bromochloroacetic-acid and Periapical-Diseases

Inflammatory cysts, granulomas, abscesses, and fibrous scars represent most periapical radiolucencies. However, other less common lesions, such as orthokeratinized odontogenic cysts (OOCs), can be found at this region, and they deserve to be discussed because the prognosis for an OOC is different from that expected for the ordinary inflammatory periapical diseases.. An interesting case of OOC associated with a nonvital tooth in a 40-year-old woman is described. After a previous clinical diagnosis of a radicular cyst, the tooth was extracted, and the lesion was enucleated and submitted to microscopy examination.. Because of the detection of an orthokeratinized epithelium lining, a diagnosis of OOC was concluded. After 2 years of periodic follow-up, no signs of recurrence were detected.. The presence of keratin in radicular lesions must be carefully evaluated to eliminate the diagnosis of lesions with more aggressive behavior, such as an OOC or even a keratocystic odontogenic tumor. Hence, histopathologic examination is mandatory to confirm the type of lesion and to differentiate other pathologic conditions, therefore establishing patients' prognoses precisely.

Topics: Adult; Connective Tissue; Diagnosis, Differential; Epithelium; Female; Follow-Up Studies; Humans; Keratins; Odontogenic Cysts; Periapical Diseases; Radicular Cyst; Tooth Extraction; Tooth, Nonvital

To present a clinical case of odontogenic keratocyst (OKC) simulating a lateral periodontal cyst.. A 39-year-old female complaining of swelling and pain in the left mandibular premolar area was found to have a radiolucent lesion between teeth 34 and 35 (FDI). Both teeth had incomplete root fillings, and orthograde re-treatment of both premolars was performed. At 2-year follow-up, radiographic examination showed an increase in the radiolucent defect with respect to the previous examination. A surgical treatment of tooth 34 was then performed, with histological examination of the lesion. Histological features were consistent with an OKC, and the lesion was successfully treated by complete enucleation and application of Carnoy's solution. At 2-year follow-up, no clinical signs or symptoms were found and the radiolucent area had disappeared.. Odontogenic keratocysts may mimic endodontic lesions. Clinicians should carefully review their cases and consider surgical intervention with biopsy in cases that do not heal.

Topics: Adult; Diagnosis, Differential; Female; Humans; Keratins; Mandibular Diseases; Odontogenic Cysts; Periapical Diseases; Periodontal Cyst; Radiography; Root Canal Therapy

The purpose of this study was to test the hypothesis that odontogenic cysts can be induced by periapical infection. Pulp extirpation and reaming beyond the root apices were performed in 53 lower first molars in 27 Sprague-Dawley rats. The cavities were left open to allow continuous contamination by oral bacteria. Animals were killed at 6 and more than 8 months after operation. Odontogenic cysts were found in association with 8/53 teeth in 6 animals. Histologically, cysts were observed around the lower incisors below the first molars. The cyst wall consisted of fibrous connective tissue with inflammation and was lined with keratinized squamous epithelium. The cyst cavity contained a mass of keratin and necrotic debris. These results support the hypothesis that inflammatory stimulation from the apices can cause cystic changes in the enamel epithelium of underlying teeth.

Topics: Animals; Bacterial Infections; Connective Tissue; Dental Pulp Cavity; Dental Pulp Exposure; Disease Models, Animal; Epithelium; Female; Inflammation; Keratins; Male; Mandibular Diseases; Necrosis; Odontogenic Cysts; Periapical Diseases; Periapical Periodontitis; Pulpectomy; Rats; Rats, Sprague-Dawley; Root Canal Therapy; Time Factors

We examined 30 specimens of mucosal sinus tracts arising in association with periapical inflammation. Immunocytochemistry and a panel of monoclonal antibodies to keratins were used to demonstrate the epithelial lining and its pattern of keratin expression. Half of the specimens were found to have an epithelial lining that was continuous with the mucosal epithelium and showed various degrees of extension into the sinus. The presence of an epithelial lining appeared to correlate with the duration of the sinus tracts. The immunostaining patterns of the epithelial linings were similar to those of the mucosal epithelium near the sinus opening although some differences were found. Proliferating strands of epithelium, presumably derived from the rest of Malassez, were observed deep in the tissues but were not continuous with the epithelial lining. The results suggest that the epithelial lining of sinus tracts is derived not from epithelial rests in the periapical region but from the mucosal epithelium adjacent to the opening of the sinus tract and that the observed changes in the pattern of keratinization are due to the influence of inflammation or of the connective tissue substrate.

Topics: Antibodies, Monoclonal; Dental Fistula; Epithelium; HLA-DR Antigens; Humans; Immunohistochemistry; Keratinocytes; Keratins; Periapical Diseases; Periodontal Ligament; Staining and Labeling

Sections of 565 radicular cysts were examined for keratinization of epithelium. 4 cysts showed keratinization, 2 of ortho and 2 of para type. Due to other histological features typical for odontogenic keratocysts, it was concluded that these cysts were odontogenic keratocysts that occurred in the periapical region of the involved teeth.

Topics: Epithelium; Humans; Keratins; Odontogenic Cysts; Periapical Diseases; Radicular Cyst