Correlation between histology and radiography in the assessment of healing after endodontic surgery

By Andreasen JO, Rud J

Date: 07/1972
Journal: Oral Surg Oral Med Oral Patho

Summary: 

•Purpose:  to correlate histological and radiographical findings after endodontic surgery.

•Materials/Methods:

n: 70 biopsy of apices and PA tissue  (35 Max. laterals) were investigated by both methods (histological sections and RG examination). Specimens were divided according to degree of inflammation: Mild: <105 μ m2 – Moderate: from 105 μ m2 to 3X105 μ  m2 -Severe: >105 μ  m2 . Radiographic material consisted of periapical orthoradial projections (straight) taken immediately before and after surgery.

Most highlighted Results:   

⁻PARL of ≥ twice the size of a normal PDL space was mostly with moderate to severe inflammation. If it’s with no to mild inflammation it showed fibrous scar tissue.

⁻Fibrous scar tissue was found in all groups but sig less in the severe inflammation group only 25%.

⁻Scar tissue was found in 90% of decreasing PAL (no to mild inflammation) and 60% of cases with no scar tissue had remained stationary PAL or increased.

⁻The outline of rarefaction of no to mild inflammation was irregular in 75% and circular or semi circular in 80% of cases with moderate to severe inflammation.

⁻The radiographical outline was mostly irregular in cases with scar tissue and irregular outline was not found without scar tissue.

⁻Rarefaction was mostly symmetrical in 90% with no scar tissue and 55% symmetrical in cases with scar tissue.

⁻1/3 of cases with scar tissue had no bone within the lesion but bone peripheral to LD increased in 50%.

⁻Cases with no scar tissue had mostly normal bone structure peripheral to LD (increased in only 10%).

⁻In cases with no to mild inflammation 80% with scar tissue showed angular extension to the PDL compared to cases with severe inflammation and no scar tissue all cases showed funnel shaped extension.

⁻A collar shaped increase of the LD was 4 times more likely in  moderate to sever inflammation.

Clinical significance:   

In patients presenting with PAL associated with adequate RCT and obtaining previous Rgs of the lesion is not feasible a clinician can assume the stage of inflammation by the radiographical appearance.

Severe inflammation will show: 1- circular or semi circular PARL; 2-Collar shaped thickness of the LD; 3-Regular outline of the PARL; 4- Symmetrical PARL; 5- Funnel shaped extension of the PARL.