Clinicopathological Study of 72 Periapical Lesions from Vietnamese Patients

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Cuong Van Le
Pasutha Thunyakitpisal
Risa Chaisuparat


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.


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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:
Original Article
Author Biography

Pasutha Thunyakitpisal

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
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
-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
 1st place, the Southeast Asian Division – IADR, Unilever Divisional Hatton
Award, Bangkok, Thailand 2013 (Dr. Pintu-on Chantarawarati, Ph.D
 1st place, the Southeast Asian Division – IADR, Unilever Divisional Hatton
Award, Bali, Indonesia 2007 (Dr. Siriwimon Jettanacheawchankit, Ph.D
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,
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.
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;
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;
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.
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.


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