Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology

Does the quality of residual alveolar bone apical to a periodontal lesion beneath the maxillary sinus play a vital role in preventing the extension of periodontal disease to maxillary sinus? A CBCT-assisted retrospective study

BACKGROUND

The mucous membrane of the maxillary sinus is sensitivis susceptible to infection or inflammation adjacent to it, which may contribute to mucous membrane thickening (MMT). Residual alveolar bone quality (RABQ) is considered a quality of the remaining bone apical to periodontal defect adjoining to the floor of the maxillary sinus.

OBJECTIVE

The current study aimed to analyze the minimum RABQ to prevent the extension of periodontal pathology from reaching maxillary sinus using cone-beam computed tomography (CBCT).

METHODS

In this retrospective observational study, 240 sinus exposure CBCT records of 146 patients were evaluated. Patients with at least one sinus exposure were included. RABQ and MMT were calculated using CBCT inbuilt tools. RABQ was divided into four groups based on gray scale values (GSV). Statistical analysis was performed using one way ANOVA and independent sample t-tests. Correlation was completed applying Pearson's correlation coefficient.

RESULTS

A significant difference (p< 0.05) was observed between the MMT values of the four RABQ groups. Inverse correlation was observed between mean MMT and GSV values. Mean MMT was higher than pathological MMT range (> 2 mm), with significant differences in groups A and B, where mean GSV values are less than 500. Mean GSV greater than 500 in groups C and D show non-pathological MMT. Prevalence of MMT is 91.4% if GSV is < 500 and 7.5% if GSV is > 500.

CONCLUSIONS

Our study suggests that MMT is present if RABQ has GSV values < 500. Maxillary sinusitis and its etiology from periodontal pathology can be excluded based on RABQ adjoining periodontal lesion. Early detection and prompt treatment along with appropriate regenerative protocols can be performed to increase the RABQ. Further microbiological investigation is required to support the present results.

A cone-beam computed tomography study of the prevalence and location of the second mesiobuccal root canal in maxillary molars

Objectives

This study aimed to investigate the incidence and location of the second mesiobuccal root (MB2) canal in maxillary molars with the aid of various measuring points and lines using cone-beam computed tomography (CT).

Materials and Methods

A total of 205 images of patients who underwent cone-beam CT examinations between 2011 and 2015 as part of their dental diagnosis and treatment were included. There were 76 images of the maxillary first molar and 135 images of the maxillary second molar. Canal orifices were detected at −1 mm from the top of the pulpal floor on cone-beam CT images. Image assessment was performed by 2 observers in reformatted image planes using software. Assessments included measurement of the distance between the MB1 and MB2 canals, and the angles between the lines connecting the MB1-MB2 and distobuccal (DB)-palatal (P) canals. The data were analyzed using the student's t-test.

Results

The prevalence of the MB2 canal was 86.8% in the first molar and 28.9% in the second molar. The angle between the lines connecting the MB1-MB2 and DB-P canals was 2.3° ± 5.7° in the first molar and −3.95° ± 7.73° in the second molar. The distance between the MB1 and MB2 canals was 2.1 ± 0.44 mm in the first molar and 1.98 ± 0.42 mm in the second molar.

Conclusions

The angles between the lines connecting the MB1-MB2 and DB-P canals was almost parallel. These findings may aid in the prediction of the location of the MB2 canal orifice.

Comparison of Cone-beam Computed Tomography and Periapical Radiography to Determine the Proximity of Periapical Lesions to Anatomical Structures in Premaxillary Area prior to Surgical Endodontics: A Clinical Study

Aim

In the anterior maxillary region when periapical (PA) surgery is contemplated, knowledge of relation between root apices and lesion, spatial relationship of tooth root to adjacent anatomical structures is essential. The aim of this study was to compare cone-beam computed tomography (CBCT) and PA radiography to determine the proximity of PA lesions to anatomical structures in the premaxillary area for decision-making before apical surgery.

