Boonkasemsanti Weeraya, Padungkarn Chavisa, Tewtipsakul Saruth, Phattarataratip Ekarat
Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.
Int Endod J. 2025 Oct;58(10):1582-1593. doi: 10.1111/iej.14278. Epub 2025 Jul 1.
Endodontic periapical lesions are prevalent in routine dental practice, yet a substantial proportion of these lesions may not be directly attributable to pulpal infection. This study aimed to assess the diagnostic accuracy of periapical lesions and the prevalence and demographic profiles of nonendodontic lesions misdiagnosed as endodontic in origin.
The clinical and pathologic diagnoses of periapical lesions associated with the apex of nonvital or endodontically treated teeth over a 20-year period were systematically collected. These diagnoses were categorized into endodontic and nonendodontic lesions. Endodontic diagnoses included radicular cyst, periapical granuloma, periapical abscess and periapical scar. The diagnostic accuracy, receiver operating characteristics curves and the differences in clinical characteristics of these lesions were subsequently analysed. Additionally, the frequency and clinical data of nonendodontic periapical lesions were tabulated.
Of the 1611 periapical lesions included, 1521 cases (94.4%) were endodontic lesions, whilst 90 cases (5.6%) were nonendodontic in origin. The overall diagnostic accuracy was 91.4%, with areas under curve (AUCs) for diagnosing endodontic and nonendodontic periapical lesions being 0.955 and 0.767, respectively. Clinicians correctly diagnosed endodontic lesions with 95.5% sensitivity, whilst the specificity of diagnosing nonendodontic lesions was 23.3%. Endodontic lesions exhibited a significantly higher prevalence of cases presenting with a size less than 2 cm, exhibiting no swelling and presenting with a rounded radiographic appearance. The frequency of nonendodontic periapical lesions clinically misdiagnosed as endodontic in origin was 69 out of a total sample of 1521 (4.5%). Most lesions (47.8%) affected the anterior maxilla. Odontogenic keratocyst (27.5%) and ameloblastoma (24.6%) were the most common pathoses mimicking endodontic lesions clinically. Malignant neoplasms constitute 5.8% of all nonendodontic periapical lesions, the most common of which were intraosseous squamous cell carcinoma.
Despite the high overall diagnostic accuracy, the specificity of recognizing nonendodontic periapical lesions is relatively low. Clinicians often overdiagnose endodontic lesions clinically. In the presence of periapical lesions with a diameter of 2 cm or more, clinical swelling or a nonrounded radiographic appearance, clinicians should consider the possibility of nonendodontic lesions. Diverse benign and malignant conditions can mimic endodontic pathoses. Tissue biopsy is indispensable for accurate and timely management.
牙髓根尖周病变在常规牙科诊疗中很常见，但这些病变中有很大一部分可能并非直接由牙髓感染引起。本研究旨在评估根尖周病变的诊断准确性以及被误诊为牙髓源性的非牙髓性病变的患病率和人口统计学特征。
系统收集了20年间与无活力或已进行牙髓治疗牙齿根尖相关的根尖周病变的临床和病理诊断。这些诊断被分为牙髓性和非牙髓性病变。牙髓性诊断包括根端囊肿、根尖肉芽肿、根尖脓肿和根尖瘢痕。随后分析了这些病变的诊断准确性、受试者工作特征曲线以及临床特征的差异。此外，还列出了非牙髓性根尖周病变的频率和临床数据。
在纳入的1611例根尖周病变中，1521例（94.4%）为牙髓性病变，而90例（5.6%）为非牙髓源性。总体诊断准确性为91.4%，诊断牙髓性和非牙髓性根尖周病变的曲线下面积（AUC）分别为0.955和0.767。临床医生诊断牙髓性病变的敏感性为95.5%，而诊断非牙髓性病变的特异性为23.3%。牙髓性病变在病变大小小于2cm、无肿胀且影像学表现为圆形的病例中患病率显著更高。在总共1521例样本中，临床上被误诊为牙髓源性的非牙髓性根尖周病变的频率为69例（4.5%）。大多数病变（47.8%）累及上颌前部。牙源性角化囊肿（27.5%）和成釉细胞瘤（24.6%）是临床上最常见的模拟牙髓性病变的疾病。恶性肿瘤占所有非牙髓性根尖周病变的5.8%，其中最常见的是骨内鳞状细胞癌。
尽管总体诊断准确性较高，但识别非牙髓性根尖周病变的特异性相对较低。临床医生在临床上常过度诊断牙髓性病变。对于直径2cm或更大、有临床肿胀或影像学表现非圆形的根尖周病变，临床医生应考虑非牙髓性病变的可能性。多种良性和恶性疾病可模拟牙髓性病变。组织活检对于准确及时的治疗必不可少。
