Incidência de anormalidades histológicas em tecido correspondente ao espaço pericoronário de terceiros molares inclusos e semi-inclusos
Incidence of the so tissue changes around unerupted or impacted third molars
Dutra, Kamile Leonardi; Rojas, Elisabete Ulsenheimer; Modolo, Filipe; Rivero, Elena Riet C.; Rodrigues Filho, Rubens
Resumo
Introdução: O Folículo Pericoronário envolve a coroa do germe dental durante seu desenvolvimento. Quando o dente permanece incluso, alterações do folículo podem originar doenças, como cistos e tumores odontogênicos. Objetivo: Analisar as alterações histológicas no tecido mole circundante a terceiros molares inclusos e semiinclusos, independentemente de alterações patológicas aparentes em suas radiografias correspondentes, além de relacionar o diagnóstico histológico com o diagnóstico radiográfico dos casos. Material e método: A partir de terceiros molares extraídos de 26 pacientes, foram analisados espécimes histológicos de folículos pericoronários por dois examinadores calibrados. O diagnóstico histopatológico obtido foi relacionado ao radiográfico, sendo este realizado por meio de radiografias periapicais e, quando necessário, complementado por radiografias panorâmicas. Resultado: Dos 37 folículos pericoronários avaliados, 30% mostraram alterações histológicas compatíveis com cistos dentígeros; 51% eram folículos normais, e 19% continham apenas fragmentos de mucosa. Radiograficamente, 100% dos casos demonstraram características de folículos sem alterações. Conclusão: Esses dados exemplificam que anormalidades podem estar presentes nos tecidos pericoronários sem que haja evidências clínicas e radiográficas. O exame histopatológico provê um diagnóstico mais preciso e deve ser considerado para a construção do diagnóstico definitivo.
Palavras-chave
Abstract
Introduction: Dental follicles remain adjacent to the crown of an unerupted or impacted tooth. Changes in dental follicles can occur and form a solitary cyst around the crown of the tooth, deemed dentigerous cysts. Objective: The aim of this study was to determine the incidence of soft tissue changes around unerupted or impacted third molars. Material and method: Pericoronal tissue of patients who were referred to our clinic for removal of third molars for a variety of reasons was examined histopathologically. Follicular spaces were measured from periapical and panoramic radiographs by each author independently. Result: Of the 37 specimens submitted for histopathologic examination, 19 normal follicular tissues (51%), 11 arrangements typical of a cyst (30%) and 7 normal tissues of oral mucous (11%) were found. Conclusion: Cystic changes may be encountered in the histopathologic examination of radiographically normal unerupted or impacted third molar follicles.
Keywords
References
1. Chu FC, Li TK, Lui VK, Newsome PR, Chow RL, Cheung LK. Prevalence of impacted teeth and associated pathologies: a radiographic study of the Hong Kong Chinese population. Hong Kong Med J. 2003 June;9(3):158-63. PMid:12777649.
2. Lautenschläger GA, Gallina MC, Ferreira Júnior O, Lara VS. Primary failure of tooth eruption associated with secondarily inflamed dental follicle: inflammatory follicular cyst? Braz Dent J. 2007; 18(2):144-7. http://dx.doi.org/10.1590/S0103-64402007000200011. PMid:17982555
3. Damante JH, Fleury RN. Contribuição para o diagnóstico do pequeno cisto dentígero ou do cisto paradentário. Pesqui Odontol Bras. 2001; 15(3):238-46. PMid:11705271.
4. Ohshima A, Ariji Y, Goto M, Izumi M, Naitoh M, Kurita K, et al. Anatomical considerations for the spread of odontogenic infection originating from the pericoronitis of impacted mandibular third molar: computed tomographic analyses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 November;98(5):589-97. http://dx.doi.org/10.1016/j.tripleo.2004.07.012. PMid:15529132
5. Curran AE, Damm DD, Drummond JF. Pathologically significant pericoronal lesions in adults: Histopathologic evaluation. J Oral Maxillofac Surg. 2002 June;60(6):613-7. http://dx.doi.org/10.1053/joms.2002.33103. PMid:12022092
6. Razavi SM, Hasheminia D, Mehdizade M, Movahedian B, Keshani F. The relation of pericoronal third molar follicle dimension and bcl-2/ki-67 expression: An immunohistochemical study. Dent Res J. 2012 December;9(Suppl 1):S26-31. http://dx.doi.org/10.4103/1735-3327.107931. PMid:23814558.
