Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Department of Oral and Maxillofacial Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
J Endod. 2019 Oct;45(10):1200-1208. doi: 10.1016/j.joen.2019.06.014. Epub 2019 Aug 7.
Dental cysts can be of inflammatory (radicular cysts) or noninflammatory (dentigerous cysts) origin. Apical periodontitis is a necrosis of the pulp and infection of the root canal causing the development of apical granulomas or radicular cysts. The immunology of granuloma and cyst formation is important because modern root filling materials are immunologically active and can contribute to the resolution of apical granulomas. In contrast, radicular cysts often require apicectomy. A better understanding of the pathophysiology of inflammation and bone resorption in apical periodontitis could be the basis for developing new root filling materials with superior immunomodulatory properties.
Forty-one apical granulomas, 23 radicular cysts, and 23 dentigerous cysts were analyzed in this study. A tissue microarray of the 87 consecutive specimens was created, and human leukocyte antigen-DR isotype (HLA-DR)-, CD83-, receptor activator of nuclear factor kappa B ligand-, macrophage colony-stimulating factor (MCSF)-, galectin-3 (Gal3)-, CD4-, and CD8-positive cells were detected by immunohistochemistry. Tissue microarrays were digitized, and the expression of markers was quantitatively assessed.
HLA-DR, CD83, MCSF, and Gal3 expression was significantly (P < .05) higher in radicular cysts compared with apical granulomas. HLA-DR, CD83, MCSF, receptor activator of nuclear factor kappa B ligand, and Gal3 expression in dentigerous cysts was significantly (P < .05) lower than in both periapical lesions (apical granulomas and radicular cysts). CD4 and CD8 infiltration was not statistically different between apical granulomas and radicular cysts. Dentigerous cysts showed a significantly (P < .05) lower T-cell infiltration than apical periodontitis. The CD4/CD8 ratio was not significantly different between the analyzed groups.
The development of radicular cysts in apical periodontitis is associated with an increased expression of myeloid inflammatory markers and bone resorption parameters. Antigen-presenting cells and myeloid cells might be more relevant for the pathogenesis of apical periodontitis than T cells. Increased inflammation might promote the formation of radicular cysts and more pronounced bone resorption.
牙囊肿可分为炎症性（根尖囊肿）或非炎症性（含牙囊肿）。根尖周炎是牙髓坏死和根管感染导致根尖肉芽肿或根尖囊肿形成。肉芽肿和囊肿形成的免疫学很重要，因为现代根管充填材料具有免疫活性，可以促进根尖肉芽肿的消退。相比之下，根尖囊肿通常需要根尖切除术。更好地了解根尖周炎炎症和骨吸收的病理生理学可能为开发具有更好免疫调节特性的新型根管充填材料奠定基础。
本研究分析了 41 个根尖肉芽肿、23 个根尖囊肿和 23 个含牙囊肿。制作了 87 例连续标本的组织微阵列，并通过免疫组织化学检测人类白细胞抗原-DR 同种型（HLA-DR）、CD83、核因子 κB 配体受体激活剂、巨噬细胞集落刺激因子（MCSF）、半乳糖凝集素-3（Gal3）、CD4 和 CD8 阳性细胞。组织微阵列进行数字化，定量评估标记物的表达。
与根尖肉芽肿相比，根尖囊肿中 HLA-DR、CD83、MCSF 和 Gal3 的表达显著（P <.05）升高。与根尖周炎相比，含牙囊肿中 HLA-DR、CD83、MCSF、核因子 κB 配体受体激活剂和 Gal3 的表达显著（P <.05）降低。根尖肉芽肿和根尖囊肿之间 CD4 和 CD8 浸润无统计学差异。含牙囊肿的 T 细胞浸润明显低于根尖周炎（P <.05）。分析组之间的 CD4/CD8 比值无显著差异。
根尖周炎中根尖囊肿的形成与髓系炎症标志物和骨吸收参数表达增加有关。抗原呈递细胞和髓系细胞可能比 T 细胞更与根尖周炎的发病机制相关。炎症的增加可能促进根尖囊肿的形成和更明显的骨吸收。
