A correlation between clinical and pathohistological diagnosis of chronic periapical lesions

The diagnosis of periapical lesion is based on clinical signs and radiographic presentations, which are only empiric methods. The final confirmatory diagnosis is performed only by histopathological examination of the tissues The aim of the present study was to determine the types of periapical lesions in teeth treated with periapical surgery and to evaluate the correlation between clinical and histopathological diagnoses of chronic periapical inflammatory lesions. Methods: Anamnestic data were taken from each subject comprised in the study and clinical examination and radiography was performed. Chronic periapical tissues were collected during periapical surgery from 80 teeth with clinically and radiographically verified different chronic periapical lesions (43 granulomas, 17 diffuse periapical lesions and 20 cysts). After root-end resection, the root tip was removed together with the periapical pathological tissue and processed for histological and pathological definition by light microscopy analysis on standard paraffin and semithin cross sections. Results: Histological analysis revealed five categories of inflammatory response: granulomas were registered in 56.3%, 16.3% were cystic lesions, 13.8% were periapical abscesses, 8.8% diffuse chronic inflammations and in 5% periapical scar tissues were found. Correlation between clinical and histopathological diagnoses was not significant (2= 4,9 d.f=8 p=0,76) and clinical examination was pathohistologically confirm only in 50% of cases. Conclusions: Histopathological studied of the specimens showed that there was no obligate correlation between the types of lesions and the clinical signs and symptoms of the patients. Key words: clinical diagnosis, periapical lesion, periapical granuloma, radicular cyst, diffuse chronic inflammation , scar tissue