Restorative Dentistry & Endodontics

Differential diagnosis of periapical cyst using collagen birefringence pattern of the cyst wall: Hyo Jin Ji, Se-Hee Park, Kyung-Mo Cho, Suk Keun Lee, Jin Woo Kim; Restor Dent Endod 2017;42(2):111-117. Published online February 9, 2017; DOI: https://doi.org/10.5395/rde.2017.42.2.111

Abstract PDF PubReader ePub: Objectives
Periapical lesions, including periapical cyst (PC), periapical granuloma (PG), and periapical abscess (PA), are frequently affected by chemical/physical damage during root canal treatment or severe bacterial infection, and thus, the differential diagnosis of periapical lesions may be difficult due to the presence of severe inflammatory reaction. The aim of this study was to make differential diagnosis among PC, PG, and PA under polarizing microscope.
Materials and Methods
The collagen birefringence patterns of 319 cases of PC (n = 122), PG (n = 158), and PA (n = 39) obtained using a polarizing microscope were compared. In addition, 6 cases of periodontal fibroma (PF) were used as positive controls.
Results
Collagen birefringence was condensed with a thick, linear band-like pattern in PC, but was short and irregularly scattered in PG, and scarce or absent in PA. PF showed intense collagen birefringence with a short, palisading pattern but no continuous band-like pattern. The linear band-like birefringence in PC was ascribed to pre-existing expansile tensile stress of the cyst wall.
Conclusions
In this study all PCs (n = 122) were distinguishable from PGs and PAs by their characteristic birefringence, despite the absence of lining epithelium (n = 20). Therefore, the authors suggest that the presence of linear band-like collagen birefringence of the cyst wall aids the diagnostic differentiation of PC from PG and PA.

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The use of platelet rich plasma in the treatment of immature tooth with periapical lesion: a case report: Günseli Güven Polat, Ceren Yıldırım, Özlem Martı Akgün, Ceyhan Altun, Didem Dinçer, Cansel Köse Özkan; Restor Dent Endod 2014;39(3):230-234. Published online June 2, 2014; DOI: https://doi.org/10.5395/rde.2014.39.3.230

Abstract PDF PubReader ePub: This study describes the treatment of an immature permanent tooth with periapical lesion which was treated with regenerative approach using platelet rich plasma (PRP). The root canal of immature human permanent tooth with periapical lesion was gently debrided of necrotic tissue and disinfected with 2.5% NaOCl, and then medicated with triple antibiotic paste comprised of ciprofloxacin, metronidazole, and tetracycline. When the tooth was asymptomatic, PRP and mineral trioxide aggregate (MTA) were placed into the root canal. Six months after PRP treatment, radiographical examination revealed resolution of the radiolucency and progressive thickening of the root wall and apical closure. Our findings suggest that PRP can be used for the treatment of immature permanent teeth with periapical lesion, as part of a regenerative endodontic treatment procedure.

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Vital tooth with periapical lesion: spontaneous healing after conservative treatment: Hyun-Joo Kim, Seung-Jong Lee, Il-Young Jung, Sung-Ho Park; Restor Dent Endod 2012;37(2):123-126. Published online May 18, 2012; DOI: https://doi.org/10.5395/rde.2012.37.2.123

Abstract PDF PubReader ePub: It is often presumed that apical periodontitis follows total pulp necrosis, and consequently root canal treatment is commonly performed. Periapical lesion development is usually caused by bacteria and its byproduct which irritate pulp, develop pulpitis, and result in necrosis through an irreversible process. Afterwards, apical periodontitis occurs. This phenomenon is observed as an apical radiolucency in radiographic view. However, this unusual case presents a spontaneous healing of periapical lesion, which has developed without pulp necrosis in a vital tooth, through conservative treatment.

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A retrospective study of the intentionally replanted mandibular second molars with C-shaped root canal configurations: Won-Jun Shon, Kee-Yeon Kum, Seung-Ho Baek, Woo-Cheol Lee; J Korean Acad Conserv Dent 2011;36(1):19-25. Published online January 31, 2011; DOI: https://doi.org/10.5395/JKACD.2011.36.1.19

Abstract PDF PubReader ePub: Objectives
The purpose of this retrospective study was to evaluate the success rate of intentionally replanted mandibular second molar with C-shaped canal configurations and to access the impact of preoperative periapical lesion on the success of intentional replantation procedure.
Materials and Methods
This retrospective chart review study evaluated 52 intentionally replanted mandibular second molar teeth treated at Seoul National University Dental Hospital Department of Conservative Dentistry from January 2005 to December 2007. Seventeen teeth were lost for the follow-up, and another 6 teeth did not meet inclusion criteria of C-shaped root canal configurations. Healing outcome such as success, uncertain healing, and failure after follow-up was evaluated by clinical criteria and radiographs.
Results
The overall success rate was 72.4% for the 29 intentionally replanted C-shaped mandibular second molars. The success rate of replanted teeth with preoperative periapical lesions was similar to that of replanted teeth which have no periapical lesions.
Conclusions
Therefore, root canal treatment failure on C-shaped mandibular second molar can be predictably treated by intentional replantation regardless of the presence of periapical lesion.

