Differentiation of radicular cysts and radicular granulomas via texture analysis of multi-slice computed tomography images

OBJECTIVES

This study aimed to establish a method for differentiating radicular cysts from granulomas via texture analysis (TA) of multi-slice computed tomography (CT) images.

METHODS

A total of 222 lesions with multi-slice computed tomography images acquired at our hospital between 2013 and 2022 that were pathologically diagnosed were included in this study. Cases of contrast-enhanced images, severe metallic artifacts, and lesions that were not sufficiently large to be analyzed were excluded. The images were chronologically divided into a training group and a validation group. The radiological characteristics were determined. Subsequently, a TA was performed. Pyradiomics software was used for the TA of three-dimensionally segmented volumes extracted from 2-mm slice thickness images with a soft-tissue algorithm. Features that differed significantly between the two lesions in the training group were extracted and used to create machine-learning models. The discriminative ability of these models was evaluated in the validation group using receiver operating characteristic curve analysis.

RESULTS

A total of 131 lesions, comprising 28 radicular cysts and 103 granulomas, were analyzed. Forty-three texture features that exhibited significant variations were extracted. A support vector machine and decision tree model, with areas under the curves of 0.829 and 0.803, respectively, were created. These models showed high discriminative abilities, even for the validation group, with areas under the curve of 0.727 and 0.701, respectively. Both models showed superior performance compared with that of the models based on radiographic findings.

CONCLUSION

Discriminatory models were established for the TA of radicular cysts and granulomas using CT images.

A case of radicular cyst on deciduous tooth in a 7-year-old child

Radicular cysts are the most common cystic lesions in the oral cavity, and have a rare occurrence in the primary dentition. We report a case of radicular cyst of mandible in child by multimodal imaging including panoramic radiography, CT, and MR imaging. A 7-year-old girl presented with swelling and without pain, and hypoesthesia on the right side of the mandible. On clinical examination, an expansive lesion with undulation was found to the buccal cortex of the right side of the mandible. Panoramic radiograph showed a unilocular radiolucency with well-defined margin, displaced tooth, and root resorption in the right mandible. Regarding CT imaging, axial soft tissue algorithm CT and bone tissue algorithm CT showed a low-attenuation internal structure and expansion of the buccal cortex of the right side of the mandible. Three-dimensional-CT showed expansion of the buccal cortex of the right side of the mandible. Multiplanar reformation imaging showed displaced tooth, root resorption, and expansion of the buccal cortex of the right side of the mandible. On T1-weighted image, the expansive lesion showed low signal intensity, and T2-weighted and STIR images revealed high signal intensity. A partial biopsy of the mandibular region was performed. Histopathological diagnosis was radicular cyst caused by apical periodontitis with abscess. This case suggests that multimodal imaging, especially CT and MR imaging, could be effective for evaluating mandibular lesions in child.

Immunohistochemical expression of SPARC in odontogenic keratocysts: a comparative study with other odontogenic cysts

BACKGROUND

Secreted protein acidic and rich in cysteine (SPARC) has been shown to modulate aggressive behavior in several benign and malignant tumors. Little is known about SPARC expression in odontogenic keratocyst (OKC), an odontogenic cyst with an aggressive nature. To the best of our knowledge, only one study has been investigated the expression of this protein in OKCs. This study aimed to characterize SPARC expression in OKCs. Additionally, to determine whether SPARC is associated with aggressive behavior in OKCs, SPARC expression in OKCs was compared with radicular cysts (RCs), dentigerous cysts (DCs) and calcifying odontogenic cysts (COCs). These odontogenic cysts showed no or less aggressive behavior.

METHODS

SPARC expression was evaluated in 38 OKCs, 39 RCs, 35 DCs and 14 COCs using immunohistochemistry. The percentages of positive cells and the intensities of immunostaining in the epithelial lining and the cystic wall were evaluated and scored.

RESULTS

Generally, OKCs showed similar staining patterns to RCs, DCs and COCs. In the epithelial lining, SPARC was not detected, except for ghost cells in all COCs. In the cystic wall, the majority of positive cells were fibroblasts. Compared between 4 groups of odontogenic cysts, SPARC expression in OKCs was significantly higher than those of RCs (P < 0.001), DCs (P < 0.001) and COCs (P = 0.001).

CONCLUSIONS

A significant increase of SPARC expression in OKCs compared with RCs, DCs and COCs suggests that SPARC may play a role in the aggressive behavior of OKCs.

A Rare Case of Calcified Radicular Cyst in Deciduous Tooth

Radicular cysts (RCs) are one of the most common odontogenic cystic lesions of inflammatory origin. It originates mostly from epithelial residues in periodontal ligaments secondary to inflammation. The pathogenesis involves the activation of epithelial cell rests of Malaseez after physical, chemical, or bacterial injury. Radiographically, it is seen as a well-defined unilocular lesion of size >1.5 cm. RCs are considered rare in the primary dentition, comprising only 0.5-3.3% of the total number of RCs in both primary and permanent dentitions. This is the first case to be reported of a radicular cyst in primary teeth, with dystrophic calcification.

How to cite this article

Sunny R, Rag B, Punathil S, et al. A Rare Case of Calcified Radicular Cyst in Deciduous Tooth. Int J Clin Pediatr Dent 2024;17(1):86-88.

Radicular Cyst with Primary Mandibular Molar: A Rare Occurrence

Aim

This case report aims to describe the importance of early diagnosis, various clinical features, and management of radicular cyst with primary mandibular molar.

Background

Radicular cyst is an odontogenic inflammatory cyst in origin seen more frequently in permanent dentition and rarely in the primary dentition. It can develop due to pulp injuries or pulp necrosis caused by deep dental caries or dental trauma. It may adversely affect the normal development and eruption of the permanent succedaneous teeth.

Case description

We report a case of radicular cyst in association with the primary mandibular molar and its therapeutic management.

Conclusion

The efforts in diagnosing and managing radicular cyst when associated with primary teeth hold a good impact on a child's oral health status. Good amount of bone healing and development of the succedaneous permanent tooth bud in its normal position were observed when managed appropriately.

Clinical significance

Early diagnosis, proper treatment planning, appropriate management, and regular follow-ups of radicular cyst in primary dentition hold great importance for pediatric dentists as well as general dentists in routine dental practice.

P63 and Ki-67 expression in radicular cyst

Objectives

The aim of the current study was to identify the expression of P63 and its relation to odontogenic epithelial cell proliferation, severity of the inflammatory infiltrate and size of radicular cysts (RCs).

Methods

In this retrospective cross-sectional study, 30 cases of paraffin-embedded RCs were randomly selected from the archive. P63 and Ki-67 expression was assessed by immunohistochemistry.

Results

Epithelial P63 expression was absent in four (13.3%), weak in 10 (33.3%), and moderate in 16 (53.3%) cases. In the connective tissue wall of RC, P63 expression was absent in two (6.7%) cases, weak in 24 (80.0%) cases, and moderate in four (13.3%) cases. Ki-67 was found to be weakly expressed in 12 (40.0%) cases, moderately expressed in 13 (43.3%), and strongly expressed in five (16.7%) cases. No correlation was found between Ki-67 expression in odontogenic epithelium and P63 expression in the odontogenic epithelium (rho = 0.110, p = .563) or fibrous capsule (rho = 0.160, p = .399). Nevertheless, we found a positive correlation between Ki-67 expression in the odontogenic epithelium and the size of the RC (rho = 0.450, p = .013). The inflammatory infiltrate was negatively correlated with P63 expression in the odontogenic epithelium (rho = -0.428, p = .018), and with the size of cysts (rho = -0.728, p < .001).

Conclusions

There is a high expression of P63 throughout the odontogenic epithelium and connective tissue capsule of the RC. P63 expression in the odontogenic epithelium is negatively correlated with the degree of the inflammatory infiltrate but not with epithelial cell proliferation or the size of the cyst.

