DATE: 21 April 2004

TOPIC: Lesions of Endodontic Origin

CHAIRPERSON: LT HAMAD


SEMINAR OBJECTIVE: Each resident should understand the pathophysiology of
periradicular lesions in order to accurately diagnose, treat, and assess their healing potential.

MAIN POINTS: At the conclusion of the seminar, each resident should:

MP #1 - classify periradicular lesions of endodontic origin.

MP #2 - know the differential diagnosis of periradicular lesions of endodontic
origin.

MP #3 - know the frequency of occurrence of periradicular lesions of endodontic origin.

MP #4 - be able to describe in detail the histopathologic appearance of
periradicular lesions of endodontic origin.

MP #5 - relate the phenomenon of epithelial proliferation in periradicular granulomas.

MP #6 - explain the theories of periradicular cyst formation.

MP #7 - relate the inflammatory and immunologic mechanisms involved in periradicular lesion formation.

MP #8 - be able to compare the healing potential of periradicular granulomas and cysts.



GENERAL READINGS: All residents should review and be prepared to discuss the following text and literature references.

Nair PNR. Pathology of apical periodontitis. In: Ørstavik D, Pitt Ford TR, eds. Essential endodontology prevention and treatment of apical periodontitis. United Kingdom: Blackwell Science, 2001;68-105.

Nair PNR. Pathobiology of the periapex. In: Cohen S, Burns RC, eds. Pathways of the pulp. 8th ed. St. Louis: Mosby, Inc., 2002:472-500.

Seltzer S. Periapical granuloma and radicular cyst. In: Seltzer S, ed. Endodontology. 2nd ed. Philadelphia: Lea & Febiger, 1988:195-236.

Seltzer S. Periapical granuloma and radicular cyst. In: Seltzer S, ed. Endodontology. 3rd ed. CD-ROM edition. Chapter 7, University of North Carolina at Chapel Hill, School of Dentistry;2000.

Simon JHS. Periapical pathology. In: Cohen S, Burns RC, eds. Pathways of the pulp.
7th ed. St Louis: Mosby, Inc., 1998:425-62.

Smulson MH, Hagen JC, Ellenz SJ. Pulpoperiapical pathology and immunologic considerations. In: Weine FS, ed. Endodontic therapy. 5th ed. St Louis: Mosby-Year Book, 1996:166-202.

Torabinejad M, Walton RE. Periapical lesions. In: Ingle JI, Bakland LK, eds. Endodontics. 4th ed. Baltimore: Williams & Wilkins, 1994:439-64.

Torabinejad M, Walton RE. Periradicular lesions. In: Ingle JI, Bakland LK, eds. Endodontics. 5th ed. Hamilton, Ont: BC Decker Inc., 2002:175-201.

Bando Y, Henderson B, Meghji S, Poole S, Harris M. Immunocyto-chemical localization of inflammatory cytokines and vascular adhesion receptors in radicular cysts. J Oral Pathol Med 1993;22:221-7.

Di Lenarda R, Cadenaro M, Stacchi C. Paresthesia of the mental nerve induced by periapical infection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:746-9.

Gnanasekhar JD, Walvekar SV, Al-Kandari AM, Al-Duwairi Y. Misdiagnosis and mismanagement of a nasopalatine duct cyst and its corrective therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:465-70.

Hoen MM, LaBounty GL, Strittmatter EJ. Conservative treatment of persistent periradicular lesions using aspiration and irrigation. J Endodon 1990;16:182-6.

Kabashima H, Nagata K, Maeda K, Lijima T. Involvement of substance P, mast cells, TNF-alpha and ICAM-1 in the infiltration of inflammatory cells in human periapical granulomas. J Oral Pathol Med 2002;31:175-80.

Khayat A, Vesal N, Rasti M. Analysis of arylsulfatases A and B, acid phosphatase, lactate dehydrogenase, and aspartate transaminase in chronic periapical lesions of endodontic origin. J Endodon 2001;27:285-7.

Lalonde ER. A new rationale for the management of periapical granulomas and cysts: an evaluation of histopathological and radiographic findings. J Am Dent Assoc 1970;80:1056-9.

Leonardo MR, Rossi MA, Silva LAB, Ito IY, Bonifacio KC. EM evaluation of bacterial bioifilm and microorganisms on the apical external root surface of human teeth. J Endodon 2002;28:815-8.

