristic aspect of honeycombs (Fig. 5). Generally, the areas of resorption were superimposed, projecting pronounced margins (Fig. 4). However, in some cases, due to the fusion of the lacuna, or due to its shallowness, the interlacunae crests became less obvious or even absent (Figs 4 and 6).

Table 3. Extension degrees of periforaminal and foraminal resorption of the dental apexes.

Extension degrees of periforaminal and foraminal resorption of the dental apexes
* In one specimen, it was not possible to performa classification of the foraminal resorption.

Table 4. Distribution of degrees of periforaminal and foraminal resorption combined.

Distribution of degrees of periforaminal and foraminal resorption combined

Table 5. Median (p25-75) of the degrees of periforaminal and foraminal resorption according to the different periapical lesions.

Median of the degrees of periforaminal and foraminal resorption according to the different periapical lesions
Periforaminal: P = 0.227; foraminal: P = 0.163.
A1-noncystic lesions with absence or with a small degree of abscess.
A2-noncystic lesions with high degree of abscess.
B1-cystic lesions with absence or with a minimum degree of abscess.
B2-cystic lesions with high degree of abscess.
* In one specimen, it was not possible to perform a classification of the foraminal resorption.

The resorbed areas resulted in the presence of one or two isolated lacunae, surrounded by an integral cementum surface or by a set of interconnected gaps that were occasionally related to other resorption zones. Sometimes, the apex had fused areas of resorption, and was totally deprived of intact cementum (Fig. 5). There were cases with evidence of exposed dental tubules (Fig. 8), demonstrating sites of increased resorption.
The foraminal resorption viewed by SEM followed two peculiar characteristics. In some apices, there was deformation of the original foramen outline, due to deep resorption, though in very specific places (Fig. 9). In others, although the apical foramen had not suffered visible morphological alterations, it was possible to observe shallow resorption gaps, surrounding the majority of its outline (Figs 5 and 8).
According to Table 5, we can verify that there was no statistically meaningful difference between the type of periapical lesion and the degree of periforaminal and foraminal resorption at the root apex.

Figure 1. Periapical abscess degree 3 (14x).

Periapical abscess degree

Figure 2. Periapical cyst (cystic lesion with the absence of abscess microcavities) (32x).

Periapical cyst cystic lesion with the absence of abscess microcavities

Figure 3. Abscessed cyst degree 3, with abscessed area adjacent to the epithelial component (14x).

Abscessed cyst degree 3, with abscessed area adjacent to the epithelial component

Figure 4. Apex with periforaminal resorption involving1/4-1/2 of the area. Pronounced areas of lacunae (A). Interlacunae crests were not much evident (B) (PR:2; FR:2; lesion: B2) (100x).

Apex with periforaminal resorption involving1/4-1/2 of the area. Pronounced areas of lacunae. Interlacunae crests were not much evident

Figure 5. Apex with periforaminal resorption involving more than half of the radicular surface examined. The resorption displayed a honeycomb aspect (PR:3; FR:3; lesion: A2) (100x).

Apex with periforaminal resorption involving more than half of the radicular surface examined. The resorption displayed a honeycomb aspect

Figure 6. Apex with foraminal resorption involving1/4-1/2 of the perimeter with a not well defined, or even absent outline of the interlacunae crests (PR:1; FR:2; lesion: B2) (100x).

Apex with foraminal resorption involving1/4-1/2 of the perimeter with a not well defined, or even absent outline of the interlacunae crests

Figure 7. Apex with periforaminal and foraminal resorption involving more than half of the radicular surface examined (PR:3; FR:3; lesion: A2) (100x).

Apex with periforaminal and foraminal resorption involving more than half of the radicular surface examined

Figure 8. Apex with extensive periforaminal and foraminal resorption exposing dentinal tubules (PR:3; FR:2; lesion: A2) (100x).

Apex with extensive periforaminal and foraminal resorption exposing dentinal tubules

Figure 9. Apex with foraminal resorption with morphological alterations of the apical contour (PR:3; FR:3; lesion: A2) (100x).

Apex with foraminal resorption with morphological alterations of the apical contour