A deep learning approach for radiological detection and classification of radicular cysts and periapical granulomas

OBJECTIVES

Dentists and oral surgeons often face difficulties distinguishing between radicular cysts and periapical granulomas on panoramic imaging. Radicular cysts require surgical removal while root canal treatment is the first-line treatment for periapical granulomas. Therefore, an automated tool to aid clinical decision making is needed.

METHODS

A deep learning framework was developed using panoramic images of 80 radicular cysts and 72 periapical granulomas located in the mandible. Additionally, 197 normal images and 58 images with other radiolucent lesions were selected to improve model robustness. The images were cropped into global (affected half of the mandible) and local images (only the lesion) and then the dataset was split into 90% training and 10% testing sets. Data augmentation was performed on the training dataset. A two-route convolutional neural network using the global and local images was constructed for lesion classification. These outputs were concatenated into the object detection network for lesion localization.

RESULTS

The classification network achieved a sensitivity of 1.00 (95% C.I. 0.63 - 1.00), specificity of 0.95 (0.86 - 0.99), and AUC (area under the receiver-operating characteristic curve) of 0.97 for radicular cysts and a sensitivity of 0.77 (0.46 - 0.95), specificity of 1.00 (0.93 - 1.00), and AUC of 0.88 for periapical granulomas. Average precision for the localization network was 0.83 for radicular cysts and 0.74 for periapical granulomas.

CONCLUSIONS

The proposed model demonstrated reliable diagnostic performance for the detection and differentiation of radicular cysts and periapical granulomas. Using deep learning, diagnostic efficacy can be enhanced leading to a more efficient referral strategy and subsequent treatment efficacy.

CLINICAL SIGNIFICANCE

A two-route deep learning approach using global and local images can reliably differentiate between radicular cysts and periapical granulomas on panoramic imaging. Concatenating its output to a localizing network creates a clinically usable workflow for classifying and localizing these lesions, enhancing treatment and referral practices.

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts: A case report

BACKGROUND

Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw. Nonsurgical treatment of large radicular cysts is a topic of ongoing debate, and there is still no clear consensus on the most effective therapies. The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst, representing a minimally invasive approach for decompression. In this case, the radicular cyst was in close proximity to the mandibular nerve canal. We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.

CASE SUMMARY

A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing. The patient had no history of drug allergies or systemic disease. A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system, deep margin elevation and prosthodontic treatment. According to a 1-year follow-up period, the patient showed a favorable outcome.

CONCLUSION

This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.

Guide bone regeneration (GBR) reconstruction of extensive alveolar bone defect due to infected radicular cyst enucleation: 2 case reports

INTRODUCTION AND IMPORTANCE

Reconstruction of alveolar bone defects caused by radicular cysts is challenging for oral and maxillofacial surgeons.

CASE PRESENTATION

Two Indonesian females had similar complaint of swelling in the vestibule area of the right mandible. Panoramic radiography showed radiolucent lesions. Participants underwent guided bone regeneration (GBR) reconstruction, which used pericardium membrane in the first case and amnion membrane in the second case. Post-surgery condition showed an improved prognosis and histology showed a radicular cyst.

DISCUSSION

The use of pericardium membrane is easier compared to the amnion membrane, where success requires regular follow-up.

CONCLUSION

Alveolar bone defect reconstruction based on GBR requires meticulous preparation regarding patient condition, case selection and technical comprehension to ensure better treatment outcomes.

Inflammation-associated long non-coding RNA signature in radicular cyst tissues

Radicular cysts are characterized by significant levels of changes in inflammatory biomarkers. Among them, interleukins and growth factors have been reported to be deregulated in radicular cyst tissues. Moreover, long non-coding RNAs are recently discovered non-coding RNA molecules that regulate various intracellular stimuli to keep homeostasis in balance. A growing body of evidence suggests that lncRNAs are significantly involved in the regulation of inflammation by targeting various inflammatory biomarkers. Accordingly, the present study was aimed to investigate the gene expression levels of inflammation-related lncRNAs in radicular cysts and show their possible roles in the development of radicular cysts. For the study, a total of 25 patients with a radiologically and pathologically confirmed radicular cyst were enrolled. For the determination of non-coding RNA expression levels, real-time qPCR was used. As a result of the current study, expression levels of PACER and THRIL were found to be significantly elevated in radicular cyst tissues compared to control tissue samples. However, MALAT1, ANRIL, and NEAT1 expression levels were not significantly altered in radicular cyst tissues compared to control tissue samples. In conclusion, long non-coding RNAs, PACER and THRIL, seem to have significant pathophysiological roles by acquiring molecular changes during inflammation and might be involved in the development and formation of radicular cysts.

Expression pattern of hypoxia-related genes in odontogenic cysts

OBJECTIVE

The aim of the present study was to reveal the effects of hypoxia-associated signaling in odontogenic cysts.

DESIGN

The expression levels of genes involved in the hypoxia-associated signaling pathway were determined by quantitative Polymerase Chain Reaction (PCR) method.

RESULTS

As a result, it was found that phosphatase and tensin homolog (PTEN) expression was low (p = 0.037), and the expression levels of phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) (p = 0.0127), hypoxia inducible factor 1 alpha (HIF1A) (p < 0.001), and HIF1A antisense RNA 1 (HIF1A-AS1) (p = 0.0218) were higher in cyst tissue compared to normal tissue. HIF1A gene expression was found to be significantly altered according to the pathologic subtypes of odontogenic keratocyst, dentigerous cyst, and radicular cyst.

CONCLUSIONS

Odontogenic cysts were found to have higher expression of HIF1A and HIF1A-AS1, which may be related to the increased hypoxia in these lesions. In addition, PI3K/Akt signaling may be stimulated by increased PIK3CA and decreased PTEN expression, which promote cell survival and support the mechanism of cyst formation.

Cystic lesion between a deciduous tooth and the succeeding permanent tooth: a retrospective analysis of 87 cases

Objectives

The purpose of this study is to investigate the characteristics of dentigerous and radicular cysts that occur between deciduous and succeeding permanent teeth and to propose considerations for differential diagnosis of cysts at the treatment planning stage in the outpatient clinic.

Materials and Methods

A total of 87 patients with a cystic lesion located between a deciduous tooth and the succeeding permanent tooth participated in the study. Twelve variables were analyzed to diagnose such a cyst. For data analysis, Fisher's exact test was used to determine the statistical significance of the variables.

Results

Of the total 87 patients who participated in this study, 69 were diagnosed with dentigerous cysts and 18 were diagnosed with radicular cysts. Seven of the 12 differential factors analyzed in this study were statistically significant: age, location, symptoms, dental caries, endodontic treatment, delayed eruption, and size.

Conclusion

Several criteria can be considered for diagnosis of dentigerous cysts or radicular cysts. Age, location, presence of symptoms and dental caries, previous endodontic treatment, cystic size, and delayed eruption of impacted permanent teeth are reliable factors that should be considered when diagnosing dentigerous and radicular cysts.

Evaluation of CT and MRI Imaging Results of Radicular Cysts, Odontogenic Keratocysts, and Dentigerous Cysts and their Contribution to the Differential Diagnosis

AIM

This study aimed to evaluate the contribution of the MRI and CT results to the differential diagnosis of histopathologically different odontogenic cysts.

BACKGROUND

Odontogenic cysts are commonly seen in the jaw bone and their surgical operations have an important place in the practice of maxillofacial surgery; treatment options for these cysts differ according to their histopathology. Differential results that can be obtained from the radiological evaluations of different cyst groups will allow the surgeon to plan a more accurate approach at the beginning of the operation. In this study, computed tomography (CT) and magnetic resonance imaging (MRI) results of different cyst groups were interpreted together with their histopathological diagnosis.

