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Mostafapoor M, Hemmatian S. Evaluation of the accuracy values of cone-beam CT regarding apical periodontitis: a systematic review and meta-analysis. Oral Radiol 2021; 38:309-314. [PMID: 34176005 DOI: 10.1007/s11282-021-00549-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/19/2021] [Indexed: 11/24/2022]
Abstract
Specialists need to know how accurate and effective each radiographic procedure is, and which ones can provide better images for bone resorption around the apical periodontitis. Therefore, the researcher decided to conduct the present study with the aim of evaluate the accuracy values of cone-beam CT regarding apical periodontitis. The PubMed, Embase, ISI, Scopus, and Medicine have been used to search articles over the last 15 years between 2005 and December 2020. Meta-analysis data with 95% confidence interval (CI), Random effect model, and restricted maximum-likelihood methods were calculated. Random effects were used to deal with potential heterogeneity and I2 showed heterogeneity. I2 values above 50% signified moderate-to-high heterogeneity. The meta-analysis has been evaluated with the statistical software Stata/MP v.16 (The fastest version of Stata). One hundred and fifty-eight studies were selected to review the abstracts, six papers met these crucial criteria to do a systematic review and meta-analysis. Sensitivity and specificity of digital periapical radiography was 50% (ES 0.50; 95% CI 0.05, 0.95) and 83% (ES 0.83; 95% CI 0.52, 1.15), respectively. Sensitivity and specificity of cone-beam computed tomographic was 95% (ES 0.95; 95% CI 0.80, 1.00) and 90% (ES 0.90; 95% CI 0.78, 1.03), respectively. In conclusion, CBCT imaging reports values with excellent accuracy vs digital periapical radiography.
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Affiliation(s)
- Marjan Mostafapoor
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Sahar Hemmatian
- Department of Periodontics, School of Dentistry, Hamedan University of Medical Sciences, Hamedan, Iran.
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Aminoshariae A, Kulild J, Nagendrababu V. Artificial Intelligence in Endodontics: Current Applications and Future Directions. J Endod 2021; 47:1352-1357. [PMID: 34119562 DOI: 10.1016/j.joen.2021.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) has the potential to replicate human intelligence to perform prediction and complex decision making in health care and has significantly increased its presence and relevance in various tasks and applications in dentistry, especially endodontics. The aim of this review was to discuss the current endodontic applications of AI and potential future directions. METHODS Articles that have addressed the applications of AI in endodontics were evaluated for information pertinent to include in this narrative review. RESULTS AI models (eg, convolutional neural networks and/or artificial neural networks) have demonstrated various applications in endodontics such as studying root canal system anatomy, detecting periapical lesions and root fractures, determining working length measurements, predicting the viability of dental pulp stem cells, and predicting the success of retreatment procedures. The future of this technology was discussed in light of helping with scheduling, treating patients, drug-drug interactions, diagnosis with prognostic values, and robotic-assisted endodontic surgery. CONCLUSIONS AI demonstrated accuracy and precision in terms of detection, determination, and disease prediction in endodontics. AI can contribute to the improvement of diagnosis and treatment that can lead to an increase in the success of endodontic treatment outcomes. However, it is still necessary to further verify the reliability, applicability, and cost-effectiveness of AI models before transferring these models into day-to-day clinical practice.
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Affiliation(s)
- Anita Aminoshariae
- Department of Endodontics, Case School of Dental Medicine, Cleveland, Ohio.
| | - Jim Kulild
- Department of Endodontics, University of Missouri-Kansas City School of Dentistry, Kansas City, Missouri
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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Mota de Almeida FJ, Hassan D, Nasir Abdulrahman G, Brundin M, Romani Vestman N. CBCT influences endodontic therapeutic decision-making in immature traumatized teeth with suspected pulp necrosis: a before-after study. Dentomaxillofac Radiol 2021; 50:20200594. [PMID: 34086502 DOI: 10.1259/dmfr.20200594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To evaluate the impact of cone-beam computed tomography (CBCT) in endodontic therapeutic decision-making of immature traumatized teeth with suspected pulp necrosis. METHODS Over two years, consecutive patients with a dental trauma in their front teeth (apex >0.5 mm) and with suspected pulp necrosis based on clinical and radiographic findings were referred to a specialist clinic in Sweden. Fifteen patients aged 6-13 (18 teeth) were included and clinically examined by an endodontist. Intraoral radiographs and CBCT examinations were obtained. Five practitioners, three endodontists and two residents in endodontics, used these examinations to determine the most appropriate treatment for the 18 cases (all central incisors) on two occasions scheduled 19 weeks apart. On the first occasion, the practitioners had access to clinical information and the intraoral radiographs ('before' CBCT); on the second occasion, the practitioners had also access to a radiologist report and the CBCT images ('after' CBCT). Their treatment plans - no treatment, watchful waiting, endodontic orthograde treatment, or extraction - were made anonymously and independently. Results were analysed using descriptive statistics and Wilcoxon signed-rank test. RESULTS 'After' CBCT, practitioners changed treatment plans in 30% of the 90 assessments, 74% of which were more aggressive (p = 0.028). In 49% of the assessments, practitioners who chose the watchful and waiting treatment plan 'before' CBCT changed to a more aggressive therapy such as endodontic orthograde treatment and extraction 'after' CBCT (p = 0.005). CONCLUSION This study provides evidence that CBCT influences endodontic therapeutic decision-making regarding immature traumatised teeth with suspected pulp necrosis, chiefly when expectant management (i.e., watchful and waiting) was selected before access to CBCT.
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Affiliation(s)
| | - Dalya Hassan
- Department of Odontology, Umeå University, Umeå, Sweden
| | | | - Malin Brundin
- Department of Odontology, Umeå University, Umeå, Sweden
| | - Nelly Romani Vestman
- Department of Endodontics, Region of Västerbotten, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
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Peršić Bukmir R, Paljević E, Pezelj-Ribarić S, Brekalo Pršo I. Coronal Restoration as a Predictor of Periapical Disease in Non-Endodontically Treated Teeth. Acta Stomatol Croat 2021; 55:56-68. [PMID: 33867538 PMCID: PMC8033623 DOI: 10.15644/asc55/1/7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives To compare the frequency of apical periodontitis (AP) in non-endodontically treated teeth restored with full coverage crowns, amalgam and resin composite fillings, and to disclose the association of type and quality of coronal restoration with periapical disease. Material and Methods The cross-sectional study involved 597 subjects who attended the Dental Clinic of the Clinical Hospital Centre, Rijeka, Croatia for the first time. Data were collected by means of a clinical and radiological survey. The following data were recorded for all permanently restored non-endodontically treated teeth: the type, the quality of coronal restoration according to clinical and radiographic criteria for marginal integrity as well as the recurrent caries presence, periapical status and marginal bone loss. Chi-square tests were used to analyze the difference in periapical status regarding the type and the quality of restoration. The multivariate logistic regression analysis was used to assess the effect of explanatory tooth-specific variables on periapical status. Results There was no significant difference in the proportion of AP with regards to the type and material of adequate quality coronal restorations (χ2=5.000, P=0.082). The regression analysis revealed significant positive associations with outcome variable (AP) for crowns (OR=3.39; P<0.001), recurrent caries (OR=4.67; P<0.001) and premolar teeth (OR=1.73; P=0.002). Conclusion If the quality of restorations is adequate, there is no difference in the periapical status of non-endodontically treated teeth regarding the type and material of coronal restoration.
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Affiliation(s)
- Romana Peršić Bukmir
- Department of Endodontics and Restorative Dentistry, Rijeka Clinical Hospital Centre, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Ema Paljević
- Department of Endodontics and Restorative Dentistry, Rijeka Clinical Hospital Centre, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Sonja Pezelj-Ribarić
- Department of Oral Medicine and Periodontology, Rijeka Clinical Hospital Centre, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
| | - Ivana Brekalo Pršo
- Department of Endodontics and Restorative Dentistry, Rijeka Clinical Hospital Centre, Faculty of Dental Medicine, University of Rijeka, Rijeka, Croatia
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Van Gorp G, Lambrechts M, Jacobs R, Declerck D. Paediatric dentist's ability to detect and diagnose dental trauma using 2D versus 3D imaging. Eur Arch Paediatr Dent 2021; 22:699-705. [PMID: 33713318 DOI: 10.1007/s40368-021-00611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visualisation of the third dimension has been reported to increase effectiveness of correctly diagnosing traumatic dental injuries. AIM To assess the ability of paediatric dentists to detect and diagnose Traumatic Dental Injuries (TDI) using two different imaging modalities, intraoral radiographs (2D) and CBCT scans (3D). In addition, observer's confidence regarding the obtained diagnosis, using either technique, was assessed. MATERIAL AND METHODS Both 2D and 3D images of 20 dental trauma cases in children were presented in random order to a panel of thirteen paediatric dentists. Observers received instructions for the screening of the images for radiographic findings related to dental trauma, using structured scoring sheets for 2D and 3D images. Observed data were compared to those recorded by two experienced benchmark observers. A ten-point scale was used for assessing observer's confidence regarding their final diagnosis using 2D versus 3D images. RESULTS Performance of individual observers showed wide variation. Statistical significance was reached for correctly detected and correctly diagnosed findings (p = 0.02), in favor of 3D. Most of the observers reported comparable confidence using 2D and 3D, two observers were more confident using 3D and one observer was more confident using 2D. CONCLUSIONS Paediatric dentist's ability to detect and diagnose findings in patients with TDI was higher on 3D images. Most observers showed a similar confidence score of their diagnostic performance both on 2D and on 3D.
