Baseline MMP expression in periapical granuloma and its relationship with periapical wound healing after surgical endodontic treatment

Background Matrix metalloproteinases (MMPs) catalyzes the degradation of the extracellular matrix components and have a major role in many physiological processes including wound healing. In the current study, we examined the correlation of baseline MMPs 1, 2, 7, and 9 expressions with periapical wound healing after surgical endodontic treatment. Methods 27 patients aged between 15–57 years presenting with chronic apical periodontitis or chronic apical abscess of an anterior tooth with previously attempted or failed root canal treatment were included in this study. During surgical endodontic treatment, tissue from the periapical lesion sample was collected and used for gross histopathological analysis as well as mRNA expression analysis of MMPs 1, 2, 7, and 9. Patients were recalled for follow-up after 6 and 12 months to evaluate the healing status both clinically and radiographically and healing was correlated with baseline MMP expression. Results Out of 27 patients, healing was observed in 15 patients at the end of 6 months, and patients after 12 months. Six patients showed no healing even after 12 months. Analysis of baseline MMP 1, 2, 7, and 9 expression levels with healing status showed the mean relative expression of MMP2 and MMP9 to be considerably increased in the non-healing group as compared to the healing group. Conclusion Overexpression of MMP2 and MMP9 may be considered as a potential prognostic biomarker for periapical wound healing after surgical endodontic treatment. However, further studies are desirable to establish its precise relationship with periapical wound healing.

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.

Comparative evaluation to determine the efficacy of conventional radiography, digital radiography and ultrasound imaging in the diagnosis of periapical lesions

In recent time several imaging modalities have been implicated for diagnosing periapical lesion. The present study is carried out to determine and compare the nature and extent of periapical lesions using conventional radiography, digital radiography and ultrasound imaging and to confirm the diagnosis with histopathological examination. Thirty patients aged between 15 and 45 years with well-defined periapical radiolucency associated with anterior maxillary or mandibular teeth requiring endodontic surgery or extraction were selected. The pre-operative intraoral periapical radiographs and digital images and were diagnosed by three observers. Ultrasound examination was performed and the images were assessed by an ultrasonographer. The periapical tissues were obtained to enable histopathological investigation. The data was statistically analysed using the kappa procedure, Kruskal Wallis Anova & Mann-Whitney U test. Results showed that the percentage accuracy of diagnosing periapical lesions using conventional radiography, digital radiography and ultrasound was – 86.67%, 93.33% & 93.33% respectively. Thus, we conclude that ultrasound helps in distinguishing between periapical granuloma and cyst which is of importance in predicting the treatment outcome. So, ultrasound can be used as an adjunct to conventional or digital radiography in diagnosing periapical lesions.

Immunohistochemical analysis of ADAMTS-1, versican and pEGFR expressions in periapical granuloma and radicular cyst

Background ADAMTS expression can be associated with several inflammatory processes, and has been correlated with tumorigenesis of some neoplasms, but its participation in the development of periapical lesions has not been investigated. Therefore, our objective was to verify the expression of ADAMTS-1, versican and pEGFR in Periapical Granuloma (PG) and in the Radicular Cyst (RC) since they are the most common lesions of the periapex. Methods 25 samples of RC and 10 of PG were used. As a control, 10 samples of inflammatory fibrous hyperplasia (IFH) and 10 of dental follicle (DF) were used. The expression of these proteins was investigated using immunohistochemistry. Results In the epithelium of RC, IFH and DF, the expression of ADAMTS-1 was greater in DF than in RC (p < .001). Versicano showed greater expression in IFH than in RC, DF than in RC (p < .001). pEGFR showed greater expression in IFH and RC than in DF (p < .01 and p < .05, respectively). In connective tissue, ADAMTS-1 expression was greater in PG and RC than in IFH and DF (p < .001). Versicano showed greater expression in PG, RC and IFH compared to DF (p < .001). In pEGFR there was a higher expression in PG when compared to RC, IFH and DF (p < .001). Greater immunostaining occurred in the RC than in the DF (p < .001). Conclusions Our results suggest that the studied proteins may participate in the pathogenesis of PG and RC, through the interaction of these proteins, in the remodeling of the ECM (versican) by ADAMTS-1, producing bioactive fragments, which could activate EGFR, contributing to the formation, growth and maintenance of injuries.

Cirurgia do periápice para remoção de lesões granulomatosas: relato de caso

Periapical granuloma is a histological term that refers to the formation of a mass of granulomatous tissue around the apex of a tooth resulting from inflammation and necrosis of the pulp tissue. It consists of an infiltrate of inflammatory cells such as macrophages, plasmocytes and lymphocytes, as well as fibroblasts, collagen fibers and capillaries. Periapical surgery is an alternative for preserving the tooth in the oral cavity in cases where periapical inflammation is persistent even after treatment of root canals. The objective of this study was to report a clinical case in which the surgical technique was used to remove granulomatous lesions from a patient, female, with a history of recurrent periapical abscess without painful symptomatology in the region of the anterior 11,12 and 13 teeth. The histopathological exam demonstrated the presence of a granulomatous tissue with intense inflammatory infiltrate mixed, permeated with lymphocytes and high number of plasmocytes, confirming the diagnosis of periapical granuloma. The treatment was considered successful since the patient remained asymptomatic and there was incorporation of the inorganic bovine bone graft and initiation of bone neoformation in the periapical region.