METHODS

CT and MRI results of 17 patients aged between 19-61 were evaluated, whose histopathological diagnosis consisted of 3 radicular cysts (RC), a total of 9 odontogenic keratocysts (OKC) of which 4 were inflamed, and a total of 5 dentigerous cysts (DC) of which one of them was inflammatory.

RESULTS

In the CT scan, all cysts showed lytic, a sclerotic surrounding, and showed MRI peripheral enhancement, whereas solid nodular enhancement was only observed in OKCs. Edema and/or air in the surrounding bone medulla was observed in the infected lesions. OKC was heterogeneous, whereas RC and DC were more homogeneous. Diffusion restriction was observed to be frequent in OKCs. The OKCs were ellipsoidal in appearance and were located parallel to the long axis of the bone, and their dimensions were observed to be larger than the other cysts. OKCs may be accompanied by unerupted teeth. Radicular cysts were located perpendicular to the long axis of the bone and were globular in appearance, and their dimensions were smaller and more homogeneous compared to the OKCs. Dentigerous cysts are also accompanied by an unerupted tooth, and their peripheral enhancement is minimal and homogeneous. However, dentigerous cysts can be dense in content and smaller in size, and ellipsoidal localization is more common than OKCs.

CONCLUSION

In addition to classic panoramic radiography in the evaluation and differential diagnosis of maxillary and mandibular lesions, CT and MRI evaluations can provide helpful information to the surgeon and pathologist in making the diagnosis and may further help plan the operation.

Treatment of Radicular Cyst with Marsupialization in Children: Report of Two Rare Cases

Aim

To present the treatment of radicular cysts with marsupialization in children and help reduce morbidity.

Background

Radicular cyst is a cyst with an odontogenic origin seen more frequently in permanent dentition and seldom in primary dentition. Radicular cysts can develop due to apical infection caused by caries or can also occur as a consequence of pulp therapy in primary teeth. It may adversely affect the normal development and eruption of the permanent succedaneous teeth.

Case description

We report two cases of radicular cysts in association with primary teeth with different etiologies and their conservative management with marsupialization and decompression techniques.

Conclusion

Marsupialization has shown to be effective in treating radicular cysts in primary teeth. Good bone healing and normal continued development of the succedaneous permanent tooth bud were observed.Clinical significance: Marsupialization helps in preserving vital structures and reduces morbidity. It should be a preferred treatment modality for the management of large-sized radicular cysts.

How to cite this article

Ahmed T, Kaushal N. Treatment of Radicular Cyst with Marsupialization in Children: Report of Two Rare Cases. Int J Clin Pediatr Dent 2022;15(4):462-467.

Radicular Cyst Involving Deciduous Maxillary Incisor along with Bilateral Supernumerary Teeth: A Case Report

Radicular cyst involving the deciduous dentition is rare. Most of the cases reported it with primary molar teeth with apical infection. But very rare literature is available regarding radicular cysts associated with primary incisors.

Case report

A case of 9-year-old boy, who had bilaterally impacted supernumerary teeth, had developed a radicular cyst associated with a previously traumatized and intruded right upper primary lateral incisor is reported. Supernumerary teeth and intruded primary lateral incisor were removed along with enucleation of a radicular cyst.

Conclusion

The importance of correct diagnosis and management of radicular cyst in pediatric patients is important as most of the radicular cysts of primary teeth go undiagnosed, which can affect the developing succedaneous tooth bud.

How to cite this article

Bhosale AN, Desai S, Patil S, et al. Radicular Cyst Involving Deciduous Maxillary Incisor along with Bilateral Supernumerary Teeth: A Case Report. Int J Clin Pediatr Dent 2022;15(2):218-221.

Infected Radicular Cyst of Deciduous Second Molar Mimicking Dentigerous Cyst of Second Premolar in a Young Child: A Rare Entity

Radicular cysts are the most common cystic lesions in the oral cavity. Radicular cysts have a rare occurrence in the primary dentition. Radicular cysts arising from deciduous teeth are reported to occur in the age range of 3–19 years with a male predominance. The etiological factor is long-standing dental caries and dental trauma. The present case report describes the inflammatory radicular cyst involving the deciduous mandibular second molar. Surgical management includes enucleation of the cyst along with mandibular second premolar in a 5-year-old female patient. The surgical cavity was closed by an obturator appliance to maintain the patency. Eventful healing was seen after 3 months of follow-up.

How to cite this article: Kajjari S, Gowtham A, Meharwade P, et al. Infected Radicular Cyst of Deciduous Second Molar Mimicking Dentigerous Cyst of Second Premolar in a Young Child: A Rare Entity. Int J Clin Pediatr Dent 2021;14(3):434–437.

Preserving the vitality of teeth adjacent to a large radicular cyst in periapical microsurgery: a case report with 4-year follow-up

Background

Radicular cysts may enlarge considerably, cause extensive bone destruction, and jeopardize the integrity of the associated vital teeth. The different treatment approaches are aimed mainly at eliminating the cystic epithelial membrane while reducing the risk of injury to vital structures. Contrary to other treatment modalities, preapical surgery offers an unequivocal single occasion resolution for the patient. However, it has been associated with higher risk of collateral damages.

Case presentation

A patient presented with a large radicular cyst originating from a maxillary lateral incisor. The adjacent central and canine teeth initially failed to exhibit responses to sensibility tests but showed signs of vitality. Microsurgical management was aimed at enucleating the cystic membrane while maintaining adjacent teeth vitality. Upon careful and controlled cyst enucleation under the dental operating microscope, the neurovascular bundle of one of the involved teeth was visualized and its integrity was maintained throughout the procedure.

Results

The procedure was successful and follow up recalls revealed recovery of normal sensibility of tooth 11 and 13 with complete bone regeneration around their apices.

Conclusion

Within the limitation of the present case report, we demonstrated that complete excision of large periapical cyst can be performed without sacrificing the vitality of the adjacent teeth, by preserving the integrity of their neurovascular supply through controlled microsurgical enucleation, and by a potential apical vascular repair ensuing unintended injury. Diagnosing the pulp vitality of non-offending teeth whose apices protrude into the cystic lumen is a complex process and can be misleading. Pressure from the growing cyst can inhibit vital teeth responses to neural-based sensibility tests leading to false negative results. Thus, in such cases, the use of blood perfusion-based vitality testing is recommended for correct initial diagnosis.

Clinicopathological study of radicular cysts with actinomycosis

Background/purpose

Actinomycosis is sometimes associated with a radicular cyst (RC). This retrospective study evaluated the clinical and histopathological features of 6 RCs with actinomycosis (AM/RCs).

Materials and methods

The demographic data and clinicopathological features of 6 AM/RCs were collected and analyzed.

Results

The 6 AM/RCs were taken from 2 male and 4 female patients, and 3 were found in the maxilla and the other 3 in the mandible. The involved teeth included maxillary or mandibular incisors (2 cases) and maxillary or mandibular first and second molars (4 cases). The most common symptom was pain (5 cases) and the more frequent signs were sinus tract and pus discharge (4 cases). Microscopically, the actinomycotic colony presented as a mass with filamentous bacteria arranging in a sun-ray pattern at the periphery. The mean actinomycotic colony number was 7.7 ± 6.6 colonies per slide. Due to the severe inflammation in all 6 AM/RCs, the stratified squamous epithelial lining was completely abolished in 2 cases and partially destroyed in 4 cases with the residual epithelial lining varying from approximately 10%-50%.

Conclusion

Our results indicate that pain is the most common symptom and sinus tract and pus discharge are the two frequent signs of our 6 AM/RCs. The stratified squamous epithelial lining was either completely abolished (2 cases) or partially destroyed (4 cases) in 6 AM/RCs. Thus, if the endodontically-treated tooth shows a recurrent sinus tract and poor response to repeated conventional root canal treatments, periradicular actinomycotic infection should be highly suspected.

