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The purpose of this study was to assess the sphericity of periapical lesions and its relation to the cone-beam computed tomography periapical volume index (CBCTPAVI).A total of 261 periapical lesions were assessed using cone-beam computed tomography images from InteleViewer. Three-dimensional analysis of the lesions was conducted using analytical imaging software Mimics Research. Lesion volume and surface area measurements were determined using the semiautomatic segmentation technique, and these measurements were then used to determine lesion sphericity and CBCTPAVI score. One-way analysis of variance with post hoc Tukey test was used to assess for differences in sphericity among CBCTPAVI groups.The mean sphericity of periapical lesions was 62%. Periapical lesions with larger CBCTPAVI scores were significantly less spherical than lesions with smaller CBCTPAVI scores.Periapical lesions of endodontic origin are mostly semi-spherical in their spread, and as CBCTPAVI score increases, sphericity decreases, indicating that larger lesions expand less uniformly compared with smaller lesions. Clinicians should be aware that lesions of increased volume have less sphericity, and are thus elongated or stretched in 1 or more anatomic plane. This information will assist clinicians in planning and performing periapical surgery and may aid in differential diagnosis of radiolucent jaw lesions.

Objectives Cysts of the mandible are common and are often found clinically in oral surgery. Marsupialization for relatively large cystic lesions may be performed to reduce the size of the lesion and to obtain a histopathological diagnosis. For cystic lesions of the mandible, the effect of marsupialization has many advantages, such as a reduction in lesion size, the avoidance of mental nerve palsy, and preservation of the teeth. It is still unclear whether there is a difference in the reduction rate based on patient age and pathology (dentigerous cyst, odontogenic keratocyst, radicular cyst, ameloblastoma (unicystic type)) and initial size of the lesion. Methods The subjects included 55 patients with cystic lesions with a major axis of 3 cm or greater (16 dentigerous cysts, 20 odontogenic keratocysts, 7 radicular cysts, and 12 ameloblastoma) who underwent treatment at our department. Using simulation software (ProPlanCMF®), the volume of the lesion was extracted from the CT data before and after the marsupialization, and the three-dimensional reduction rate before and after marsupialization was calculated. Results No significant difference was observed between the subgroups in terms of histopathological diagnosis, patient age or size of lesion. Although the effect of marsupialization on cystic lesions with a major axis of 3 cm or more showed a significant difference between 3.0 months and 4.5 months, the difference was not significant between 4.5 months and 6.0 months. Conclusions An indication for the enucleation timing after marsupialization is 4.5 months when the rate of decrease after fenestration slows down.

Background/purpose Actinomycosis is sometimes associated with a radicular cyst (RC). This retrospective study evaluated the clinical and histopathological features of 6 RCs with actinomycosis (AM/RCs). Materials and methods The demographic data and clinicopathological features of 6 AM/RCs were collected and analyzed. Results The 6 AM/RCs were taken from 2 male and 4 female patients, and 3 were found in the maxilla and the other 3 in the mandible. The involved teeth included maxillary or mandibular incisors (2 cases) and maxillary or mandibular first and second molars (4 cases). The most common symptom was pain (5 cases) and the more frequent signs were sinus tract and pus discharge (4 cases). Microscopically, the actinomycotic colony presented as a mass with filamentous bacteria arranging in a sun-ray pattern at the periphery. The mean actinomycotic colony number was 7.7 ± 6.6 colonies per slide. Due to the severe inflammation in all 6 AM/RCs, the stratified squamous epithelial lining was completely abolished in 2 cases and partially destroyed in 4 cases with the residual epithelial lining varying from approximately 10%–50%. Conclusion Our results indicate that pain is the most common symptom and sinus tract and pus discharge are the two frequent signs of our 6 AM/RCs. The stratified squamous epithelial lining was either completely abolished (2 cases) or partially destroyed (4 cases) in 6 AM/RCs. Thus, if the endodontically-treated tooth shows a recurrent sinus tract and poor response to repeated conventional root canal treatments, periradicular actinomycotic infection should be highly suspected.

Non-neoplastic jaw cyst (NJC) is one of the most common lesions in oral cavity, but there are only few detailed and extended epidemiological data based on the 2017 WHO classification. The aim of this study was to perform an epidemiological analysis of all NJCs treated from 1990 to 2019 at the Marche Polytechnic University, and to compare these data with those published in the literature. This retrospective study considered 2060 patients treated from 1990 to 2019. The NJCs were classified according to the 2017 WHO classification, and the main clinicopathological variables were analysed (sex, age, diagnosis, site of onset, size, and recurrences). Of 2150 total lesions, there were 2095 primary cysts and 55 recurrences; men are more frequently affected than women (M/F ratio of 1.73:1). The mean age of occurrence was 46.6 years, with a peak of frequency in the fifth decade. The mandible was more frequently involved than the maxilla, with a mean size of 1.9cm. Radicular cyst was the most frequently diagnosed cyst (56.6%), followed by dentigerous cyst (23.4%) and odontogenic keratocyst (12.9%). This is the first epidemiological study on NJCs in the Italian population according to 2017 WHO classification.

Introduction This study compared the main clinical, radiographic, and histologic features of true and bay apical cysts. Methods The study material comprised 95 biopsy specimens of apical periodontitis lesions obtained attached to the root tip of both untreated and root canal–treated teeth. Clinical and radiographic data were recorded. Specimens were obtained by extraction or periradicular surgery and were meticulously processed for histopathologic and histobacteriologic methods. All cases diagnosed as apical cysts (n = 23) were divided into the true and bay types, which were then compared for tooth location, patient’s sex, lesion size, severity of clinical symptoms, presence of a sinus tract, previous abscess episodes, and prevalence of bacteria in the main root canal lumen and ramifications, on the outer root surface, and within the cyst cavity. Results Eleven specimens were classified as true (48%) and 12 (52%) as bay cysts. Bacteria were found in all specimens, regardless of the histopathologic diagnosis. Planktonic bacteria were observed in the main root canal in all true cysts and in 11 of 12 (92%) bay cyst cases. Biofilms were detected in the main canal in 10 cases from each diagnostic group and were frequently observed in ramifications. Extraradicular biofilms occurred in a few specimens only. Bacteria were visualized within the cavity of both true (4/11, 36%) and bay (6/12, 50%) cyst specimens. The severity of histologic inflammation was always high. There were no significant differences between true and bay cysts for all the clinical, radiographic, histopathologic, and histobacteriologic parameters assessed. Conclusions Except for the morphologic relationship of the cyst cavity with the root canal space, true and bay cysts exhibited no other significant differences in the various parameters evaluated. The 2 cyst types were always associated with an intraradicular infection and sometimes with an extraradicular infection. Findings question the need to differentiate true and bay cysts and do not support the assumption that true cysts are self-sustainable entities not maintained by infection.