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Affiliation(s)
- G Van Gorp
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium.
| | - M Lambrechts
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium
| | - R Jacobs
- OMFS IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University of Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - D Declerck
- Department of Oral Health Sciences and Department of Dentistry, Unit of Paediatric Dentistry and Special Dental Care, KU Leuven, University Hospitals Leuven, Kapucijnenvoer 7, PO box 7001, B-3000, Leuven, Belgium
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Patel S, Puri T, Mannocci F, Navai A. Diagnosis and Management of Traumatic Dental Injuries Using Intraoral Radiography and Cone-beam Computed Tomography: An In Vivo Investigation. J Endod 2021; 47:914-923. [PMID: 33705831 DOI: 10.1016/j.joen.2021.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/28/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to compare periapical radiographs (PRs) and upper standard occlusal (USO) radiographs with cone-beam computed tomographic (CBCT) imaging on clinicians' confidence in the diagnosis and management of traumatic dental injuries (TDIs). METHODS This study included 35 maxillary anterior teeth from 25 patients with at least 1 PR (parallax view) and a CBCT scan. Fourteen patients also had a USO radiograph. Ten examiners selected a diagnosis and treatment plan, which were compared with a reference standard. Sensitivity, specificity, positive and negative predictor values, and receiver operating characteristic analysis were used to determine the diagnostic accuracy. RESULTS CBCT imaging exhibited significantly higher sensitivity than both conventional radiographic techniques combined (PRs and PRs + USO radiographs) for all diagnoses (TDI: 99% vs 84%, lateral luxation: 80% vs 34%, extrusions: 92% vs 42%, and cortical plate fracture: 58% vs 1%) other than horizontal root fractures in which the results were close to statistical significance (88% vs 69%). CBCT imaging was significantly more accurate for all diagnoses (TDI: 91% vs 70%, lateral luxations: 83% vs 61%, extrusive luxations: 92% vs 68%, alveolar cortical plate fractures: 78% vs 48%, and horizontal root fractures: 93% vs 82%). Examiners had the most confidence with CBCT imaging and the least confidence in diagnosing using PRs + USO radiographs than with PRs alone. Agreement with management plans was significantly better using CBCT imaging compared with PRs and PRs + USO radiographs. CONCLUSIONS CBCT imaging improved the clinical diagnosis of TDIs. The addition of USO radiographs to PRs did not improve the diagnosis of TDIs in this investigation. CBCT imaging improved confidence in the diagnosis of TDI cases and treatment planning compared with conventional radiography.
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Affiliation(s)
- Shanon Patel
- Centre for Oral, Clinical and Translational Science, King's College London Dental Institute, London, United Kingdom; Specialist Practice, London, United Kingdom.
| | - Taranpreet Puri
- Centre for Oral, Clinical and Translational Science, King's College London Dental Institute, London, United Kingdom
| | - Francesco Mannocci
- Centre for Oral, Clinical and Translational Science, King's College London Dental Institute, London, United Kingdom
| | - Aram Navai
- Centre for Oral, Clinical and Translational Science, King's College London Dental Institute, London, United Kingdom
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Yapp KE, Brennan P, Ekpo E. Endodontic disease detection: digital periapical radiography versus cone-beam computed tomography-a systematic review. J Med Imaging (Bellingham) 2021; 8:041205. [PMID: 33644251 PMCID: PMC7904533 DOI: 10.1117/1.jmi.8.4.041205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/28/2021] [Indexed: 02/01/2023] Open
Abstract
Purpose: To assess the comparative diagnostic performance of digital periapical (PA) radiography and cone-beam computed tomography (CBCT) imaging on endodontic disease detection and to provide study methodology and design recommendations for future studies comparing the diagnostic performance of imaging modalities on endodontic disease detection. Approach: A search of the Medline, Embase, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials databases was conducted. Studies that compared the performance of CBCT to digital PA radiography for detecting endodontic disease had an independent reference standard determining the presence of endodontic disease and conducted data analysis including either sensitivity, specificity, receiver operating characteristic (ROC) analysis or free response operating characteristic analysis were included. Of the 20,530 identified studies, only 3 fulfilled the inclusion criteria. Results: Most studies assessed for eligibility were excluded due to limitations and biases in study design-15 of 18 studies had no reference standard. Only one retrospective clinical study reported on the diagnostic performance of CBCT and showed a sensitivity of 86% and specificity of 26%. Two cadaver studies reported sensitivity ranging from 60% to 100%, specificity ranging from 79% to 100%, and an area under the ROC curve of 0.943 for CBCT. The reported sensitivity for digital PA radiography ranged from 27% to 60%, specificity was 99%, and the area under the ROC curve was 0.629. Conclusions: There is a lack of quality evidence and insufficient data to compare diagnostic performance of digital PA and CBCT imaging. This emphasizes the need for well-designed studies to inform clinicians about the relative diagnostic performance of these imaging modalities.
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Affiliation(s)
- Kehn E Yapp
- The University of Sydney, School of Health Sciences, Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Australia
| | - Patrick Brennan
- The University of Sydney, School of Health Sciences, Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Australia
| | - Ernest Ekpo
- The University of Sydney, School of Health Sciences, Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and Health, Australia
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Han Z. Clinical Analysis of Alveolar Bone Changes After Chronic Periodontitis Based on Cone Beam CT (CBCT). JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the diagnosis and treatment of oral diseases, imaging examination is a more important auxiliary method. Among them, the application of digital X-ray examination is the most common. However, because the image information provided by this technology is a two-dimensional model, it is
difficult to obtain a comprehensive image, so there is a missed diagnosis. With the development of imaging technology, cone-beam CT (CBCT) is widely used in the diagnosis and treatment of oral diseases. This is a non-invasive imaging examination. The diagnosis effect is achieved by cone-beam
computed tomography or volume tomography. It has less radiation and low cost. Clear imaging and high spatial resolution. This study compared the diagnostic effect of cone-beam CT and traditional X-ray examination in diseases related to oral medicine to observe the diagnostic superiority of
cone-beam CT. In this study, we can know that 30 patients with periapical periodontal disease have been treated by this technique, and the detection accuracy rate is 100.00%. The damage of the apical root of the patient’s tooth is completely displayed in the image. The measurement results
of the bone defect around the tooth are accurate and space and the location image is presented in front of the doctor, so the detection accuracy of this technology is high. The study found that cone beam CT is effective in the diagnosis and treatment of diseases in oral medicine, and can clearly
show the three-dimensional structure of oral tissue, which is convenient for physicians to observe the shape of the disease and improve the accuracy of disease diagnosis.
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Affiliation(s)
- Zhenghua Han
- College of Stomatology, Sanquan College of Xinxiang Medical College, Xinxiang, Henan 453003, China
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Gaêta-Araujo H, Leite AF, Vasconcelos KDF, Jacobs R. Two decades of research on CBCT imaging in DMFR - an appraisal of scientific evidence. Dentomaxillofac Radiol 2021; 50:20200367. [PMID: 33555198 DOI: 10.1259/dmfr.20200367] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This article aims to appraise how scientific evidence related to CBCT has changed over the years, based on levels of evidence and diagnostic efficacy. METHODS A general search strategy was used in different databases (Pubmed, Embase, and Web of Science) to identify systematic reviews (SRs) on CBCT until November of 2020. The SRs included were divided according to different specialties of dentistry. A critical review of the articles was made, describing the level of evidence and efficacy. RESULTS In total, 75 articles were selected. There was an increase in the number of SRs on CBCT from 2014 onwards, as 83% of the SRs on this topic were published after 2013, and 72% between 2016 and to date. Twenty SRs (27%) performed meta-analysis. Only 28% of the SRs provided a detailed description of CBCT protocols. According to SR evidence, almost all specialties of dentistry have advanced concomitantly with the introduction of CBCT. The majority of SRs were related to clinical applications (level 2 of efficacy), followed by technical parameters (level 1 of efficacy). Only some CBCT models were mentioned in the SRs selected. CONCLUSION Over the course of 20 years, SRs related to CBCT applications for a broad range of dental specialties have been published, with the vast majority of studies at levels 1 and 2 of diagnostic efficacy. Not all CBCT models available on the market have been scientifically validated. At all times, one should remain cautious as such not to simply extrapolate in vitro results to the clinical setting. Also, considering the wide variety of CBCT devices and protocols, reported results should not be overstated or generalized, as outcomes often refer to specific CBCT devices and protocols.
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Affiliation(s)
- Hugo Gaêta-Araujo
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Av. Limeira, 901, 13414-903, Piracicaba, Sao Paulo, Brazil
| | - André Ferreira Leite
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dentistry, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institute, Stockholm, Sweden
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Nosrat A, Verma P, Glass S, Vigliante CE, Price JB. Non-Hodgkin Lymphoma Mimicking Endodontic Lesion: A Case Report with 3-dimensional Analysis, Segmentation, and Printing. J Endod 2021; 47:671-676. [PMID: 33493549 DOI: 10.1016/j.joen.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/12/2021] [Indexed: 12/29/2022]
Abstract
Non-Hodgkin lymphoma (NHL) of the oral cavity can present with pain, swelling and radiolucent lesion mimicking endodontic diseases. This article reports on a case of diffuse large B-cell lymphoma initially diagnosed and treated as periodontal disease and then endodontic disease in the maxillary anterior and premolar area of a 40-year old female. A cone beam computed tomography (CBCT) image of the lesion was taken. The lesion was segmented using Mimics software (Materialise NV, Lueven, Belgium). Three-dimensional models of the tumor were printed. During the surgical phase teeth #4, 6, and 7 were extracted and biopsy samples were obtained. Histopathologic examination showed invasive sheets of large, atypical, basophilic cells strongly and diffusely positive for CD20. Three-dimensional analysis, segmentation, and printing of radiolucent lesions of the jaws assists with differential diagnosis and efficient treatment. Oral health professionals can play a crucial role in the early detection and diagnosis of oral NHL, thereby preventing extensive loss of function and esthetics, and even saving lives.
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Affiliation(s)
- Ali Nosrat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland; Private Practice, Centerville Endodontics, Centreville, Virginia.
