Immunohistochemical expression of Cyclooxygenase 2 reflects the proliferative activity in the epithelium of odontogenic lesions

Purpose: Odontogenic cysts and tumors comprise a major component of lesions of the oral and maxillofacial region. The pathogenesis of these lesions involves the interaction between the odontogenic epithelium and the ectomesenchyme. However, the clinical behavior of these biological entities is unpredictable. The aim of this study was to evaluate the role of Cyclooxygenase 2 (COX-2) in the pathogenesis and prognostication of odontogenic lesions.Material and method: : In this study formalin-fixed paraffin-embedded tissue section of Odontogenic Keratocyst (n=10) Dentigerous cyst (n=10), Radicular cyst (n=10) and unicystic ameloblastoma (n=10) were immunohistochemically stained with COX-2 (NCL2-COX-2- 4H12) and with Ki 67 (Ki-67 GM001) using standard staining protocols. The cytoplasmic expression of COX-2 in all the lesions was semi-quantitatively assessed. The pattern of expression of COX-2 among the different odontogenic lesions was statistical analyzed using the ANOVA test and the chi-square test.Results: All the 40 odontogenic lesions that were evaluated expressed COX-2 immunohistochemically. A high number of odontogenic epithelial cells expressed COX-2 in most of the odontogenic keratocyst, radicular cyst and unicystic ameloblastomas. The expression of COX-2 was significantly (p=0.036) higher in Unicystic Ameloblastomas and Radicular cyst compared to that of Odontogenic Keratocyst and the dentigerous cyst.Conclusion: The recognition that expression of COX-2 by odontogenic epithelial cells may indeed shed a new light on the biological mechanisms involved in the development of these benign yet aggressive lesions of the jaws. An insight into the molecular interactions occurring in the odontogenic epithelium will aid in better management of these lesions.

Odontogenic Cysts and Tumors of Maxilla and Maxillary Sinus (A Clinicopathological Analysis)

Background: Knowledge about the prevalence and distribution of pathologies in a particular location is important when a differential diagnosis is being formulated. The aim of this study was to describe the prevalence and the clinicopathological features of odontogenic cysts and tumors affecting the maxilla and to discuss the unusual presentation of those lesions within maxillary sinus. Materials and Methods: A multicenter retrospective analysis was performed on pathology archives of patients who were diagnosed with maxillary odontogenic cysts and tumors from 2010 to 2020. Data were collected with respect to age, gender and location. Result: A total of 384 cases was identified, 320 (83.3%) cases were diagnosed as odontogenic cysts and 64 (16.6%) as odontogenic tumors. The mean age was 30.5 years with a standard deviation of 16.2 years. Male patients were more commonly affected (n=220, 57.3%). Radicular cyst was the most common cyst (n=205, 64.1%), while the most common tumor was odontoma (n=14, 21.9%) and dentigerous cyst was the most common lesion to present within the maxillary sinus. Conclusion: This study indicates that there are some geographic similarities and differences in regard to distribution of odontogenic cysts and tumors in maxilla and it raises awareness of their presentation within maxillary sinus especially if there is an association with an ectopic or adjacent impacted tooth.

FISTULA MANAGEMENT DUE TO CHRONIC INFECTION OF RADICULAR CYST

A radicular cyst is the most common odontogenic cyst that arises from the epithelial residues in the periodontal ligament due to periapical periodontitis following death and necrosis of the pulp. A fistula may form a cyst with a pulp infection that produces pus and seeks its way out to the gingival surface to create a canal. The purpose of this case report is to report the management of a patient with a chronically infected radicular cyst with fistula while retaining the involved tooth. A case report was a 13-year-old female patient who came to Department Oral Surgery of a hospital with a complaint of a lump in the front gum and palate that didn't heal for two years ago and often discharged pus. Intraoral examination showed a lump in the gingiva and palate with fistula in the interdental gingiva of teeth 11-12 with soft consistency and pain with palpation. Panoramic results showed characteristics of the radicular cyst at the 13-11 tooth region. The lesion is diagnosed as a chronic infection of a radicular cyst due to pulp necrosis in teeth 12-11 with interdental fistulas. Biopsy enucleation of the cyst was performed with teeth preservation. The patient was advised to have regular check-ups. On the sixth month of control, the surgical wound was good, without any complaints and signs of recurrence. The result is that a radicular cyst can become chronically infected and form a fistula that oozes pus into the oral cavity. The cyst can be treated with enucleation biopsy and fistulectomy with the preservation, without any recurrences.

