A comparative investigation of cone-beam computed tomography and periapical radiography in the diagnosis of a healthy periapex.

Purpose:

Compare appearance of healthy periapical tissues in cone-beam with PA and measure PDL on CBCT in health vs necrosis

Materials/Methods:

N=200 teeth that had PA, pulp tested, and CBCT from endodontists

  • 2 independent, blind examiners  analyzed the images using a modified CBCT-PAI (CBCT- Periapical Index) score and PAI score for PA radiographs
  • Fisher exact and X(2) analysis for relationships between CBCT-PAI, PAI, and pulp status

Results:

  • 166 out of 200 were vital
  • 72 % CBCT-PAI was greater than PAI in vital teeth with radiographic PDL widening of 0-1 mm (p< 0.001)
  • 2 healthy teeth showed 2-4 mm radiolucencies on CBCT when PA radiograph showed none
  • In 20% of vital teeth had CBCT-PAI of 2+
  • PDL > 1-2 mm was indicative of a necrotic pulp (p< 0.001)

Clinical Significance:

  1. Teeth with necrotic pulps were more likely to have PDL widening
  2. Most healthy teeth showed some widening
  3. The normal 3-dimensional anatomy of the PDL space appears to entail greater variation than previously thoughtà questions traditional radiographic interpretation
  4. CBCT must be further investigated before usage in outcome or epidemiological investigations

Association between chronic apical periodontitis and coronary artery disease.

Purpose:

Investigate if there an association between chronic apical periodontitis and coronary artery disease

Materials/Methods:

N=103 patients underwent coronary angiography (52 men, 51 women; mean age 62)

Prevalence of Chronic apical periodontitis (CAP)- 41.7 % and Coronary Artery Disease (CAD)- 65 % (Patients were categorized having  CAD if they had coronary artery obstruction > 50 % in at least 1 coronary artery)

Exclusion criteria: > 2 months after exam.

Evaluation: Angiography and full mouth series of radiographs

Results:

Patients with CAP had a 2.79 times higher risk of developing CAD

Clinical Significance:

In these patients, the presence of CAP was independently associated with CAD

Polymorphism of the CD14 and TLR4 genes and post-treatment apical periodontitis.

Purpose:

  • Investigate the association of CD14 -260C>T and TLR4 +896A>G gene polymorphisms with post-treatment apical periodontitis in Brazilian individuals.

Materials/Methods:

  • N= 41 patients with post-treatment apical periodontitis and 42 individuals with root canal–treated teeth exhibiting healed/healing periradiculartissues (controls).
  • Inclusion criteria: 1 tooth with endodontic treatment ranked as adequate. Treated teeth had coronal restorations
  • ranked as adequate. All patients from Rio de Janeiro.
  • Exclusion criteria: No RCT, not adequate RCT/coronal restoration.
  • Positive/negative control: Patients who received RCT and exhibited healing periapical tissues.
  • Design: Saliva was collected from the participants; DNA was extracted and used for CD14 and TLR4 genotyping using the polymerase chain reaction–restriction fragment length polymorphism approach and a real-time PCR TaqMan assay.
  • Criteria of evaluation: Periapicalhealing, TLR4/CD14 genotype differences

Results:

  • No specific genotype or allele of the CD14 and TLR4 genes was positively associated with post-treatment apical periodontitis (P > .05).

Clinical Significance:

Data from the study suggests that polymorphisms in the CD14 and TLR4 genes do not influence the response to endodontic treatment of teeth with apical periodontitis.

Revascularization Outcomes: A Prospective Analysis of 16 Consecutive Cases

Purpose:

  • Present a preliminary prospective analysis of 16 teeth in 12 consecutive patients where a standardized protocol for regenerative endodontic procedure was undertaken for the treatment of immature infected teeth.

Materials/Methods:

  • N= n=16 teeth (13 incisors, 3 PM’s) – Ave age 10 yo.
  • Exclusion criteria: Closed apex and any longitudinal fracture of the root.
  • Inclusion criteria: Open apex that was considered as greater than 1.1 mm in diameter.
  • Positive/negative control: N/A
  • Control & Design: Tooth accessed, WL confirmed w/apex locator and radiograph. Irrigation w/1% NaOCl2 mm short of WL. Canal dried w/paper points. TAP (metro, cipro, amox – mixed w/1mL sterile water) placed with lentulo. Canal filled below CEJ. 4 mm Cavit w/Fuji IX placed as temp.
  • Teeth reviewed 4 wks later. Re-access, irrigated, dried w/paper points. Where possible, blood was allowed to clot to a level 3mm below the CEJ. 3mm white MTA placed onto clot. Access sealed w/3mm GI.
  • The teeth were reviewed 6 months after access closure for at least 18 months.
  • Qualitative and Quantitative analyses used to determine change in root, dentin thickness.
  • Criteria of evaluation: TurboReg plug-in used to evaluate change in root length, width

Results:

  • Qualitative assessment:
    • 90.3% resolution of PA radiolucency
    • Apical closure assessed as incomplete in 47.2% and complete apical closure in 19.4%
  • Quantitative assessment:
    • Change in root length: -2.7% to 25.3%
    • Change in dentin thickness: -1.9% to 72.6%
    • Discoloration was common result, w/unaesthetic results in 10/16 cases
    • 2 cases continued root development through 36 mo’s

Clinical Significance:

The results of this study have showed that the pattern for further root maturation of roots after regenerative procedures was variable when assessed at 18 months, although in almost all cases, periapical pathology appeared to resolve completely.

Agreement between periapical radiographs and cone-beam computed tomography for assessment of periapical status of root filled molar teeth.

Purpose:

To assess the agreement between periapical radiograph (PA) and cone-beam computed tomography (CBCT) for periapical assessment of root filled maxillary and mandibular molars.

Materials/Methods:

  • N= 60 teeth
  • Exclusion criteria: N/A
  • Inclusion criteria: Patients who had received RCT of max/mand molar in a dental teaching hospital between 2001-2005.
  • Positive/negative control: N/A
  • Control & Design: Patients were recalled that had RCT performed between 2001-2005. One intraoral paralleling radiograph  w/size 2 x-ray film and XCP. In-house CBCT was then performed. 2 Pre-calibrated examiners (Endodontist, Oral radiologist) then examined the films. PA’s were measured using stainless steel ruler. CBCT images assessed using iCAT Vision.
  • Criteria of evaluation: Mean difference in (i) number of canals per tooth, (ii) number of lesions per tooth, (iii) M-D diameter of lesions, (iv) C-A diameter of lesions and (v) number of ‘J’ shaped lesions was compared.

Results:

  • No significant differences between Endodontist and Radiologist findings
  • Significant differences in: mean number of canals identified, mean number of lesions identified, size of lesions  (M/D, C/A), J shape lesions (few cases).
  • Discrepancy more pronounced in maxillary molars in terms of presence/size of lesion

Clinical Significance:

CBCT has some obvious advantages to PA in terms of identification of lesions/canals. Consideration need be given to exposure vs. benefit however. Also, the study is limited due to only having one endodontist/radiologist and could benefit from an increased sample size.