Materials and methods

Twenty subjects were selected. Three endodontists viewed PA radiographs and CBCT images. These observers (1) determined proximity of lesion to anatomical structures and (2) made decisions on treatment based on each imaging modality. Chi-square test was used to check the relationship between the treatment plans given by PA radiographs and CBCT images. Reliability of the observations was evaluated using intraclass correlation (ICC).

Results

Significant difference was noted in the treatment plan selected by the observers using the two modalities (p < 0.05).

Conclusion

After the lesions were observed with CBCT, there was an increase in the number of teeth involved with the lesion. A change in the observer's treatment plan was recorded after viewing the CBCT scans.

How to cite this article

Sheth K, Kapoor S, Daveshwar S, et al. Comparison of Cone-beam Computed Tomography and Periapical Radiography to Determine the Proximity of Periapical Lesions to Anatomical Structures in Premaxillary Area prior to Surgical Endodontics: A Clinical Study. Int J Clin Pediatr Dent 2020;13(4):322-326.

A randomized controlled trial of endodontic treatment using ultrasonic irrigation and laser activated irrigation to evaluate healing in chronic apical periodontitis

Background

Aim of this trial was to evaluate the combined clinical and radiographic success rate of endodontic treatment using passive ultrasonic irrigation (PUI) and laser activated irrigation (LAI) as compared to conventional syringe irrigation.

Material and Methods

Permanent incisors and single rooted premolars were assessed for eligibility and 69 patients were randomly divided into three treatment groups (n=23) by allocation concealment method and irrigation was performed in accordance with the allocated group. Teeth were evaluated clinically and radiographically with CBCT after 6 months and 12 months of the treatment.

Results

A significant difference was observed in the radiographic healing rates among three groups (χ2=12.29, p=0.05). On comparing the final outcome among the three groups (n=19), it was found that 2 (10.5%) cases of group I(Conventional Syringe irrigation), 7 (36.8%) cases of group II (Passive ultrasonic irrigation) and 8 (42.1%) cases of group III(Laser activated irrigation) were healed while under healing category 13 (68.4%) cases of group I, 12 (63.2%) cases of group II and 11 (57.9%) of group III were observed whereas 4 (21.1%) cases were categorised as diseased in group I only.

Conclusions

LAI and PUI can increase the predictability of the endodontic treatment success in cases of chronic apical periodontitis.

Key words:Cone-beam computed tomography, CBCT-PAI, Irrigation, LASER, Radiographic healing, Root canal treatment, Ultrasonic.

Applications of cone beam computed tomography in endodontics

Background

Endodontic disease can adversely affect the quality of life and therefore early diagnosis and consequent timely treatment is of paramount importance for the Endodontist. Radiology is an essential component in treatment planning, disease monitoring and assessment of treatment outcome. Periapical radiographs and panoramic radiography are frequently utilised but they provide only two-dimensional representation of three-dimensional structures. The advent of cone beam computed tomography (CBCT) offers three-dimensional accuracy of the hard tissue images with a reasonable cost and this has revolutionised imaging of the dentomaxillofacial structures. This imaging system has been seen to overcome some limitations of conventional radiography, as brought out in this review. The improvement in the accuracy is, however, accompanied at the cost of increased radiation exposure to the patient. Nevertheless, smaller areas of exposure are normally appropriate for endodontic imaging, and adjustment in the exposure parameters can further moderate the effective dose (Loubele et al. 37(6):309-18, 2008).

Aims and objectives

The aim of this review is to present the pertinent literature on the various applications of cone beam computed tomography in the field of endodontics.