Sine Qua Non: Dentigerous Cyst

Dentigerous cysts, also known as follicular cysts, are among the most common developmental cysts of the gnathic bones. The majority of cases are clinically asymptomatic and discovered incidentally on panographic radiographs during routine dental care. The cyst appears as a radiolucency, classically unilocular, associated with the crown of an unerupted or impacted tooth. Usually diagnosed in the 2nd-3rd decade, third molars of the mandible are the most commonly affected teeth. Histologically, dentigerous cysts demonstrate a fibrous or fibromyxoid connective tissue wall lined by squamous epithelium, classically lacking rete ridges. Inflammation may introduce histologic changes, however. The differential diagnosis includes hyperplastic dental follicle, periapical or radicular cyst, unicystic ameloblastoma, odontogenic keratocyst, and other odontogenic cysts and tumors. While the findings are generally classic and pose no diagnostic dilemma, the diagnosis is best made in the context of the appropriate clinical and radiographic setting. Submitted tissue with a lack of history, to include a detailed relationship with the affected tooth, may result in misdiagnosis and subsequent confusion for the clinician. So, despite its simple features, dentigerous cysts are not uncommonly mischaracterized. Therefore a review of a classic case of dentigerous cyst is presented.

Immunohistochemical analysis of ADAMTS-1, versican and pEGFR expressions in periapical granuloma and radicular cyst

Background

ADAMTS expression can be associated with several inflammatory processes, and has been correlated with tumorigenesis of some neoplasms, but its participation in the development of periapical lesions has not been investigated. Therefore, our objective was to verify the expression of ADAMTS-1, versican and pEGFR in Periapical Granuloma (PG) and in the Radicular Cyst (RC) since they are the most common lesions of the periapex.

Methods

25 samples of RC and 10 of PG were used. As a control, 10 samples of inflammatory fibrous hyperplasia (IFH) and 10 of dental follicle (DF) were used. The expression of these proteins was investigated using immunohistochemistry.

Results

In the epithelium of RC, IFH and DF, the expression of ADAMTS-1 was greater in DF than in RC (p < .001). Versicano showed greater expression in IFH than in RC, DF than in RC (p < .001). pEGFR showed greater expression in IFH and RC than in DF (p < .01 and p < .05, respectively). In connective tissue, ADAMTS-1 expression was greater in PG and RC than in IFH and DF (p < .001). Versicano showed greater expression in PG, RC and IFH compared to DF (p < .001). In pEGFR there was a higher expression in PG when compared to RC, IFH and DF (p < .001). Greater immunostaining occurred in the RC than in the DF (p < .001).

Conclusions

Our results suggest that the studied proteins may participate in the pathogenesis of PG and RC, through the interaction of these proteins, in the remodeling of the ECM (versican) by ADAMTS-1, producing bioactive fragments, which could activate EGFR, contributing to the formation, growth and maintenance of injuries.

[Three-dimentional radiographic features of 67 maxillary radicular cysts]

OBJECTIVE

To analyze the three-dimensional radiographic characteristics of maxillary radi-cular cysts using cone-beam computed tomography (CBCT) and spiral CT.

METHODS

Clinical records, histopathological reports, and CBCT or non-enhanced spiral CT images of 67 consecutive patients with maxillary radicular cysts were retrospectively acquired, and radiographic features, including size, shape, expansion, internal structure and relationship with the surrounding tissues, were analyzed. The lesions were divided into three types according to the involved tooth number, as follows: type Ⅰ (single tooth), the epicenter of the cyst was located at the apex of a nonvital tooth, without involvement of the neighbo-ring tooth; type Ⅱ (adjacent tooth involvement), the cyst was located at the apex of a nonvital tooth with involvement of the mesial and/or distal tooth root; and type Ⅲ (multi-teeth), the cyst involved the apexes of ≥4 teeth. Besides, these cysts were classified as another three types on sagittal views, as follows: centripetal, the root apex was oriented centripetally to the center of the cyst; palatal, the cyst was located mainly at the palatal side of the apex; and labial/buccal, the cyst was located mainly at the labial/buccal side of the apex.

RESULTS

Totally, 67 patients with maxillary radicular cysts were acquired, including 38 males and 29 females, and their ages ranged from 13 to 77 years. Among them, 46 lesions (68.7%) were located in the anterior maxilla and 65 (97.0%) were round or oval. Labial/buccal cortex expansion was present in 43 cases (64.2%) and palatal cortex expansion in 37 cases (55.2%). The nasal floor was invaded in 27 cases (40.3%), the maxillary sinus was invaginated in 26 cases (38.8%), and root resorption was present in 9 cases (13.4%). The average diameter of lesions was (20.89±8.11) mm mesio-distally and (16.70±5.88) mm bucco-palatally. In spite of the 4 residual cysts, the remaining 63 lesions included 14 type Ⅰ, 26 type Ⅱ and 23 type Ⅲ cysts according to the involved tooth number. Besides, the 63 lesions included 46 centripetal, 15 palatal and 2 buccal cysts on sagittal views.

CONCLUSION

The maxillary radicular cysts were frequently well-circumscribed round or oval radiolucency, with significantly different sizes. According to the involved tooth number, it can be divided into single tooth, adjacent tooth involvement and multi-teeth types. On sagittal views, the root-cyst relationship was centripetal in most cases, while a minority of cysts expanded palatally or buccally.

Radicular cysts and Chin implants; An unexpected complication prompting explantation - Case report

•

Radicular cysts are benign, odontogenic, and inflammatory in nature that commonly arise in the maxilla.

•

No link has been previously found between silicone chin implants and radicular cysts or fistulating radicular cysts.

•

We suggest dental panoramic X-ray screening for patients with poor oral hygiene or dental trauma to detect radicular cysts before the operation.

•

The decision to proceed with chin implant in a patient known for treated radicular cyst may be unsafe, as the recurrence rate is unknown.

Introduction

Implant-based genioplasty is a simple and safe but not complication-free cosmetic procedure. Patients are commonly briefed about anticipated complications and their management pre-operatively, but few unexpected complications may arise; and this case report is an example. This paper is the first to report a radicular cyst fistulating through chin implant pocket to the skin. Moreover, we present our prevention strategy and recommendations.

Presentation of case

A 39-year-old-lady underwent a silicone implant-based genioplasty that was uneventful. Later, she developed a reddish nodule on the chin necessitating fistulectomy followed by a recurrence leading to explantation. It was not until the second recurrence that a fistulating radicular cyst was discovered and was treated with the help of a dentist.

Discussion

Radicular cysts are benign, inflammatory cysts that arise in a background of dental trauma or caries. No link has been discovered yet between silicone implants and radicular cysts or fistulating cysts. Moreover, we propose that poor oral hygiene could be implicated in the development of these cysts. Dental panoramic X-ray has been used to diagnose radicular cysts, but its efficacy as a screening tool needs to be studied. Finally, the recurrence rate of radicular cysts is unknown.

Conclusion

In a patient with chin implant, radicular cysts could lead to a disastrous outcome. Through history and physical examination, a plastic surgeon should identify patients with poor oral hygiene and dental trauma prior to implant-based genioplasty to arrange for a dental panoramic X-ray. Patients known to have radicular cysts should not undergo an implant-based genioplasty.

