Histopathological analysis of persistent periapical lesions

• Published in: International dental journal 2023-09, Vol.73, p.S44-S45
• Main Authors: Grgurevic, Dr Josko, Nola Fuchs, Dr Petra
• Format: Article
• Language: English
• ISSN: 0020-6539; 1875-595X
• DOI: 10.1016/j.identj.2023.07.673

Analyze the factors associated with the existence of persistent periapical lesions by histopathological methods. 49 endodontically and prosthetically rehabilitated teeth with inaccessible persistent processes were selected. Periapical tissue samples of single and double-rooted teeth with the root tip were taken during apicectomy and placed in labeled sterile glass vials with 10% formalin. After preparation, microscopic analysis was used to reveal microorganisms in the periapical area of the teeth and in the final part of the root canal. The findings, type and arrangement of inflammatory cells and dense connective and epithelial tissue were described. If possible, the lesions were characterized as true or pocket cysts. Non-standard pathohistological features were specifically described. Fungi and Gram-positive cocci were found in 12% of the samples. Granulomatous processes were identified in 66%, granulomas with epithelial strips in 22%, and cysts in 6% of samples. Foreign material was present in 14%, and scarring was found in 2% of the samples. Periapical granulomas and cysts are most common periapical lesions, and pocket cysts have a very low incidence in treated cases. The cocci and fungi found in the periapical granuloma confirm the existence of an extra-root infection. Foreign material found in the periapical tissue causes foreign body reaction, so more attention should be paid to the depth to which the root canal is treated. Periapical scar occurs after conservative endodontic therapy and it manifests as x-ray translucence impossible to distinguish from unsuccessful endodontic treatment.