Objective To describe our strategy for the management of odontogenic cysts involving the maxillary sinus, and to define the role of transnasal endoscopic sinus surgery in the treatment algorithm. Methods A retrospective study was conducted. Included were all consecutive patients with odontogenic cysts involving the maxillary sinus who were treated in a single medical center between 2011 and 2019. Their medical records were reviewed for demographic data, preoperative presentation, surgical approach, final pathology, and postoperative course. Odontogenic cysts were classified as small or large according to maxillary sinus extension within or beyond the alveolar recess, respectively. Results A total of 30 patients with odontogenic cysts involving the maxillary sinus were treated by a team of maxillofacial and endoscopic sinus surgeons during the study period. There were 11 cases of dentigerous cysts, 11 radicular cysts, seven odontogenic keratocysts (OKCs), and one glandular cyst. Sixteen cases were managed by transnasal endoscopic sinus surgery alone and 14 were managed by a combined intraoral and endoscopic sinus surgery approach. A total of 22 patients had large cysts and total resection was achieved in 20 of them. There was one case of OKC recurrence during an average follow-up of 31 months. No major complications were recorded. Conclusions The endoscopic approach can serve as an alternative to the transalveolar or lateral window approach. The endoscopic approach is associated with low morbidity and low recurrence rates.

This article reports on the management of a large median symmetrical lesion of the anterior palate, which was clinically and radiographically diagnosed as an infected nasopalatine duct cyst. However, histopathology demonstrated it to be a radicular cyst of endodontic origin.

Cyclophilin A (CypA) is a cytosolic protein involved in multiple biological functions, such as inflammation, tissue remodeling, tumorigenesis, and vascular diseases. Human periapical lesions are induced by bacterial infections. However, the expression of CypA in human periapical lesions remains unclear. This study aimed to investigate the presence of CypA in human periapical lesions and the possible association of CypA with angiogenesis, inflammatory cell infiltration, and alveolar bone degradation during inflammatory development.Fifty-eight human periapical tissues, including periapical granulomas (PGs, n = 28), radicular cysts (RCs, n = 24), and healthy control tissues (control group, n = 6) were collected. Samples were fixed and analyzed. CypA expression was detected and analyzed by immunohistochemistry in different cross sections. Double immunofluorescence was assessed to colocalize CypA with CD34, CypA with matrix metalloproteinase 9 (MMP-9), and CD147 with MMP-9.CypA was significantly overexpressed in the RC and PG groups compared with the control group (P.05), but the difference between the RC and PG groups was insignificant (P.05). CypA-positive cells were mainly lymphocytes, endothelial cells, epithelial cells, and plasma cells. The double-labeling analysis of CypA with CD34 suggested that CypA expression was associated with angiogenesis during periapical lesions. MMP-9 colocalized with both CypA and CD147 indicated that CypA may colocalize with CD147 and may be associated with the degradation of soft and hard tissues around human periapical lesions.CypA may be involved in the development of periapical lesions with an increase in inflammatory cell infiltration, angiogenesis acceleration, and alveolar bone degradation.

Dental cysts can be of inflammatory (radicular cysts) or noninflammatory (dentigerous cysts) origin. Apical periodontitis is a necrosis of the pulp and infection of the root canal causing the development of apical granulomas or radicular cysts. The immunology of granuloma and cyst formation is important because modern root filling materials are immunologically active and can contribute to the resolution of apical granulomas. In contrast, radicular cysts often require apicectomy. A better understanding of the pathophysiology of inflammation and bone resorption in apical periodontitis could be the basis for developing new root filling materials with superior immunomodulatory properties.Forty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray of the 87 consecutive specimens was created, and human leukocyte antigen-DR isotype (HLA-DR)-, CD83-, receptor activator of nuclear factor kappa B ligand-, macrophage colony-stimulating factor (MCSF)-, galectin-3 (Gal3)-, CD4-, and CD8-positive cells were detected by immunohistochemistry. Tissue microarrays were digitized, and the expression of markers was quantitatively assessed.HLA-DR, CD83, MCSF, and Gal3 expression was significantly (P.05) higher in radicular cysts compared with apical granulomas. HLA-DR, CD83, MCSF, receptor activator of nuclear factor kappa B ligand, and Gal3 expression in dentigerous cysts was significantly (P.05) lower than in both periapical lesions (apical granulomas and radicular cysts). CD4 and CD8 infiltration was not statistically different between apical granulomas and radicular cysts. Dentigerous cysts showed a significantly (P.05) lower T-cell infiltration than apical periodontitis. The CD4/CD8 ratio was not significantly different between the analyzed groups.The development of radicular cysts in apical periodontitis is associated with an increased expression of myeloid inflammatory markers and bone resorption parameters. Antigen-presenting cells and myeloid cells might be more relevant for the pathogenesis of apical periodontitis than T cells. Increased inflammation might promote the formation of radicular cysts and more pronounced bone resorption.

Background/purpose: Macrophages participate in the periapical inflammation with pro-inflammatory M1 cells and anti-inflammatory M2 cells. Gas6/Axl signal is the responsible pathway for the activation of M1 and polarization of M2. The aim of this study was to compare the number of CD16+ M1 cells, CD206+ M2 cells, and Gas6/Axl expression between apical granulomas and radicular cysts. Materials and methods: Twenty-four cases of granuloma and twenty of cysts were submitted to immunohistochemistry using anti-CD16 and anti-CD206 antibodies for determining M1 and M2 macrophages and investigating the cells with positive Gas6 and Axl expression. Results: There were more numerous of M1 macrophages in radicular cysts (175.9 ± 87.7) compared to apical granuloma (116.6 ± 55.8), and M2 macrophages was higher in cysts (204.0 ± 97.6) than granuloma (152.9 ± 64.6). The level of Gas6/Axl expression were similar. There was a significant different in M1 macrophage (P = 0.014) between two diagnosis. In patients with or without root resorption, the number of M1 were 194.6 ± 57.2 compared with 139.1 ± 79.6. The number of M2 were 241.7 ± 81.4 and 164.6 ± 77.1. The expression of Axl was stronger in root resorption patients (191.1 ± 43.6), but the tendency in Gas6 expression was similar. Significant differences were noted in high M2 infiltration and Axl positive lesions. Conclusion: It appears that macrophages associated with significantly higher numbers in radicular cysts than apical granuloma. Meanwhile, macrophages and Axl receptor was intensively expressed in patients with root resorption, related to severe inflammation. Keywords: Apical granuloma, Axl, Gas6, Macrophage, Radicular cyst

The purpose of this study was to report the clinical efficacy of decompression for 3 cases with large periapical lesions and to review technique details. Three cases with large periapical cystic lesions were treated with decompression after root canal treatment. A traditional decompression technique was used for the first case. After aspiration, mucogingival incision, irrigation, and incisional biopsy, a pediatric endotracheal tube was sutured in place and kept for 3 weeks for lesion debridement. An aspiration/irrigation technique was adopted for the second case. An 18-G needle with a syringe was used to aspirate the cystic lesion. Two needles were then inserted into the lesion; copious saline irrigation was delivered from 1 needle and until clear saline was expressed from the other. For the third case, decompression was accomplished with a surgical catheter that was subsequently replaced with a gutta-percha plug after 1 month. None of the 3 cases underwent complete enucleation and root-end surgery. Healed lesions or lesions in healing were observed after 1 to 2 years. Based on the presented cases and published case reports on decompression, a literature review was provided covering indications, technique details, modification, and prognosis of decompression in endodontics. For large periapical cystic lesions, conservative decompression may be used for certain cases before or in lieu of apical surgery. Decompression enables healing of large, persistent periapical lesions after root canal treatment.

