Presence of cholesterol clefts in apical periodontitis lesions is a common histopathological observation. However, a potential aetiological association of cholesterol crystals to non-resolving apical periodontitis lesions after endodontic treatment has been suggested only recently. This article is an attempt to explain the biological basis for the inability of body cells to eliminate the local accumulation of cholesterol crystals, and to consolidate available clinical and experimental data in support of the view that massive accumulation of cholesterol crystals in inflamed periapical tissues can interfere with the periapical healing after conventional root canal treatment. As the irritating cholesterol crystals and certain other aetiological agents of failed endodontic treatment exist outside the root canal system, it is concluded that re-treatment alone, of such cases, is unlikely to resolve the factors that sustain the lesion. Apical surgery is indicated for successful management of such cases.

No abstract

A crypto-lymphatic unit was observed at the left lateral aspect of the uvula of a mature female monkey, Macaca fascicularis. A light- and transmission electron-microscopic investigation revealed that the lumen of the crypt was filled with bacteria, desquamated epithelial cells, lymphocytes and neutrophils. The non-keratinized stratified squamous epithelium of the crypt was fragmented and showed heavy mononuclear cell infiltration and surface discontinuities, exposing lymphoid cells to foreign material. The lymphatic parenchyma consisted of organized lymphatic tissue including germinal centres. The resident cell population included lymphocytes of varying size, blastforming B- and T-lymphocytes and two types of reticular cells resembling the fibroblastic reticulum cell and the follicular dendritic cell, respectively. Occasionally granulocytes were encountered. At its base and laterally the crypto-lymphatic unit was ensheathed by a thin connective tissue capsule. Three other monkeys of the same species failed to reveal similar structures at the same site.