Clinico-Radiological Study of Odontogenic Cysts in Mandibular Region from Agartala, Tripura

BACKGROUND Most common osseous destructive lesions effecting the jawbone are odontogenic cystic lesions, which are lined by epithelium, has been involved in the formation of teeth as the epithelial cell rest are present in jawbone after teeth formation. The three most common odontogenic cysts (OCs) are radicular cyst (RC), dentigerous cyst (DC) and the odontogenic keratocyst (OKC). Less common variety is the residual cyst. Odontogenic cysts are mainly developmental and inflammatory in origin. The objective of the present study was to find clinico-radiographic characteristics of odontogenic cysts in the mandible. METHODS This was a case series (descriptive) study on OCs of mandible conducted at Tripura Medical College and Dr BRAM Teaching Hospital, Hapania, Agartala, Tripura (W), India, over a period of 6 months from August 2019 to January 2020. Subjects showing clinico-radiographic features of OCs in mandible were included, subsequently confirmed by histopathological examinations. Usually orthopantomograms (OPGs) and intra oral peri apical radiograph (IOPAs) were done for radiological findings, computed tomography (CT) scan was required for examination of the size of lesion. Data were analysed using windows excel. RESULTS Diagnosis of OCs was confirmed in 20 patients, among them, males were (60 %) and female were (40 %). The age range of the patients was 17 - 65 years. Most common type of cyst diagnosed in the study was radicular cyst in 50 % cases followed by dentigerous cysts which were in 30 % cases, odontogenic keratocysts were in 15 % patients and others were 5 %. RCs were represented in higher percentage (50 %). Right side of mandible was the most effected side (60 %) than left side (40 %). Main finding of the study was, in every type of cystic lesions, males were recorded as predominant, and it occurred in early age group. CONCLUSIONS Main finding of the study was radicular cyst which was in higher percentage (50 %) and was being most common with association of carious tooth. KEYWORDS Odontogenic Cysts, Mandible, Finding

Comparative Metabolomics Reveals the Microenvironment of Common T-Helper Cells and Differential Immune Cells Linked to Unique Periapical Lesions

Periapical abscesses, radicular cysts, and periapical granulomas are the most frequently identified pathological lesions in the alveolar bone. While little is known about the initiation and progression of these conditions, the metabolic environment and the related immunological behaviors were examined for the first time to model the development of each pathological condition. Metabolites were extracted from each lesion and profiled using gas chromatography-mass spectrometry in comparison with healthy pulp tissue. The metabolites were clustered and linked to their related immune cell fractions. Clusters I and J in the periapical abscess upregulated the expression of MMP-9, IL-8, CYP4F3, and VEGF, while clusters L and M were related to lipophagy and apoptosis in radicular cyst, and cluster P in periapical granuloma, which contains L-(+)-lactic acid and ethylene glycol, was related to granuloma formation. Oleic acid, 17-octadecynoic acid, 1-nonadecene, and L-(+)-lactic acid were significantly the highest unique metabolites in healthy pulp tissue, periapical abscess, radicular cyst, and periapical granuloma, respectively. The correlated enriched metabolic pathways were identified, and the related active genes were predicted. Glutamatergic synapse (16–20),-hydroxyeicosatetraenoic acids, lipophagy, and retinoid X receptor coupled with vitamin D receptor were the most significantly enriched pathways in healthy control, abscess, cyst, and granuloma, respectively. Compared with the healthy control, significant upregulation in the gene expression of CYP4F3, VEGF, IL-8, TLR2 (P < 0.0001), and MMP-9 (P < 0.001) was found in the abscesses. While IL-12A was significantly upregulated in cysts (P < 0.01), IL-17A represents the highest significantly upregulated gene in granulomas (P < 0.0001). From the predicted active genes, CIBERSORT suggested the presence of natural killer cells, dendritic cells, pro-inflammatory M1 macrophages, and anti-inflammatory M2 macrophages in different proportions. In addition, the single nucleotide polymorphisms related to IL-10, IL-12A, and IL-17D genes were shown to be associated with periapical lesions and other oral lesions. Collectively, the unique metabolism and related immune response shape up an environment that initiates and maintains the existence and progression of these oral lesions, suggesting an important role in diagnosis and effective targeted therapy.