| | - Prashant Verma
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland; Private Practice, Centerville Endodontics, Centreville, Virginia
| | - Sarah Glass
- Department of Oral Diagnostic Sciences, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia
| | - Craig E Vigliante
- Private Practice, Potomac Surgical Arts, PC, Leesburg, Virginia; Reston Advanced Oral and Cosmetic Facial Surgery, LLC, Reston, Virginia
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, Maryland
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Tibúrcio-Machado CS, Michelon C, Zanatta FB, Gomes MS, Marin JA, Bier CA. The global prevalence of apical periodontitis: a systematic review and meta-analysis. Int Endod J 2021; 54:712-735. [PMID: 33378579 DOI: 10.1111/iej.13467] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Apical periodontitis (AP) frequently presents as a chronic asymptomatic disease. To arrive at a true diagnosis, in addition to the clinical examination, it is mandatory to undertake radiographic examinations such as periapical or panoramic radiographs, or cone-beam computed tomography (CBCT). Thus, the worldwide burden of AP is probably underestimated or unknown. Previous systematic reviews attempted to estimate the prevalence of AP, but none have investigated which factors may influence its prevalence worldwide. OBJECTIVES To assess: (i) the prevalence of AP in the population worldwide, as well as the frequency of AP in all teeth, nontreated teeth and root filled teeth; (ii) which factors can modify the prevalence of AP. METHODS A search was conducted in the PubMed-MEDLINE, EMBASE, Cochrane-CENTRAL, LILACS, Google scholar and OpenGrey databases, followed by hand searches, until September 2019. Cross-sectional, case-control and cohort studies reporting the prevalence of AP in humans, using panoramic or periapical radiograph or CBCT as image methods were included. No language restriction was applied. An adaptation of the Newcastle-Ottawa Scale was used to evaluate the quality of the studies. A meta-analysis was performed to determine the pooled prevalence of AP at the individual level. Secondary outcomes were the frequency of AP in all teeth, nontreated teeth and rootfilled teeth. Subgroup analyses using random-effect models were carried out to analyse the influence of explanatory covariables on the outcome. RESULTS The search strategy identified 6670 articles, and 114 studies were included in the meta-analysis, providing data from 34 668 individuals and 639 357 teeth. The prevalence of AP was 52% at the individual level (95% CI 42%-56%, I2 = 97.8%) and 5% at the tooth level (95% CI 4%-6%; I2 = 99.5%). The frequency of AP in root-filled teeth and nontreated teeth was 39% (95% CI 36%-43%; I2 = 98.5%) and 3% (95% CI 2%-3%; I2 = 99.3%), respectively. The prevalence of AP was greater in samples from dental care services (DCS; 57%; 95% CI 52%-62%; I2 = 97.8%) and hospitals (51%; 95% CI 40%-63%; I2 = 95.9%) than in those from the general population (GP; 40%; 95% CI 33%-46%; I2 = 96.5%); it was also greater in people with a systemic condition (63%; 95% CI 56%-69%, I2 = 89.7%) compared to healthy individuals (48%; 95% CI 43%-53%; I2 = 98.3%). DISCUSSION The subgroup analyses identified explanatory factors related to the variability in the prevalence of AP. However, the high clinical heterogeneity and high risk of bias across the primary studies indicate that the findings must be interpreted with caution. CONCLUSIONS Half of the adult population worldwide have at least one tooth with apical periodontitis. The prevalence of AP is greater in samples from the dental care services, but it is also high amongst community representative samples from the general population. The present findings should bring the attention of health policymakers, medical and dental communities to the hidden burden of endodontic disease in the population worldwide.
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Affiliation(s)
- C S Tibúrcio-Machado
- Graduate Program in Dental Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - C Michelon
- Medical and Dental Center of the Brazilian Army, Santa Maria, Brazil
| | - F B Zanatta
- Graduate Program in Dental Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.,Department of Stomatology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - M S Gomes
- Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Medical and Dental Center of the Military Police, Porto Alegre, Brazil
| | - J A Marin
- Universidade Franciscana (UFN), Santa Maria, Brazil
| | - C A Bier
- Graduate Program in Dental Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil.,Department of Stomatology, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
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Balto H, Al-Ekrish AA. To the Editor-in-Chief of the International Endodontic Journal. Int Endod J 2021; 53:1742-1743. [PMID: 33448408 DOI: 10.1111/iej.13375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Balto
- Department of Restorative Dental Sciences, Division of Endodontics, King Saud University, Riyadh, Saudi Arabia
| | - A A Al-Ekrish
- Department of Oral Medicine and Diagnostic Sciences, Division of Oral and Maxillofacial Radiology, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Silva EJNL, Pinto KP, Ferreira CM, Maia LC, Sassone LM, Fidalgo TKS. Methodologic concerns regarding the evidence of a higher prevalence of apical periodontitis and endodontic treatment need in tobacco smokers. Int Endod J 2021; 53:1744-1747. [PMID: 33448421 DOI: 10.1111/iej.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- E J N L Silva
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.,Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | - K P Pinto
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - C M Ferreira
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - L C Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - L M Sassone
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - T K S Fidalgo
- Department of Community and Preventive Dentistry, School of Dentistry, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
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Mao WY, Lei J, Lim LZ, Gao Y, Tyndall DA, Fu K. Comparison of radiographical characteristics and diagnostic accuracy of intraosseous jaw lesions on panoramic radiographs and CBCT. Dentomaxillofac Radiol 2020; 50:20200165. [PMID: 32941743 DOI: 10.1259/dmfr.20200165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the differences in imaging characteristics and the diagnostic accuracy of 225 intraosseous jaw lesions on panoramic radiographs (PAN) versus cone beam computed tomography (CBCT). METHODS 225 sets of PAN and CBCT images with biopsy-proven histopathological diagnoses were retrospectively compared in terms of radiographic features and diagnostic accuracy. The imaging characteristics of PAN and CBCT were independently evaluated by two oral and maxillofacial radiologists who were required to answer 12 questions and provided up to three differential diagnoses with their confidence scores. RESULTS Odds ratios (ORs) were statistically significant for border cortication (OR = 1.521; p = .003) and border continuity (OR = 0.421; p = .001), involvement on neurovascular canals (OR = 2.424; p < .001), expansion (OR = 7.948; p < .001), cortical thinning (OR = 20.480; p < .001) as well as its destruction (OR = 25.022; p < .001) and root resorption (OR = 2.477; p < .001). Furthermore, imaging features in the posterior and mandibular regions showed better agreement than those in the anterior and maxillary regions, respectively. The diagnostic accuracy of the first differential diagnosis was higher on CBCT than on PAN (Observer 1:78.7 vs 64.4%; Observer 2: 78.7 vs 70.2% (p < .001)). The observers' confidence scores were also higher at CBCT interpretation compared with PAN. CONCLUSIONS CBCT demonstrated a greater number of imaging characteristics of intraosseous jaw lesions compared with PAN, especially in the anterior regions of both jaws and in the maxilla. Diagnostic accuracy is improved with CBCT compared to PAN, especially for lesions in the maxilla. Radiologists have greater confidence when using CBCT.
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Affiliation(s)
- Wei-Yu Mao
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Jie Lei
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Li Zhen Lim
- Discipline of Oral & Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore, Singapore.,Department of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, NC, USA
| | - Yan Gao
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China.,Department of Oral Pathology, Peking University School & Hospital of Stomatology, Beijing, China
| | - Donald A Tyndall
- Department of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, NC, USA
| | - Kaiyuan Fu
- Department of Oral & Maxillofacial Radiology, Peking University School & Hospital of Stomatology, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Jakovljevic A, Nikolic N, Jacimovic J, Pavlovic O, Milicic B, Beljic-Ivanovic K, Miletic M, Andric M, Milasin J. Prevalence of Apical Periodontitis and Conventional Nonsurgical Root Canal Treatment in General Adult Population: An Updated Systematic Review and Meta-analysis of Cross-sectional Studies Published between 2012 and 2020. J Endod 2020; 46:1371-1386.e8. [PMID: 32673634 DOI: 10.1016/j.joen.2020.07.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This study aimed to summarize data on apical periodontitis (AP) and nonsurgical root canal treatment (NSRCT) prevalence and risk factors related to age, gender, and quality of restorative and endodontic treatment in the general population from cross-sectional studies published between 2012 and 2020. METHODS An electronic search was performed in the following databases: Web of Science, Scopus, and PubMed. The conducted literature search covered studies published between 2012 and 2020, without restrictions on language. The STROBE and NOS tools were used for quality assessment of the included studies. RESULTS Sixteen articles were included in the review. In total, 200,041 teeth were examined. On average, 6.3% of teeth had AP, and 7.4% had NSRCT. Forty-one percent of RCT teeth had AP, and 3.5% of untreated teeth had AP. Female patients were less prone to AP in endodontically treated teeth only, compared with male patients (P < .001). Variable stratification of age subgroups among included studies prevented us from conducting a meta-analysis. An increase in AP frequency was found in teeth with inadequate restorative and endodontic treatment (P < .001 and P < .001, respectively). Because of high heterogeneity, these results should be taken with caution. CONCLUSIONS There is an increased AP prevalence in the adult general population compared with data from 2012 (6.3% versus 5.4%) in both endodontically treated (41.3% versus 35.9%) and untreated teeth (3.5% versus 2.1%). In addition, AP developed less frequently in female patients with endodontically treated teeth and in teeth with inadequate compared with adequate restorative and endodontic treatment.
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Affiliation(s)
- Aleksandar Jakovljevic
- University of Belgrade, School of Dental Medicine, Department of Pathophysiology, Belgrade, Serbia.
| | - Nadja Nikolic
- University of Belgrade, School of Dental Medicine, Department of Biology and Human Genetics, Belgrade, Serbia
| | - Jelena Jacimovic
- University of Belgrade, School of Dental Medicine, Central Library, Belgrade, Serbia
| | - Ognjan Pavlovic
- University of Belgrade, School of Dental Medicine, Laboratory for Basic Research, Belgrade, Serbia
| | - Biljana Milicic
- University of Belgrade, School of Dental Medicine, Department for Medical Statistics and Informatics, Belgrade, Serbia
| | - Katarina Beljic-Ivanovic
- University of Belgrade, School of Dental Medicine, Department of Restorative Odontology and Endodontics, Belgrade, Serbia
| | - Maja Miletic
- University of Belgrade, School of Dental Medicine, Department of Pathophysiology, Belgrade, Serbia
| | - Miroslav Andric
- University of Belgrade, School of Dental Medicine, Clinic of Oral Surgery, Belgrade, Serbia
| | - Jelena Milasin
- University of Belgrade, School of Dental Medicine, Department of Biology and Human Genetics, Belgrade, Serbia
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66
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Musu D, Cadeddu Dessalvi C, Shemesh H, Frenda MG, Mercuro G, Cotti E. Ultrasound examination for the detection of simulated periapical bone lesions in bovine mandibles: an ex vivo study. Int Endod J 2020; 53:1289-1298. [PMID: 32531801 DOI: 10.1111/iej.13346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the accuracy of ultrasound examination (USE) for the detection of artificial bone defects in bovine mandibles in the absence of complete erosion of the cortical bone plate and to determine the minimum cortical thickness that constitutes a barrier for ultrasound waves. METHODOLOGY Sixty bovine mandibular anatomical blocks were harvested and uniformly distributed amongst six experimental groups. The negative control consisted of blocks with no intra-bony defects, whereas the positive control consisted of blocks with an artificial lesion of 2 mm diameter that perforated the buccal cortical bone plate. Two experimental groups comprised blocks with small (2 mm) and large (5 mm) artificial defects created under a cortical plate thinned to varying thicknesses. Two additional groups had small (2 mm) and large (5 mm) artificial defects that did not involve the cortical plate. After USE, the scans were saved and submitted to three blinded examiners. Sensitivity, specificity, predictive values and receiver-operating characteristics (ROC) were analysed. The significance of the findings (P < 0.05) was appraised using the chi-square statistics with the Yates correction, whilst the intra- and inter-examiner agreements were evaluated through Kappa statistics. RESULTS USE was associated with high sensitivity (97.3%) and negative predictive value (89%), and a perfect score for specificity and positive predictive value. The ROC curve analysis revealed an accuracy of 97.8%. The k-values were 0.86 and 0.89 for the first and second examinations, respectively, demonstrating very high inter-observer agreement. The intra-observer agreement was also high (k-value = 0.92). A significant correlation between the echographic diagnosis and the presence or absence of artificial intraosseous lesions in the anatomical blocks of bovine mandibles was observed (P < 0.0001). CONCLUSIONS USE was highly accurate and reliable for the detection of artificial lesions within bovine mandibles, regardless of the thickness or presence of the cortical plate.
