Clinicopathological Study of 72 Periapical Lesions from Vietnamese Patients

Main Article Content

Cuong Van Le
Pasutha Thunyakitpisal
Risa Chaisuparat

Abstract

OBJECTIVES: This retrospective study evaluated the clinical and histopathological features of 72 periapical lesions in Vietnamese patients.


MATERIAL AND METHODS: Seventy- two periapical lesions obtained from 72 patients after periapical surgery due to unsuccessful root canal retreatment of anterior teeth were histologically analyzed and classified as periapical granulomas, periapical cysts, and periapical scars. The demographic data: patient’s age, gender, and lesion sites were also recorded.


RESULT: The mean age was 34.74 years, with a range from 12-65. Of these lesions, 53 cases were found in the maxilla and 19 cases in the mandible. The lesions occurred more frequently in the third to fourth decade of life and the most involved tooth was the lateral incisor. Periapical granulomas accounted for 45 cases (62.5%), followed by periapical cysts with 27 cases (37.5%). Of the 27 periapical cysts, 96.3% of the cases were lined with stratified squamous epithelium and the remaining with respiratory epithelium. The prevalence of cholesterol clefts, foamy histocytes, and dystrophic calcification in the periapical cyst was 22.2%, 29.6%, 25.7%, and 8.8%, 11.1%, 51.1% in the periapical granuloma, respectively. One periapical cyst contained a foreign body (3.7%). Only two periapical granulomas demonstrated mixed acute and chronic inflammation.


CONCLUSION: All cases were identified as benign lesions with the most common type being periapical granuloma. The data of this study also confirms the importance of histological examination to establish an accurate diagnosis to eradicate a malignant lesion that may be present in the periapical region of teeth.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Le CV, Thunyakitpisal P, Chaisuparat R. Clinicopathological Study of 72 Periapical Lesions from Vietnamese Patients. BKK Med J [Internet]. 2020Sep.24 [cited 2021Mar.2];16(2):130. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/235804
Section
Original Article
Author Biography

