Histopathological Findings of Persistent Periapical Radiolucent Lesions of Endodontic Origin Obtained during Apical Resective Surgery: An Analysis of 128 Surgical Cases
Jorge Paredes Vieyra *
Autonomous University of Baja California, Campus Tijuana, México.
Francisco Javier Jiménez Enríquez
Department of Oral Surgery, Campus Tijuana, Mexico.
Alan Hidalgo Vargas
Autonomous University of Baja California, Campus Tijuana, Mexico.
*Author to whom correspondence should be addressed.
Abstract
Background: Apical periodontitis is an acute or chronic inflammatory lesion that develops around the apex of a tooth as a consequence of persistent bacterial infection within the root canal system. It is one of the most common pathological conditions of endodontic origin and is characterised by inflammatory and immunological responses in the periapical tissues. Persistent apical radiolucent lesions may remain after endodontic treatment and can represent different histopathological entities, including periapical granulomas, radicular cysts, and abscesses. Histopathological examination of these lesions is essential for establishing an accurate diagnosis and improving understanding of persistent periapical disease.
Aims: The aim of this study was to evaluate the histopathological findings of 128 persistent apical radiolucent lesions of endodontic origin obtained during apical resective surgery.
Materials and Methods: The study was conducted at the Universidad Autónoma de Baja California, Facultad de Odontología, Tijuana, Mexico. The case group comprised 128 biopsies obtained through apical surgery. The biopsies were examined to establish the diagnosis as periapical granuloma, radicular cyst, or abscess. The radiographic size of the lesion (area in cm2) was measured before surgery and after two years of follow-up. Statistical analysis was performed using analysis of variance. The hypothesis tests were conducted at the 0.05 level of significance.
Results: The study comprised 128 patients, 79 women (61.71%) and 49 men (38.28%), with a mean age of 43.54 years. Histopathological analysis of the 128 apical lesions showed that 74.21% were from the maxilla, especially from the anterior teeth and premolars, and 25.78% were from the mandible. The lesions comprised 72.65% granulomas, 21.85% periapical cysts, 4.68% periapical abscesses, and 0.78% scar tissue. Apical lesions were associated with overfilled canals.
Conclusions: Overall, this study reinforces the importance of histopathological examination for the accurate diagnosis of periapical lesions and supports the view that chronic apical periodontitis is mainly represented by granulomatous and cystic lesions. These results contribute to a better understanding of the distribution and characteristics of apical lesions and may assist in improving diagnostic and treatment strategies in endodontic practice.
Keywords: Periapical pathosis, apical lesions, granuloma, cyst, abscess