Periapical cysts form when inflammatory mediators at the apices of non-vital teeth stimulate cell rests of Malassez to proliferate and form the cyst’s epithelial lining 8. These odontogenic inflammatory cysts are pathologic cavities whose lumens are lined by epithelium and a wall of connective tissue 6. Less frequently, about 23% of the time, samples taken from apical surgeries included periapical cysts 7. In 2009, Schulz determined that 70% of periapical lesions obtained during apical surgeries could be diagnosed histologically as granulomas 7. Periapical granulomas are surrounded by a fibrous capsule within which exists granulation tissue including new capillary loops, macrophages, plasma cells, as well as fibroblast cells, which produce collagen fibers 6. Various inflammatory mediators present at the apex of a necrotic pulp can initiate hyperplasia of granulation tissue, a fibro-vascular matrix which forms a scaffold to wall off an active periapical inflammatory process 5. Without a biopsy, a clinician can only provisionally diagnose a well corticated radiolucent lesion surrounding the apex of a tooth with pulpal necrosis as apical periodontitis. However, the gold standard for diagnosing these conditions remains histological examination 1. Notably, if a sinus tract forms and pus is clinically detectable, one can almost be certain that the radiographic lucency in question is a periapical abscess. This apical periodontal inflammation can sometimes resolves on its own, but in many cases it leads to the formation of a periapical granuloma, cyst, abscess, or scar.Įach of these diagnoses describes a biologically distinct process, however, they are radiographically indistinguishable 4. There, microbial and necrotic debris initiate an inflammatory cascade, which ultimately leads to soft tissue and alveolar bone destruction, visible radiographically as a periapical radiolucency. 2 The resulting inflammation builds up within the enclosed pulpal space and tends to leach out of the apical foramen and into the surrounding periodontium. The requirement of microbes to initiate apical periodontitis has been demonstrated by Kakehashi et al. In some instances, apical periodontitis can be initiated by trauma. In the vast majority of cases, it occurs when microbes from deep carious lesions infiltrate the dental pulp and establish an infection. It is my hope that this article will serve as a brief review of relevant pathologies for endodontists, endodontic residents, and predoctoral students interested in the field.Īpical periodontitis is the most frequently encountered and therefore the most pertinent pathological process within endodontology. This paper seeks to outline the distinguishing features of apical periodontitis and other forms of periapical pathology. Still, it is important to be aware of other, less common, pathological entities which can and will present in such a large pool of endodontic patients. The vast majority of periapical pathology seen in these patients will meet the criteria of apical periodontitis 1. If the average endodontist sees just four cases per workday, they will have encountered well over thirty thousand patients throughout their career. Endo Careers Knowledge Center Submissions.Guidelines for Publishing Papers in the JOE.Oral, Poster & Table Clinic Presentations.
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