Methods

Literature was electronically searched on the following sources; Medline and Keats Library. Further, a manual search was performed on the following journals: International Endodontic Journal, Journal of Endodontics, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Endodontology, Journal of Dental Research, European Journal of Oral Sciences & Odontology and Dentomaxillofacial Radiology. A preliminary search was performed to gain an idea of the available literature using keywords ‘Cone Beam Computed Tomography’ to view the volume of the literature evident and identify questions to be addressed in this review. The initial search showed 243 potential articles. After scrutinising the titles and abstracts of the retrieved articles, 70 relevant studies were reviewed in full text. Furthermore, ‘published guidelines on the use of CBCT’ were also searched so as to include the results as an additional source material. All the articles eligible to be included in the review were in the English language and ranged from the year 1960 to the present. Also all the studies reviewed were based on the various uses of cone beam computed tomography in the field of endodontics. The keywords used to search were ‘Cone Beam Computed Tomography (CBCT)’, ‘Conventional radiography’, ‘Applications of CBCT in endodontics’, ‘CBCT and tooth morphology’, ‘CBCT and apical periodontitis’, ‘CBCT and vertical root fractures’, ‘CBCT and resorption’, ‘CBCT and pre-surgical assessment’, ‘CBCT and dento-alveolar trauma’ and ‘CBCT and endodontic outcome’.

Results

Every case is unique and CBCT should be considered only after studying each case individually. CBCT imaging needs to be adopted or used where information from conventional imaging systems is either inadequate for the management of endodontic problems or inconclusive. Having said that, it is safe to state that CBCT imaging has the potential to become the first choice for endodontic treatment planning and outcome assessment, especially when new scanners with lower radiation doses and enhanced resolution would be available.

Odontogenic maxillary sinusitis: A comprehensive review

Odontogenic maxillary sinusitis (OMS) is a well-recognized condition in both the dental and otolaryngology communities. Close to 30% of cases of unilateral maxillary sinusitis may have an underlying dental pathology. Failure to identify a dental cause usually lead to cases recalcitrant sinusitis often associated with serious complications. The aim of this study is to describe the literature findings on odontogenic maxillary sinusitis that discuss anatomy, epidemiology, etiology, bacteriology, diagnosis and treatment.

The present review is based on a current search using bibliographic database and academic search engine. All the articles on odontogenic maxillary sinusitis published after 2000 were included. This study seeks to provide clinicians with evidence that motivates a comprehensive approach to the evaluation and management of OMS. Controversies on diagnosis and management have been addressed and data from different treatment plans were collected by exploring relevant publications.

The surgical treatment of OMS is based essentially on the dental surgery, combined with endoscopic sinus surgery, in order to completely remove the infection, restore the physiological drainage of the sinus and prevent recurrences of sinusitis. A multidisciplinary otolaryngology and dental team is mandatory to successfully manage the dental pathology and the complications resulting from the dental treatments.

Comparison of Selected Anatomical and Treatment-related Diagnostic Parameters Estimated by Cone-Beam Computed Tomography and Digital Periapical Radiography in Teeth with Apical Periodontitis

Objectives

To compare selected anatomical and treatment-related diagnostic parameters estimated by cone-beam computed tomography and by digital periapical radiography in teeth with apical periodontitis, and to evaluate reliability of different examiners in interpretation of images obtained by both methods.

Material and Methods

Teeth with apical periodontitis were evaluated independently by 2 endodontists and 1 radiologist based on 128 cone-beam computed tomography (CBCT) and 162 digital periapical radiography (DPR) images. Anatomical (size, relation with root, location of periapical radiolucency) and treatment-related (canal obturation length, homogeneity, coronal seal) parameters were assessed. Fleiss kappa reflected inter-observer agreement while intra-examiner agreement was estimated by Cohen’s kappa. McNemar and McNemar-Bowker tests served for evaluation of differences between CBCT- and DPR-based estimates.

Results

Cohen’s kappa ranged from 0.62 to 1 for all examiners. Fleiss kappa values were nearly perfect for majority of parameters. Diagnostic discrepancy between methods was found for size of radiolucency that in 15 - 17% cases was larger, and in 25 - 28% smaller in DPR than in CBCT images. DPR revealed 20% of root canals scored as non-obturated while in CBCT - obturation present. Canal obturation was rated as homogenous by CBCT, while absent or non-homogenous by DPR, in 17 - 23%, and 11 - 14% of cases, respectively. Radiologist detected more root perforations in CBCT than in DPR images.

