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

Radicular Cysts and Periapical Granulomas: Data Documentation for 696 Cases and Findings on Fibrosis, and Porphyromonas gingivalis and Fusobacterium nucleatum in These Lesions

OBJECTIVE

The objective of our study was to re-evaluate periapical lesions, including radicular cysts (RCs) and periapical granulomas (PGs) for locations, histopathological features, and degree of fibrosis in relation to the inflammatory response. In addition, we examined the presence of Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) since both are widely recognized pathogens in periodontal infections.

METHODS

We re-evaluated samples of RCs and PGs (n = 728) and collected data for analyses by IBM's SPSS Statistics. Among these samples, we stained 93 samples to determine the immunoexpression of Pg and Fn. For immunostaining, we used Gingipain R1 antibody for Pg and Rabbit anti-Fn antibody for Fn.

RESULTS

Fibrosis is associated with mild inflammation. We found a significant positive correlation between Pg and Fn. Thus, these pathogens are likely to occur together in periapical inflammatory lesions. We additionally noted that these periodontopathic pathogens are more likely to be present in RCs than in PGs.

CONCLUSIONS

Asymptomatic radiologically diagnosed periapical lesions may not necessarily need root canal retreatment in healthy patients since these lesions may represent scar tissue rather than active apical periodontitis. Clinical and radiological follow-up is still needed. Yet, periapical lesions, especially cysts, may contain dystopic periodontopathic pathogens, and Pg and Fn often occur together in periapical lesions.

Periapical cysts in dogs: 10 cases (2000-2020)

Objective

To characterize the clinical, diagnostic imaging, and histologic features with description of treatment outcome of periapical cysts in dogs.

Animals

Ten client-owned dogs diagnosed with periapical cysts biopsied between July 1, 2000 and June 30, 2020.

Procedures

Medical records of the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania were retrospectively searched to identify dogs that had surgical biopsy specimens of cavitary lesions diagnosed as odontogenic cysts and that met additional inclusion criteria. Complete medical records were reviewed.

Results

Range age and body weight of affected dogs were 2.5-12.1 years and 4.3-38.4 kg (9.5-84.7 lb), respectively. All periapical cysts were affecting the incisive bone and/or the maxilla. Nine dogs presented with a fluctuant swelling of the oral mucosa and gingiva; one dog without clinical swelling presented with a history of difficulty breathing. All cysts originated from a non-vital tooth with a structural defect (wear or fracture without pulp exposure) and/or intrinsic staining. Extraction of the associated non-vital teeth, enucleation of the cysts, and curettage of the surgical sites resulted in resolution of the clinical signs.

Conclusions and clinical relevance

The findings indicate that periapical cysts are associated with a non-vital tooth without pulp exposure. Complete evaluation of the clinical, diagnostic imaging, and histologic features of the lesion in affected dogs is necessary to differentiate periapical cysts from other odontogenic cysts and tumors.

Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review

OBJECTIVE

This systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm.

STUDY DESIGN

A literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included.

RESULTS

Of 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk.

CONCLUSION

This study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.

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 H2O2-induced oxidative stress conditions and then cell proliferation, senescence, apoptosis, and associated signaling were evaluated by EdU labeling, β-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 H2O2-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 H2O2-induced cellular senescence, which could serve as a potential therapeutic target.

Machine learning in the detection of dental cyst, tumor, and abscess lesions

BACKGROUND AND OBJECTIVE

Dental panoramic radiographs are utilized in computer-aided image analysis, which detects abnormal tissue masses by analyzing the produced image capacity to recognize patterns of intensity fluctuations. This is done to reduce the need for invasive biopsies for arriving to a diagnosis. The aim of the current study was to examine and compare the accuracy of several texture analysis techniques, such as Grey Level Run Length Matrix (GLRLM), Grey Level Co-occurrence Matrix (GLCM), and wavelet analysis in recognizing dental cyst, tumor, and abscess lesions.

MATERIALS & METHODS

The current retrospective study retrieved a total of 172 dental panoramic radiographs with lesion including dental cysts, tumors, or abscess. Radiographs that failed to meet technical criteria for diagnostic quality (such as significant overlap of teeth, a diffuse image, or distortion) were excluded from the sample. The methodology adopted in the study comprised of five stages. At first, the radiographs are improved, and the area of interest was segmented manually. A variety of feature extraction techniques, such GLCM, GLRLM, and the wavelet analysis were used to gather information from the area of interest. Later, the lesions were classified as a cyst, tumor, abscess, or using a support vector machine (SVM) classifier. Eventually, the data was transferred into a Microsoft Excel spreadsheet and statistical package for social sciences (SPSS) (version 21) was used to conduct the statistical analysis. Initially descriptive statistics were computed. For inferential analysis, statistical significance was determined by a p value < 0.05. The sensitivity, specificity, and accuracy were used to find the significant difference between assessed and actual diagnosis.

RESULTS

The findings demonstrate that 98% accuracy was achieved using GLCM, 91% accuracy using Wavelet analysis & 95% accuracy using GLRLM in distinguishing between dental cyst, tumor, and abscess lesions. The area under curve (AUC) number indicates that GLCM achieves a high degree of accuracy. The results achieved excellent accuracy (98%) using GLCM.

CONCLUSION

The GLCM features can be used for further research. After improving the performance and training, it can support routine histological diagnosis and can assist the clinicians in arriving at accurate and spontaneous treatment plans.

