The importance of histopathologic diagnosis in the treatment of periapical lesions: a retrospective study.

OBJECTIVES

This study evaluates the implications of clinical and radiographic diagnostic errors on the treatment of non-endodontic and truly endodontic periapical lesions, as determined by histopathologic findings.

STUDY

DESIGN

A retrospective review was conducted on 236 histopathological reports of periapical lesions collected via apical surgery, extraction, or cystectomy (2020-2024). Clinical diagnoses based on 2-dimensional radiographs and CBCT were compared with histopathological results. Cases with soft tissue lesions, lesions with no detectable radiographic findings, or non-periapical pathoses were excluded. Data were categorized and statistically analyzed to determine diagnostic accuracy.

RESULTS

Of 236 cases, 136 (57.62%) were of endodontic origin (apical granulomas and radicular cysts), while 100 (42.37%) were nonendodontic, including 56 (23.73%) odontogenic cysts, 18 (7.63%) tumors, 16 (6.78%) non-odontogenic cysts, and 10 (4.24%) fibro-osseous lesions. Misdiagnosis led to inappropriate treatments such as unnecessary extractions or ineffective root canal therapy. CBCT with histopathological confirmation significantly improved diagnostic precision. Notably, 63 (26.79%) of teeth linked to odontogenic cysts were vital, indicating that root canal therapy was unwarranted.

CONCLUSIONS

Based on the findings of this retrospective study, a substantial proportion of periapical lesions are non-endodontic, emphasizing the importance of clinical evaluation, including vitality testing, alongside imaging in the differential diagnosis as opposed to reliance on imaging alone. Reliance solely on imaging can cause treatment errors. Improved protocols and further research are essential to optimize outcomes.