We describe complete healing of an extensive cystic lesion by using a conservative approach: root canal treatment with concurrent surgical drainage. A silicone Foley catheter drain was modified into a surgical drainage stent, which was then used for 4 weeks. Disinfection of the root canal was achieved by the use of hand files and irrigation with 5.25% NaOCl for a minimum of 30 minutes. The irrigant changes were performed at 5-minute intervals, and no intracanal dressing was used. At subsequent follow-up examinations, cone-beam computed tomography and periapical radiographs confirmed that complete healing had occurred around the periapical and lateral areas of affected teeth. This case report indicates the potential for healing of large cystic lesions by nonsurgical root canal treatment.

Introduction Interferon regulatory factor 8 (IRF8) is a critical transcription factor in innate immune responses that regulates the development and function of myeloid cells. Human periapical lesions are caused by endodontic microbial infections. However, the presence of IRF8 in human periapical lesions remains elusive. This study aims to explore the expression of IRF8 in human periapical lesions and the possible association of IRF8 with macrophages, nuclear factor kappa B (NF-κB) signaling, and the autophagy process. Methods Thirty-nine human periapical tissues, including healthy control tissues (n = 15), radicular cysts (RCs, n = 11), and periapical granulomas (PG, n = 13), were examined. Tissues were fixed in paraformaldehyde and analyzed. The inflammatory infiltrates of lesions were evaluated by hematoxylin-eosin, and the expression of IRF8 was analyzed by immunohistochemistry. Double immunofluorescence assessment was performed to colocalize IRF8 with CD68, NF-κB p65, and LC3B. Results The expression of IRF8 was significantly higher in RCs and PGs than in the healthy control group, but no significant difference was found between RCs and PGs. There were significantly more IRF8-CD68 double-positive cells in RCs and PGs than in the healthy control group, but no significant difference was observed between RCs and PGs. Double-labeling analysis of IRF8 with NF-κB and LC3B indicated that IRF8 expression is associated with NF-κB signaling and the autophagy process during periapical lesions. Conclusions IRF8 could be observed and might possibly be involved in macrophages in the development of periapical lesions.

Objective To describe the endoscopic approach for management of large jaw cysts and assess the feasibility of endoscopic enucleation as well as analyze its outcome on a wide scale at Mansoura University Hospital MUH. Methods This prospective cohort study was done on 23 consecutive cases presenting with different types of large jaw cysts in the period from January 2013 to July 2016 at ENT Department, Mansoura University Hospital. All patients, (16 maxillary & 7 mandibular) cysts, were managed endoscopically. Follow up ranged from 6 to 48 months. Results All patients showed complete resolution of their symptoms postoperatively except for 2 maxillary case who didn’t undergo an antrostomy and 1 mandibular indicated a second look. Conclusion Large jaw cysts lie at the border line of management options. Resection of the affected segment is a radical option but the most deforming. On the other hand, conservative procedures are prolonged and not definitive. To our knowledge this is the first case series of endoscopic enucleation of large maxillary and mandibular cysts, highlighting its advantages in variable types.

The keratocystic odontogenic tumor (KCOT) is capable of causing vast osseous destruction. Histopathological examination is pivotal for diagnosis. The diagnostic process can sometimes be hindered by tissue inflammation of KCOTs with loss of defining criteria, resulting in misdiagnosis as an odontogenic jaw cyst. We discuss the possible merits of volumetric analysis when facing this particular diagnostic dilemma and for pathophysiological characterization of KCOTs. We included 114 patients, of whom 27 were histopathologically diagnosed with a KCOT and 87 with dentigerous (n = 41) and periapical cyst (n = 46). Semiautomatic segmentation and radiological analysis of preoperative cone beam computed tomography (CBCT) image data was carried out using ITK-SNAP. The mean volumetric extent of KCOTs is significantly higher compared to non-neoplastic odontogenic jaw cysts (p = 0.001). The mean volume and standard deviation for KCOTs and non-neoplastic odontogenic jaw cysts was 10381 mm 3 ± 6410 and 5813 mm 3 ± 4425, respectively. Volumetric analysis reveals that KCOTs significantly exceed the mean size of non-neoplastic odontogenic jaw cysts, adding an argument in favor of the neoplastic nature of KCOTs. In the case of difficult histopathological examination, lesions with a size exceeding a value of about 3000 mm 3 could be considered for close clinico-radiologic follow-up.

Objective The biologic effects of surgical decompression on the epithelium and connective tissues of periapical cysts are not fully understood. The aim of this study was to evaluate the expression of tissue repair and inflammatory biomarkers in periapical cysts before and after surgical decompression. Study design Nine specimens of periapical cysts treated with decompression before undergoing complete enucleation were immunohistochemically analyzed to investigate the expression of interleukin-1β, tumor necrosis factor-α, transforming growth factor-β1, matrix metalloproteinase-9, Ki-67, and epidermal growth factor receptor. Expression of the biomarkers was classified as positive, focal, or negative. Ki-67 immunoexpression was calculated as a cell proliferation index. The expression of the biomarkers was compared in the specimens from decompression and from the final surgical procedure. Results Computed tomography demonstrated that volume was reduced in all cysts after decompression. There were no differences in the immunoexpression of the proinflammatory and tissue repair biomarkers when comparing the specimens obtained before and after the decompression. Conclusions Surgical decompression was efficient in reducing the volume of periapical cysts before complete enucleation. When comparing the specimens obtained from surgical decompression and from complete surgical removal, the immunohistochemical analysis did not show a decrease in proinflammatory biomarkers; neither did it show an increase in tissue repair biomarkers.

Radicular Cysts (RCs) are the most common inflammatory cysts arising from the odontogenic remnants. It is usually associated with carious, non-vital, or fractured tooth. Although the occurrence of RCs is not uncommon, but bilaterally symmetrical presentation of these cysts in young patient is quite rare. Present case was treated successfully with endodontic treatment of the adjoining involved teeth, followed by extraction of the offending teeth and enucleation of the cysts. Hereby we report case of bilaterally infected RCs in a 14 years old female patient. Also an attempt has been made to discuss its pathogenesis and clinical features in light of current information from the literature.