Pasutha Thunyakitpisal

1
Pasutha Thunyakitpisal
Research Unit of Herbal Medicine, Biomaterial and Material for Dental Treatment
Department of Anatomy, Faculty of Dentistry, Chulalongkorn University,
Bangkok, THAILAND 10330
Phone: 081-713-3311
Email: pthunyak@yahoo.com
Education:
Visiting Scientist, Tokyo Medical and Dental University, Tokyo, Japan 2002
Postdoctoral Fellowship, Department of Anatomy, Indiana University, Indianapolis,
IN, USA 1999-2000
Ph.D., Dental Science, Indiana University, Indianapolis, IN, USA 1999
D.D.S., Chulalongkorn University, Bangkok, Thailand 1991
Academic Appointments:
Professor, 2012-present
Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Thailan
Associate Professor, 2004-2011
Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Thailand
Assistant Professor, 2001-2004
Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Thailand
Instructor, 1991-2001
Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Thailand
Additional Academic Experience:
-Director, 2006-present
Dental Biomaterials Science Program, Graduate School, Chulalongkorn University
-Head, 2010-present
Research Unit of Herbal Medicine, Biomaterial and Material for Dental Treatment,
Chulalongkorn University
-President, 2012-present
Thailand Society of Dental Biomaterials
2
-President, 2011-2013
International Association of Dental Research, Southeast Asian Division
-President, 2013-2014
International Association of Dental Research, Asia-Pacific Region
-Chairman of the Local Organizing Committee of the 2nd Asia-Pacific Region-IADR
meeting, Bangkok, Thailand, 2010-2013
Honors and Awards:
 1st place, the Southest Asian Division- IADR, Unilever Divisional Hatton
Award, Sarawak, Malaysia 2014 (Dr. Siriporn Songsiriphadapbun, Ph.D
student)
 1st place, the Southeast Asian Division – IADR, Unilever Divisional Hatton
Award, Bangkok, Thailand 2013 (Dr. Pintu-on Chantarawarati, Ph.D
student)
 1st place, the Southeast Asian Division – IADR, Unilever Divisional Hatton
Award, Bali, Indonesia 2007 (Dr. Siriwimon Jettanacheawchankit, Ph.D
student)
Selected peer-reviewed international publication
1. Chantarawaratit P, Sangvanich P, Banlunara W, Soontornvipart K,
Thunyakitpisal P. Acemannan sponges stimulate alveolar bone, cementum,
and periodontal ligament regeneration in a canine class II furcation defect
model. Journal of Periodontal Research.2014;49:164-78.
2. Boonyagul S, Banlunara W, Sangvanich P, Thunyakitpisal P. Effect of
acemannan, an extracted polysaccharide from Aloe vera, on BMSCs
proliferation, differentiation, extracellular matrix synthesis, mineralization,
and bone formation in a tooth extraction model. Odontology. 2014;102:310-7.
3. Bhalang K, Thunyakitpisal P, Rungsirisatean N. Acemannan, a
Polysaccharide Extracted from Aloe vera, Is Effective in the Treatment of Oral
Aphthous Ulceration. J Altern Complement Med. 2013;19:429-34.
4. Sahawat D, Kanthasuwan S, Sangvanich P, Takata T, Kitagawa M,
Thunyakitpisal P. Acemannan induces cementoblast proliferation,
3
differentiation, extracellular matrix secretion, and mineral deposition. Journal
of Medicinal Plant Research 2012; 6: 4069-76.
5. Srakaew V, Ruangsri P, Suthin K, Thunyakitpisal P, Tachaboonyakiat W.
Sodium-phosphorylated chitosan/zinc oxide complexes and evaluation of their
cytocompatibility: an approach for periodontal dressing. J Biomater Appl.
2012;27:403-12.
6. Jittapiromsak N, Sahawat D, Banlunara W, Sangvanich P, Thunyakitpsial P.
Acemannan, an extracted product from Aloe vera, stimulates dental pulp cell
proliferation, differentiation, mineralization, and dentin formation. Tissue Eng
Part A. 2010;16:1997-2006.
7. Niyomploy P, Thunyakitpisal P, Karnchanatat A, Sangvanich P. Cell
proliferative effect of polyxyloses extracted from the rhizomes of wild
turmeric, Curcuma aromatica. Pharm Biol. 2010;48:932-7.
8. Jettanacheawchankit S, Sasithanasate S, Sangvanich P, Banlunara W,
Thunyakitpisal P. Acemannan stimulates gingival fibroblast proliferation;
expressions of keratinocyte growth factor-1, vascular endothelial growth
factor, and type I collagen; and wound healing. J Pharmacol Sci. 2009;
109:525-31.
9. Jittapiromsak N, Jettanacheawchankit S, Lardungdee P, Sangvanich P,
Thunyakitpsial P. Effect of Acemannan on BMP-2 expression in primary
pulpal fibroblasts and periodontal fibroblasts, in vitro study. J Oral Tissue
Engin 2007;4:149-54.
10. Thunyakitpisal P, Chaisuparat R. Simvastatin, an HMG-CoA reductase
inhibitor, reduced the expression of matrix metalloproteinase-9 (gelatinase B)
in osteoblastic cells and HT1080 fibrosarcoma cells. J Pharmacol Sci 2004;
94:403-9.
11. Alvarez MB, Thunyakitpisal P, Rhodes SJ, Everett ET, Bidwell JP. (2002):
Assignment of Nmp4 to mouse chromosome 6 band F1 flanked by D6Mit134
and D6Mit255 using radiation hybrid mapping and fluorescence in situ
hybridization. Cytogenet Cell Genet.2002; 94:244-5.
12. Thunyakitpisal P, Alvarez M, Tokunaga K, Onyia JE, Hock J, Ohashi N,
Feister H, Rhodes SJ, Bidwell JP. Cloning and functional analysis of a family
of nuclear matrix transcription factors (NP/NMP4) that regulate type I
collagen expression in osteoblasts. J Bone Miner Res.2001;16:10-23.
4
13. Feister H, Torrungruang K, Thunyakitpisal P, Parker G, Rhodes S, Bidwell J.
NP/NMP4 transcription factors have distinct osteoblast nuclear matrix
subdomain. J Cellular Biochemistry 2000;79:506-17.
14. Alvarez M, Thunyakitpisal P, Morrison P, Onyia J, Hock J, Bidwell JP.
PTH-responsive osteoblast nuclear matrix architectural transcription factor
binds to the rat type I collagen promoter. J Cell Biochem 1998;69:336-52.