Conclusions

Good intra- and inter-examiner agreement for anatomical and treatment-related diagnostic parameters was achieved using cone-beam computed tomography and digital periapical radiography methods and demonstrated similar diagnostic capability, although variation regarding root perforations and canal obturation quality was observed.

3D Assessment of Endodontic Lesions with a Low-Dose CBCT Protocol

Background: Cone beam computed tomography (CBCT) is often used in different fields of dental science, especially in complex anatomical districts like the endodontic one. The aim of this study is to propose a low-dose CBCT protocol useful in cases of endodontic lesions. Methods: The device used was a MyRay Hyperion X9-11x5; the low dose setting of the machine was 90 Kv, 27 mAs, CTDI/Vol 2.89 mGy. The absorbed organ doses have been evaluated with an anthropomorphic phantom loaded with thermoluminescent dosimeters positioned at the level of sensitive organs like brain, bone marrow, salivary glands, thyroid, esophagus, oral mucosa, extrathoracic airways, and lymph nodes. Equivalent and effective doses have been calculated; the last one has been calculated using the recommendations approved by the Main Commission of ICRP (International Commission Radiological Protection) in March 2007. For the assessment of image quality, five senior clinicians, independent and experienced clinicians, were asked to state if CBCT scans were accurate enough to assess endodontic lesions. Results: The use of a low-dose CBCT acquisition produced the lowest organ dose (5.01 microSv) at the level of the esophagus. Image quality has been considered accurate enough for endodontic diagnostic needs. Conclusions: CBCT low-dose protocol can be used over the standard one in endodontic special cases because it provides a significantly lower radiation dose to the patients while ensuring good image quality. However, further studies are necessary to evaluate the opportunity of low-dose CBCT exams in endodontic clinical practice.

Two-dimensional Periapical, Panoramic Radiography Versus Three-dimensional Cone-beam Computed Tomography in the Detection of Periapical Lesion After Endodontic Treatment: A Systematic Review

Radiographic imaging is a common resource for endodontic diagnosis, treatment, and prognosis. Two-dimensional (2D) periapical and digital panoramic radiographs often showed image distortion; this issue was resolved with the emergence of three-dimensional (3D) cone-beam computed tomography (CBCT). This review examines the accuracy of various radiographic techniques in the assessment of periapical lesion after endodontic treatment. Our goal was to determine whether a 2D radiograph (periapical and panoramic) is as accurate as a 3D radiograph (i.e., CBCT) in the assessment of periapical lesion after endodontic treatment. We searched the electronic databases Medline and Cochrane and trial registries for ongoing trials. We included both retrospective and prospective studies comparing the efficacy of periapical healing with various radiographic techniques after endodontic treatment. The outcome of interest was the percentage detection of periapical lesions and periapical healing assessment after endodontic treatment. All data were collected using a specially designed extraction form. We assessed the risk of bias in the studies using the Cochrane tool for diagnostic tests (QUADAS). We judged two studies to be at low risk and two to be at moderate risk of bias. Although there was a difference in the percentage detection of periapical healing efficacy by various radiographic techniques, all studies reported that CBCT had higher accuracy in the detection of periapical lesions compared to periapical and panoramic radiography. The next best choice is periapical radiographs, followed by panoramic radiographs as they provide better visualization and accuracy.

Association between the dimensions of the maxillary sinus membrane and molar periodontal status: A retrospective CBCT study

BACKGROUND

The information of the association between residual alveolar bone height and mucosal thickening is sparse. This study aimed to explore the effect of maxillary molar periodontal status on sinus mucosal thickening using cone-beam computed tomography (CBCT).

METHODS

One hundred ninety-four CBCT images were evaluated for the following parameters: age, sex, alveolar bone loss, maximum mucosal thickness (maxMT), minimum residual alveolar bone height (minRABH), and vertical infrabony pockets. The presence of mucosal thickening (maxMT > 2 mm) of the maxillary sinus was recorded. The parameters that could influence the dimensions of the maxillary sinus membrane were assessed. The data were analyzed using logistic regression, and multivariate linear regression with the significant level at α = 0.05.