Introduction The role of the volume of radicular and dentigerous cysts on clinical symptoms is unclear and potentially may predict development of pre- and postoperative complications, especially after cystectomies with large bony defects. Therefore the aim of this study was to assess pre- and postoperative symptoms associated to the volume of jaw cysts. Material and methods Retrospective chart review of 111 patients with follicular or dentigerous cysts from 2008–2012. Anterior iliac crest grafts were used to fill defects after cystectomy. χ2-test was performed to analyze associations between two qualitative variables. Binary logistic regression analysis was used as multivariate analysis. P-values p Results Postoperative hypaesthesia correlated significantly with histology (p = 0.025) and localization (p = 0.006). Volume was associated significantly with preoperative hypaesthesia (p = 0.052), postoperative hypaesthesia (p Conclusions Volume analysis appears to be a method that allows risk stratification after surgery of jaw cysts. Therefore we recommend a precise treatment planning with the means of volume analysis to improve therapy outcome of patients with jaw cysts.

Objective To investigate whether the microscopic filamentous aggregates observed in radicular cysts are associated with the molecular identification of Actinomyces israelii . Moreover, to verify whether this bacterium can be detected in radicular cyst specimens not presenting aggregates. Study Design Microscopic colonies suggestive of Actinomyces were found in 8 out of 279 radicular cyst samples (case group). The case and control groups (n = 12; samples without filamentous colonies) were submitted to the semi-nested polymerase chain reaction to test the presence of A israelii. DNA sequencing was performed to validate polymerase chain reaction results. Results Two and 3 samples in the case and control groups, respectively, did not present a functional genomic DNA template and were excluded from the study. A israelii was identified in all samples of the case group and in 3 out of 9 samples of the control group. Conclusions Although A israelii is more commonly identified in radicular cysts presenting filamentous aggregates, it also appears to be detected in radicular cysts without this microscopic finding.

Introduction Cone-beam computed tomographic (CBCT) analysis allows for 3-dimensional assessment of periradicular lesions and may facilitate preoperative periapical cyst screening. The purpose of this study was to develop and assess the predictive validity of a cyst screening method based on CBCT volumetric analysis alone or combined with designated radiologic criteria. Methods Three independent examiners evaluated 118 presurgical CBCT scans from cases that underwent apicoectomies and had an accompanying gold standard histopathological diagnosis of either a cyst or granuloma. Lesion volume, density, and specific radiologic characteristics were assessed using specialized software. Logistic regression models with histopathological diagnosis as the dependent variable were constructed for cyst prediction, and receiver operating characteristic curves were used to assess the predictive validity of the models. A conditional inference binary decision tree based on a recursive partitioning algorithm was constructed to facilitate preoperative screening. Results Interobserver agreement was excellent for volume and density, but it varied from poor to good for the radiologic criteria. Volume and root displacement were strong predictors for cyst screening in all analyses. The binary decision tree classifier determined that if the volume of the lesion was >247 mm3, there was 80% probability of a cyst. If volume was Conclusions The good accuracy and high specificity of the decision tree classifier renders it a useful preoperative cyst screening tool that can aid in clinical decision making but not a substitute for definitive histopathological diagnosis after biopsy. Confirmatory studies are required to validate the present findings.

Glanzmann thrombasthenia is a severe defect of platelet function caused by an inherited deficiency or dysfunction of the glycoprotein IIb/IIIa complex, the platelet fibrinogen receptor. Patients with Glanzmann thrombasthenia experience lifelong spontaneous and post-traumatic mucocutaneous bleeding diathesis. Surgery is usually very challenging, requiring close cooperation among surgeons, hematologists, and anesthesiologists. For anatomic reasons, oral surgery is particularly difficult owing to the inherent risk of hemorrhage and the difficulty in achieving local hemostasis. In the present report, we describe 3 successful cases of oral surgery in patients with Glanzmann thrombasthenia and report the surgical and hematologic management of each case.

A 15-year-old male presented with historical trauma on tooth #11, 18 months before. During physical examination facial asymmetry was observed, resulting from a swelling beneath the alae of the nose, maxilla, and upper lip at the right side and extending to the right palate and the buccal region of the teeth #11 to #13, and a temporary restoration in #11. Panoramic radiography showed an extensive radiolucent unilocular area including teeth #11 to #17. Cone beam computed tomography showed an extensive unilocular hypodense area that overpassed the midline and displaced the floor of the nasal fossa gauging 22 × 39 × 29 mm. Incisional biopsy with marsupialization was performed showing histologic features of virtual cystic cavity covered by stratified squamous epithelium, with mononuclear inflammatory infiltration and Russell corpuscles underlying the epithelium characterizing apical periodontal cyst. After 4 weeks the patient was referred for endodontic treatment and is still in follow-up. This study was financed in part by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior-Brasil (CAPES)-Finance Code 001.

Squamous odontogenic tumor-like proliferations (SOT-LPs) are an uncommon histopathological finding occurring in the fibrous capsule of odontogenic cysts, which share certain microscopic features with squamous odontogenic tumor (SOT). A 36-year-old woman presented with an 18-month history of a painless, slow-growing swelling in the maxilla. Her medical history was unremarkable. Computed tomography revealed a well-defined, unilocular hypodense lesion extending from nonvital tooth #21 to tooth #11, with expansion and rupture of vestibular cortical bone, measuring approximately 1.5 cm. Under the diagnostic hypothesis of radicular cyst, an excisional biopsy was performed. Histopathological analysis disclosed a cystic cavity lined by nonkeratinized stratified squamous epithelium exhibiting hyperplasia, exocytosis, and spongiosis. The fibrous capsule revealed conspicuous islands of well-differentiated squamous epithelium, some of them exhibiting foci of microcystic degeneration. The final diagnosis was radicular cyst with SOT-LPs. The patient remains under close follow-up.

