A Clinicopathologic Study of Periapical Lesions Obtained During Apical Endodontic Surgery of Maxillary Anterior Teeth
Objective: To compare the histopathologic types of periapical lesions obtained during apicectomy of maxillary anterior teeth, with the clinico-radiological findings and treatment outcome of the lesions.
Methods: A prospective study was carried out over a 3-year period, during which periapical tissues obtained after apicectomy of maxillary anterior teeth were routinely examined histologically. Post-apicectomy radiological assessment of the patients was performed over a period of 2 weeks to 1 year.
Results: Thirteen patients with clinically diagnosed periapical lesions had apicectomy performed on their maxillary anterior teeth during the study period. There was a male to female ratio of 2.3:1 and the peak age group for the patients was 21 to 25 years (n=6, 46.2%). The mean duration of presentation of the lesions was 5.4 years + 4.6. The lesions were diagnosed histologically as periapical granuloma (n=9, 69.2%) and periapical cyst (n=4, 30.8%). A significant association of periapical granuloma with upper central incisor tooth and the clinical diagnosis of acute apical periodontitis was observed (p<0.05). A considerable post-apicectomy bone deposition around the root apex of the tooth was observed within 3 months (n=5, 38.5%) and complete bone deposition was observed within a year (n=4, 30.8%).
Conclusion: Periapical granuloma and periapical cyst were diagnosed histologically in this study, following routine biopsies after surgical endodontic treatment of maxillary anterior teeth with periapical lesions. The clinical diagnosis of acute apical periodontitis of upper central incisor was significantly associated with histological diagnosis of periapical granuloma. A satisfactory treatment outcome was observed in about a third of the patients, based on radiological evidence of post-apicectomy bone deposition.