Simultaneous Perio-endo Surgery with ER:YAG Laser and Bone Xenograft. A Case Report

Periodontally affected teeth with periapical lesion indicated for periapical surgery have a poor prognosis. Using Er:YAG lasers to perform simultaneous surgery on both defects may increase their survival rate. Preparing a retrograde cavity on affected teeth and obturating it is still a matter of debate among clinicians. The purpose of this case report was to describe the simultaneous use of Erbium-doped Yttrium Aluminium Garnet Er:YAG (2,940 nm) laser in the treatment of periapical granuloma and infraossal defect and the achieved results. The Er:YAG laser was used to perform flap dissection, granulation tissue removal, osteotomy and root-end resection except for initial flap incision and reflection. The cystic cavity was filled with Bio-Oss Collagen&reg; xenograft. Results were followed up for 18 months with the help of radiographic orthopantomographic images. The outcome of this clinical case indicates that the use of Er:YAG laser could be considered a suitable method to perform simultaneous periodontal and endodontic surgery.

Clinical and Histopathological Concordance of oral Bone Lesions. Retrospective Study

Bone lesions of the jaws have their origin from odontogenic and non-odontogenic structures. They can be benign or malignant, asymptomatic, they can be located around the root of the tooth, around the crown and in the interradicular area or they may not be related to the teeth. OBJECTIVE: to determine the frequency of the different bone lesions and the concordance between the clinical and histopathological diagnosis, in the clinical internship of the Faculty of Dentistry of the University of Costa Rica (UCR). METHODOLOGY: retrospective study of bone lesions recovered from the biopsy archive of the Faculty of Dentistry of the UCR from 2008 to 2015. Information on sex, age, location of the lesion, clinical diagnosis and diagnosis were evaluated and described. The agreement between the clinical and histopathological diagnosis was verified by the Kappa test. RESULTS: The 77 cases of oral bone lesions preferentially affected men 53.8% (n=41), the average age was 34.7 years (s.d.±19.6) and with lesions predominantly located in the posterior jaw 36.4% (n=28) and anterior maxilla 35.1% (n=27). Odontogenic cysts (OC) 42.9% (n=33), non-specific or unclassified diagnosis 28.6% (n=22) and inflammatory lesions of pulp and periapical origin 14.2% (n=11). TOs accounted for 7.8% (n=6) of the lesions. The four most predominant lesions were the radicular cyst, nonspecific diagnosis, dentigerous cyst and periapical granuloma. Concordance with the first diagnostic hypothesis was presented in 24 (31.2%) cases, the value of Kappa was 0.274 (discrete concordance) and 20.8% without clinical diagnosis only a description of the lesion. CONCLUSIONS: The OC were the predominant; being individually the radicular cyst the most frequent lesion. The clinical and histopathological concordance was discrete.

Proporsi gambaran radiografis lesi periapikal gigi nekrosis pada radiograf periapikalRadiographic image proportion of necrotic teeth periapical lesions on periapical radiographs

Pendahuluan: Karies merupakan penyakit yang paling banyak terjadi. Pada tahun 2013 kerusakan gigi masyarakat Indonesia adalah 460 buah gigi per 100 orang. Jika dibiarkan tidak dirawat akan berkembang mengarah pada kematian pulpa dan akan menyebar menyebabkan infeksi periapikal. Tahun 2010 penyakit pulpa dan periapikal menempati posisi ke 7 dari 10 penyakit terbanyak pada pasien rawat jalan di rumah sakit di Indonesia. Teknik radiograf yang dapat digunakan untuk diagnosis penyakit pulpa dan periapikal adalah teknik radiografi periapikal. Tujuan penelitian adalah mendapatkan informasi mengenai proporsi gambaran radiografis lesi periapikal gigi nekrosis di RSGM Unpad. Metode: Jenis penelitian deskriptif. Populasi penelitian adalah seluruh radiograf periapiakal gigi nekrosis dengan lesi periapikal pada bulan November 2018 – Januari 2019 di Instalasi Radiologi Kedokteran Gigi RSGM Unpad. Sampel penelitian ditentukan dengan metode purposive sampling. Jumlah sampel sebanyak 54 radiograf periapikal. Hasil: Proporsi gambaran radiografis lesi periapikal yaitu abses periapikal sebanyak 42 kasus (77,78%), granuloma periapikal 8 kasus (14,81%) dan kista periapikal 4 kasus (7,40 %). Simpulan: Proporsi gambaran radiografis lesi periapikal gigi nekrosis di RSGM Unpad didapatkan proporsi tertinggi adalah abses periapikal diikuti granuloma periapikal dan yang terakhir adalah kista periapikal.Kata Kunci: Gigi nekrosis, lesi periapikal, radiograf periapikal ABSTRACTIntroduction: Caries is the most common disease. In 2013, tooth decay of Indonesian people was 460 teeth per 100 people. If left untreated, it will develop, leading to pulp death and will spread, causing periapical infection. In 2010, pulp and periapical diseases were ranked 7th out of the ten most diseases in outpatients of the hospitals in Indonesia. A radiographic technique that can be used for the diagnosis of pulp and periapical disease is a periapical radiographic technique. This study was aimed to obtain information about the radiographic image proportion of necrotic teeth periapical lesions at Universitas Padjadjaran Dental Hospital. Methods: This study was descriptive, with study population was all radiographs of the necrotic teeth periapical lesions in November 2018 - January 2019 at Dentomaxillofacial Radiology Installation of Universitas Padjadjaran Dental Hospital. The research sample was determined by purposive sampling method. The number of samples was 54 periapical radiographs. Results: The radiographic image proportion of necrotic teeth periapical lesions, namely periapical abscesses in 42 cases (77.78%), periapical granuloma in 8 cases (14.81%) and periapical cysts in 4 cases (7.40%). Conclusion: The radiographic image proportion of necrotic teeth periapical lesions at Universitas Padjadjaran Dental Hospital mostly are periapical abscesses, followed by periapical granuloma, and the least is periapical cysts.Keywords: Necrotic teeth, periapical lesions, periapical radiographs