RESULTS

Mucosal thickening was present in 32% of the analyzed CBCT images and increased in frequency as the periodontal status of the corresponding molar progressed from mild (2.6%) to moderate (14.9%) to severe (75.5%). Mucosal thickness was significantly increased in cases of moderate (odds ratio = 5.73, P < 0.05) and severe (odds ratio = 82.06, P < 0.001) alveolar bone loss. Multivariate linear regression revealed that alveolar bone loss and minRABH had a statistically significant influence on maxMT (P < 0.05).

CONCLUSIONS

Alveolar bone loss and minRABH were significantly associated with mucosal thickening of the maxillary sinus.

Nasopalatine canal and periapical radiolucency fusion following dentoalveolar trauma: A CBCT-based case-control study

BACKGROUND/AIM

There is a lack of evidence regarding the radiological characteristics of a periapical radiolucency (PRL) fusion with the nasopalatine canal (NPC) following dentoalveolar trauma. The aim of this study was to assess the NPC enlargement resulting from fusion with a PRL and its relationship with the surrounding anatomical structures.

MATERIAL AND METHODS

A total of 100 patients was retrospectively recruited and divided into two groups: case group and control group. The case group consisted of 50 cone-beam computed tomography scans of the maxilla of patients (32 males, 18 females; age range: 11-83 years) with a known history of dentoalveolar trauma in the maxillary anterior region and the presence of an undiagnosed and/or asymptomatic NPC and PRL fusion. An age- and gender-matched control group of 50 patients (32 males, 18 females; age range: 11-82 years) without trauma history to the upper anterior teeth, demonstrating normal maxillary scans, was recruited. A subjective scoring criterion was established for assessing the characteristics of the fused lesion and its relationship with the buccal/palatal alveolar cortex, nasal cavity cortex, NPC cortical border, and maxillary sinus floor.

RESULTS

The fused NPC and PRL was mainly lobular in appearance (88%) with non-corticated well-defined margins (80%). Male patients showed larger (68%) dimensions compared with female patients (32%). The NPC cortical bone was the most commonly perforated structure in relation to fusion (72%), whereas maxillary sinus cortical bone was the least effected (2%). A statistically significant difference was observed between the NPC dimensions in the control and test groups, with fused lesions having larger mesiolateral, craniocaudal, and buccopalatal dimensions (P < .001).

CONCLUSIONS

Periapical radiolucencies should be treated as soon as possible before they fuse with NPC. In case of fusion, surgical enucleation should be considered as the treatment of choice.

Can Cone-beam Computed Tomography Change Endodontists' Level of Confidence in Diagnosis and Treatment Planning? A Before and After Study

INTRODUCTION

This study evaluated the influence of cone-beam computed tomography (CBCT) on endodondists' level of confidence in their diagnosis of endodontic cases and their treatment plans.

METHODS

Twenty clinical cases with periapical radiographs and small-volume CBCT scans were classified according to the American Association of Endodontists guidelines. Information was provided on patient clinical history, and both extraoral and intraoral examinations were simulated. Fifteen endodontists filled out 2 questionnaires. In the first (Q1), the clinical description and a periapical radiograph were presented, followed by the questions. Thirty days later, they answered a second questionnaire (Q2) containing the same clinical description and CBCT. Their confidence in diagnosis and treatment planning was analyzed before and after receiving the tomographic images. Responses were recorded on a 5-point Likert scale, and the Wilcoxon test was used to investigate before and after levels of confidence in diagnosis and treatment planning.

RESULTS

The CBCT images influenced confidence in diagnosis and treatment planning of endodontic cases classified as complex (Wilcoxon test; P ≤ .05). There was a substantial change in the treatment planned in both moderate and complex cases after CBCT. Case complexity did not affect the participants' decision to request complementary information through CBCT.