References

1. Love RM, Firth N. Histopathological profile of surgically removed persistent periapical radiolucent lesions of endodontic origin. Int Endod J. 2009;42(3):198-202.
2. Nair P. On the causes of persistent apical periodontitis: A review. Int Endod J. 2006;39:249-281.
3. Pontes FSC, Paiva Fonseca F, Souza de Jesus A, et al. Nonendodontic lesions misdiagnosed as apical periodontitis lesions: Series of case reports and review of literature. J Endod. 2014;40(1):16-27.
4. García C, Sempere V, Penarrocha M, et al. The post-endodontic periapical lesion: Histologic and etiopathogenic aspects. Med Oral Patol Oral Cir Bucal. 2008;12:E585-90.
5. European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006;39:921-930.
6. von Arx T. Apical surgery: A review of current techniques and outcome. Saudi Dent J. 2011;23:9-15.
7. Enriquez FJJ, Vieyra JP, Ocampo FP. Relationship between clinical and histopathologic findings of 40 periapical lesions. Dentistry. 2015;5(2):1.
8. Lin H-P, Chen H-M, Yu C-H, et al. Clinicopathological study of 252 jaw bone periapical lesions from a private pathology laboratory. J Formos Med Assoc. 2010;109:810-818.
9. Akinyamoju AO, Gbadebo SO, Adeyemi BF. Periapical lesions of the jaws: a review of 104 cases in Ibadan. Ann Ibadan Postgrad Med. 2014;12(2):115-119.
10. Bhullar RK, Sandhu S V, Bhandari R, et al. Histopathological insight into periapical lesions: An institutional study from Punjab. Int J Oral Maxillofac Pathol. 2012;3(3).
11. Safi L, Adl A, Azar MR, et al. A twenty-year survey of pathologic reports of two common types of chronic periapical lesions in Shiraz Dental School. J Dent Res Dent Clin Dent Prospects. 2008;2(2):63-70.
12. Stockdale CR, Chandler NP. The nature of the periapical lesion—a review of 1108 cases. J Dent. 1988;16(3):123-129.
13. Do L, Spencer A, Roberts-Thomson K, et al. Oral health status of Vietnamese adults: findings from the national oral health survey of Vietnam. Asia Pac J Public Health. 2009;23:228-236.
14. Carrillo C, Penarrocha M, Ortega B, et al. Correlation of radiographic size and the presence of radiopaque lamina with histological findings in 70 periapical lesions. J Oral Maxillofac Surg. 2008;66(8):1600-1605.
15. Kaur A, Mohindroo A, Thakur G, et al. Anterior tooth trauma: A most neglected oral health aspect in adolescents. Indian J Oral Sci. 2013;4:31.
16. Ge L, Chen J, Zhao Y, et al. Analysis of traumatic injury in 886 permanent anterior teeth. J Hard Tissue Biol. 2005;14:53-54.
17. Vier F V, Figueiredo JAP. Internal apical resorption and its correlation with the type of apical lesion. Int Endod J. 2004;37(11):730-737.
18. Hama S, Takeichi O, Hayashi M, et al. Co-production of vascular endothelial cadherin and inducible nitric oxide synthase by endothelial cells in periapical granuloma. Int Endod J. 2006;39:179-184.
19. Block RM, Bushell A, Rodrigues H, et al. A histopathologic, histobacteriologic, and radiographic study of periapical endodontic surgical specimens. Oral Surg Oral Med Oral Pathol. 1976;42(5):656-678.
20. Suzuki T, Kumamoto H, Ooya K, et al. Immunohistochemical analysis of CD1a-labeled Langerhans cells in human dental periapical inflammatory lesions – correlation with inflammatory cells and epithelial cells. Oral Dis. 2001;7(6):336-343.
21. Schulz M, von Arx T, Altermatt HJ, et al. Histology of periapical lesions obtained during apical surgery. J Endod. 2009;35(5):634-642.
22. Vier F, Figueiredo JA. Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extent of apical external root resorption. Int Endod J. 2002;35:710-719.
23. Nair PNR, Pajarola G, Luder H-U. Ciliated epithelium–lined radicular cysts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;94(4):485-493.
24. Nair PNR, Sjögren U, Sundqvist G. Cholesterol crystals as an etiological factor in non-resolving chronic inflammation, an experimental study in guinea pigs. Eur J Oral Sci. 1998;106(2p1):644-650.
25. Chen J-H, Tseng C-H, Wang W-C, et al. Clinicopathological analysis of 232 radicular cysts of the jawbone in a population of southern Taiwanese patients. Kaohsiung J Med Sci. 2018;34(4):249-254.