Clinical Presentation A 61-year-old male with a noncontributory medical history and a facial swelling of 1 week’s duration reported to his local emergency room. The physician prescribed penicillin and made a dental referral. The dentist obtained a pantomograph and, upon visualization of the lesions, referred the patient to the University of Florida Emergency Department, where cone beam computed tomography (CBCT) was performed. The pantomograph illustrated 2 well-localized, partially corticated, radiolucent entities, which appeared hydraulic in nature, in the maxilla and a well-defined, corticated, mixed-density entity, which appeared hydraulic in nature, in the right parasymphyseal region of the mandible. Evaluation of the CBCT scan affirmed the maxillary lesions to be consistent with radicular cysts. The mandibular lesion was well defined, expansile, corticated, and unilocular and was predominantly radiolucent but with internal radiopaque entities. There was thinning of the mandibular buccal and lingual cortices, with possible disruption of the lingual cortex. Differential Diagnosis Calcifying odontogenic cyst (COC), ameloblastic fibro-odontoma, calcifying epithelial odontogenic tumor (CEOT), and ossifying fibroma were considered in the differential diagnosis. Diagnosis and Management The histologic investigation determined all 3 lesions to be radicular cysts. The radiopaque entities seen in the mandibular lesion were identified as cholesterol granulomas with multiple foci of calcification. Management included extraction of tooth #29 and surgical removal of all 3 radicular cysts. Discussion Radicular cysts with internal calcifications have been described in histopathologic evaluations but rarely in radiographic evaluations of radicular cysts. The differential diagnosis of COC was believed to be the most likely diagnosis because of its variable presentation. CEOT was not considered because of the advanced age of the patient but could not be ruled out. Similarly, the differential diagnosis of an ameloblastic fibro-odontoma was unlikely because it is typically seen in a much younger age group, but was included in the differential diagnosis. Radicular cyst was not initially considered in the differential diagnosis because of the presence of internal radiopaque entities. This case reinforces the importance of correlating clinical findings with radiographic findings. Even though radicular cysts with internal calcifications are rare and not often documented in the literature, under the right circumstances and with the aid of proper clinical information, a radicular cyst should be considered in the differential diagnosis of a lesion with internal calcifications. The proper diagnosis of radicular cysts may lead to a more conservative treatment approach, such as endodontic therapy vs enucleation, greatly improving the patient’s comfort and prognosis.

Glandular odontogenic cyst is a rare jaw lesion that is thought to arise from rests of the dental lamina with unpredictable and potentially aggressive behavior. A white 17-year-old female adolescent complained of pain in the posterior region of the mandible beginning about 1 year ago, which increased after the indirect dental restoration of tooth #46 that was submitted to root canal treatment about 8 years ago. Intraoral examination showed swelling of vestibular region between teeth #45 and #47 and cortical perforation of the same lingual region of the mandible, which was painless on palpation. Orthopantomogram revealed a well-defined, large, radiolucent, and unilocular lesion in the periapical region of teeth #45, #46, and #47. Diagnostic hypotheses were radicular cyst, odontogenic keratocyst, ameloblastoma, and simple bone cyst. The treatment consisted of enucleation and curettage of the lesion. The histopathologic analysis of the surgical specimen was suggestive of a glandular odontogenic cyst. The patient is still being followed up.

Introduction Matrix metalloproteinases (MMPs) are the major class of enzymes responsible for degradation of extracellular matrix components and participate in the pathogenesis of periapical inflammatory lesions. MMP expression may be regulated by DNA methylation. The purpose of the present investigation was to analyze the expression of MMP2 and MMP9 in periapical granulomas and radicular cysts and to test the hypothesis that, in these lesions, their transcription may be modulated by DNA methylation. Methods Methylation-specific polymerase chain reaction was used to evaluate the DNA methylation pattern of the MMP2 gene in 13 fresh periapical granuloma samples and 10 fresh radicular cyst samples. Restriction enzyme digestion was used to assess methylation of the MMP9 gene in 12 fresh periapical granuloma samples and 10 fresh radicular cyst samples. MMP2 and MMP9 messenger RNA transcript levels were measured by quantitative real-time polymerase chain reaction. Results All periapical lesions and healthy mucosa samples showed partial methylation of the MMP2 gene; however, periapical granulomas showed higher MMP2 mRNA expression levels than healthy mucosa (P = .014). A higher unmethylated profile of the MMP9 gene was found in periapical granulomas and radicular cysts compared with healthy mucosa. In addition, higher MMP9 mRNA expression was observed in the periapical lesions compared with healthy tissues. Conclusions The present study suggests that the unmethylated status of the MMP9 gene in periapical lesions may explain the observed up-regulation of messenger RNA transcription in these lesions.

This is a case of radicular cyst associated with tooth 22 of a 63-year-old woman, with complaint of increased gingival volume. The sensitivity test was negative and the periapical radiography showed a radiopaque lesion associated with the root of the tooth, circumscribed by a radiolucent lesion. An access and placement of paste of calcium hydroxide with olive oil was performed and a CT scan was requested. It wasn’t possible to remove the lesion that was associated with the root during the intraoperative period, choosing the tooth extraction, curettage of the lesion, a bone graft, and the placement of a membrane for posterior implant installation. The first microscopic exam revealed excessive formation of the cementum and the second shows cavity internally coated by epithelium and a fibrous connective tissue capsule that coats it externally, with chronic inflammatory infiltrate. The patient was diagnosed with hypercementosis and radicular cyst, respectively.

Odontogenic keratocyst (OKC) classified by the World Health Organization as a cystic lesion of benign development stands out among the other odontogenic lesions due to potentially aggressive biological behavior, with a tendency to recurrence. The present study aims to report an OKC case in the mandible, as well as discuss aspects related to the radiographic findings and types of treatments of this lesion. A male patient exhibited a circumscribed lesion, and a hard consistency, lasting for 6 months, measuring approximately 1.0 cm in extension in the posterior region of the left mandible. Under the clinical hypothesis of radicular cyst, incisional biopsy was performed. Based on the definitive diagnosis of odontogenic keratocystic after histopathological examination, tooth removal was performed and an intraosseous device was placed to allow OKC decompression. After 1 year of observation, no evidence of relapse was found, and total lesion regression was observed. The findings of the present case highlight the importance of the correct diagnosis and emphasize the importance of a thorough clinical examination of the oral cavity.

Radicular cysts are defined as a cavity lined by epithelium and with development related to an inflammatory stimulus. We will approach, through a clinical case report, the method of diagnostic evaluation based on histopathologic criteria, as well as the surgical treatment choice of an inflammatory cyst with clinical characteristics of aggressive lesions. A male patient with an intra-osseous lesion associated with impacted teeth was evaluated. Due to the extension of the lesion, 2 surgical stages were chosen. At the first moment, aspiration, marsupialization, and incisional biopsy were performed. The result was compatible with a radicular cyst. In the second surgical stage, the cyst was enucleated and elements 37 and 38 removed, and intermaxillary block was performed with the purpose of preventing jaw fracture. The material was sent to histopathology study, with a final diagnosis of inflammatory cyst. Especially in extensive lesions, the definitive diagnosis must be made before performing more radical surgical procedures.