7. Tegginamani AS, Prasad R. Histopathologic evaluation of follicular tissues associated with impacted lower third molars. J Oral Maxillofac Pathol. 2013 January;17(1):41-4. http://dx.doi.org/10.4103/0973-029X.110713. PMid:23798828
8. Neville BW, Damm DD, Allen CM, Bouquot JE. Patologia oral e maxilofacial. Rio de Janeiro: Guanabara Koogan; 2004.
9. Carli JP, Colpani JT, Linden MSS, Moraes NP, Damian MF, Silva SO. Relação diagnóstica entre folículo pericoronário e cisto dentígero. Rev Gaucha Odontol. 2010 April-June;58(2):207-13.
10. Nolla C. The development of permanent teeth. ASDC J Dent Child. 1960; 27:254-66.
11. Adelsperger J, Campbell JH, Coates DB, Summerlin DJ, Tomich CE. Early soft tissue pathosis associated with impacted third molars without pericoronal radiolucency. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 April;89(4):402-6. http://dx.doi.org/10.1016/S1079-2104(00)70119-3. PMid:10760721
12. Kim J, Ellis GL. Dental follicular tissue: misinterpretation as odontogenic tumors. J Oral Maxillofac Surg. 1993 July;51(7):762-7, discussion 767-8. http://dx.doi.org/10.1016/S0278-2391(10)80417-3. PMid:8509916
13. Lara HRO. Contribuição ao estudo da correlação entre a imagem radiográfica e o aspecto histológico dos sacos pericoronários normais e dos cistos dentígeros [tese]. Porto Alegre: Faculdade de Odontologia, Universidade Católica do Rio Grande do Sul; 1982.
14. Baykul T, Saglam AA, Aydin U, Başak K. Incidence of cystic changes in radiographically normal impacted lower third molar follicles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 May;99(5):542-5. http://dx.doi.org/10.1016/j.tripleo.2004.08.010. PMid:15829874
15. Knights EM, Brokaw WC, Kessler HP. The incidence of dentigerous cysts associated with a random sampling of unerupted third molars. Gen Dent. 1991; 39:96-8.
16. Daley TD, Wysocki GP. The small dentigerous cyst: a diagnostic dilemma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995 January;79(1):77-81. http://dx.doi.org/10.1016/S1079-2104(05)80078-2. PMid:7614167
17. Kramer IR, Pindborg JJ, Shear M. The WHO histological typing of odontogenic tumours. A commentary on the Second Edition. Cancer. 1992 December;70(12):2988-94. http://dx.doi.org/10.1002/1097-0142(19921215)70:12<2988::AID-CNCR2820701242>3.0.CO;2-V. PMid:1451083
18. Glosser JW, Campbell JH. Pathologic change in soft tissues associated with radiographically ‘normal’ third molar impactions. Br J Oral Maxillofac Surg. 1999 August;37(4):259-60. http://dx.doi.org/10.1054/bjom.1999.0061. PMid:10475645
19. Knutsson K, Brehmer B, Lysell L, Rohlin M. Pathoses associated with mandibular third molars subjected to removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 July;82(1):10-7. http://dx.doi.org/10.1016/S1079-2104(96)80371-4. PMid:8843448
20. Stathopoulos P, Mezitis M, Kappatos C, Titsinides S, Stylogianni E. Cysts and tumors associated with impacted third molars: is prophylactic removal justified? J Oral Maxillofac Surg. 2011 February;69(2):405-8. http://dx.doi.org/10.1016/j.joms.2010.05.025. PMid:21050646
21. Baykul T, Saglam AA, Aydin U, Başak K. Incidence of cystic changes in radiographically normal impacted lower third molar follicles. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 May;99(5):542-5. http://dx.doi.org/10.1016/j.tripleo.2004.08.010. PMid:15829874
22. Saravana GH, Subhashraj K. Cystic changes in dental follicle associated with radiographically normal impacted mandibular third molar. Br J Oral Maxillofac Surg. 2008 October;46(7):552-3. http://dx.doi.org/10.1016/j.bjoms.2008.02.008. PMid:18406023
23. Chrcanovic BR, Freire-Maia B, Gomez RS. Small central odontogenic fibroma mimicking hyperplastic dental follicle and dentigerous cyst. J Maxillofac Oral Surg. 2014 September;13(3):332-6. http://dx.doi.org/10.1007/s12663-011-0221-1. PMid:25018609
24. Edamatsu M, Kumamoto H, Ooya K, Echigo S. Apoptosis-related factors in the epithelial components of dental follicles and dentigerous cysts associated with impacted third molars of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 January;99(1):17-23. http://dx.doi.org/10.1016/j.tripleo.2004.04.016. PMid:15599344
25. Mesgarzadeh AH, Esmailzadeh H, Abdolrahimi M, Shahamfar M. Pathosis associated with radiographically normal follicular tissues in third molar impactions: a clinicopathological study. Indian J Dent Res. 2008 July-September;19(3):208-12. http://dx.doi.org/10.4103/0970-9290.42952. PMid:18797096
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email