Дослідження остеорегенераційної активності окістя нижньощелепних кісток, уражених кістами різного ґенезу

In response to the prolonged increasing influence of the radicular cyst, there is an adaptive compensatory reaction of the adjacent bone tissue and periosteum located in the area of damage. However, in the available professional literature there is no data on the activity of the marker of osteoregeneration-alkaline phosphatase in the periosteum of the mandible, which is in the growth zone of osteoblastoclastoma. The purpose of the study: to study in a comparative aspect osteoregenerative activity of the periosteum of the mandibular bones affected by radicular cyst and cystic form of osteoblastoclastoma by using the histochemical method. Histochemical studies were performed in 10 patients with large radicular cysts (d>3.0 cm) located on the mandibles – 1st clinical group, and in 9 patients with cystic forms of osteoblastoclastomas, localized on the mandibles - 2nd clinical group. Determination of alkaline phosphatase in periosteal tissues of the mandible was performed by the method of simultaneous azo combination according to Kaplow. Prepared samples of histochemicals were studied under a light microscope, the received images were photographed. Digitized images of histochemicals were analyzed using the computer program ImageJ. The accumulation of alkaline phosphatase in the periosteum of the mandibular areas affected by osteoblastoclastomas is less intense compared to the process of synthesis of this enzyme in the periosteum of the mandible, which is affected by radicular cysts of large size. Osteoregenerative potential of periosteum of mandibular bones affected by radicular cysts is much greater than in the periosteum located in the growth zone of the cystic form of osteoblastoclastoma.

Cistos e tumores odontogênicos: estudo retrospectivo dos casos diagnosticados no período de 10 anos em um hospital no sul do Brasil

Introduction: odontogenic lesions (OLs) represent a heterogeneous group of oral and maxillofacial pathologies presenting distinct characteristics. The present study aimed to identify the clinical and pathological characteristics of OLs diagnosed in a southern Brazilian hospital. Materials and methods: a retrospective study was performed to evaluate cases with histopathological diagnosis of OLs identified in the period between 2007 and 2017. The patient's medical records were evaluated in order to obtain the clinical and pathological characteristics and the histopathological diagnosis from each case. Results: a total of 255 cases of OLs were identified. From these, 197 (77%) odontogenic cysts and 58 (23%) odontogenic tumors were surveyed, with only one case (0,39%) of a malignant odontogenic neoplasm. The most prevalent diagnosis were radicular cyst (32.5%) and dentigerous cyst (31.76%), followed by odontogenic keratocyst (10.98%), odontoma (10%) and ameloblastoma (10%). The majority of the cases affected the mandible (53.7%) with a slight preference by female individuals (51%). The mean age was 34±20.53 years old. Discussion: the presented data are in accordance with the literature regarding the rarity of the diagnosis of odontogenic tumors. Conclusion: the present study demonstrated the main clinical and pathological characteristics of OLs diagnosed in a southern Brazilian hospital, contributing to a better understanding of these injuries profiles.

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.