Association between Clinical/Radiographic Characteristics and Histopathological Diagnoses of Periapical Granuloma and Cyst

OBJECTIVE

 The aim of this study was to determine the association between clinical/radiographic characteristics and histopathological diagnoses of periapical granuloma and cyst obtained from the teeth treated with endodontic microsurgery.

MATERIALS AND METHODS

 The clinical, radiographic (periapical and cone-beam computed tomography), and histopathological data were collected from patients' dental records of endodontic microsurgery on the teeth with periapical lesions. These lesions were histopathologically diagnosed as either granuloma or cyst, at the Endodontic Clinic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand, from 2016 to 2021 according to inclusion and exclusion criteria. The data were analyzed using bivariate analysis and a multinomial logistic regression at a significance level of p-value less than 0.05.

RESULTS

 A total of 83 patients (58 females and 25 males) with an average age of 45 to 49.5 years old met the criteria including 68 periapical granulomas (81.9%) and 15 periapical cysts (18.1%). A periapical lesion involving multiple teeth in a periapical radiograph was significantly associated with the histopathological diagnosis of periapical cyst (p < 0.05). Such periapical lesion was six times more likely to be periapical cyst than periapical granuloma.

CONCLUSIONS

 A significant factor for predicting periapical cyst from periapical granuloma was the presence of a periapical lesion with multiple-teeth involvement in a dental radiograph.

Gut microbiota may mediate the impact of chronic apical periodontitis on atherosclerosis in apolipoprotein E-deficient mice

AIM

There are growing evidences linking chronic apical periodontitis (CAP) to atherosclerosis. Gut microbiota is found to be involved in the development of atherosclerosis. Recent studies have shown that CAP could change the diversity and composition of the gut microbiota. It was therefore, we hypothesized that gut microbiota and its metabolites could mediate the impact of CAP on atherosclerosis.

METHODOLOGY

Twenty-four 5-week-old lipoprotein E knockout (apoE^-/- ) mice were randomly divided into four groups: the CAP group, Con group, Co-CAP (cohoused with CAP) and Co-Con (cohoused with Con) group. In the CAP group, sterile cotton wool containing P. gingivalis was placed into the exposed pulp chamber, followed by coronal resin-based composite restoration of the bilateral maxillary first and second molars. In the Con group, a sham operation was performed. Biweekly, mice in the CAP group were anaesthetised to check the sealing of coronal access. Meanwhile, the animals in the Con group were anaesthetised. The cohousing approach was used to introduce gut microbiota from the CAP and Con groups into the Co-CAP and Co-Con groups, respectively. Alterations in the abundance and diversity of the gut microbiota were detected using 16S rRNA sequencing, Oil-red O staining was used to demonstrate the extent of lesions, and serum levels of trimethylamine N-oxide (TMAO), and immunohistochemistry of flavin-containing monooxygenase 3 (FMO3) in liver were used to assess TMAO-related metabolic alterations.

RESULTS

Alterations of alpha and beta diversity were shown both in the CAP and the Co-CAP groups. Moreover, the percentage of atherosclerotic lesion area increased in the CAP and Co-CAP groups (p < .05). Linear discriminant analysis effect size (LEfSe) at the family level found the increases of Lachnospiraceae and Ruminococcaceae (p < .05), which were positively correlated with serum TMAO levels (p < .05). In the redundancy analysis technique (RDA), serum levels of TMAO were positively associated with the atherosclerotic lesions. Co-occurrence analysis revealed that the relative abundances of Lachnospiraceae and Porphyromonadacae were positively correlated with both the percentage of lesion area and TMAO level (p < .05).

CONCLUSION

Thus, within the limitations of this study, the data suggest that the gut microbiota can mediate the effects of CAP on atherosclerosis.

0.1% Nano-silver mediates PD-1/PD-L1 pathway and alleviates chronic apical periodontitis in rats

This study was to investigate whether the programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) and T-helper 17 (Th17)/regulatory T (Treg) balance are associated with chronic apical periodontitis (CAP) relived by 0.1% nano-silver. CAP rat models were established by opening the first molars of the right and left mandible and exposing the pulp cavity to the oral cavity. CAP model was verified by cone-beam computed tomography, X-ray digital radiovisiography, and hematoxylin-eosin (H and E) staining. The rats were randomly divided into the sham, Ca(OH)₂, and 0.1% nano-silver groups (n = 12 in each group) 2 weeks after surgery. The pathological changes in the apical area were detected by H and E staining. PD-1, PD-L1, RORγT, IL-17, and Foxp3 in periapical tissues were detected by qRT-PCR and immunohistochemistry. Th17/Treg and PD-1/PD-L1 were analyzed by flow cytometry. After 7, 14, and 21 days of 0.1% nano-silver treatment, inflammatory cells in the apical region were slightly reduced and inflammatory infiltration was relieved compared with the sham group. RORγT, IL-17, PD-1, and PD-L1 decreased and Foxp3 increased after 7, 14, and 21 days of 0.1% nano-silver treatment compared with the sham group (p < 0.05); however, there were no significant differences with Ca(OH)₂ group (p > 0.05). Flow cytometry revealed that 0.1% nano-silver solution decreased Th17/Treg and PD-1/PD-L1 ratio. 0.1% Nano-silver significantly reduced the inflammation of CAP in rats. PD-1/PD-L1 was included in Th17/Treg balance restored by 0.1% nano-silver.