Schulz Malte, von Arx Thomas, Altermatt Hans Jörg, Bosshardt Dieter
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland.
J Endod. 2009 May;35(5):634-42. doi: 10.1016/j.joen.2009.01.024.
The aim of this was to evaluate the histology of periapical lesions in teeth treated with periapical surgery. After root-end resection, the root tip was removed together with the periapical pathological tissue. Histologic sectioning was performed on calcified specimens embedded in methylmethacrylate (MMA) and on demineralized specimens embedded in LR White (Fluka, Buchs, Switzerland). The samples were evaluated with light and transmission electron microscopy (TEM). The histologic findings were classified into periapical abscesses, granulomas, or cystic lesions (true or pocket cysts). The final material comprised 70% granulomas, 23% cysts and 5% abscesses, 1% scar tissues, and 1% keratocysts. Six of 125 samples could not be used. The cystic lesions could not be subdivided into pocket or true cysts. All cysts had an epithelium-lined cavity, two of them with cilia-lined epithelium. These results show the high incidence of periapical granulomas among periapical lesions obtained during apical surgery. Periapical abscesses were a rare occasion. The histologic findings from samples obtained during apical surgery may differ from findings obtained by teeth extractions. A determination between pocket and true apical cysts is hardly possible when collecting samples by apical surgery.
本研究旨在评估根尖手术治疗牙齿的根尖周病变的组织学情况。根尖切除术后，根尖连同根尖周病理组织一并切除。对包埋于甲基丙烯酸甲酯（MMA）中的钙化标本以及包埋于LR White（瑞士布克斯的Fluka公司）中的脱矿标本进行组织学切片。采用光学显微镜和透射电子显微镜（TEM）对样本进行评估。组织学结果分为根尖周脓肿、肉芽肿或囊性病变（真性或袋状囊肿）。最终材料包括70%的肉芽肿、23%的囊肿、5%的脓肿、1%的瘢痕组织和1%的角化囊肿。125个样本中有6个无法使用。囊性病变无法细分为袋状囊肿或真性囊肿。所有囊肿均有上皮衬里的腔隙，其中两个有纤毛衬里的上皮。这些结果表明，根尖手术中获得的根尖周病变中根尖周肉芽肿的发生率较高。根尖周脓肿较为少见。根尖手术中获得的样本的组织学结果可能与拔牙获得的结果不同。通过根尖手术采集样本时，很难确定是袋状囊肿还是真性根尖囊肿。