CONCLUSIONS

In complex cases, CBCT increased endodontists' confidence to diagnose and plan treatment, when compared with periapical radiographs. Endodontists tended to recommend intervention when periapical images were supplemented with CBCT. CBCT proved to be an imaging method that influences endodontists' preoperative evaluation and treatment choice.

Electronic processing of digital panoramic radiography for the detection of apical periodontitis

INTRODUCTION

This study aimed to evaluate the accuracy of both digital complete and small portion of panoramic radiography (PAN) in the detection of clinically/surgically confirmed asymptomatic apical periodontitis (AP) lesions with and without endodontic treatment.

METHODS

A total of 480 patients/teeth including 120 AP with and without endodontic treatment, and 120 healthy periapex with and without endodontic treatment were detected via CBCT using the periapical index system. Each diseased and healthy patient underwent PAN first and a CBCT scan within 40 days. All 480 cases were assessed by four different methods, as follows: complete PAN with clinical examination of each tooth available and not available, respectively, and small portion of PAN in which a root with crown and root without crown were displayed, respectively. Periapical index system was also used to assess AP by PAN. Accuracy for both complete and small portion of PAN with respect to CBCT was analyzed.

RESULTS

The overall accuracy of the four methods for teeth with endodontic treatment (73.4) was higher than teeth without endodontic treatment (66.6). Accuracy of complete PAN and portion of PAN was 71.3 and 68.7, respectively. As regards teeth without endodontic treatment, accuracy was higher for complete PAN in the upper/lower incisive area and for small portion of PAN in the upper molar area. No difference was found in teeth with endodontic treatment.

CONCLUSION

Complete and small portion of PAN showed greater accuracy in the upper/lower incisive area and upper molar area of untreated teeth, respectively, whereas no difference was found in treated teeth.

Cone-beam computed tomography in the assessment of periapical lesions in endodontically treated teeth

Objective:

This study aimed to evaluate the relationship between the quality of the coronal restoration and the root canal filling on the periapical status of endodontically treated teeth using CBCT.

Materials and Methods:

CBCT data were obtained from the records of patients who deny any dental treatment in the 2 years prior to the CBCT examination. CBCT images (90 kVp and 7 mA, exposure time of 23 s, and a voxel size of 0.2 mm, with a field of view of 13 cm × 13 cm) of 1011 endodontically treated teeth were observed. A score was given to the quality of the root filling and the quality of the coronal restoration.

Statistical Analysis Used:

Data were statistically analyzed to correlate the periapical status with gender, dental group. and quality of endodontic treatment and restoration (Chi-square test with a significance level of P < 0.001).

Results:

Absence of periapical periodontitis was found in 54.9% of the cases. The periapical outcome was not related to gender or dental group (P > 0.05). A statistically significant factor (Chi-square test, P < 0.0001) resulted when different qualities of sealing were compared.

Conclusions:

CBCT showed that high-quality root canal treatments followed by an adequate coronal sealing restoration avoid the presence of periapical periodontitis in time.

Use of Texture Feature Maps for the Refinement of Information Derived from Digital Intraoral Radiographs of Lytic and Sclerotic Lesions

The aim of this study was to examine whether additional digital intraoral radiography (DIR) image preprocessing based on textural description methods improves the recognition and differentiation of periapical lesions. (1) DIR image analysis protocols incorporating clustering with the k-means approach (CLU), texture features derived from co-occurrence matrices, first-order features (FOF), gray-tone difference matrices, run-length matrices (RLM), and local binary patterns, were used to transform DIR images derived from 161 input images into textural feature maps. These maps were used to determine the capacity of the DIR representation technique to yield information about the shape of a structure, its pattern, and adequate tissue contrast. The effectiveness of the textural feature maps with regard to detection of lesions was revealed by two radiologists independently with consecutive interrater agreement. (2) High sensitivity and specificity in the recognition of radiological features of lytic lesions, i.e., radiodensity, border definition, and tissue contrast, was accomplished by CLU, FOF energy, and RLM. Detection of sclerotic lesions was refined with the use of RLM. FOF texture contributed substantially to the high sensitivity of diagnosis of sclerotic lesions. (3) Specific DIR texture-based methods markedly increased the sensitivity of the DIR technique. Therefore, application of textural feature mapping constitutes a promising diagnostic tool for improving recognition of dimension and possibly internal structure of the periapical lesions.