A Clinicopathological Approach to Odontogenic Cysts: the Role of Cytokeratin 17 and bcl2 Immunohistochemistry in Identifying Odontogenic Keratocysts

Odontogenic keratocysts (OKCs) are developmental cysts of the jaws that require proper diagnosis due to their potential for local aggressive growth and recurrences. OKCs have a typical parakeratotic epithelium demonstrating transepithelial cytokeratin 17 (CK17) and basal bcl2 staining on immunohistochemistry (IHC), which distinguishes them from other common jaw cysts. Secondary to inflammation, the epithelial lining may be altered and loses the typical IHC phenotype. The aim of the present study was to analyse a series of consecutive jaw cysts for their expression of CK17 and bcl2 and assess how these IHC stains may help in their diagnosis. All cysts were retrospectively assessed for available clinical, radiological and pathological findings and diagnoses were revised whenever needed. 85 cysts from 72 patients were collected from two departments. The series had 21 OKCs, the remaining non-OKCs included radicular/residual, dentigerous, paradental, lateral periodontal, botryoid odontogenic cysts. OKCs with typical epithelium showed the typical IHC phenotype, which was generally lost in inflammation-associated altered epithelium. Contrarily to earlier descriptions, a wide variety of CK17 positivity was seen in the majority of non-OKCs, including focal transepithelial staining. Basal bcl2 staining was also seen in 16 non-OKCs. These stainings were never as strong in intensity as seen in OKCs. One case was histopathologically identified as OKC due to focally maintained IHC profile. CK17 and bcl2 IHC may help in the diagnosis of OKCs, but must be interpreted with caution and is not a yes or no tool in the diagnostic puzzle.

Evaluation of concordance between clinical and histopathological diagnoses in periapical lesions of endodontic origin

Background/purpose: Periapical lesions of endodontic origin are often diagnosed based on the clinical and radiological presentations that may be different from the histological diagnoses. The purpose of this study was to assess the concordance between the clinical diagnosis of these lesions and the histopathological diagnoses and to analyze their clinical and pathological features.

Materials and methods

Biopsies of periapical lesions of endodontic origin diagnosed in the histopathology laboratory between 2006 and 2017 were retrieved from the database and used to conduct this retrospective review. Clinical data were obtained, and tissue samples were re-evaluated. The overall agreement between the clinical and histological diagnoses was tested utilizing the Cohen kappa (k).

Results

A total of 317 periapical biopsy specimens were included in this study which consisted of 137 periapical granulomas, 174 periapical cysts, and six periapical scars. Generally there was weak overall agreement between the clinical and histological diagnoses of periapical granuloma and periapical cysts (Cohen kappa, k = 0.059).

Conclusion

The findings of this study indicate that clinical/radiographic examinations are not able to preoperatively determine whether a periapical lesion is a cyst or a granuloma and highlights the importance of developing a reliable nonsurgical diagnostic method to differentiate periapical lesions.

Infected Dentigerous Cyst and its Conservative Management: A Report of Two Cases

Aim

To check the efficacy of decompression technique in children with dentigerous cysts.

Background

Most commonly occurring odontogenic cysts in the oral cavity are radicular cysts and dentigerous cysts.¹ According to Kramer, a cyst is defined as a pathological cavity having fluid, semi-fluid, or gaseous contents, which is not created by the accumulation of pus. A cyst which is lined by epithelium is known as a true cyst and that which is not lined by epithelium known as a pseudocyst.² The dictionary meaning of dentigerous is “structures resembling teeth”.³ A dentigerous cyst is found enveloping the crown of an unerupted, embedded, or submerged tooth by the expansion of its follicle till the neck of the tooth.¹ It is not unusual for a dentigerous cyst to mimic a radicular cyst, especially when the cyst is associated with a pulpectomized or carious primary tooth and its unerupted permanent successor. This article presents two cases of infected dentigerous cysts. The first case was of a female patient associated with tooth 45; and another case was of a male patient associated with tooth 35. The infected dentigerous cyst in both the cases was treated with the most conservative option available, i.e., decompression technique.

Case description

In this article, two cases of infected dentigerous cysts are discussed, in which one case deals with the female patient associated with tooth 45 and the other case deals with the male patient associated with tooth 35. The infected dentigerous cysts in both the cases were treated conservatively, i.e., with the decompression technique.

Conclusion

The present case report states that the decompression technique may be the most conservative method available for managing dentigerous cysts in children.

How to cite this article

Patil AS, Jathar PN, et al. Infected Dentigerous Cyst and its Conservative Management: A Report of Two Cases. Int J Clin Pediatr Dent 2019;12(1):68–72.

Huge Radicular Cyst of the Maxilla Treated with Complete Resection and Immediate Reconstruction by Rib Bone Graft

Radicular cysts are the most common odontogenic cystic lesions that occur in jaws. They rarely become problematic and are incidentally found on routine dental radiographs. As they appear to reach a considerable size prior to medical attention due to their insidious and destructive growth characteristics during the intraosseous stage, treatment often requires extensive cystectomy and skeletal reconstruction. Here we present the case of an 18-year-old man who was sent to our department, because of a huge, bulging mass in his left cheek. Surgery consisted of complete removal of the cyst and immediate reconstruction of the midfacial buttress using an autologous rib graft in a tongue-and-groove fashion. Histopathological examination of the lesion confirmed the diagnosis of a maxillary radicular cyst. This case underscores the nature of the frequently asymptomatic and long-term evolution of maxillary radicular cysts, with their growth causing massive bone destruction for which skeletal reconstruction is required.

Relationship between mast cells and E-cadherin in odontogenic keratocysts and radicular cysts

OBJECTIVE

This study aimed to evaluate tryptase and E-cadherin protein expression in odontogenic keratocysts (OKCs) and radicular cysts (RCs) and their relationship with lesion size.

MATERIALS AND METHODS

Thirty OKC and 30 RC cases were analyzed by immunohistochemistry. Tryptase expression was quantitatively assessed using the quantification of mast cells, and expression of E-cadherin was semi-quantitatively analyzed estimating the proportion of positive cells: 1 = less than 25% of immunopositive cells; 2 = 26 to 50% of immunopositive cells; 3 = 51 to 75% of immunopositive cells; 4 = more than 75% of immunopositive cells. Data on cystic lesion sizes were obtained from patients' clinical files, based on previous radiographic exams, and the lesions were categorized into three groups: group 1 (< 2 to 2 cm); group 2 (> 2 to 4 cm), and group 3 (> 4 cm).

RESULTS

Higher mast cell means were found for RCs, with the predominance of degranulated mast cells in both OKCs and RCs (p = 0.082). Concerning the epithelial component, a higher concentration of degranulated mast cells was detected in RCs (p = 0.000). Regarding connective tissue, degranulated mast cells were more evident in OKCs (p = 0.762). A negative correlation was observed between E-cadherin expression and total number of mast cells (p = 0.011), degranulated mast cells (p = 0.040), and degranulated mast cells in both superficial (p = 0.035) and deep connective tissues (p = 0.009). Concerning lesion size, a negative correlation with total number of mast cells (p = 0.016) and number of degranulated mast cells (p = 0.049) was observed, both in the epithelial components. Herein, the larger the lesion size, the lower the number of degranulated mast cells in the epithelium (r = - 0.271; p = 0.49), suggesting that these cells play a role in the initial cystic expansion phase.

CONCLUSION

The higher expression of tryptase in degranulated mast cells was linked to a lower expression of E-cadherin, which may be related to a change in the epithelial permeability in these lesions, contributing to increased cystic content and lesion growth.

CLINICAL RELEVANCE

Evidence of the relationship between mast cells and E-cadherin in the growth of odontogenic cysts was studied.

Macrophage phenotypes and Gas6/Axl signaling in apical lesions

Background/purpose

Macrophages participate in the periapical inflammation with pro-inflammatory M1 cells and anti-inflammatory M2 cells. Gas6/Axl signal is the responsible pathway for the activation of M1 and polarization of M2. The aim of this study was to compare the number of CD16⁺ M1 cells, CD206⁺ M2 cells, and Gas6/Axl expression between apical granulomas and radicular cysts.