Objective: To determine the demographic profile of all histologically diagnosed odontogenic cysts (OC) and nonodontogenic cysts (nOC) over a 30-year period in a Brazilian population. Study Design: A descriptive cross-sectional study was performed with OC and nOC to obtain information about epidemiologic data. The diagnosis followed the World Health Organization (2017) parameters of a descriptive statistical analysis. Results: A total of 6235 lesions were diagnosed. Of these, 544 (8.72%) corresponded to OCs and nOCs. Radicular cyst was the most frequently inflammatory OC (81.76%). Among the development of OCs and nOCs, the dentigerous cyst was the most frequent (56.78%), followed by odontogenic keratocyst (34.67%) and glandular odontogenic cyst (3.01%). The inflammatory OCs were most common in female (53.4%) patients, with a mean age of 34.4 years, and the maxilla (56.6%) was the most affected anatomic site. In addition, the OCs and nOCs were more frequent in female (62.8%) patients, with a mean age of 29.2 years, located in the mandible (66.8%). Conclusion: Knowledge of the epidemiologic profile, clinical aspects, and pathologic aspects of OC and nOC provides more accurate data about diagnosis and appropriate treatment.

Glandular odontogenic cyst is a rare developmental odontogenic cyst that arises from the dental lamina epithelium and presents with glandular characteristics. It occurs most commonly in the anterior mandible of middle-aged male patients and its clinical importance comes from the potentially aggressive behavior due to high recurrence. A 29-year-old man was referred for evaluation of an asymptomatic swelling in the anterior region of the mandible with 1-year duration. Intraoral examination showed an expansion of the vestibular plate of the anterior mandible covered by healthy oral mucosa without extraoral asymmetry. Panoramic radiography revealed well-defined unilocular radiolucent lesion without root resorption or displacement. The diagnostic hypothesis was radicular cyst and excisional biopsy was performed. The histopathologic examination revealed a glandular odontogenic cyst. The patient remains under follow-up considering the recurrence risk.

Background Nasopalatine duct cysts are the most common nonodontogenic cysts of the oral cavity. These cysts are classified as being developmental in nature because they most likely develop after spontaneous cystic degeneration of the epithelial remnants of the nasopalatine duct. Imaging plays a vital role in the diagnosis and management of these cysts. Discussion/Conclusions We present 5 cases consisting of 3 males and 2 females seen in the Oral and Maxillofacial Radiology clinic at University of Toronto Faculty of Dentistry (Toronto, Canada). The ages of the patients ranged from 40 to 65 years. These cases all exhibited unusual imaging features that posed difficulties in interpretation. One potential difficulty in the radiologic interpretation of these entities was that these cysts exhibited a range of growth patterns that were unconventional; for example, some were asymmetric, and their epicenters were not located in the midlines of the anterior maxillae. Furthermore, some entities demonstrated benign-appearing expansile characteristics, whereas others had more aggressive features. Because of their positions and their proximities to the maxillary anterior teeth, the lesions appeared to resorb or displace teeth. Therefore, the possibility that these entities could be interpreted as rarefying osteitis (e.g., radicular cysts) or odontogenic keratocysts could not be ruled out on the basis of plain film imaging alone. Although there is value in planar film imaging as the preliminary imaging modality, atypical features, such as asymmetric location and loss of normal anatomic structures, made routine interpretation difficult. As a result, we undertook advanced imaging of these patients which enabled us to identify additional key features that enabled us to make a more definitive interpretation. This presentation aims to demonstrate the range of atypical presentations of the nasopalatine duct cysts. A clear understanding of this range of imaging features will improve the interpretive skill of oral and maxillofacial radiologists.

Purpose To evaluate the efficiency of decompression in treating odontogenic cystic lesions of the jaws in children. Materials and Methods All consecutive odontogenic cysts occurring in children and treated by decompression from 1994 to 2009 at 1 maxillofacial center were included in the present study. Clinical data included age, gender, jaw, histopathologic diagnosis, and decompression time. Radiologic data from panoramic radiographs before and after decompression included tooth involvement, locularity, location, involvement of adjacent vital anatomic structures, and cyst area. Results Thirty-two odontogenic cystic lesions from 26 children (14 boys [53.8%] and 12 girls [46.2%]) treated with decompression were included. The average age at the time of presentation was 11.6 ± 3.3 years (range, 7 to 18 yr). The mandible was involved in 13 cases (40.6%) and the maxilla in 19 (59.4%). All cysts were unilocular at presentation. Twenty-seven cysts (84.4%) showed tooth involvement. The diagnoses consisted of dentigerous cysts (20 [62.5%]), keratocysts (9 [28.1%]), and radicular cysts (3 [9.4%]). The mean decompression period was 7.45 ± 2.6 months (2 to 14 months). The mean standard lesion area index changed from 12.7 ± 0.9 mm 2 (3.6 to 44 mm 2 ) before compression to 2.3 ± 4.3 mm 2 (0 to 22.3 mm 2 ) after decompression. The mean percentage of reduction (POR) was 82 ± 16% (49 to 100%). The POR was ranked as good in 22 lesions (69%), moderate in 9 lesions (28%), and poor in 1 lesion (3%). Surgery was performed for 15 lesions (47%). Conclusion Decompression results in good regeneration potential of the bone in the developing craniofacial skeleton of children. Children might benefit from a less invasive surgical protocol.

Glandular odontogenic cyst (GOC) is a rare, benign, cystic lesion of the jaws, which occurs mostly in the mandible, especially in the anterior region. The histogenesis of GOC remains uncertain and the World Health Organization classified the lesion as a developmental odontogenic epithelial cyst in 1992. In this article, we describe a rare case of GOC arising in the posterior region of the mandible in a 64-year-old male and also present the clinical, radiological and histopathological features of GOC. Radiological examination revealed a solitary well-defined unilocular radiolucent lesion in the left mandibular posterior region. The lesion was clinically diagnosed as radicular cyst associated with the left first molar. The cystic lesion was enucleated from the jaw bone in one piece and tooth extraction was performed under general anesthesia. The surgical specimen was investigated histopathologically and was diagnosed as GOC. Due to the high recurrence rate of GOC, complete removal of the cystic lesion and careful clinical and radiological follow-up are important. In the present case, a panoramic radiograph was taken after 19 months of follow-up, which revealed complete healing of the involved site with no evidence of recurrence.

Introduction Interleukin (IL)-17 expression has been detected in apical periodontitis lesions, but its role in the disease process remains unclear. The present study compared the expression of IL-17 in periradicular cysts and granulomas and evaluated the association of this cytokine with clinical and radiographic findings. Methods Apical periodontitis lesions (18 cysts and 20 granulomas) were obtained from 38 patients subjected to periradicular surgery. Some clinical, radiographic, and cone-beam computed tomographic features were recorded. Silanized slides containing paraffin sections were used for the immunohistochemical reactions using anti–IL-17 antibody. Image analysis was performed using an optical microscope, and each sample was divided into 5 high-power fields, which were evaluated for the expression of IL-17 in the epithelium and connective tissues. Results were evaluated for correlations with the lesion size and the occurrence of symptoms and sinus tract. Results Expression of IL-17 was significantly higher in cysts than in granulomas ( P = .02). Among the periradicular cysts, a thin epithelium showed significantly increased labeling for IL-17 when compared with a hyperplastic epithelium ( P = .003). IL-17 expression was usually associated with focal accumulations of polymorphonuclear leukocytes. No association of IL-17 expression with symptoms, sinus tract, or lesion size was observed ( P > .05). Conclusions The present study reinforces the notion that IL-17 may take part in the pathogenesis of apical periodontitis lesions. A role in the exacerbation of chronic inflammation and cyst formation is suspected. Further studies are required to shed light on the specific functions of IL-17 in periradicular inflammatory processes.