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Affiliation(s)
- D Musu
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - C Cadeddu Dessalvi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - H Shemesh
- Department of Endodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, Netherlands
| | - M G Frenda
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
| | - G Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - E Cotti
- Department of Conservative Dentistry and Endodontics, University of Cagliari, Cagliari, Italy
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Endres MG, Hillen F, Salloumis M, Sedaghat AR, Niehues SM, Quatela O, Hanken H, Smeets R, Beck-Broichsitter B, Rendenbach C, Lakhani K, Heiland M, Gaudin RA. Development of a Deep Learning Algorithm for Periapical Disease Detection in Dental Radiographs. Diagnostics (Basel) 2020; 10:E430. [PMID: 32599942 PMCID: PMC7344682 DOI: 10.3390/diagnostics10060430] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022] Open
Abstract
Periapical radiolucencies, which can be detected on panoramic radiographs, are one of the most common radiographic findings in dentistry and have a differential diagnosis including infections, granuloma, cysts and tumors. In this study, we seek to investigate the ability with which 24 oral and maxillofacial (OMF) surgeons assess the presence of periapical lucencies on panoramic radiographs, and we compare these findings to the performance of a predictive deep learning algorithm that we have developed using a curated data set of 2902 de-identified panoramic radiographs. The mean diagnostic positive predictive value (PPV) of OMF surgeons based on their assessment of panoramic radiographic images was 0.69(± 0.13), indicating that dentists on average falsely diagnose 31% of cases as radiolucencies. However, the mean diagnostic true positive rate (TPR) was 0.51(± 0.14), indicating that on average 49% of all radiolucencies were missed. We demonstrate that the deep learning algorithm achieves a better performance than 14 of 24 OMF surgeons within the cohort, exhibiting an average precision of 0.60(± 0.04), and an F1 score of 0.58(± 0.04) corresponding to a PPV of 0.67(± 0.05) and TPR of 0.51(± 0.05). The algorithm, trained on limited data and evaluated on clinically validated ground truth, has potential to assist OMF surgeons in detecting periapical lucencies on panoramic radiographs.
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Affiliation(s)
- Michael G. Endres
- Laboratory for Innovation Science, Harvard University, 175 N. Harvard Street, Suite 1350, Boston, MA 02134, USA;
| | - Florian Hillen
- Laboratory for Innovation Science, Harvard University, 175 N. Harvard Street, Suite 1350, Boston, MA 02134, USA;
- Institute for Data, Systems and Society, Massachusetts Institute of Technology, 50 Ames St, Cambridge, MA 02142, USA;
| | - Marios Salloumis
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203 Berlin, Germany; (M.S.); (C.R.); (B.B.-B.); (M.H.)
| | - Ahmad R. Sedaghat
- Department of Otolaryngology—Head and Neck Surgery, University of Cincinnati College of Medicine, Medical Sciences Building Room 6410, 231 Albert Sabin Way, Cincinnati, OH 45267, USA;
| | - Stefan M. Niehues
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203 Berlin, Germany;
| | - Olivia Quatela
- Department of Oral- and Maxillofacial Surgery, Universitätsklinikum Hamburg, Eppendorf, Maritnistraße 52, 20246 Hamburg, Germany; (O.Q.); (R.S.); (H.H.)
| | - Henning Hanken
- Department of Oral- and Maxillofacial Surgery, Universitätsklinikum Hamburg, Eppendorf, Maritnistraße 52, 20246 Hamburg, Germany; (O.Q.); (R.S.); (H.H.)
| | - Ralf Smeets
- Department of Oral- and Maxillofacial Surgery, Universitätsklinikum Hamburg, Eppendorf, Maritnistraße 52, 20246 Hamburg, Germany; (O.Q.); (R.S.); (H.H.)
| | - Benedicta Beck-Broichsitter
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203 Berlin, Germany; (M.S.); (C.R.); (B.B.-B.); (M.H.)
| | - Carsten Rendenbach
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203 Berlin, Germany; (M.S.); (C.R.); (B.B.-B.); (M.H.)
| | - Karim Lakhani
- Laboratory for Innovation Science, Harvard University, 175 N. Harvard Street, Suite 1350, Boston, MA 02134, USA;
- Technology and Operations Management Unit, Harvard Business School, Wyss House, Boston, MA 02163, USA;
| | - Max Heiland
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203 Berlin, Germany; (M.S.); (C.R.); (B.B.-B.); (M.H.)
| | - Robert A. Gaudin
- Laboratory for Innovation Science, Harvard University, 175 N. Harvard Street, Suite 1350, Boston, MA 02134, USA;
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203 Berlin, Germany; (M.S.); (C.R.); (B.B.-B.); (M.H.)
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Kaufmann ME, Solderer A, Hofer D, Schmidlin PR. The Strange Case of a Broken Periodontal Instrument Tip. Dent J (Basel) 2020; 8:dj8020055. [PMID: 32503214 PMCID: PMC7345799 DOI: 10.3390/dj8020055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/16/2022] Open
Abstract
This case report describes a rare case of a broken periodontal probe tip and its removal. A male patient presented himself in June 2019 due to a painful tooth in the upper left quadrant. The patient elected treatment in the dental school’s student course. In October 2019, in preparation for full-mouth rehabilitation, a complete diagnostic status was performed, including radiographs. In this context, a metal-dense fragment was identified in the apical region of the (missing) tooth 45. It was diagnosed as the broken tip of a periodontal probe (type AE P OWB). Since a PCP-12 probe is generally used in-house, iatrogenic damage during the initial examination or student course could be excluded a priori. The patient was not able to remember any treatment that could be associated with the instrument’s breaking. Since the probe fragment was palpable and a translocation could not be precluded, the patient agreed to its removal under local anesthesia, after a cone-beam CT. This article describes and discusses this particular case, with special emphasis on iatrogenic instrument fractures and their removal.
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69
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Arslan ZB, Demir H, Berker Yıldız D, Yaşar F. Diagnostic accuracy of panoramic radiography and ultrasonography in detecting periapical lesions using periapical radiography as a gold standard. Dentomaxillofac Radiol 2020; 49:20190290. [PMID: 32453610 DOI: 10.1259/dmfr.20190290] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to compare the accuracy of imaging techniques in diagnosing periapical lesions. METHODS Imaging records of 80 patients (51 females, 29 males, aged between 14 and 75 years) including periapical and panoramic radiographs and ultrasonographic images were selected from databases of Selcuk University Dentistry Faculty. Periapical radiographs were accepted as gold-standard and 160 anterior maxillary and mandibular teeth with or without periapical lesion were included to the study. Three specialist observers (dental radiologists) evaluated the presence and appearance of periapical lesions on panoramic radiograph and ultrasonographic images.Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic value of panoramic radiographs and ultrasonography were determined. RESULTS Sensitivity was 0.80 and 0.77 for ultrasonographic images and panoramic radiographs, respectively which shows that periapical lesion was correctly detected in 80% of the cases with ultrasound and in 77% of the cases with panoramic radiography. Specificity values were determined as 0.97 for ultrasound and 0.95 for panoramic radiography. Overall diagnostic accuracy was 0.86 and 0.84 for ultrasound and panoramic radiography, respectively. CONCLUSIONS Periapical and panoramic radiographs are commonly used to visualize periapical lesions. Besides, ultrasonography is an alternative method to digital radiographic techniques in the diagnosis of anterior teeth with periapical lesions.
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Affiliation(s)
- Zeynep Betül Arslan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hilal Demir
- Konya Oral and Dental Health Center, Konya, Turkey
| | | | - Füsun Yaşar
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Selcuk University, Konya, Turkey
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Setzer FC, Shi KJ, Zhang Z, Yan H, Yoon H, Mupparapu M, Li J. Artificial Intelligence for the Computer-aided Detection of Periapical Lesions in Cone-beam Computed Tomographic Images. J Endod 2020; 46:987-993. [PMID: 32402466 DOI: 10.1016/j.joen.2020.03.025] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of this study was to use a Deep Learning (DL) algorithm for the automated segmentation of cone-beam computed tomographic (CBCT) images and the detection of periapical lesions. METHODS Limited field of view CBCT volumes (n = 20) containing 61 roots with and without lesions were segmented clinician dependent versus using the DL approach based on a U-Net architecture. Segmentation labeled each voxel as 1 of 5 categories: "lesion" (periapical lesion), "tooth structure," "bone," "restorative materials," and "background." Repeated splits of all images into a training set and a validation set based on 5-fold cross validation were performed using Deep Learning segmentation (DLS), and the results were averaged. DLS versus clinical-dependent segmentation was assessed by dichotomized lesion detection accuracy evaluating sensitivity, specificity, positive predictive value, negative predictive value, and voxel-matching accuracy using the DICE index for each of the 5 labels. RESULTS DLS lesion detection accuracy was 0.93 with specificity of 0.88, positive predictive value of 0.87, and negative predictive value of 0.93. The overall cumulative DICE indexes for the individual labels were lesion = 0.52, tooth structure = 0.74, bone = 0.78, restorative materials = 0.58, and background = 0.95. The cumulative DICE index for all actual true lesions was 0.67. CONCLUSIONS This DL algorithm trained in a limited CBCT environment showed excellent results in lesion detection accuracy. Overall voxel-matching accuracy may be benefited by enhanced versions of artificial intelligence.