Materials and methods

Twenty-four cases of granuloma and twenty of cysts were submitted to immunohistochemistry using anti-CD16 and anti-CD206 antibodies for determining M1 and M2 macrophages and investigating the cells with positive Gas6 and Axl expression.

Results

There were more numerous of M1 macrophages in radicular cysts (175.9 ± 87.7) compared to apical granuloma (116.6 ± 55.8), and M2 macrophages was higher in cysts (204.0 ± 97.6) than granuloma (152.9 ± 64.6). The level of Gas6/Axl expression were similar. There was a significant different in M1 macrophage (P = 0.014) between two diagnosis. In patients with or without root resorption, the number of M1 were 194.6 ± 57.2 compared with 139.1 ± 79.6. The number of M2 were 241.7 ± 81.4 and 164.6 ± 77.1. The expression of Axl was stronger in root resorption patients (191.1 ± 43.6), but the tendency in Gas6 expression was similar. Significant differences were noted in high M2 infiltration and Axl positive lesions.

Conclusion

It appears that macrophages associated with significantly higher numbers in radicular cysts than apical granuloma. Meanwhile, macrophages and Axl receptor was intensively expressed in patients with root resorption, related to severe inflammation.

Is it a cystic or a cyst-like condition? Discussing the etiology of an unusual large mandibular lesion in a Roman skeleton from Quinta da Torrinha/Quinta de Santo António (Almada, Portugal)

Cystic and cyst-like lesions of the jaw are a recurrent finding in routine dental radiography but not in paleopathology. This paper describes a large oval osteolytic cavity (23 × 14 mm) observed in the mandible of a middle-aged female unearthed from the Roman necropolis of Quinta da Torrinha/Quinta de Santo António (Almada, Portugal, 3rd-5th centuries AD). The lesion was located in the body of the mandible, inferior to the alveolus of the first left molar. The associated tooth exhibited a carious lesion that destroyed the tooth crown and exposed the pulp cavity. The osteolytic lesion presented inner smooth walls and sharped regular contours, surrounded by slight microporosity. Radiography revealed an unilocular lesion with well-defined contours and a thin opaque rim. The differential diagnosis considered several odontogenic and non-odontogenic conditions of the jaw. The size and shape of the cavity, the nature of its walls and contours, and the presence of a source of infection in the pulp is consistent with an odontogenic condition of inflammatory origin, probably a radicular cyst.

Spatial distribution of osteopontin, CD44v6 and podoplanin in the lining epithelium of odontogenic keratocyst, and their biological relevance

BACKGROUND AND AIMS

The odontogenic keratocyst (OKC) remains the most challenging jaw cyst to treat because of its locally-aggressive behaviour and high recurrence potential. Emerging evidence suggests that osteopontin, its receptors CD44v6 and integrin α_v, and podoplanin, have a role in the local invasiveness of this cyst. However the spatial distribution characteristics of these pro-invasive markers in the lining epithelium of OKC, and their association with the clinicopathologic parameters of OKC are largely unexplored. This study sought to address these issues in comparison with dentigerous cysts (DCs) and radicular cysts (RCs) and to evaluate their biological relevance.

METHODS

A sample consisting of 20 OKC cases, 10 DCs and 10 RCs was subjected to immunohistochemical staining for osteopontin, CD44v6 and integrin α_v, and podoplanin, and semiquantitative analysis was performed.

RESULTS

All factors (except integrin α_v) were detected heterogeneously in the constitutive layers of the lining epithelium in all three cyst types. Key observations were significant upregulation of CD44v6 and podoplanin in OKC compared to DCs and RCs, suggesting that these protein molecules may play crucial roles in promoting local invasiveness in OKC (P<0.05). Osteopontin underexpression and distribution patterns were indistinctive among all three cysts indicating its limited role as pro-invasive factor. Clinical parameters showed no significant correlations with all protein factors investigated.

CONCLUSIONS

Present findings suggest that an osteopontin^low CD44v6^high and podoplanin^high immunoprofile most probably represent epithelial signatures of OKC and are markers of local invasiveness in this cyst.

Immunohistochemical evaluation of podoplanin in odontogenic tumours & cysts using anti-human podoplanin antibody

BACKGROUND

Odontogenic Cysts & tumors originate through some aberration from the normal pattern of odontogenesis. Ameloblastoma is one of the most frequent intraosseous odontogenic tumors. However it is no longer appropriate to use the diagnosis of ameloblastoma without specifying the type. Varied-clinical entities of ameloblastoma differ in their biologic behaviour. Odontogenic cysts like dentigerous and radicular cysts are less aggressive in nature than odontogenic tumors. Recently, podoplanin commonly used as a lymphatic endothelial marker in cancers has recently been found to play a possible role in odontogenic tumorigenesis also. Therefore the purpose of this study was to immunohistochemically analyse the expression of podoplanin in ameloblastomas, KCOTs, dentigerous cysts, radicular cysts & dental follicles.

METHODS

Paraffin-embedded tissue specimens of 15 Ameloblastomas (7 follicular, 6 unicystic, 2 desmoplastic),10KCOTs, 5 dentigerous cysts, 5 radicular cysts & 5 dental follicles were immunohistochemically examined using antibody against podoplanin.

RESULTS

All ameloblastomas displayed podoplanin expression in ameloblast-like cells of the epithelial islands while the stellate-reticulum like cells exhibited no or weak immunostaining. Expression of podoplanin in KCOTs was strongly positive in the cells of the basal and suprabasal layers & odontogenic epithelial nests. Positive immunoreaction for podoplanin was observed in the inflammatory radicular cysts and inflamed dentigerous cyst only and negative or weak expression in the lining epithelium of uninflamed dentigerous cysts and dental follicles.

CONCLUSION

Our results suggest that podoplanin can be used as a potential proliferative marker to observe the aggressive behaviour of ameloblastomas and KCOTs.

Current concepts in odontohypophosphatasia form of hypophosphatasia and report of two cases

BACKGROUND

Hypophosphatasia is a rare inherited disease derived from mutations in tissue non-specific alkaline phosphatase genes, with typical oral symptoms including short root anomaly and dysplasia of dentin or cementum.

CASE PRESENTATION

Two young female patients presented with short root anomaly with a history of premature loss of deciduous and/or permanent teeth. The laboratory and imaging investigations were performed. One case was diagnosed as odontohypophosphatasia concurrent with hyperthyroidism, the other was odontohypophosphatasia concurrent with multiple radicular cysts.

CONCLUSION

This report presents two cases of odontohypophosphatasia, a rare disease which is difficult to be diagnosed, and highlights that the history of premature loss of deciduous and/or permanent teeth, oral manifestation and laboratory tests are crucial for clinical diagnosis.

Radiographic Assessment of Bone Formation Using rhBMP2 at Maxillary Periapical Surgical Defects: A Case Series

Periapical cysts are the most common inflammatory odontogenic cysts arising from untreated dental caries with pulp necrosis and periapical infection. The choice of treatment is often influenced by various factors like size, extension of the lesion, proximity to vital structures, systemic condition and compliance of the patient too. The treatment protocol for management of periapical cysts is still under discussion and options vary from conservative treatment by means of endodontic technique to surgical treatment like decompression or a marsupialisation or even to enucleation. Large bony defect secondary to periapical surgery compromising the tooth integrity often requires bone graft to enhance bone formation and thus restoring function at the earliest. The present case series included 10 patients who had established periapical pathology secondary to history of trauma on upper anterior teeth as well patients with history of carious teeth with an apparent failure in root canal therapy. All ten patients were treated with cyst enucleation and apiceotomy along with 1.4cc Recombinant Human Bone Morphogenetic Protein-2 soaked Absorbable Collagen Sponge implantation at surgical defect. Radiographs and clinical examinations were done upto 3 months to evaluate healing. Radiographic and clinical assessments revealed bone regeneration and restoration of the maxillary surgical defects in all 10 patients. No evidence of graft failure was noted. The Recombinant Human Bone Morphogenetic Protein-2 soaked Absorbable Collagen Sponge carrier is thus proved to be a viable option for the treatment of maxillary periapical surgical defects.