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Prognostic factors influencing clinical outcome of nonsurgical endodontic treatment: Seonah Kim; J Korean Acad Conserv Dent 2010;35(6):436-444. Published online November 30, 2010; DOI: https://doi.org/10.5395/JKACD.2010.35.6.436

Abstract PDF PubReader ePub: Objectives
This study aimed to assess prospectively the clinical outcome of nonsurgical endodontic treatment and identify patient- and tooth-related factors, rather than treatment-related factors, that were the best predictors of this outcome.
Materials and Methods
The inception cohort comprised 441 teeth (320 patients) and 175 teeth (123 patients) were followed up for 1-2 years. Age, gender, presence of medical disease, number of canals, previous endodontic treatment, presence of sensitivity and pain, pulp vitality, swelling or sinus tract of pulpal origin on the gingiva, periapical radiolucency and tendency of unilateral bite on the affected tooth were recorded at treatment start.
Results
The outcome was classified on the basis of periapical radiolucency as healed or non healed. The overall healed rate in these cases, including nonsurgical retreatment, was 81.1%. Four tooth-related factors had a negative impact in the bivariate analysis: previous endodontic treatment, necrotic pulp, preoperative gingival swelling or sinus tract of pulpal origin, and preoperative periapical radiolucency. Stepwise logistic regression analysis including patient-, tooth-related factors and level of the root canal filling as a treatment-related factor showed that preoperative gingival lesion (odds ratio [OR]: 4.4; p = 0.005), preoperative periapical radiolucency (OR: 3.6; p = 0.011), and ≤ 1-2 mm under root filling length (OR: 9.6; p = 0.012) were significant predictors of failure.
Conclusions
A preoperative gingival lesion of pulpal origin can influence the outcome of nonsurgical endodontic treatment in addition to preoperative periapical radiolucency.

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Reconsideration of treatment protocol on the reduction of Enterococcus faecalis associated with failed root canal treatment: Woo Cheol Lee, Seong-Tae Hong, WonJun Shon; J Korean Acad Conserv Dent 2008;33(6):560-569. Published online November 30, 2008; DOI: https://doi.org/10.5395/JKACD.2008.33.6.560

Abstract PDF PubReader ePub: Microorganism survived in the root canal after root canal cleaning and shaping procedure is a main cause of root canal treatment failure. There are several mechanisms for the bacteria to survive in the root canal after chemomechanical preparation and root canal irrigation. Bacteria organized as biofilm has been suggested as an etiology of persistent periapical lesion. Recent studies were focus on removal of Enterococcus faecalis biofilm due to the report that the persistence of this bacteria after root canal treatment may be associated with its ability to form biofilm. Several investigations demonstrated that current root canal treatment protocol including use of NaOCl, EDTA and Chlorhexidine as irrigants is quite effective in eliminating E. faecalis biofilm. However, this microorganism still can survive in inaccessible areas of root canal system and evade host immune response, suppress immune activity and produce biofilm. Up to date, there is no possible clinical method to completely get rid of bacteria from the root canal. Once the root canal treatment failure occurred, and conventional treatment incorporating current therapeutic protocol has failed, periapical surgery or extraction should be considered rather than prolong the ineffected retreatment procedure.

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Distribution of oral pathogens in infections of endodontic origin: Seung-Yoon Kim, Ho-Young Choi, Sang-Hyuk Park, Gi-Woon Choi; J Korean Acad Conserv Dent 2003;28(4):303-313. Published online July 31, 2003; DOI: https://doi.org/10.5395/JKACD.2003.28.4.303

Abstract PDF PubReader ePub

It has been documented that periodontopathic bacteria are also implicated in endodontic infections. 16S rDNA gene-directed PCR was to examine the prevalence of periodontopathic bacteria including Actinobacillus actinomycetemcomitans (Aa), Prevotella intermedia (Pi), Prevotella nigrescens (Pn), Porphyromonas gingivalis (Pg), Porphyromonas endodontalis (Pe), and Treponema denticola (Td) in the root canals of 36 endodontically infected teeth having apical lesions with or without clinical symptoms like pain, swelling, and fistula.

In 36 infected root canals, most frequently detected bacterial species was Pg (61.1%), followed by Td (52.8%) and Pe (38.9%).

Of 36 infected root canals, Aa was detected in 6 canals (16.7%) of the teeth, all of which showed clinical symptoms.

Of 36 infected root canals, Pi and Pn were found in 4 (13.9%) and 5 (33.3%), respectively. Notably, prevalence of Pn in the symptomatic teeth was 50.0%.

One of black-pigmented anaerobic bacteria (BPB) including Pi, Pn, Pe, and Pg was detected in all of the teeth that showed pain or especially swelling but not fistula. It was, however, found that prevalence of BPB in the asymptomatic teeth or the teeth with fistula was only 40%.

Pe and Pg were detected in the teeth regardless of the presence or absence of symptoms.

Td was detected in the teeth regardless of the presence or absence of symptoms.

High prevalence of BPB in the symptomatic teeth but low in the asymptomatic teeth suggests that BPB may play an important role in the pathogenesis of periapical lesions.

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