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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
Discussion - References.



Discussion.
Many teeth with apical periodontitis are believed to show some degree of external periapical resorption, but few studies have related resorption with the nature of the apical lesion (Delzangles 1989, Bohne 1990, Vier & Figueiredo 2000). This study sought to address this issue by correlating periapical pathology with the presence and extension of periforaminal and foraminal resorption.
The presence of periapical pathosis was determined by direct visualization of root apices (Linenberg et al. 1964, Simon1980, Garrocho & Antonio Neto 1984, Nair 1987, Bohne1990, Nair et al.1996). Radiographic examination was not conducted prior to tooth extraction. The presence of a periapical radiolucency does not necessarily indicate periapical inflammation, other causes may include apical scar tissue (Nair et al. 1999). Conversely, a periapical inflammatory reaction of endodontic origin may exist without being visible radiographically (Bender & Seltzer1961).
Semi-serial sections were performed on the specimens, since abscess cavities or even the epithelial lumen of a cystic cavitymay be away from the centre of the specimen or from the place elected for randomized sections (Garrocho & Antonio Neto 1984), a fact which could make it difficult to reach the final diagnosis. The most accurate analysis is achieved from serial sectioning of intact lesions.
We classified abscesses as lesions without epithelium in the body of the lesion and with a massive accumulation of neutrophils. The lesions diagnosed as periapical granulomas exhibited neutrophils, though not forming distinct arrangements or fina degenerating state. We classified cysts according to Patterson et al. (1964), Lalonde & Luebke (1968), Lalonde (1970), Nobuhara & del Rio (1993) and White et al. (1994), because when cysts become infected the epithelium may not be complete or intact, but disintegrated in some areas.
After a thorough hand individual analysis of each histological section, we agreed with Linenberg et al. (1964), who demonstrated transitional stages between one type of lesion and another when analysing various histological sections of the same lesion.
Differences in histological criteria create difficulty in comparing similar studies (Langeland et al.1977, Spatafore et al.1990, Nobuhara & del Rio1993). Our study, for example, demonstrated an unusually low prevalence of periapical granuloma and high prevalence of noncystic abscesses. This may be due to the sample, which consisted of teeth extracted in the Public Oral Services in poor areas in southern Brazil, where the presence of symptoms is one of the main reasons for dental visits.
The prevalence of 24.5% of cystic lesions is in accord with previous reports (Linenberg et al.1964, Langeland et al. 1977, Nobuhara & del Rio 1993, White et al. 1994). However, when evaluating other studies with similar methodology, i.e. lesions associated with the apices of extracted teeth, the results were higher than the 17 and15%of the cysts diagnosed by Simon (1980) and Nair et al. (1996) respectively. The results were closer to the 28% reported by Linenberg et al. (1964), whose samples included material curetted from extraction sockets and lesions associated with extracted teeth.
This study also evaluated the extension of resorption over the apical root surface. The results are difficult to correlate with many others who simply reported the presence of resorption on the root surface (Simon et al. 1981, Hess et al.1983, Laurent-Maquin et al.1986,Delzangles 1989, Bohne 1990, Lomc¸ ali et al. 1996, Bonifa. cio et al. 2000).
From the methodology employed, 8.9% of specimens had no periforaminal or foraminal resorption, despite pulp necrosis and periapical lesions. These results are in agreement with those of Henry & Weinmann (1951) and Ferlini Filho (1999) who reported that 10% of their specimens had no resorption.
Apical periodontitis is amongst the causes of progressive inflammatory resorption cited by Soares & Goldberg (2001). Nevertheless, it is impossible to determine the influence of other factors that might potentiate resorption such as occlusal trauma. We had no access to detailed medical or clinical data to control for such parameters.
The apical resorption observed in the present study did not differ amongst the various periapical pathological conditions, since all of them exhibited a common feature, i.e. the presence of inflammation. This is an important aspect to consider in the histological description of these cystic and noncystic lesions, independent of the degree of abscess. Both constitute a continuous and variable aspect of the same phenomenon, inflammation. The physical presence of a periapical lesion could promote root resorption in addition to bone lysis, as it makes room for its organization and growth, independently of its histological classification. Thus, the results of the present study differ from those of Delzangles (1989) and Vier & Figueiredo (2000), who included a small number of cystic samples and used less refined histological sectioning.
Normally, the failure of root-canal treatment is related to the persistence of infection in the root-canal system (Sjogren et al. 1997, Sundqvist et al. 1998). The presence of root resorption in teeth with periapical lesions is important for infection control since these areas are niches for bacteria. Moreover, the apical limit of instrumentation may be altered in teeth with widely resorbed apices, since the cementum-dentine junction at the constriction can be missing (Delzangles 1989, Malueg et al. 1996). In such circumstances, sealing the canal may be difficult and over filling is likely.
Bacteria may also be found in the external surface of the root, forming a periapical biofilm (Leonardo & Silva 1998), thus confirming the importance of appreciating the existence of periforaminal root resorption. No bacterial bio films were, however, demonstrated in this study.

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