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Affiliation(s)
- Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Katherine J Shi
- Private Practice, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zhiyang Zhang
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, Arizona
| | - Hao Yan
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, Arizona
| | - Hyunsoo Yoon
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, Arizona
| | - Mel Mupparapu
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jing Li
- School of Computing, Informatics, and Decision Systems Engineering, Arizona State University, Tempe, Arizona
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Orhan K, Bayrakdar IS, Ezhov M, Kravtsov A, Özyürek T. Evaluation of artificial intelligence for detecting periapical pathosis on cone-beam computed tomography scans. Int Endod J 2020; 53:680-689. [PMID: 31922612 DOI: 10.1111/iej.13265] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/07/2020] [Indexed: 12/17/2022]
Abstract
AIM To verify the diagnostic performance of an artificial intelligence system based on the deep convolutional neural network method to detect periapical pathosis on cone-beam computed tomography (CBCT) images. METHODOLOGY images of 153 periapical lesions obtained from 109 patients were included. The specific area of the jaw and teeth associated with the periapical lesions were then determined by a human observer. Lesion volumes were calculated using the manual segmentation methods using Fujifilm-Synapse 3D software (Fujifilm Medical Systems, Tokyo, Japan). The neural network was then used to determine (i) whether the lesion could be detected; (ii) if the lesion was detected, where it was localized (maxilla, mandible or specific tooth); and (iii) lesion volume. Manual segmentation and artificial intelligence (AI) (Diagnocat Inc., San Francisco, CA, USA) methods were compared using Wilcoxon signed rank test and Bland-Altman analysis. RESULTS The deep convolutional neural network system was successful in detecting teeth and numbering specific teeth. Only one tooth was incorrectly identified. The AI system was able to detect 142 of a total of 153 periapical lesions. The reliability of correctly detecting a periapical lesion was 92.8%. The deep convolutional neural network volumetric measurements of the lesions were similar to those with manual segmentation. There was no significant difference between the two measurement methods (P > 0.05). CONCLUSIONS Volume measurements performed by humans and by AI systems were comparable to each other. AI systems based on deep learning methods can be useful for detecting periapical pathosis on CBCT images for clinical application.
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Affiliation(s)
- K Orhan
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey
| | - I S Bayrakdar
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - M Ezhov
- Diagnocat Inc, San Francisco, CA, USA
| | | | - T Özyürek
- Department of Endodontics, Faculty of Dentistry, Istanbul Medeniyet University, Istanbul, Turkey
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Thang TST, Kishen A, Moayedi M, Tyrrell PN, Zhao W, Perschbacher SE. The effects of physical photostimulable phosphor plate artifacts on the radiologic interpretation of periapical inflammatory disease. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 129:621-628. [PMID: 31983634 DOI: 10.1016/j.oooo.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/22/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate how physical photostimulable phosphor (PSP) plate artifacts, such as those created by scratches, phosphor degradation, and surface peeling, affect the radiologic interpretation of periapical inflammatory disease. STUDY DESIGN A novel technique was developed to digitally superimpose 25 real PSP artifact masks over 100 clinical complementary metal oxide semiconductor (CMOS) periapical images with known radiologic interpretations. These images were presented to 25 general dentists, who were asked to state their radiologic interpretations, their confidence in their interpretations, and their opinions on whether the plates should be discarded. Statistical analyses were conducted by using random intercept mixed models for repeated measures and χ2 tests of the pooled data. RESULTS No statistically significant adverse effect on interpretation was seen, even at severe artifact levels. There was a statistically significant decrease in the clinicians' confidence and an increase in discard proportions when interpreting images with severe PSP plate artifacts (P < .05). CONCLUSIONS Although diagnostic efficacy was unaffected, clinicians' confidence decreased and proportionally more clinicians opted to discard sensors when interpreting images with severe artifacts. Future studies on the effects of artifacts on the efficacy of diagnosis of other dental diseases are recommended. Ultimately, these results can guide recommendations for PSP plate quality assurance.
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Affiliation(s)
| | - Anil Kishen
- Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - Massieh Moayedi
- Faculty of Dentistry, University of Toronto, Toronto, Canada; Centre for the Study of Pain, University of Toronto
| | - Pascal N Tyrrell
- Department of Medical Imaging, University of Toronto; Department of Statistical Sciences, University of Toronto
| | - Wenda Zhao
- Department of Medical Imaging, University of Toronto
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Buitrago Rojas SM, Castellanos Dominguez YZ, Contreras Vargas JA, Solano Diaz YT, Gutierrez Argote EF. Reproducibilidad en el diagnóstico imagenológico de periodontitis apical a partir de CBCT. ACTA ODONTOLÓGICA COLOMBIANA 2020. [DOI: 10.15446/aoc.v10n1.81133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: esta investigación evaluó la reproducibilidad en el diagnóstico imagenológico de PA en dientes del maxilar superior a partir de 60 CBCT tomadas en una institución clínica en una ciudad intermedia en Colombia. Métodos: el estudio fue realizado por dos observadores previamente calibrados de CBCT del maxilar superior que contenían dientes permanentes con ápice cerrado, correspondientes a adultos mayores de 18 años de edad. La presencia o ausencia de periodontitis apical se analizó utilizando el índice CBCT PAI. La información registrada fue relacionada con variables de interés. Resultados: la reproducibilidad entre los evaluadores fue sustancial o perfecta. La prevalencia de periodontitis apical encontrada fue del 21,6%, en los dientes con tratamiento de endodoncia 12,4% y en los dientes sin tratamiento endodóntico 9,2%. Conclusiones: la tomografía CBCT proporciona al clínico información que permite una mayor claridad en la fase de diagnóstico. Los dientes con la mayor prevalencia de PA fueron el primer molar y el primer premolar superior izquierdo respectivamente.
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Horner K, Barry S, Dave M, Dixon C, Littlewood A, Pang CL, Sengupta A, Srinivasan V. Diagnostic efficacy of cone beam computed tomography in paediatric dentistry: a systematic review. Eur Arch Paediatr Dent 2019; 21:407-426. [PMID: 31858481 PMCID: PMC7415745 DOI: 10.1007/s40368-019-00504-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023]
Abstract
Purpose To determine in which clinical situations it is indicated or contra-indicated to prescribe cone beam computed tomography (CBCT) for paediatric patients. Methods Systematic review of in vivo paediatric research studies of diagnostic efficacy using CBCT, with supplementary searches for guideline documents on CBCT and for systematic reviews permitting inclusion of ex vivo and adult studies. Results After screening, 190 publications were included, mostly case studies. No systematic reviews were found of in vivo paediatric research. Fourteen studies of diagnostic efficacy were identified. The supplementary searches found 18 guideline documents relevant to the review and 26 systematic reviews. The diagnostic efficacy evidence on CBCT was diverse and often of limited quality. There was ex vivo evidence for diagnostic accuracy being greater using CBCT than radiographs for root fractures. The multiplanar capabilities of CBCT are advantageous when localising dental structures for surgical planning. Patient movement during scanning is more common in children which could reduce diagnostic efficacy. Conclusions No strong recommendations on CBCT are possible, except that it should not be used as a primary diagnostic tool for caries. Guidelines on use of CBCT in the paediatric age group should be developed cautiously, taking into account the greater radiation risk and the higher economic costs compared with radiography. CBCT should only be used when adequate conventional radiographic examination has not answered the question for which imaging was required. Clinical research in paediatric patients is required at the higher levels of diagnostic efficacy of CBCT. Electronic supplementary material The online version of this article (10.1007/s40368-019-00504-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Horner
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland Building 3, Manchester, M13 9PL, UK.
- Dental Radiology, University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Higher Cambridge Street, Manchester, M15 6FH, UK.
| | - S Barry
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland Building 3, Manchester, M13 9PL, UK
- Paediatric Dentistry, University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Higher Cambridge Street, Manchester, M15 6FH, UK
| | - M Dave
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland Building 3, Manchester, M13 9PL, UK
| | - C Dixon
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland Building 3, Manchester, M13 9PL, UK
- Paediatric Dentistry, University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Higher Cambridge Street, Manchester, M15 6FH, UK
| | - A Littlewood
- Information Specialist, Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland Building 3, Manchester, M13 9PL, UK
| | - C L Pang
- Division of Imaging, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK
| | - A Sengupta
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland Building 3, Manchester, M13 9PL, UK
- Dental Radiology, University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Higher Cambridge Street, Manchester, M15 6FH, UK
| | - V Srinivasan
- Paediatric Dentistry, University Dental Hospital of Manchester, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Higher Cambridge Street, Manchester, M15 6FH, UK
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Detection of Simulated Periapical Lesion in Intraoral Digital Radiography with Different Brightness and Contrast. Eur Endod J 2019; 4:133-138. [PMID: 32161900 PMCID: PMC7006595 DOI: 10.14744/eej.2019.46036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/17/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: To assess the detection of simulated periapical lesions in digital intraoral radiography with different levels of brightness and contrast combinations, and to investigate the observers’ preference of image quality for this diagnostic task. Methods: Digital radiographs were acquired prior to periapical lesion simulation and after each one of four defects enlargement. Original images were adjusted in 4 brightness and contrast combinations. Five observers evaluated the images according to the presence of periapical lesion on a 5-point scale. In a second moment, the observers ordinated the images subjectively, according to quality, from the best to the worst to detect the bone defect. The area under the receiver operating characteristic curve was calculated for the diagnostic values and compared by two-way ANOVA. The significance level was set at 5% (P<0.05). Results: No differences were found between the diagnostic values of the five combinations of brightness and contrast (P>0.05). The overall results showed low values of area under the Receiver Operating Characteristic (ROC) curve and sensitivity of the periapical radiography in the detection of periapical lesions of sizes from 1 to 3, which rose substantially in size 4. For image quality, combinations with the lowest brightness and highest contrast were preferred by the observers in 58% of the cases. Conclusion: Brightness and contrast adjustments do not influence the detection of simulated periapical lesions in digital intraoral radiography. Lower brightness and higher contrast images were preferred for this diagnostic task.
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Ketabi AR, Ketabi S, Nabli MB, Lauer HC, Brenner M. Detection and measurements of apical lesions in the upper jaw by cone beam computed tomography and panoramic radiography as a function of cortical bone thickness. Clin Oral Investig 2019; 23:4067-4073. [DOI: 10.1007/s00784-019-02843-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 02/07/2019] [Indexed: 11/29/2022]
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Ramis-Alario A, Tarazona-Alvarez B, Cervera-Ballester J, Soto-Peñaloza D, Peñarrocha-Diago M, Peñarrocha-Oltra D, Peñarrocha-Diago M. Comparison of diagnostic accuracy between periapical and panoramic radiographs and cone beam computed tomography in measuring the periapical area of teeth scheduled for periapical surgery. A cross-sectional study. J Clin Exp Dent 2019; 11:e732-e738. [PMID: 31598202 PMCID: PMC6776403 DOI: 10.4317/jced.55986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/04/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The aim of the study was compare the sensitivity and measurements obtained from teeth with apical lesions scheduled for periapical surgery using three different diagnostic methods: periapical radiography (Gendex Expert DC), panoramic radiography (Planmeca® Promax 3D Classic) and cone beam computed tomography (CBCT) (Planmeca® Promax 3D Classic). MATERIAL AND METHODS This cross-sectional study involved 35 patients (45 teeth) scheduled for periapical surgery in which periapical radiographs, panoramic radiographs and CBCT scans had been obtained. The images were used to analyze the maximum vertical and horizontal dimension and the resulting areas of the periapical lesions based on the three diagnostic methods. RESULTS The two-dimensional techniques (periapical radiography and panoramic radiography) yielded a sensitivity of 82% versus 100% in the case of CBCT. The mean vertical dimension of the apical areas was 5.48 mm with periapical radiography and 5.04 mm with panoramic radiography - the difference with respect to CBCT being statistically significant (6.36 mm for the coronal sections). There were no significant differences among the three techniques in terms of horizontal dimension (p>0.05) or lesion area. CONCLUSIONS The sensitivity of periapical radiolucencies detected using CBCT was significantly greater than with the two-dimensional imaging techniques. Significant differences between the latter and CBCT were only observed in the case of the vertical measurements. Key words:Periapical lesion, apicoectomy, CBCT, periapical radiography, panoramic radiography.