Progression of periapical cystic lesion after incomplete endodontic treatment

We report a case of large radicular cyst progression related to endodontic origin to emphasize proper intervention and follow-up for endodontic pathosis. A 25 yr old man presented with an endodontically treated molar with radiolucency. He denied any intervention because of a lack of discomfort. Five years later, the patient returned. The previous periapical lesion had drastically enlarged and involved two adjacent teeth. Cystic lesion removal and apicoectomy were performed on the tooth. Histopathological analysis revealed that the lesion was an inflammatory radicular cyst. The patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. Although the patient had been asymptomatic, close follow-ups are critical to determine if any periapical lesions persist after root canal treatment.

Immunohistochemical Assessment of Mast Cells and Small Blood Vessels in Dentigerous Cyst, Odontogenic Keratocyst, and Periapical Cyst

PURPOSE

The aim of this study was to verify the density of mast cells (MCs) and microvessels in odontogenic cysts. Furthermore, the correlation between MCs and microvessels was evaluated to assess the contribution of MCs to angiogenesis and growth of odontogenic cysts. This approach may be a basis for the development of future pharmaceuticals addressed to MCs performance to manage odontogenic cysts. To our knowledge, no study investigating the correlation between MCs and microvessels has been performed to date.

METHODS

60 cases of odontogenic cysts consisting of 20 radicular cysts (RCs), 20 odontogenic keratocysts (OKCs) and 20 dentigerous cysts (DCs) were included in this study. Five high power fields in superficial connective tissue and five high power fields in deep connective tissue were counted for each sample. Moreover, a total mean of ten fields was calculated.

RESULTS

RC showed the highest mean numbers of MCs and microvessels (p<0.05). The subepithelial zones of all cysts contained more MCs and microvessels compared to the deeper zones. A statistically significant correlation between the numbers of MCs and microvessels was not observed (r=0.00, p=0.49).

CONCLUSION

Although the number of MCs was not significantly associated with microvessels, these cells may be related to the growth of odontogenic lesions, particularly RCs. Further studies on the in vivo functions of MCs will make the concept more clear.

Ameloblastomatous Change in Radicular Cyst of The Jaw in a Nigerian Population

OBJECTIVE

To determine the incidence, age, gender, jaw-sites and subtypes of radicular cyst, and to determine the incidence of ameloblastomatous change in radicular cyst in a Nigerian population.

METHOD

A 10-year retrospective analysis of all diagnosed orofacial lesions in the Department of Oral Pathology and Medicine, University of Benin Teaching Hospital, Benin City, Nigeria.

RESULTS

From the 785 diagnosed orofacial lesions within the study period; there were 54 (6.9%) cases of radicular cysts of the jaws. The peak age group was the 3(rd) decade (n=23, 42.6%) with a mean age of 31 ± 1.7 years. There were 29 (53.7%) males and 25 (46.3%) females, giving a ratio of 1.2:1. The mandible was the commonest jaw-site (n=32, 59.3%). There were 12 (22.2%) cases of periapical cyst which were significantly associated with anterior maxillary site (n=8, 14.8%) [p=0.001]. Seven (13.0%) cases of cystic ameloblastoma were diagnosed among the radicular cysts, with a predilection of the lesions for 3(rd) and 4(th) decades of life (n=6, 11.1%), and posterior mandible (n=5, 9.3%).

CONCLUSION

This study showed a low incidence of radicular cyst of the jaw among orofacial lesions and a relatively higher incidence of ameloblastomatous change in radicular cyst compared to previous reports. Immuno-histochemical examination is recommended to differentiate radicular cyst with ameloblastomatous-like change from cystic ameloblastoma arising from radicular cyst.

Multidisciplinary Approach in Management of a Large Cystic Lesion in Anterior Maxilla - A Case Report

Management of large cystic lesion requires a multidisciplinary approach. In this case report a large radicular cyst is managed by conventional root canal treatment with triple antibiotic paste followed by surgical enucleation. In this case, patient presented with a 4 cm symptomatic swelling of the palate adjacent to teeth 21, 22 and 23. The swelling was soft on palpation and the overlying mucosa was of normal color. Radiographically, a well-defined unilocular radiolucency with corticated margins was seen. A full-thickness flap was reflected and revealed a large cyst-like lesion that had perforated the lingual cortical plate. The lesion was enucleated and submitted for microscopic examination. The biopsy report confirmed the diagnosis as radicular cyst.The patient was recalled after 6 months, and no symptoms or signs were noted. Radiograph showed the healing lesion.

Biochemical and Cytological Comparison of Keratocystic Odontogenic Tumours to Nonkeratinising Odontogenic Cysts Fluid

AIM

To evaluate the levels of albumin, prealbumin, total protein, inorganic phosphate and presence of keratinocytes in the cystic fluid for the diagnosis and appropriate treatment planning of keratocystic odontogenic tumours and other non keratinizing odontogenic cysts.

MATERIALS AND METHODS

Fifteen keratocystic odontogenic tumour and 15 controls were studied. The cystic fluid was aspirated and analysed to determine the levels of albumin, prealbumin, total protein, inorganic phosphate and the presence of keratinocytes. The data collected was statistically evaluated using Mann Whitney U-Test and Student's t-test.

RESULTS

A highly significant difference (p<0.0001) was seen when a comparison of Prealbumin, total protein, inorganic phosphate and presence of keratinocytes was made between keratocystic odontogenic tumour and non keratinizing odontogenic cysts. The presence of albumin also showed a significant difference (p<0.01).

CONCLUSION

A combined analysis of total protein, albumin, prealbumin, inorganic phosphorous and detection of epithelial squames may be used as a diagnostic adjunct in the preoperative diagnosis of keratocystic odontogenic tumour in a minimally invasive and highly accurate fashion.

Quantification and localization of mast cells in periapical lesions

Background:

Periapical lesions occur in response to chronic irritation in periapical tissue, generally resulting from an infected root canal. Specific etiological agents of induction, participating cell population and growth factors associated with maintenance and resolution of periapical lesions are incompletely understood. Among the cells found in periapical lesions, mast cells have been implicated in the inflammatory mechanism.

Aim:

Quantifications and the possible role played by mast cells in the periapical granuloma and radicular cyst. Hence, this study is to emphasize the presence (localization) and quantification of mast cells in periapical granuloma and radicular cyst.

Materials and Methods:

A total of 30 cases and out of which 15 of periapical granuloma and 15 radicular cyst, each along with the case details from the previously diagnosed cases in the department of oral pathology were selected for the study. The gender distribution showed male 8 (53.3%) and females 7 (46.7%) in periapical granuloma cases and male 10 (66.7%) and females 5 (33.3%) in radicular cyst cases. The statistical analysis used was unpaired t-test.

Results:

Mean mast cell count in periapical granuloma subepithelial and deeper connective tissue, was 12.40 (0.99%) and 7.13 (0.83%), respectively. The mean mast cell counts in subepithelial and deeper connective tissue of radicular cyst were 17.64 (1.59%) and 12.06 (1.33%) respectively, which was statistically significant. No statistical significant difference was noted among males and females.

Conclusion:

Mast cells were more in number in radicular cyst. Based on the concept that mast cells play a critical role in the induction of inflammation, it is logical to use therapeutic agents to alter mast cell function and secretion, to thwart inflammation at its earliest phases. These findings may suggest the possible role of mast cells in the pathogenesis of periapical lesions.

