Incidence of cholesterol in periapical biopsies among adolescent and elderly patients.

By Slutzky-Goldberg I, Baev V, Volkov A, Zini A, Tsesis I.

Date: 01/2013
Journal: JOE


  • To evaluate if age is also linked to cholesterol deposition in periapical periodontitis.


  • N= 89 cases (41 adolescents, 48 elderly) obtained from biopsy reports from 2006-2009.
  • Exclusion criteria: Patients not falling in selected age groups. Not diagnosed as periapical cyst/granuloma.
  • Inclusion criteria: Biopsyreportreturned as  periapicalcystor granuloma. Adolescent= 13-21 yo. Elderly =  >60yo.
  • Positive/negative control: N/A
  • Control & Design: In initial examination, formalin-fixed biopsies were stained with hematoxylin-eosin and examined under a light microscope. The presence or absence of cholesterol clefts and foamy macrophages was recorded for each specimen.
  • Criteria of evaluation: Cholesterol cleft presence, age, gender.


  • Higher incidence of cholesterol found in elderly group
  • (Odds Ratio = 6.857)
  • No statistical significance for differences in foamy cells.
  • No difference b/w genders for cholesterol presence
  • FYI: Cholesterol crystals are believed to be released from erythrocytes of stagnant blood vessels within a lesion, dying immune cells, and circulating plasma lipids.
  • Once the cholesterol crystals have been deposited, they act as irritants and cause a foreign-body reaction.
  • Macrophages and giant cells attempt to engulf the cholesterol crystals but are unable to degrade the crystalline cholesterol.

Clinical Significance:

Higher incidence of cholesterol in the elderly group may indicate that the probability of healing periapical lesions in this age group would be lower after root canal treatment compared with that in the treatment of adolescents.