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Affiliation(s)
- Amparo Ramis-Alario
- Professor of Master in Oral Surgery and Implantology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Beatriz Tarazona-Alvarez
- Assistant Professor of Orthodontics, Master in Orthodontics, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Juan Cervera-Ballester
- Professor of Master in Oral Surgery and Implantology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - David Soto-Peñaloza
- Professor of Master in Oral Surgery and Implantology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Miguel Peñarrocha-Diago
- Chairman of Oral Surgery. Director of the Master in Oral Surgery and Implantology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - David Peñarrocha-Oltra
- Assistant Postdoctoral Professor of Oral Surgery, Master in Oral Surgery and Implantology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - María Peñarrocha-Diago
- Full Professor of Oral Surgery, Master in Oral Surgery and Implantology, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Quality of root canal fillings and prevalence of apical radiolucencies in a German population: a CBCT analysis. Clin Oral Investig 2019; 24:1217-1227. [DOI: 10.1007/s00784-019-02985-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/20/2019] [Indexed: 12/18/2022]
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79
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Ekert T, Krois J, Meinhold L, Elhennawy K, Emara R, Golla T, Schwendicke F. Deep Learning for the Radiographic Detection of Apical Lesions. J Endod 2019; 45:917-922.e5. [PMID: 31160078 DOI: 10.1016/j.joen.2019.03.016] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/25/2019] [Accepted: 03/22/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We applied deep convolutional neural networks (CNNs) to detect apical lesions (ALs) on panoramic dental radiographs. METHODS Based on a synthesized data set of 2001 tooth segments from panoramic radiographs, a custom-made 7-layer deep neural network, parameterized by a total number of 4,299,651 weights, was trained and validated via 10 times repeated group shuffling. Hyperparameters were tuned using a grid search. Our reference test was the majority vote of 6 independent examiners who detected ALs on an ordinal scale (0, no AL; 1, widened periodontal ligament, uncertain AL; 2, clearly detectable lesion, certain AL). Metrics were the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and positive/negative predictive values. Subgroup analysis for tooth types was performed, and different margins of agreement of the reference test were applied (base case: 2; sensitivity analysis: 6). RESULTS The mean (standard deviation) tooth level prevalence of both uncertain and certain ALs was 0.16 (0.03) in the base case. The AUC of the CNN was 0.85 (0.04). Sensitivity and specificity were 0.65 (0.12) and 0.87 (0.04,) respectively. The resulting positive predictive value was 0.49 (0.10), and the negative predictive value was 0.93 (0.03). In molars, sensitivity was significantly higher than in other tooth types, whereas specificity was lower. When only certain ALs were assessed, the AUC was 0.89 (0.04). Increasing the margin of agreement to 6 significantly increased the AUC to 0.95 (0.02), mainly because the sensitivity increased to 0.74 (0.19). CONCLUSIONS A moderately deep CNN trained on a limited amount of image data showed satisfying discriminatory ability to detect ALs on panoramic radiographs.
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Affiliation(s)
- Thomas Ekert
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany; CODE University of Applied Sciences, Berlin, Germany
| | - Joachim Krois
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leonie Meinhold
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karim Elhennawy
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ramy Emara
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tatiana Golla
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Ahmad P, Dummer PMH, Chaudhry A, Rashid U, Saif S, Asif JA. A bibliometric study of the top 100 most‐cited randomized controlled trials, systematic reviews and meta‐analyses published in endodontic journals. Int Endod J 2019; 52:1297-1316. [DOI: 10.1111/iej.13131] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- P. Ahmad
- Department of Oral Medicine School of Dental Sciences Universiti Sains Malaysia Kelantan Malaysia
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
| | - A. Chaudhry
- Department of Periodontics School of Dental Sciences Universiti Sains Malaysia Kelantan Malaysia
| | - U. Rashid
- Department of Periodontics School of Dental Sciences Universiti Sains Malaysia Kelantan Malaysia
| | - S. Saif
- Department of Periodontics School of Dental Sciences Universiti Sains Malaysia Kelantan Malaysia
| | - J. A. Asif
- Department of Oral and Maxillofacial Surgery School of Dental Sciences Universiti Sains Malaysia Kelantan Malaysia
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81
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The influence of apical extent of root canal obturation on endodontic therapy outcome: a systematic review. Clin Oral Investig 2019; 23:2005-2019. [DOI: 10.1007/s00784-019-02897-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/03/2019] [Indexed: 12/27/2022]
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82
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Moga RA, Cosgarea R, Buru SM, Chiorean CG. Finite element analysis of the dental pulp under orthodontic forces. Am J Orthod Dentofacial Orthop 2019; 155:543-551. [DOI: 10.1016/j.ajodo.2018.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 12/29/2022]
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83
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Jacquet W, Cleymaet RG, Bottenberg P. Grey value contrast sensitivity of dental practitioners in function of luminance and age. Dentomaxillofac Radiol 2019; 48:20180398. [PMID: 30807210 DOI: 10.1259/dmfr.20180398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Grey value perception is important in viewing and interpreting X-ray images. It is possible that ageing decreases the number of gray values that a person can distinguish. This hypothesis was tested in a group of dental practitioners from students to experienced dentists using a 12-bit grey scale. METHODS AND MATERIALS A custom-made computer software was used based on the principle of the "just noticeable difference" (JND). Observers were shown a picture of an outer square with increasing grey value in which a smaller square of different grey value popped up in changing positions. As soon as the observers could see the difference, they clicked the inner square. The grey values were shown with a 12-bit depth in batches of 400 grey value steps. 59 dentists of 3 age groups (20-24, 25-45 and 46-70 years) participated in the study. A subgroup of 20 practitioners performed a validation test with test-retest and test in reversed grey value sequence (white to black). JND was calculated and plotted against grey value using a third-order polynomial function. These curves were compared statistically. RESULTS Test-retest, also in reversed order did not yield different curves (p values between 0.79 and 0.97). Curves between different age groups showed significant differences, with older practitioners needing more contrast to accomplish the task. Contrast sensitivity showed an optimum in the darker third of the grey scale (values around 1200). CONCLUSION Age and grey value played a significant role in grey value perception by dental practitioners.
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Affiliation(s)
- Wolfgang Jacquet
- Oral health research group, Free University of Brussels (VUB), Brussels, Belgium
| | - Roberto G Cleymaet
- Oral health research group, Free University of Brussels (VUB), Brussels, Belgium
| | - Peter Bottenberg
- Oral health research group, Free University of Brussels (VUB), Brussels, Belgium
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Krug R, Connert T, Beinicke A, Soliman S, Schubert A, Kiefner P, Sonntag D, Weiger R, Krastl G. When and how do endodontic specialists use cone‐beam computed tomography? AUST ENDOD J 2019; 45:365-372. [DOI: 10.1111/aej.12337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Ralf Krug
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
| | - Thomas Connert
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental MedicineUniversity of Basel Basel Switzerland
| | - Andrea Beinicke
- Department of Psychology, Work & Organizational PsychologyUniversity of Würzburg Würzburg Germany
| | - Sebastian Soliman
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
| | - Alexander Schubert
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
| | | | - David Sonntag
- Department of Operative Dentistry, Periodontology and EndodontologyUniversity Hospital of Düsseldorf Düsseldorf Germany
| | - Roland Weiger
- Department of Periodontology, Endodontology and CariologyUniversity Center for Dental MedicineUniversity of Basel Basel Switzerland
| | - Gabriel Krastl
- Department of Operative Dentistry and Periodontology and Center of Dental TraumatologyUniversity Hospital of Würzburg Würzburg Germany
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FRANCISCATTO GJ, KOPPE BTDF, HOPPE CB, OLIVEIRA JAPD, HAAS AN, GRECCA FS, ROSSI-FEDELE G, GOMES MS. Validation of self-reported history of root canal treatment in a southern Brazilian subpopulation. Braz Oral Res 2019; 33:e007. [DOI: 10.1590/1807-3107bor-2019.vol33.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/17/2018] [Indexed: 12/28/2022] Open
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Angerame D, De Biasi M, Lenhardt M, Bevilacqua L, Franco V. Survival study on teeth after successful endodontic surgical retreatment: influence of crown height, root length, crown-to-root ratio and tooth type. GIORNALE ITALIANO DI ENDODONZIA 2018. [DOI: 10.1016/j.gien.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Milani AS, Froughreyhani M, Rahimi S, Zand V, Jafarabadi MA. Volume of Anesthetic Agents and IANB Success: A Systematic Review. Anesth Prog 2018; 65:16-23. [PMID: 29509518 PMCID: PMC5841477 DOI: 10.2344/anpr-65-01-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/16/2017] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?" Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67-3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.
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Affiliation(s)
- Amin Salem Milani
- Assistant Professor, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Froughreyhani
- Associate Professor, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Rahimi
- Professor of Endodontics, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zand
- Associate Professor, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Associate Professor of Biostatistics, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Brasil DM, Yamasaki MC, Santaella GM, Guido MCZ, Freitas DQ, Haiter-Neto F. Influence of VistaScan image enhancement filters on diagnosis of simulated periapical lesions on intraoral radiographs. Dentomaxillofac Radiol 2018; 48:20180146. [PMID: 30260235 DOI: 10.1259/dmfr.20180146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE: To evaluate whether image enhancement filters of VistaScan system improve the diagnostic accuracy of simulated periapical lesions. METHODS: 10 sockets were prepared on bovine ribs to fit a bovine tooth. Bone defects were created and successively enlarged providing four groups (n = 10): Group 0, absence of lesions; Group 1, periapical lesions with 1.6 mm in diameter; Group 2, with 1.8 mm in diameter; and Group 3, with 2.1 mm in diameter. Periapical radiographs were taken using a photostimulable storage phosphor plate and DBSWIN software. VistaScan filters were applied and the images were allocated into seven groups: Nonfiltered, Fine, Caries 1, Caries 2, Endodontic, Periodontal and Noise Reduction. All the 280 images were assessed about the presence or absence of periapical lesions. Pixel intensities standard deviation were compared between nonfiltered and filtered images. Two-Way Analysis of Variance and the post hoc Tukey's test were used to compare area under the ROC curve, sensitivity and specificity. RESULTS: VistaScan filters showed no significant difference for area under receiver operating characteristic curve (p = 0.124), sensitivity (p = 0.835) and specificity (p = 0.832). Area under receiver operating characteristic curve (p = 0.000) and sensitivity (p = 0.000) in 2.1 mm lesions size were significantly higher than in 1.6 mm and 1.8 mm lesions size. Pixel intensities standard deviation was significantly changed in the filtered images compared to nonfiltered ones (p < 0.01), except for Fine in the bone region (p > 0.05). CONCLUSION: VistaScan enhancement filters do not influence the diagnostic accuracy of simulated periapical lesions. On the other hand, larger lesions were more frequently detected. The filters change the pixel intensities reducing or intensifying the differences between similar regions.
