[Value of radiological studies in the diagnosis of chronic fibrous periapical inflammatory disease].
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Diagnosis, Differential↗
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Results for “Periapical Periodontitis”
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[Root canal overfilling. Periapical immune reactions].
The authors studied the immunological answer of periapex to look for causes of osteolysis. They did six apicoectomies in teeth with periapical lesions containing extruded material, and found an inflammatory infiltrate of T lymphocytes and macrophages with birifrangent bodies. They suppose that this immunitary answer to extruded material, prevents the periapex cure.
Apicoectomy↗
[The effect of indolacin in rat periapical lesion and radioimmunoassay determination of prostaglandin E2].
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Animals↗
Immunohistochemical study of apical periodontal cysts.
Periapical lesions, as well as periodontal disease, seems to have cyclic patterns of evolution. Periods of burst may be intercalated with periods of quiescence. Because keratinocyte division must occur during cyst growth, it is presumed that epithelium status could indicate the biological activity of radicular cysts (RCs). Th1 and Th2 are important heterogeneous stages of lymphocyte differentiation. Delayed-type hypersensitivity immune reactions are mediated by Th1 lymphocytes, whereas Th2 populations mediate some types of humoral immune response. Th2 lymphocytes are characterized by high expression of CD30 glycoprotein. Th1 and Th2 lymphocytes have not been evaluated in periapical inflammatory lesions. The purpose of this study was to evaluate CD30+ cells in RCs with atrophic and hyperplastic epithelium. A biotin-streptavidin amplified system was used for identification of CD30 receptor. Results demonstrate increased proportions of Th2 cells in cysts with hyperplastic epithelium. Our results suggest that Th2 cells could be associated with RC growth.
Analysis of Variance↗
Maxillary sinusitis and periapical abscess following periodontal therapy: a case report using three-dimensional evaluation.
BACKGROUND: Maxillary sinusitis may develop from the extension of periodontal disease. In this case, reconstructed three-dimensional images from multidetector spiral computed tomographs were helpful in evaluating periodontal bony defects and their relationship with the maxillary sinus. METHODS: A 42-year-old woman in good general health presented with a chronic deep periodontal pocket on the palatal and interproximal aspects of tooth #14. Probing depths of the tooth ranged from 2 to 9 mm, and it exhibited a Class 1 mobility. Radiographs revealed a close relationship between the root apex and the maxillary sinus. The patient's periodontal diagnosis was localized severe chronic periodontitis. Treatment of the tooth consisted of cause-related therapy, surgical exploration, and bone grafting. A very deep circumferential bony defect at the palatal root of tooth #14 was noted during surgery. After the operation, the wound healed without incidence, but 10 days later, a maxillary sinusitis and periapical abscess developed. To control the infection, an evaluation of sinus and alveolus using computed tomographs was performed, systemic antibiotics were prescribed, and endodontic treatment was initiated. RESULTS: Two weeks after surgical treatment, the infection was relieved with the help of antibiotics and endodontic treatment. Bilateral bony communications between the maxillary sinus and periodontal bony defect of maxillary first molars were shown on three-dimensional computed tomographs. The digitally reconstructed images added valuable information for evaluating the periodontal defects. CONCLUSION: Three-dimensional images from spiral computed tomographs (CT) aided in evaluating and treating the close relationship between maxillary sinus disease and adjacent periodontal defects.
Adult↗
Computed tomography evidence of dental restoration as aetiological factor for maxillary sinusitis.