Comparison of cone-beam computed tomography and panoramic radiography in the evaluation of maxillary sinus pathology related to maxillary posterior teeth: Do apical lesions increase the risk of maxillary sinus pathology?

Purpose

The aims of this study were first, to compare panoramic radiography with cone-beam computed tomography (CBCT) for evaluating topographic relationships, such as the classification of maxillary posterior teeth and their distance to the maxillary sinus floor; and second, to determine the relationship between maxillary sinus pathology and the presence of apical lesions.

Materials and Methods

In total, 285 paired CBCT and panoramic radiography records of patients (570 maxillary sinuses) were retrospectively analyzed. Both imaging modalities were used to determine the topographic relationship of the maxillary posterior teeth to the sinus floor. Mucosal thickening >2 mm was considered a pathological state. Data were analyzed using the chi-square, Wilcoxon, and Mann-Whitney U tests. Odds ratios (ORs) and confidence intervals (CIs) were calculated.

Results

The closest vertical distance measurements made between posterior maxillary teeth roots and the maxillary sinus on panoramic radiography and CBCT scans showed statistically significant differences from each other (P<0.05). Compared to panoramic radiography, CBCT showed higher mean values for the distance between the maxillary sinus floor and maxillary posterior teeth roots. The CBCT images showed that at least 1 apical lesion adjacent to the right maxillary sinus increased the risk of maxillary sinus pathology by 2.37 times (OR, 2.37; 95% CI, 1.58-3.55, P<0.05).

Conclusion

Panoramic radiography might lead to unreliable diagnoses when evaluating the distance between the sinus floor and posterior roots of the maxillary teeth. Periapical lesions anatomically associated with maxillary sinuses were a risk factor for sinus mucosal thickening.

Cone Beam Computed Tomography in Oral and Maxillofacial Surgery: An Evidence-Based Review

Cone Beam Computed Tomography (CBCT) is a valuable imaging technique in oral and maxillofacial surgery (OMS) that can help direct a surgeon’s approach to a variety of conditions. A 3-dimensional analysis of head and neck anatomy allows practitioners to plan appropriately, operate with confidence, and assess results post-operatively. CBCT imaging has clear indications and limitations. CBCT offers the clinician 3-dimensional and multi-planar views for a more accurate diagnosis and treatment without the financial burden and radiation exposure of conventional computed tomography (CT) scans. Furthermore, CBCT overcomes certain limitations of 2-dimensional imaging, such as distortion, magnification, and superimposition. However, CBCT lacks the detailed depiction of soft tissue conditions for evaluation of pathologic conditions, head and neck infections, and temporomandibular joint (TMJ) disc evaluation. This review evaluates the evidence-based research supporting the application of CBCT in the various fields of oral and maxillofacial surgery, including dentoalveolar surgery, dental implants, TMJ, orthognathic surgery, trauma, and pathology, and will assess the value of CBCT in pre-operative assessment, surgical planning, and post-operative analysis when applicable. Additionally, the significant limitations of CBCT and potential areas for future research will be discussed.

Comparison of Two-Dimensional and Three-Dimensional Radiographs Using Clinically Relevant Parameters

This work compared the assessment of clinically relevant parameters by two-dimensional, that is, full-mouth intraoral radiograph (I-O) and panoramic radiograph (OPT), and three-dimensional, that is, cone beam computed tomography (CBCT), imaging methods. Different radiographic images (CBCT, I-O and OPT) were available for a 53-year-old female patient with dental and periodontal problems. A total of 14 dental and periodontal parameters were assessed by two independent examiners and compared among the three radiographic imaging modalities. For 10 parameters (71%), the CBCT images were superior to both I-O and OPT images. In contrast, CBCT demonstrated an inferior performance compared to I-O and OPT in the assessment of caries and dental restorations. Compared to OPT, I-O provided more clinically relevant findings for 10 out of 14 parameters (71%). Agreement between I-O and OPT was found with respect to dehiscence, fenestration, the number of bone walls and the root canal cross-section. Differences between the radiographic images were more likely to be detected when maxillary teeth rather than mandibular teeth were assessed with regard to furcation involvement, root proximity and root fusion.

