Restorative Dentistry and Endodontics

The Korean Academy of Conservative Dentistry (대한치과보존학회)
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Differential diagnosis of periapical cyst using collagen birefringence pattern of the cyst wall

  • Ji, Hyo Jin (Department of Conservative Dentistry, Gangneung-Wonju National University College of Dentistry) ;
  • Park, Se-Hee (Department of Conservative Dentistry, Gangneung-Wonju National University College of Dentistry) ;
  • Cho, Kyung-Mo (Department of Conservative Dentistry, Gangneung-Wonju National University College of Dentistry) ;
  • Lee, Suk Keun (Department of Oral Pathology, Gangneung-Wonju National University College of Dentistry) ;
  • Kim, Jin Woo (Department of Conservative Dentistry, Gangneung-Wonju National University College of Dentistry)
  • Received : 2016.07.12
  • Accepted : 2016.12.26
  • Published : 2017.05.31
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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.

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References

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