Maxillary sinusitis due to dental causes is usually secondary to periodontal disease or periapical infection and is commonly associated with mucosal thickening of the floor of the maxillary antrum. Computed tomography (CT) is currently the modality of choice for evaluating the extent of disease and any predisposing factors in patients with symptoms of chronic maxillary sinusitis, but it is unable to diagnose dental disease reliably. The presence of restorative dentistry is, however, easily seen at CT and is associated with both periapical and periodontal disease. We aimed to determine whether its presence at CT may predispose to maxillary sinusitis, and in particular to focal mucosal thickening of the sinus floor characteristic of dental origin. Three hundred and thirty maxillary sinus CT images in 165 patients were reviewed for the presence of restorative dentistry in the adjacent teeth, focal maxillary sinus floor mucosal thickening, any maxillary sinus disease (including complete opacification, air fluid levels, diffuse mucosal thickening, focal mucosal thickening) and evidence of a rhinogenic aetiology (osteomeatal complex pathology, mucosal thickening in other sinuses). One hundred and ninety two sinuses adjacent to restorative dentistry and 178 sinuses not adjacent to restorative dentistry were analysed. Focal floor thickening both with, and without, evidence of a rhinogenic aetiology, was significantly more common adjacent to restorative dentistry. Maxillary sinus disease overall was no more common adjacent to restorative dentistry. This work demonstrated that the presence of restorative dentistry predisposes to focal mucosal thickening in the floor of the maxillary sinus and its presence should prompt clinical and radiographical assessment to exclude dental disease as a source of chronic maxillary sinusitis.
Adolescent↗
The interleukin network in the immunopathogenesis of oral diseases.
Interleukins produced by both lymphoid and non-lymphoid cells play a crucial role in the immune response. This paper discusses the possible interleukin network in the immunopathogenesis of some oral diseases. In chronic inflammatory periodontal diseases and periapical inflammation, interleukins such as IL-1 and IL-6 may be responsible in tissue destruction. High levels of IL-12 but not IL-4 and IL-10 may reduce the course of candidal infection. The progression of HIV infection has been associated with the regulation of distinct cytokines; thus, the pathogenesis of Kaposi's sarcoma may be regulated by IL-6. In autoimmune-associated oral diseases such as lichen planus, the role of Langerhans cells in presenting autoantigens may parallel with increased levels of IL-6. It seems, therefore, that the course of these diseases is regulated by these polypeptides which may in turn modulate the disease severity. However, whether altered levels of interleukins in certain oral disorders can be used as a diagnostic marker requires further investigation.
Acquired Immunodeficiency Syndrome↗
Analysis of sensitivity and specificity of a new digital subtraction system: an in vitro study.
OBJECTIVE: The purpose of this study was to compare a new digital subtraction system with conventional radiograph images for the detection of periapical and periodontal bone lesions. STUDY DESIGN: Periapical and periodontal bone lesions were simulated with cortical bone chips of varying sizes placed on a human dry mandible. Radiographic film images were acquired from varying projections and were subsequently digitized, registered, and subtracted. Four clinicians evaluated the subtracted images, and sensitivity and specificity were calculated. RESULTS: The mean sensitivity and specificity of the Diagnostic Subtraction Radiography system for detecting bone lesions of all sizes with varying projection geometry were 87.90% and 85.23%, respectively. The corresponding results for conventional radiograph images were 47.54% and 97.38%. The difference in sensitivity was statistically significant, whereas the difference in specificity was not. CONCLUSIONS: These results indicate that, even when radiographs are taken from disparate projection geometries, the Diagnostic Subtraction Radiography system is capable of excellent discrimination between healthy and disease states in this in vitro model.
Algorithms↗
Periodontium response to a root canal condensing device (Endotec).
Two Macaca (fascicularis) monkeys were used to study the effect of two warm endodontic condensation techniques (Endotec and vertical condensation method) on periodontal tissues. The specimens were histologically evaluated at 3 and 32 days after the endodontic treatments were completed. In this study the periodontium was divided into coronal, middle, and apical thirds. Results indicated that there was no heat-related damage to periodontal tissues from either of the two methods employed. However, some Endotec specimens generated small, reactive inflammatory infiltrates that were restricted to the root canal opening or adjacent periodontal membrane. Similarly, some vertical condensation specimens developed periapical inflammatory processes as well, but they were more extensive and comprised the alveolar bone and marrow spaces.
Animals↗
Periapical cemental dysplasia and periodontal disease. A case report with review of the literature.
The patient reported here was seen with periapical cemental dysplasia (PCD) superimposed on chronic inflammatory periodontal disease. Various aspects of the diseases and their relationships are reviewed, including the diagnosis of PCD, its significance, and suggestions for therapy.
Alveolar Process↗
Immunoelectron microscopic analysis of CD11c-positive dendritic cells in the periapical region of the periodontal ligament of rat molars.