Quantification and localization of mast cells in periapical lesions

BACKGROUND

Periapical lesions occur in response to chronic irritation in periapical tissue, generally resulting from an infected root canal. Specific etiological agents of induction, participating cell population and growth factors associated with maintenance and resolution of periapical lesions are incompletely understood. Among the cells found in periapical lesions, mast cells have been implicated in the inflammatory mechanism.

AIM

Quantifications and the possible role played by mast cells in the periapical granuloma and radicular cyst. Hence, this study is to emphasize the presence (localization) and quantification of mast cells in periapical granuloma and radicular cyst.

MATERIALS AND METHODS

A total of 30 cases and out of which 15 of periapical granuloma and 15 radicular cyst, each along with the case details from the previously diagnosed cases in the department of oral pathology were selected for the study. The gender distribution showed male 8 (53.3%) and females 7 (46.7%) in periapical granuloma cases and male 10 (66.7%) and females 5 (33.3%) in radicular cyst cases. The statistical analysis used was unpaired t-test.

RESULTS

Mean mast cell count in periapical granuloma subepithelial and deeper connective tissue, was 12.40 (0.99%) and 7.13 (0.83%), respectively. The mean mast cell counts in subepithelial and deeper connective tissue of radicular cyst were 17.64 (1.59%) and 12.06 (1.33%) respectively, which was statistically significant. No statistical significant difference was noted among males and females.

CONCLUSION

Mast cells were more in number in radicular cyst. Based on the concept that mast cells play a critical role in the induction of inflammation, it is logical to use therapeutic agents to alter mast cell function and secretion, to thwart inflammation at its earliest phases. These findings may suggest the possible role of mast cells in the pathogenesis of periapical lesions.

Cysts in periradicular region of deciduous molars in mixed dentition: retrospective study of five cases

The cyst in mixed dentition stage cause expansion of buccal cortex, displacement of teeth and may present as case of infection. The cyst in periradicular region of deciduous molar are of frequent occurrence. The differential diagnosis of this lesion is radicular cysts of deciduous molar: developmental or infammatory dentigerous cyst of corresponding unerupted premolar. After going through the available literature of radicular cyst of deciduous molars and dentigerous cysts of developing premolars in mixed dentition we studied the five cases of cyst in periradicular region of deciduous molars in mixed dentition retrospectively for the diagnostic dilemma of radicular cyst verses dentigerous cyst. In conclusion, we can set some criteria for the diagnosis which is particularly important for treatment and for conservation of developing premolar. How to cite this article: Manekar VS, Chavan A, Wadde K, Dewalwar V. Cysts in Periradicular Region of Deciduous Molars in Mixed Dentition: Retrospective Study of Five Cases. Int J Clin Pediatr Dent 2014;7(3):229-235.

Comparision of Immunohistochemical Expression of CD10 in Odontogenic Cysts

BACKGROUND

Expression of CD10 has been documented in various tumors like nasopharyngeal carcinoma, gastric carcinoma, squamous cell carcinoma, odontogenic tumors.

AIM

To evaluate and compare CD10 expression in odontogenic cysts like radicular cyst, dentigerous cyst and odontogenic keratocyst (OKC).

MATERIALS AND METHODS

Total 60 cases were included in the study, comprising 20 cases each of radicular, dentigerous and odontogenic keratocyst. Each case was evaluated and compared for immunohistochemical expression of CD10. RESULTS obtained were statistically analysed using ANOVA test followed by post hoc test Tukey-Kramer Multiple Comparisons Test for continuous variable and Chi-square test for discrete variable.

RESULTS

More number of cases showing sub-epithelial stromal CD10 expression were found in OKC among the cysts.

CONCLUSION

CD10 expression was more in OKC compared to radicular and dentigerous cysts.

Replantation of Displaced Underlying Successor and Marsupialization of Radicular Cyst associated with a Primary Molar

Radicular cysts are by far the most common cystic lesions of the jaw. However, those arising from primary teeth are comparatively rare, comprising only 0.5 to 3.3%. The aim of this paper is to present clinical, radiographic and histopathological characteristics of radicular cyst associated with a primary mandibular molar causing unusual displacement of the permanent successor. Extraction of primary tooth along with extirpation of cyst was done under local anesthesia. The displaced premolar was also extracted and then replanted in the socket after proper alignment. Healing was uneventful and the space of missing primary molar was maintained by band and loop space maintainer. The relationship between intracanal medicaments and rapid growth of cyst, as mentioned in literature was observed in our case too. Thus, pulpotomy treated primary teeth should receive periodic postoperative radiographic examination and absence of clinical symptoms does not mean that a pulpotomy treated tooth is healthy. How to cite this article: Lamba G, Ravi GR. Replantation of Displaced Underlying Successor and Marsupialization of Radicular Cyst associated with a Primary Molar. Int J Clin Pediatr Dent 2015;8(1):70-74.

Expression of inducible nitric oxide synthase in the epithelial linings of odontogenic keratocyst, dentigerous cyst and radicular cyst: a pathological insight

BACKGROUND

The present study is aimed at analyzing the expression of inducible nitric oxide synthase (iNOS) in the epithelial lining of odontogenic keratocyst (OKC), dentigerous cyst (DC), radicular cyst (RC) in order to understand the possible role of iNOS with special reference to its neoplastic nature and local aggressive of cysts.

AIM

The primary aim of the following study is to analyze the immunohistochemical expression of iNOS and secondary aim is to compare the iNOS expression, pattern and intensity of staining among the epithelial linings of OKC, DC and RC.

MATERIALS AND METHODS

iNOS in the epithelial lining cells were analyzing in 10 OKC's, 10 DC's and 10 RC's using immunohistochemistry. The percentage of positive cells was assessed and presented as mean ± standard deviation. The correlation with respect to the intensity and percentage of staining within the epithelial linings of OKCs, DCs and RCs was carried out using (analysis of variance and Student's t-test) Chi-square test.

RESULTS

Staining intensity of iNOS portion was seen in the entire thickness of the epithelial linings of OKC, whereas in DC's only one case had entire thickness of the epithelial lining staining and in RC's none of the cases showed entire thickness of staining. On comparing the staining intensity of iNOS between OKC, DC and RC groups, using Chi-square test, there was a statistically significant difference between these groups (P < 0.01). On analyzing the immuno-reactivity of iNOS in OKC, DC and RC there was a positive variable expression iNOS between the cysts.

CONCLUSION

iNOS was over expressed in OKCs when compared with DC and RC suggesting that iNOS may contribute to the aggressive behavior of OKC. This is yet another evidence to support that OKC is the neoplasm.

Coincidental Overlapping Cystic Pathological Changes: A Case against Marsupialisation

It is relatively common to observe a solitary well defined periapical cystic change associated with decayed primary tooth displacing the underlying developing permanent tooth bud. Marsupialisation of such cysts is indicated so as to allow for eruption of the underlying tooth bud. A similar solitary well defined periapical cystic lesion involving the mixed dentition in a child was planned for enucleation. Surprisingly, during the surgical intervention two distinct separate cystic pathological changes were observed. Marsupialisation of the cystic defect with extraction of the primary tooth would have left the enlarged follicle with the developing tooth bud unaddressed. The pathological process associated with the dilated follicle would continue to progress further and may require an additional surgical intervention. The distinction between enlarged follicle and dentigerous cyst clinically is also important. Considering the size, extent and presence of the large bony cavity during the surgical intervention enucleation of both the pathological changes was performed.

Radicular cyst with severe destruction of the buccal cortical plate secondary to endodontic failure

This case report highlights a massive radicular cyst with respect to the lower left premolars, that developed secondary to endodontic failure and resulted in buccal cortical bone destruction. It also discusses the investigation and the surgical approach which were carried out with regard to the cyst. Following surgical closure, the teeth were endodontically retreated. It also highlights the fact that mandibular true occlusal radiographs could be misleading with regard to the extent of bone destruction, which can otherwise be confirmed on CT scans.