Restor Dent Endod.  2017 May;42(2):111-117. 10.5395/rde.2017.42.2.111.

Differential diagnosis of periapical cyst using collagen birefringence pattern of the cyst wall

• Ji HJ
• Park SH
• Cho KM
• Lee SK
• Kim JW

• KMID: 2379460
• DOI: http://doi.org/10.5395/rde.2017.42.2.111

Abstract

OBJECTIVES
Periapical lesions, including periapical cyst (PC), periapical granuloma (PG), and periapical abscess (PA), are frequently affected by chemical/physical damage during root canal treatment or severe bacterial infection, and thus, the differential diagnosis of periapical lesions may be difficult due to the presence of severe inflammatory reaction. The aim of this study was to make differential diagnosis among PC, PG, and PA under polarizing microscope.
MATERIALS AND METHODS
The collagen birefringence patterns of 319 cases of PC (n = 122), PG (n = 158), and PA (n = 39) obtained using a polarizing microscope were compared. In addition, 6 cases of periodontal fibroma (PF) were used as positive controls.
RESULTS
Collagen birefringence was condensed with a thick, linear band-like pattern in PC, but was short and irregularly scattered in PG, and scarce or absent in PA. PF showed intense collagen birefringence with a short, palisading pattern but no continuous band-like pattern. The linear band-like birefringence in PC was ascribed to pre-existing expansile tensile stress of the cyst wall.
CONCLUSIONS
In this study all PCs (n = 122) were distinguishable from PGs and PAs by their characteristic birefringence, despite the absence of lining epithelium (n = 20). Therefore, the authors suggest that the presence of linear band-like collagen birefringence of the cyst wall aids the diagnostic differentiation of PC from PG and PA.

Keyword

Collagen birefringence; Differential diagnosis; Periapical lesions

MeSH Terms

Bacterial Infections
Birefringence*
Collagen*
Dental Pulp Cavity
Diagnosis, Differential*
Epithelium
Fibroma
Periapical Abscess
Periapical Granuloma
Radicular Cyst*
Collagen

Figure

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  Figure 1 Periapical cyst with lining epithelium after endodontic treatment, noted the linear band-like birefringence in collagen bundles (arrows) encircling the cyst wall. (e) and (g), polarized views of (d) and (f), respectively.

• 

  Figure 2 Periapical cyst with no lining epithelium after endodontic treatment, noted strong linear band-like birefringence parallel to the cyst wall in collagen bundles (arrows). (e) and (g), polarized views of (d) and (f), respectively.

• 

  Figure 3 Periapical granuloma, note the weak and rudimentary birefringence in degenerating collagen bundles (arrows) of this granulomatous lesion. (c), (e), and (g), polarized views of (b), (d), and (f), respectively.

• 

  Figure 4 Periapical abscess, note almost no birefringence in the necrotic exudate. (e) and (g), polarized views of (d) and (f), respectively.

• 

  Figure 5 Periodontal fibroma, note strong birefringence with a short and irregularly scattered pattern (arrows). (e) and (g), polarized views of (d) and (f), respectively.

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