To increase understanding of structural and phenotypic characteristics of dendritic cells (DCs) in the periapical region of the periodontal ligament (PDL) of rat molars, we performed immunoelectron microscopy for CD11c, a previously untested DC marker. Results demonstrated that CD11c clearly recognized DCs, although it also labeled certain macrophage subpopulation(s). In the normal PDL, resident DCs that extended several long cytoplasmic processes from their oval to slender cell body were identified. When the PDL was bacterially challenged by three days of unsealed pulp exposure, relatively small, irregularly shaped DCs with many thin and short cytoplasmic processes, most likely representing newly recruited DCs, were detected. The ratio of DCs in CD11c+ cells was significantly higher than that in ED1 (anti-macrophages and DCs)-positive and OX6 (anti-major histocompatibility complex class II molecules)-positive cells in normal and challenged PDL.
Animals↗
Pathophysiology of acquired dental diseases of the horse.
Periodontitis, infundibular necrosis, and periapical infection are dental diseases commonly affecting adult horses. Routine dental examinations and care may help to prevent these diseases. Further investigation of the treatment of horses with these diseases using local antimicrobial therapy, restorative dentistry, and endodontic therapy is needed. An understanding of the pathogenesis of these diseases aids in diagnosis and treatment. Gingival hyperplasia and odontogenic tumors are uncommon but should remain in a list of differential diagnoses when examining a horse with pertinent clinical signs. Recognition of odontogenic tumors as early as possible may facilitate surgery. Examination of the oral cavity of foals beyond the neonatal period should allow identification of brachygnathia and timely treatment when indicated.
Animals↗
Endodontic treatment performed by Flemish dentists. Part 2. Canal filling and decision making for referrals and treatment of apical periodontitis.
AIM: To gather information on root-canal treatment carried out by dentists working in Flanders (Belgium). METHODOLOGY: A questionnaire reported in a previous study was also used to gather information on canal medicaments, canal filling, and in decision making for referrals and treatment of apical periodontitis. RESULTS: Calcium hydroxide as an interappointment dressing was used by 69.7% of the respondents. Approximately one-third of the respondents did not use any intracanal medicament. Caustic products used for pulp tissue fixation were used by 66.8% of the respondents. Cavit (48.2%) and glass-ionomer (31.3%) were the temporary coronal-filling materials used most often, followed by zinc oxide-eugenol and IRM(R). Cold lateral condensation of gutta-percha was the filling technique most used by the respondents (65.8%). Single-cone gutta-percha placement (16%), paste techniques (4.9%) and silver points (3.9%) were still used. Resin-based sealers were used most often (88.6%). Paraformaldehyde containing sealers such as Endomethasone and N2 were used infrequently. Approximately half of the practitioners were satisfied with their canal-filling technique, others felt that they could do better (43.0%); 0.7% were not satisfied. In cases with apical periodontitis, the size of periapical lesions and/or the presence of a root filling influenced the choice of endodontic treatment. The most common reasons for referral of endodontic cases were: retrieval of silver points, surgery, and post removal. CONCLUSIONS: The results of this study indicate that techniques and methods used for canal medication and canal filling were acceptable for the majority of the respondents. Re-treatment was underestimated as a treatment option.
Attitude of Health Personnel↗
Cytotoxic and immunostimulatory effects of Bacteroides cell products.
The etiologic role of Bacteroides in both periodontal and periapical infections has been well documented, with current interest focusing on the specific pathogenic mechanisms involved. The effects of cell fractions derived from Bacteroides gingivalis (BG), Bacteroides intermedius (BI), and Bacteroides asaccharolyticus (BA) have been studied in vitro through: an assessment of the direct cytotoxic effects on human gingival fibroblasts using a tetrazolium dye reduction assay, an evaluation of murine lymphocyte stimulation and interleukin-1 release, and the induction of human lymphocyte-mediated cytotoxicity. Both BG and BI stimulated interleukin-1 release (P less than 0.001), while BA, a nonoral organism, was not significantly active in this respect. Only BG sonicates were able to induce lymphocyte-mediated cytotoxicity (P less than 0.005). All three Bacteroides species demonstrated direct cytotoxic effects on cultured gingival fibroblasts, and these effects were related to the relative protein content and endotoxin activity of the sonicate preparations for each organism. These data show that BG and BI possess factors which may enhance their virulence through activities not shared with BA.