The success of autogenous tooth transplantation depends on the vitality of the periodontal ligament attached to the donor tooth, and its viability decreases when it is exposed extraorally. This report describes the case of a 16-year-old patient in whom a rapid prototyped tooth model was performed using cone-beam technology and a surgical template guide for autotransplantation as an effective technique for a critical time-based procedure.

Adenomatoid odontogenic tumour (AOT) has been known to the pathologists for the past 100 years as a benign slow growing tumour. Histologically, this tumour has a predominantly solid component and very few case reports have described the cystic nature of AOT. In the present case we review the literature of extrafollicular AOT presenting as a periapical disease and add to the literature a case of cystic extrafollicular AOT in a 17-year-old patient, initially diagnosed as a radicular cyst. Radiographically extrafollicular AOT frequently resembles other odontogenic lesions such as residual, developmental lateral periodontal or radicular cyst, however histopathological findings of this tumour are quite characteristic and present few diagnostic problems. Correlation of clinical and radiological information with histological features is important in the diagnosis of odontogenic cysts and tumours, to decrease the incidence of misdiagnosis for such cases and this in turn will help in preventing recurrences.

Introduction Mast cells and macrophages are important components of the inflammatory infiltrate found in inflammatory periapical diseases. Several cytokines participate in the mechanisms of inflammation, tissue repair, and bone resorption associated with periapical cysts. The aim of the present study was to evaluate the distribution of mast cells and macrophages and the expression of interleukin-6 (IL-6) in periapical cysts. Methods Thirty periapical cysts were selected for the study, and clinical, demographic, and gross information from the cases was obtained from the laboratory records. Five-micrometer sections stained with hematoxylin-eosin were reviewed for analysis of the microscopic features of the cysts, and 3-μm sections on silanized slides were used for immunohistochemical reactions with anti-tryptase, anti-CD68, and anti–IL-6. Results There was no statistically significant difference in the mean number of mast cells and macrophages when comparing superficial and deep regions of the fibrous capsule of the cysts. Mean number of mast cells on the superficial region of the fibrous capsule was higher in cysts showing intense superficial inflammation and exocytosis. Macrophages were more commonly found in areas showing IL-6 expression, and IL-6 was less expressed in deep regions of the fibrous capsule in cysts showing greater gross volume. Conclusions The results reinforced the participation of mast cells and macrophages in the pathogenesis of periapical cysts and suggested that IL-6 is not the major bone resorption mediator in larger periapical cysts.

Introduction Cholesterol clefts are common histologic findings in periapical biopsies; they have a reported incidence in periapical periodontitis of up to 44%. Cholesterol crystals are also recognized in advanced atherosclerotic plaques in humans. Male sex, genetic abnormalities, and age have been associated with advanced atherosclerotic lesions. Among these nonmodifiable risk factors, age is the most dominant. The aim of the study was to evaluate if age is also linked to cholesterol deposition in periapical periodontitis. Methods The database of biopsy reports obtained between 2006 and 2009 was searched for specimens diagnosed as radicular cysts or periapical granulomas. Only data relating to biopsies obtained from adolescent (13–21 years old) and elderly (over 60 years old) patients were selected. The biopsies were examined by a pathologist under a light microscope (Zeiss, Jena, Germany) at magnifications of 40×–200×. The available material was scanned for the presence of cholesterol clefts and foamy cells in radicular cysts and granulomas. Results A total of 41 specimens were collected in the adolescent group and 48 specimens in the elderly group over a 4-year period. A higher incidence of cholesterol was found in the elderly group compared with that in the adolescent group (odds ratio = 6.857). Conclusions The highly significant incidence of cholesterol deposits in periapical biopsies among elderly patients may be a possible cause for the lack of repair. The mechanism for cholesterol accumulation is probably similar to the process leading to atherosclerosis and coronary artery disease. Statin administration may be advantageous for the treatment of persistent lesions. A clinician should be aware of the risk for persistent lesions after endodontic treatment in elderly patients.

Introduction The purpose of this study was to evaluate the reliability and accuracy of cone-beam computed tomographic (CBCT) imaging against the histopathologic diagnosis for the differential diagnosis of periapical cysts (cavitated lesions) from (solid) granulomas. Methods Thirty-six periapical lesions were imaged using CBCT scans. Apicoectomy surgeries were conducted for histopathological examination. Evaluator 1 examined each CBCT scan for the presence of 6 radiologic characteristics of a cyst (ie, location, periphery, shape, internal structure, effects on surrounding structure, and perforation of the cortical plate). Not every cyst showed all radiologic features (eg, not all cysts perforate the cortical plate). For the purpose of finding the minimum number of diagnostic criteria present in a scan to diagnose a lesion as a cyst, we conducted 6 receiver operating characteristic curve analyses comparing CBCT diagnoses with the histopathologic diagnosis. Two other independent evaluators examined the CBCT lesions. Statistical tests were conducted to examine the accuracy, inter-rater reliability, and intrarater reliability of CBCT images. Results Findings showed that a score of ≥4 positive findings was the optimal scoring system. The accuracies of differential diagnoses of 3 evaluators were moderate (area under the curve = 0.76, 0.70, and 0.69 for evaluators 1, 2, and 3, respectively). The inter-rater agreement of the 3 evaluators was excellent (α = 0.87). The intrarater agreement was good to excellent (κ = 0.71, 0.76, and 0.77). Conclusions CBCT images can provide a moderately accurate diagnosis between cysts and granulomas.

Purpose The aim of the present study was to compare the immunohistochemical detection of receptor activator nuclear κB ligand (RANKL) and osteoprotegerin (OPG) in radicular cysts (RCs), dentigerous cysts (DCs), solid ameloblastomas (SAs), and keratocystic odontogenic tumors (KOTs). Materials and Methods A total of 20 RCs, 20 DCs, 20 KOTs, 14 dental follicles (DFs), and 18 SAs were evaluated by immunohistochemistry using anti-RANKL and anti-OPG antibodies. The analysis was quantitative, and the number of positive cells was counted in 10 microscopic high-power fields (400×). Results The DFs, KOTs, and SAs showed higher expression of RANKL than did the RCs and DCs in the epithelium (P < .05). The epithelial expression of OPG was higher in the DFs, KOTs, RCs, and DCs than in the SAs (P < .05). The ratio of OPG less than RANKL was more frequent in SAs and OPG greater than RANKL in DCs (P < .05). Conclusions Our results have shown differences in RANKL and OPG detection in the odontogenic cysts and tumors studied. The higher RANKL and lower OPG detection in SA could play a role in bone resorption, compatible with the tumor's biologic behavior.