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Affiliation(s)
- Danieli Moura Brasil
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas , Sao Paulo , Brazil
| | - Mayra Cristina Yamasaki
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas , Sao Paulo , Brazil
| | - Gustavo Machado Santaella
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas , Sao Paulo , Brazil
| | - Maria Carolina Zumstein Guido
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas , Sao Paulo , Brazil
| | - Deborah Queiroz Freitas
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas , Sao Paulo , Brazil
| | - Francisco Haiter-Neto
- 1 Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas , Sao Paulo , Brazil
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Balto HA, Alabdulaaly L, Bahammam S, Al-Ekrish AA. Comparative analysis of prevalence of apical periodontitis in smokers and non-smokers using cone-beam computed tomography. Saudi Dent J 2018; 31:52-57. [PMID: 30705569 PMCID: PMC6349893 DOI: 10.1016/j.sdentj.2018.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/26/2018] [Accepted: 09/17/2018] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this study was to compare the prevalence and size of periapical lesions among smokers and non-smokers using cone-beam computed tomography (CBCT). Materials and methods Retrievable CBCT datasets for 46 male patients ≥18 years during a consecutive period from 2008 to 2016 were examined. The medical, smoking history and other clinical findings (signs of previous dental trauma; Decayed Missing Filled Teeth (DMFT) scores; the percentage of root filled teeth; and oral hygiene status) were obtained. Periapical status of all included teeth was assessed by CBCT images. Statistical analysis was conducted using t-test, Pearson correlation and multiple regression. Results The prevalence of apical periodontitis was 13.93% in smokers and 14.26% in non-smokers with no significant difference (p = 0.936). The mean of the average size of lesions between the two groups were almost comparable, 3.50 mm in smokers and 2.89 mm in non-smokers (p = 0.567). Pearson correlation and multiple regression analysis showed that the percentage of lesion present and the average lesion size were not correlated to any independent variable. Conclusions While smoking is considered a risk factor for marginal periodontitis, there was no difference between smokers and non-smokers in terms of apical periodontitis.
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Affiliation(s)
- Hanan A Balto
- Department of Restorative Dental Science, Division of Endodontics, Dental Caries Research Chair, College of Dentistry, King Saud University, P.O. Box 62645, Riyadh 11595, Saudi Arabia.,Department of Clinical Dental Science, College of Dentistry, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Lama Alabdulaaly
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 88493, Riyadh 11662, Saudi Arabia
| | - Shaima Bahammam
- College of Dentistry, King Saud University, Riyadh, Saudi Arabia.,Department of Dentistry, King Faisal Specialist Hospital and Research Centre, P.O. Box 50514, Riyadh 11533, Saudi Arabia
| | - Asma'a A Al-Ekrish
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, P.O. Box 56810, Riyadh 11564, Saudi Arabia
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90
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Beck F, Lauterbrunner N, Lettner S, Stavropoulos A, Ulm C, Bertl K. Devitalization of adjacent teeth following maxillary sinus floor augmentation: A retrospective radiographic study. Clin Implant Dent Relat Res 2018; 20:763-769. [PMID: 30086197 DOI: 10.1111/cid.12632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/17/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Elevation of the schneiderian membrane, during maxillary sinus floor augmentation (MSFA) may theoretically result in devitalization of adjacent teeth, which are in a close spatial relationship to the sinus floor. PURPOSE To assess retrospectively the probability of devitalization of teeth adjacent to the osteotomy site after MSFA in a relatively large number of patients. MATERIALS AND METHODS All MSFA procedures, performed at a university oral surgery clinic within a time period of 10 years, were assessed on the following eligibility criteria: (1) presence of vital teeth (ie, not root canal treated and no periapical radiolucency on a panoramic radiograph taken just after MSFA), (2) presence of a 3 to 12 months postoperative radiograph of the teeth adjacent to the osteotomy site displaying the root apices, and (3) complete medical records up to at least 12 months postoperatively. The radiographs of the different time points were compared and any changes in the radiographic status of the adjacent teeth (eg, development of a periapical lesion, root canal treatment, etc.) were recorded and the spatial relationship of the adjacent teeth to the maxillary sinus classified. RESULTS Out of 684 MSFAs, 257 fulfilled the inclusion criteria and involved 357 adjacent teeth, of which 221 presented close to and/or intimate relationship to the sinus. In only a single case, tooth vitality might have been lost due to the procedure. Thus, the probability for tooth devitalization for teeth with close to and/or intimate spatial relationship to the sinus floor ranged from 0.45% to 0.7%. CONCLUSIONS Even for teeth with apices very close to and/or intimately related to the sinus tooth devitalization after MSFA is an extremely rare complication; that is, the probability of tooth devitalization after MSFA is ≤0.7%.
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Affiliation(s)
- Florian Beck
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Nina Lauterbrunner
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Stefan Lettner
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria.,Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Christian Ulm
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Kristina Bertl
- Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria.,Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
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91
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Muniz FWMG, Montagner F, Jacinto RC, Rösing CK, Gomes BPFA. Correlation between crestal alveolar bone loss with intracanal bacteria and apical lesion area in necrotic teeth. Arch Oral Biol 2018; 95:1-6. [PMID: 30025275 DOI: 10.1016/j.archoralbio.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/14/2018] [Accepted: 07/10/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to analyze the correlation between crestal alveolar bone loss with the presence of some bacterial species in root canals and the apical lesion area of necrotic teeth. DESIGN Data from 20 patients with diagnosis of pulp necrosis and acute apical abscesses, without active periodontal diseases, were evaluated. Patients with history of antibiotic usage three months prior to the study, with exposed pulp cavity, and with probing depth >3 mm were not included. The root size, the distance between the bone crest to the tooth apex in the mesial and distal surfaces, and the apical lesion area were measured from standard periapical radiographies by a calibrated examiner. Root canal samples were collected using sterilized paper points. In multirooted teeth, the largest root canal was sampled. Culture, microbial isolation and identification by phenotypic methods were performed. Spearman correlation and exact Fischer test were calculated between higher/lower existing bone crests, according to the median and the presence of specific bacteria. RESULTS No statistically significant differences were found between occurrence of pathogenic bacteria, such as Porphyromonas gingivalis, Porphyromonas endodontalis, and Prevotella intermedia, and groups with higher/lower degree of bone loss (p > 0.05). A negative significant correlation was found between Parvimonas micra and periodontal bone loss (p = 0.02). Additionally, no statistically significant association was found between crestal bone loss and the apical lesion area. CONCLUSIONS It was concluded that, in patients without active periodontitis, the presence of pathogenic bacteria in the root canal was not correlated with periodontal bone loss.
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Affiliation(s)
- Francisco Wilker M G Muniz
- Department of Periodontology, Faculty of Dentistry, Federal University of Pelotas, Rua Gonçalves Chaves, 457, Pelotas, RS, 96015-560, Brazil.
| | - Francisco Montagner
- Department of Endodontics, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
| | - Rogério C Jacinto
- Department of Endodontics, Araçatuba Dental School, State University of São Paulo, Rua José Bonifácio, 1193, Araçatuba, São Paulo, 16015-050, Brazil.
| | - Cassiano K Rösing
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
| | - Brenda P F A Gomes
- Department of Restorative Dentistry, Division of Endodontics, Piracicaba Dental School, State University of Campinas - UNICAMP, Avenida Limeira, 901, Piracicaba, SP, 13414-903, Brazil.
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92
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Jakse N, Ruckenstuhl M, Rugani P, Kirnbauer B, Sokolowski A, Ebeleseder K. Influence of Extraoral Apicoectomy on Revascularization of an Autotransplanted Tooth: A Case Report. J Endod 2018; 44:1298-1302. [PMID: 29935869 DOI: 10.1016/j.joen.2018.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/06/2018] [Accepted: 04/20/2018] [Indexed: 12/11/2022]
Abstract
Autotransplantation is considered a standard procedure with a poorer prognosis for mature than for immature teeth. In this case report, the root tip of an almost fully developed tooth was resected during autotransplantation to fit into a deficient recipient site. As a positive side effect, the apical foramen was enlarged, with potential improvement of the probability of revascularization. Clinical and radiologic follow-up examinations up to 18 months indicated revascularization and uneventful periodontal regeneration and thus successful autotransplantation. This case supports the hypothesis that intraoperative apicoectomy can improve the prognosis for revascularization of mature autotransplanted teeth. Further prospective controlled clinical studies are needed to confirm this innovative surgical approach.
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Affiliation(s)
- Norbert Jakse
- Department of Dental Medicine and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Graz, Austria
| | - Max Ruckenstuhl
- Department of Dental Medicine and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Graz, Austria.
| | - Petra Rugani
- Department of Dental Medicine and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Graz, Austria
| | - Barbara Kirnbauer
- Department of Dental Medicine and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Graz, Austria
| | - Armin Sokolowski
- Department of Dental Medicine and Oral Health, Division of Prosthodontics, Restorative Dentistry and Periodontology, Medical University of Graz, Graz, Austria
| | - Kurt Ebeleseder
- Department of Dental Medicine and Oral Health, Division of Prosthodontics, Restorative Dentistry and Periodontology, Medical University of Graz, Graz, Austria
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93
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An Insight into Histopathologic Examination as a Gold Standard for the Diagnosis of Chronic Apical Periodontitis. ACTA MEDICA MARISIENSIS 2018. [DOI: 10.2478/amma-2018-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Objective: The purpose of our study was to determine the level of correlation between histopathologic results after surgery for chronic apical periodontitis and the radiographic and clinical diagnosis. The status of gold standard technique of histologic examination was evaluated in the diagnosis of apical radiolucency in necrotic teeth.