Analysis of Variance↗
Association between acute cerebrovascular ischemia and chronic and recurrent infection.
BACKGROUND AND PURPOSE: We performed a case-control study to investigate whether chronic or recurrent respiratory, ear-nose-throat (ENT), and dental infections are risk factors for cerebrovascular ischemia. METHODS: Using a standardized questionnaire we investigated past infectious diseases in 166 consecutive patients with acute cerebrovascular ischemia and in 166 age- and sex-matched nonstroke neurological patient controls. In subgroups, we performed standardized ENT (69 patients, 66 control subjects) and dental examinations including orthopantomography (66 patients, 60 control subjects). Dental status was determined by a total dental index (TDI) that reflects caries, periapical lesions, periodontitis, and other dental lesions and by an orthopantomography index (OPGI) that was assessed blinded. RESULTS: Frequent (> or = 2 episodes in each of the 2 preceding years) or chronic bronchitis was associated with cerebrovascular ischemia in age-adjusted multiple logistic regression analysis (odds ratio, OR, 2.2; 95% confidence interval, CI, 1.04 to 4.6). Groups were not different in ENT examination. Patients tended to have a worse dental status (TDI: P = .070; OPGI: P = .062) and had more severe periodontitis (P = .047) and periapical lesions (P = .027) than control subjects. In age-adjusted multiple logistic regression analysis with social status and established vascular risk factors, poor dental status (TDI) was independently associated with cerebrovascular ischemia (OR, 2.6; 95% CI, 1.18 to 5.7). CONCLUSION: Recurrent or chronic bronchial infection and poor dental status, mainly resulting from chronic dental infection, may be associated with an increased risk for cerebrovascular ischemia.
Acute Disease↗
Antibiotics and the intraoral abscess.
Sensitivity tests were administered to determine the effectiveness of several antibiotics in the management of the oral abscess. Cultures were taken from 13 patients who were diagnosed as having either a periodontal or periapical abscess. Results revealed the following 1. The most effective antibiotic was Chloromycetin. Yet it was felt that its medical contraindications far outweigh its use by the dental practitioner. 2. Tetracycline was the least effective antibiotic. 3. Penicillin, because of its high potency against microorganisms of the dental abscess, should be considered the drug of choice. Its use, however, must be restricted to patients who give a negative history to allergies and/or asthma; when such a history is positive, erythromycin should be used. 4. Appropriate culture and sensitivity tests should be performed to determine the susceptibility of the causative organism(s) to the drug of choice.
Adult↗
Inflammatory disease of the jaw: appearance on reformatted CT scans.
OBJECTIVE: Before the development of dental CT reformatting software, much of the radiographic assessment of the mandible and maxilla was performed in the dentist's office using plain radiographs. The widespread use of dental reformatting software, however, has caused the radiologist to take a more active role in evaluating the jaw. Unfortunately, most radiologists have had little experience in this area, and many of the CT findings are undescribed. Our objective, therefore, was to determine the CT appearance of dental-related inflammatory disease of the jaw and to discuss the mechanisms causing such disease. MATERIALS AND METHODS: Reformatted CT scans of 400 patients referred for dental implant assessment were evaluated for abnormalities related to infection of dental origin, inflammation of dental origin, or both. The diagnosis was confirmed by surgery, clinical presentation, classic plain film appearance, or a combination of the three. RESULTS: The following disease processes were identified and described: periodontal lesions, periapical lesions, condensing osteitis, disuse bone atrophy associated with edentia, and maxillary sinus abnormalities associated with dental disease. CONCLUSION: Inflammatory diseases of the jaw and their sequelae are frequently seen on CT scans of patients referred for examination before dental implantation. Because radiologists now take an active role in evaluating the jaw, they need to become familiar with these findings.
Adult↗
Conventional dental radiology: what the general radiologist needs to know.
This article aims to provide an overview of intraoral and orthopantomographic radiographs, including technique, indications, artefacts, relevant anatomy, current notation and common dental pathology. The normal anatomy is emphasised, because it is required for effective radiographic interpretation. Dental pathology, i.e. caries, periodontal disease, periapical inflammatory lesions and dental anomalies are illustrated.
Artifacts↗