Moss HD, Hellstein JW, Johnson JD. Endodontic considerations of the nasopalatine duct region. J Endodon 2000;26:107-10.

Nair PNR, Pajarola G, Luder HU. Ciliated epithelium-lined radicular cysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:485-93.

Natkin E, Oswald RJ, Carnes LI. The relationship of lesion size to diagnosis, incidence and treatment of periapical cysts and granulomas. Oral Surg 1984;57:82-94.

Noiri Y, Ehara A, Kawahara T, Takemura N, Ebisu S. Participation of bacterial biofilms in refractory and chronic periapical periodontitis. J Endodon 2002;28:679-83.

Reit C, Grondahl H. Management of periapical lesions in endodontically treated teeth. Swed Dent J 1984;8:1-7.

Sabeti M, Valles Y, Nowzari H, Simon JH, Kermani-Arab V, Slots J. Cytomegalovirus and Epstein-Barr virus DNA transcription in endodontic symptomatic lesions. Oral Microbiol Immunol 2003;18:104-8.

Silver GK, Simon JHS. Charcot-Leyden crystals within a periapical lesion. J Endodon 2000;26:512-4.

Su L, Weathers DR, Waldron CA. Distinguishing features of focal cemento-osseous dysplasia and cemento-ossifying fibromas. II. A clinical and radiologic spectrum of 316 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:540-9.

Toller P. Origin and growth of cysts of the jaws. Ann Roy Coll Surg Engl 1967;20:306-36.

Valderhaug J. A histologic study of experimentally induced radicular cysts. Int J Oral Surg 1972;1:137-47.

Waldron CA. Fibro-osseous lesions of the jaws. J Oral Surg 1993;51:828-35.

White S, Sapp P, Seto B, Mankovich N. Absence of radiometric differentiation between periapical cysts and granulomas. Oral Surg Oral Med Oral Pathol 1994:78;650-4.

Wood NK. Periapical lesions. Dent Clin N Am 1984;28:725-66.


SUPPLEMENTAL READINGS:

Pulver WH, Taubman MA, Smith DJ. Immune components in human dental periapical lesions. Arch Oral Biol 1978;23:435-43. (Classical Literature # 20)


SEMINAR ASSIGNMENTS: All residents should review, prepare abstracts for the assigned articles and be prepared to discuss the following literature references.


LCDR ENGEL

Bhaskar SN. Periapical lesions - types, incidence and clinical features. Oral Surg 1966;21:657-71.

LaLonde ER, Luebke RG. The frequency and distribution of periapical cysts and granulomas - an evaluation of 800 specimens. Oral Surg 1968;25:861-8.

Simon JHS. Incidence of periapical cysts in relation to the root canal. J Endodon 1980;6:845-8.

Stockdale CR, Chandler NP. The nature of the periapical lesion - a review of 1108 cases. J Dent 1988;16:123-9.


LCDR CARSON

Harris M, Toller P. The pathogenesis of dental cysts. Brit Med Bull 1975;31:159-63.

Seltzer S, Soltanoff W, Bender IB. Epithelial proliferation in periapical lesions. Oral Surg 1969;27:111-21.

Stashenko P, Wang CY, Tani-Ishii N, Yu SM. Pathogenesis of induced rat periapical lesions. Oral Surg Oral Med Oral Pathol 1994;78:494-502.

Ten Cate AR. The epithelial cell rest of Malassez and the genesis of the dental cyst. Oral Surg 1972;34:956-64.


LCDR MALONEY

Baumgartner JC, Picket AB, Muller JT. Microscopic examination of oral sinus tracts and their associated periapical lesions. J Endodon 1984;10:146-52.

Harrison JW, Larson WJ. The epithelialized oral sinus tract. Oral Surg 1976;42:511-7.

Lin L, Langeland K. Innervation of the inflammatory periapical lesions. Oral Surg 1981;51:535-43.

Spatafore CM, Griffin JA, Keyes GG, Weardon S, Skidmore AE. Periapical biopsy report: an analysis over a 10 year period. J Endodon 1990;16:239-41.


LT CRUMPTON

Fish EW. Bone infection. J Am Dent Assoc 1939;26:691-712.

Walton RE, Garnick JJ. The histology of periapical inflammatory lesions in permanent molars in monkeys. J Endodon 1986;12:49-53.

Weiner S, McKinney RV, Walton RE. Characterization of the periapical surgical specimen. Oral Surg 1982;53:293-302.