Methods: Out of 154 patients with incorrect root fillings and apical radiolucency included in an endodontic retreatment protocol, 87 patients (108 teeth) were scheduled for apical surgery at 3-6 months control recall. Clinical and radiographic exams were completed prior to surgery and compared to the histological results of apical biopsies. The collected data were statistically analyzed with the SPSS version 20.0 and the Chi-square test was used to determine the associations between clinical and histologic diagnosis. A value of p <0.05 was considered statistically significant.
Results: There was a statistically significant difference between the number of cases diagnosed as granulomas or cysts during clinical and radiological evaluation compared to histologic evaluation of tissue samples, with 40.9% to 75.9% and 54.2% to 16.8% respectively (p<0.05).
Conclusions: The final diagnosis was obtained only after histologic examination of apical tissue samples, which means that the observations made based on radiologic investigations must be confirmed by biopsy.
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94
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Nascimento EHL, Gaêta-Araujo H, Andrade MFS, Freitas DQ. Prevalence of technical errors and periapical lesions in a sample of endodontically treated teeth: a CBCT analysis. Clin Oral Investig 2018; 22:2495-2503. [PMID: 29354883 DOI: 10.1007/s00784-018-2344-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/15/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aims of this study are to identify the most frequent technical errors in endodontically treated teeth and to determine which root canals were most often associated with those errors, as well as to relate endodontic technical errors and the presence of coronal restorations with periapical status by means of cone-beam computed tomography images. METHODS Six hundred eighteen endodontically treated teeth (1146 root canals) were evaluated for the quality of their endodontic treatment and for the presence of coronal restorations and periapical lesions. Each root canal was classified according to dental groups, and the endodontic technical errors were recorded. Chi-square's test and descriptive analyses were performed. RESULTS Six hundred eighty root canals (59.3%) had periapical lesions. Maxillary molars and anterior teeth showed higher prevalence of periapical lesions (p < 0.05). Endodontic treatment quality and coronal restoration were associated with periapical status (p < 0.05). Underfilling was the most frequent technical error in all root canals, except for the second mesiobuccal root canal of maxillary molars and the distobuccal root canal of mandibular molars, which were non-filled in 78.4 and 30% of the cases, respectively. CONCLUSIONS There is a high prevalence of apical radiolucencies, which increased in the presence of poor coronal restorations, endodontic technical errors, and when both conditions were concomitant. Underfilling was the most frequent technical error, followed by non-homogeneous and non-filled canals. CLINICAL RELEVANCE Evaluation of endodontic treatment quality that considers every single root canal aims on warning dental practitioners of the prevalence of technical errors that could be avoided with careful treatment planning and execution.
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Affiliation(s)
- Eduarda Helena Leandro Nascimento
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, Sao Paulo, 13414-903, Brazil.
| | - Hugo Gaêta-Araujo
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, Sao Paulo, 13414-903, Brazil
| | - Maria Fernanda Silva Andrade
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, Sao Paulo, 13414-903, Brazil
| | - Deborah Queiroz Freitas
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, Sao Paulo, 13414-903, Brazil
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95
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Survival of Endodontically Treated Roots/Teeth Based on Periapical Health and Retention: A 10-year Retrospective Cohort Study. J Endod 2017; 43:2001-2008. [DOI: 10.1016/j.joen.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/12/2017] [Accepted: 08/02/2017] [Indexed: 11/21/2022]
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96
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Studebaker B, Hollender L, Mancl L, Johnson JD, Paranjpe A. The Incidence of Second Mesiobuccal Canals Located in Maxillary Molars with the Aid of Cone-beam Computed Tomography. J Endod 2017; 44:565-570. [PMID: 29153734 DOI: 10.1016/j.joen.2017.08.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/16/2017] [Accepted: 08/26/2017] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Many endodontic treatment failures in maxillary molars result from missed second mesiobuccal (MB2) canals. An MB2 canal orifice is present in as many as 95% of maxillary molars, but these canals are not always located during endodontic procedures. Additional tools, such as cone-beam computed tomographic (CBCT) imaging, may be needed to locate these canals in maxillary molars. Hence, the aims of this study were to investigate the frequency of use of CBCT imaging during the treatment of maxillary molars and to evaluate the influence of its use on the detection of MB2 canals. METHODS Endodontic treatment records, digital intraoral radiographs (when present), and CBCT images from all maxillary first and second molars treated at the University of Washington, Seattle, WA, between 2010 and 2014 (N = 886) were reviewed. Statistical analysis was performed to assess differences between the groups. RESULTS Overall, an MB2 canal was found in 55.8% of the maxillary molars studied, and CBCT imaging assisted in detecting 11.7% of these canals. CBCT imaging was used in 16.5% of the cases treated and was used significantly more for retreatment cases. CBCT imaging was used preoperatively in 5.6% of cases, and the data show that significantly more MB2 canals were located when a preoperative CBCT image was available. More MB2 canals were located in first molars without full-coverage crowns. CONCLUSIONS The data show that CBCT imaging is a valuable tool in locating MB2 canals. Based on the results of his study, the use of CBCT imaging could be warranted when treating maxillary molars.
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Affiliation(s)
- Ben Studebaker
- Department of Endodontics, University of Washington, Seattle, Washington
| | - Lars Hollender
- Department of Oral and Maxillofacial Radiology, University of Washington, Seattle, Washington
| | - Lloyd Mancl
- Department of Oral Health Sciences, University of Washington, Seattle, Washington
| | - James D Johnson
- Department of Endodontics, University of Washington, Seattle, Washington
| | - Avina Paranjpe
- Department of Endodontics, University of Washington, Seattle, Washington.
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Abstract
Purpose of Review This review describes the recent findings from epidemiological studies on endodontic infections. The recent literature was screened for studies on the prevalence of primary apical periodontitis and posttreatment apical periodontitis in various populations. Recent Findings Twenty-nine articles reporting data on the prevalence of primary or posttreatment apical periodontitis from all over the world were included. The prevalence of apical periodontitis varied between 7 and 86%, while that of posttreatment apical periodontitis varied between 10 and 62%. The quality of the coronal restoration and the root filling appears to be the major predictors of apical periodontitis. Summary The recent findings from epidemiological studies on the prevalence of primary and posttreatment apical periodontitis in various populations are not substantially different from those from earlier years. It appears that the health of periapical tissues has not majorly improved in the general population.
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98
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Ring J, Ring KC. Rare Root Canal Configuration of Mandibular Second Premolar Using Cone-beam Computed Tomographic Scanning. J Endod 2017; 43:1897-1900. [DOI: 10.1016/j.joen.2017.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022]
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99
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Simuntis R, Kubilius R, Padervinskis E, Ryškienė S, Tušas P, Vaitkus S. Clinical efficacy of main radiological diagnostic methods for odontogenic maxillary sinusitis. Eur Arch Otorhinolaryngol 2017; 274:3651-3658. [PMID: 28733779 DOI: 10.1007/s00405-017-4678-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
Abstract
The objective of the study was to compare the ability of dental, ENT and radiology specialists to identify the dental cause of maxillary sinusitis with conventional computed tomography, dental and panoramic radiographs. Out of 34 dental records from subjects treated at ENT and Oral and Maxillofacial Surgery Department, LUHS Kaunas Clinics, 22 females and 12 males with the diagnosis of odontogenic maxillary sinusitis, periapical (DPA), panoramic (DPR) and computed tomography (CT) images of posterior maxilla were selected for further studies. In total, 39 sinuses with an odontogenic and 37 sinuses with only rhinogenic cause (control group) were included in the study. Sinuses with mucosal thickening less than 3 mm were excluded from the research. Each image was evaluated by 5 endodontologists, 5 oral surgeons, 6 general dentists, 6 otorhinolaryngologists and an experienced oral radiologist. DPR and DPA views were not evaluated by ENT specialists. The dental cause of maxillary sinusitis was marked according to the given scale. Intraclass correlation coefficient and ROC curve statistical analysis were performed. The best accuracy was observed when CT views were evaluated by experienced oral radiologist and oral surgeons: the AUC was 0.958 and 0.859, respectively. DPR views showed the best accuracy when evaluated by oral surgeons (0.763) and DPA-by endodontologists (0.736). The highest inter-rater agreement was observed between experienced oral radiologist and oral surgeons/otorhinolaryngologists (0.87/0.78) evaluating CT. Sensitivity and specificity of CT were 89.7 and 94.6%, DPR-68.2 and 77.3%, DPA-77.9 and 67%. Identification of dental cause of maxillary sinusitis sometimes is a challenge, which depends on radiological method and, more importantly, on evaluator's experience.
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Affiliation(s)
- Regimantas Simuntis
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Eivenių street 2, 44307, Kaunas, Lithuania
| | - Ričardas Kubilius
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Eivenių street 2, 44307, Kaunas, Lithuania
| | - Evaldas Padervinskis
- Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Silvija Ryškienė
- Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Paulius Tušas
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Eivenių street 2, 44307, Kaunas, Lithuania.
| | - Saulius Vaitkus
- Department of Otolaryngology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Gopalakrishnan A, Unnikrishna K, Balan A, Haris PS. Use of Cone-Beam Computed Tomography in the Diagnosis and Treatment of an Unusual Canine Abnormality. Sultan Qaboos Univ Med J 2017; 17:e238-e240. [PMID: 28690901 DOI: 10.18295/squmj.2016.17.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 11/16/2022] Open
Abstract
Diagnosis and treatment planning are important for successful endodontic treatment. We report a 24-year old male who presented to the Government Dental College in Kozhikode, Kerala, India, in 2015 with pain in his right upper canine. A digital periapical radiograph indicated the presence of a supernumerary tooth superimposing the root of the canine. However, cone-beam computed tomography (CBCT) confirmed that the supernumerary tooth was an illusion and that the canine root had a sharp invagination involving the labial and pulpal dentin surfaces, with evidence of periapical bone destruction. A blunt resection was performed at the level of the invagination and the resected end was filled with a dentin substitute. At a one-year follow-up, the patient was asymptomatic and the periapical region appeared to be healing well. This report highlights the importance of CBCT in visualising abnormal canine morphology, thus allowing appropriate endodontic treatment.
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Affiliation(s)
- Archana Gopalakrishnan
- Department of Oral Medicine & Radiology, Government Dental College Kozhikode, Kozhikode, Kerala, India
| | - K Unnikrishna
- Department of Conservative Dentistry & Endodontics, Government Dental College Kozhikode, Kozhikode, Kerala, India
| | - Anita Balan
- Department of Oral Medicine & Radiology, Government Dental College Trivandrum, Thiruvananthapuram, Kerala, India
| | - P S Haris
- Department of Oral Medicine & Radiology, Government Dental College Kozhikode, Kozhikode, Kerala, India
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