Radiographic Markers in Periapical Actinomycosis Infections: Characterizing Potentially Helpful Features in Clinical Practice

Abstract

OBJECTIVES

To identify helpful radiographic features of actinomyces-infected periapical inflammatory lesions for potential application in early diagnosis.

METHODS

A retrospective pilot study was approved by the AU IRB and included 16 cases of periapical inflammatory lesions treated endodontically with subsequent apicoectomy, seven of which had actinomyces (group A), and nine that did not (group B), as determined histopathologically. The features of lesions in periapical radiographs, including location, borders, shape, symmetry, and evidence of encroachment on the PDL of adjacent roots, were evaluated and tabulated.

RESULTS

(If applicable) Group A cases involved four anterior and three posterior teeth. Group B cases were associated with one anterior and eight posterior teeth. The borders in both groups varied between ill-defined, sclerotic, corticated, and mixed corticated and sclerotic. All group A lesions were irregular and asymmetric, while seven out of nine group B cases were symmetric. Moreover, all group A cases encroached on the PDL of adjacent teeth, but none of group B cases did so.

CONCLUSIONS

The small pilot study revealed some differences between the radiographic features of periapical inflammatory lesions associated with actinomyces as compared to those without actinomyces. A “blinded” study of periapical radiographs is currently in progress to test the validity of radiographic features identified in the pilot study.

IMPLICATIONS

Current literature suggests that the clinical and radiographic features of apical actinomycosis are often indistinguishable from conventional apical periodontitis. However, this small pilot study revealed radiographic patterns that may help distinguish between such lesions. Practical implications of this study may include new guidance for clinical decision making by creating a reliable basis for deciding between conservative vs. surgical management of persistent periapical lesions.