Yamasaki M, Kumazawa M, Kohsaka T, Nakamura H, Kameyama Y. Pulpal and periapical tissue reactions after experimental pulpal exposure in rats. J Endodon 1994;20:13-7.


LT SAIF

Contos JG, Corcoran JF, Laturno SAL, Chiego DJ, Regezi JA. Langerhans cells in apical periodontal cysts: an immunohistochemical study. J Endodon 1987;13:52-5.

Nair PN. New perspectives on radicular cysts: do they heal? Int Endod J 1998;31:155-60.

Nobuhara W, Del Rio C. Incidence of periradicular pathoses in endodontic treatment failures. J Endodon 1993;19:315-8.

Shrout MK, Hall JM, Hildebolt CE. Differentiation of periapical granulomas and radicular cysts by digital radiometric analysis. Oral Surg Oral Med Oral Pathol 1993;76:356-61.


LT RUFF

Garlock JA, Pringle GA, Hicks ML. The odontogenic keratocyst: a potential endodontic misdiagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:452-6.

Bender IB. A commentary on General Bhaskar's hypothesis. Oral Surg 1972;34:469-75.

Bhaskar SN. Nonsurgical resolution of radicular cysts. Oral Surg 1972;34:458-67.

Maalouf EM, Gutman JL. Biological perspectives on the non-surgical endodontic management of periradicular pathosis. Int Endod J 1994;27:154-61.


LT RADEL

Nair PNR, Pajorola G, Schroeder HE. Types and incidence of human periapical lesions obtained with extracted teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;81:93-102.

Green TL, Walton RE, Taylor JK, Merrel P. Radiographic and histologic periapical findings of root canal treated teeth in cadaver. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:707-11.

Freedland JB. Conservative reduction of large periapical lesions. Oral Surg 1970;29:455-64.

Neaverth EJ, Burg HA. Decompression of large periapical lesions. J Endodon 1982;8:175-82.


LT HUTTULA

Eliasson S, Halvarsson C, Ljungheimer C. Periapical condensing osteitis and endodontic treatment. Oral Surg 1984;57:195-9.

Gervasio AM, Silva DAO, Taketomi EA, Souza CJA, Sung SSJ, Loyola AM. Levels of GM-CSF, IL-3, and IL-6 in fluid and tissue from human radicular cysts. J Dent Res 2002;81:64-8.

Morse DR, Patnik JW, Schacterle GR. Electrophoretic differentiation of radicular cysts and granulomas. Oral Surg 1973;35:249-64.

Torabinejad M. The role of immunological reactions in apical cyst formation and the fate of epithelial cells after root canal therapy: a theory. Int J Oral Surg 1983;12:14-22.


Chairman's discussion articles: These articles are histological findings in periradicular lesions. It is of benefit to the residents to be aware that different diseases can mimic periradicular disease. Although the following disease states may not make your top five differential diagnoses for submission of a biopsy specimen, it is important to be informed of the possibility of the histological findings. The chairman should prepare a summary of these articles to be included in a section of the handout.

Ardekian L, Peleg M, Samet N, Givol N, Taicher S. Burkitt's lymphoma mimicking an acute dentoalveolar abscess. J Endodon 1996;22:697-8.

Elkins DA, Torabinejad M. Polymerase chain reaction detection of human immunodeficiency virus DNA in human periradicular lesions. J Endodon 1994;20:386-8.

Huey MW, Bramwell JD, Hutter JW, Kratochvil FJ. Central odontogenic fibroma mimicking a lesion of endodontic origin. J Endodon 1995;21:625-7.

Morgan LA. Infiltrate of chronic lymphocytic leukemia appearing as a periapical radiolucent lesion. J Endodon 1995;21:475-8.

Selden HS, Manhoff DT, Hatges NA, Michel RC. Metastatic carcinoma to the mandible that mimicked pulpal/periodontal disease. J Endodon 1998;24:267-70.

Simon JH, Chimenti RA, Mintz GA. Clinical significance of the pulse granuloma.
J Endodon 1982;8:116-9.

Svirsky JA, Epstein RA. Small cell carcinoma of the lung metastatic to the wall of a radicular cyst. J Endodon 1994;20:512-4.

Wright JM, Radman WP. Intrabony lymphoma simulating periradicular inflammatory disease. J Am Dent Assoc 1995;126:101-5.