Objective The articles on the usage of marsupialization and decompression for most cystic lesions of the jaws were reviewed by literature. Methods A computer database search was performed on PubMed and Ovid for all years before 2011 available. Search key words were (marsupialization or decompression), (cyst or cystic) and (dental or oral). The descriptive statistics were made based on journals, areas that originated from, diagnosis, site of involvement, treatment modality, devices, follow-up, and recurrence. Results A total of 69 articles were included and analyzed. The topic has been reported in 33 kinds of journals by 23 countries and areas. The cystic lesions mainly included dentigerous cyst, keratocystic odontogenic tumor, radicular cyst, and ameloblastoma. The other treatments combined with marsupialization and decompression was tooth extraction, tooth traction, enucleation, curettage, and bone resection. 32 articles reported the devices, including tube, gauze, obturator and others. 45 articles reported the definite time for follow-up and 54 articles reported no recurrence of the lesions. Conclusion Marsupialization or decompression could be performed as single surgical procedure or combined with other treatment modalities through different devices for many cystic lesions in different sites of jaws. It has been accepted and used as a conservative surgical option. The long term observation confirmed the effectiveness of the treatment.

The aim of this study was to evaluate the expression and localization of tight junction proteins (TJPs) or claudins in the keratocystic odontogenic tumor (KCOT) and to correlate with its biological behavior.Five claudins (-1, -3, -4, -5, and 7) were examined immunohistochemically in 25 KCOTs and compared with 10 dentigerous cysts (DCs) and 10 radicular cysts (RCs).Marked claudin-3 loss of expression in KCOT basal layer (n=24/25; 96%) compared with DCs (n=1/10; 10%) and RCs (n=5/10; 50%) (P.05) suggests that claudin-3 downregulation may indicate altered or loss of basal cell polarity and impaired barrier function of KCOT lining epithelium and this might contribute indirectly to its biological behavior. In contrast, claudins-1, -4, -5, and -7 distribution patterns were less distinctive in all three entities, suggesting that these TJP molecules probably play limited roles in influencing their different growth potentials.Present findings suggest that differential claudin expressions in the lining epithelium of KCOTs, DCs, and RCs probably reflect their neoplastic or nonneoplastic nature.

Introduction This article describes a case in which signs and symptoms persisted in spite of the endodontic treatment following high standards to characterize a short-term failure. Methods After several appointments of root canal treatment in an attempt to resolve persistent symptoms, including 106 days of calcium hydroxide intracanal medication, periradicular surgery was performed, and the root apex and the lesion were subjected to histologic and histobacteriologic analyses. Results The lesion was diagnosed as a cyst, and the main root canal was free of bacteria and debris. Conclusions The cause of the short-term failure was an exuberant bacterial biofilm colonizing a lateral canal in the apical root segment. This case report highlights one of the major problems of modern endodontic therapy; bacteria located in areas distant from the main root canal can remain unaffected by treatment procedures and maintain disease. The challenge for researchers and clinicians that arises from this problem is to develop strategies, instruments, or substances that can reach those areas and achieve sufficient reduction in the infectious bioburden to permit predictable periradicular healing.

Introduction Interferon-γ plays an important role in the pathogenesis of periapical lesions, and the methylation of IFNG has been associated with transcriptional inactivation. The purpose of the present study was to investigate IFNG promoter methylation in association with gene transcription and protein levels in periapical granulomas and radicular cysts. Methods Methylation-specific polymerase chain reaction was used to assess the DNA methylation pattern of the IFNG gene in 16 periapical granulomas and 13 radicular cyst samples. The transcription levels of IFNG mRNA were verified by quantitative real-time polymerase chain reaction, and protein expression was evaluated by immunohistochemistry. Results All the periapical lesion samples exhibited partial or total methylation of the IFNG gene. In addition, an increased methylation profile was found in radicular cysts compared with periapical granulomas. Increased IFNG mRNA expression was observed in the partially methylated periapical lesion samples relative to the samples that were completely methylated. Conclusions The present study provides the first evidence of the possible impact of IFNG methylation on IFNG transcription in periapical lesions.

A 43-year-old woman presented with a swelling in the anterior mandible appearing radiographically as a well-defined radiolucency causing mobility of the anterior teeth. A clinical diagnosis of a radicular cyst led to removal of the lesion and the associated mobile teeth. Postoperative histopathology led to a diagnosis of intraosseous solitary myofibroma of the mandible. Solitary lesions of myofibroma are exceedingly rare in adult jaws, with only 3 previously documented cases.

Objective The purpose of this study was to investigate the usefulness of computerized tomography (CT), particularly contrast-enhanced CT, in differentiation of jaw cysts and cystic-appearing tumors. Study Design We retrospectively analyzed contrast-enhanced CT images of 90 patients with odontogenic jaw cysts or cystic-appearing tumors. The lesion size and CT values were measured and the short axis to long axis (S/L) ratio, contrast enhancement (CE) ratio, and standard deviation ratio were calculated. Results The lesion size and the S/L ratio of keratocystic odontogenic tumors were significantly different from those of radicular cysts and follicular cysts. There were no significant differences in the CE ratio among the lesions. Conclusions Multidetector CT provided diagnostic information about the size of odontogenic cysts and cystic-appearing tumors of the jaws that was related to the lesion type, but showed no relation between CE ratio and the type of these lesions.

Objectives To compare the number of FoxP3 + cells between periapical granulomas (PGs) and radicular cysts (RCs), and to correlate this number with the intensity of the inflammatory infiltrate in these lesions and with epithelial thickness of RCs. Study design Thirty PGs and 30 RCs were submitted to immunohistochemical analysis using an anti-FoxP3 polyclonal antibody. FoxP3 + cells were counted under a light microscope (×400 magnification) in five fields and the mean value was calculated for each specimen. Statistical tests were used to evaluate differences in the number of FoxP3 + cells according to type of lesion (PG vs. RC), intensity of the inflammatory infiltrate (grade I/II vs. grade III), and epithelial thickness of RCs (atrophic vs. hyperplastic). Results FoxP3 + cells were detected in most PGs (93.3%) and RCs (93.3%). The median number of FoxP3 + cells was 2.40 in PGs and 1.00 in RCs, with this difference being statistically significant ( P = 0.005). No significant differences in the number of FoxP3 + cells were observed in terms of the intensity of the inflammatory infiltrate ( P = 0.465) or epithelial thickness of RCs ( P = 0.737). Conclusions The present results suggest a greater participation of regulatory T cells in the modulation of the inflammatory response in PGs. In addition, the presence of a less effective regulatory environment in RCs, together with the high levels of inflammatory mediators as reported in the literature, may contribute to the greater growth potential of these lesions.