Evaluation of Odontogenic Maxillary Sinusitis with Cone Beam Computed Tomography: A Retrospective Study with Review of Literature

Aim and Objectives:

The purpose of this study was to describe the radiographic characteristics of odontogenic maxillary sinusitis as seen on cone beam computed tomography (CBCT) scans and determine whether any tooth or any tooth root, was more frequently associated with this disease.

Materials and Methods:

The present study included 500 CBCT images that included the entire maxillary sinus of both the sides in all the three planes. The modified classification of Abrahams and Glassberg was used to assess maxillary sinusitis of odontogenic origin. Furthermore, the proximity of the tooth root to the sinus floor, periapical pathology, and the septae within the maxillary sinus were also assessed.

Results:

In the present study, 1000 hemimaxillas were analyzed. Majority of the cases (74.9%) the apex of either tooth was touching the floor of the sinus. While 16.9% were in close relationship to the sinus while 8.2% of the cases, the apices were present within the sinus. Furthermore, in the present study, 38 of the total cases had an odontogenic cause of maxillary sinusitis, whereas 273 of them had a nonodontogenic cause, 96 have an undetermined cause, and the rest 593 cases had healthy sinus.

Conclusion:

The incidence of odontogenic sinusitis is likely under-reported in the available literature. The introduction of low-dose CBCT is particularly useful to establish a definitive diagnosis to augment in the treatment of chronic maxillary sinusitis of odontogenic origin.

Cone beam computed tomography in Endodontics - a review of the literature

The use of cone beam computed tomography (CBCT) in the diagnosis and/or management of endodontic problems is increasing and is reflected in the exponential rise in publications on this topic in the last two decades. The aim of this paper is to: (i) Review current literature on the endodontic applications of CBCT; (ii) Based on current evidence make recommendations for the use of CBCT in Endodontics; (iii) Highlight the areas in which more research is required.

What are the risk factors for maxillary sinus pathologies? A CBCT study

OBJECTIVE

Some anatomic variations may interfere with proper airflow in the maxillary sinus and predispose to maxillary sinus pathologies. It was also reported that as a result of the transport of microorganisms from infected periapical tissues, maxillary sinus pathologies can develop. The objective of this study was to determine the potential relationships of maxillary sinus septa, concha bullosa, nasal septal deviation, and teeth with periapical lesion to maxillary sinus pathologies.

METHODS

200 cone beam computed tomography scans obtained at Necmettin Erbakan University, Faculty of Dentistry from 2013 to 2018 were retrospectively reviewed for the presence of maxillary sinus septa, concha bullosa, nasal septal deviation, teeth with periapical lesions, and maxillary sinus pathologies. When maxillary sinus mucosal thickening exceeded 2 mm, it was considered as a pathological condition. Logistic regression analysis was used to determine the risk factors for maxillary sinus pathologies. p < 0.05 considered statistically significant.

RESULTS

185 (46.2%) of the 400 maxillary sinuses showed maxillary sinus pathologies. Maxillary sinus septa, concha bullosa, and nasal septal deviation were not found to be as a risk factor for the maxillary sinus pathologies (p > 0.05). At least one apical lesion adjacent to the maxillary sinus increased the maxillary sinus pathology by 5.24 times on the right (OR 5.24, p < 0.001) and by 4.67 times on the left side (OR 4.67, p < 0.001).

CONCLUSION

To prevent maxillary sinus pathologies, it is important for the teeth adjacent to the maxillary sinus to be healthy.

Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review

OBJECTIVE

The aim of this systematic review was to identify, review, analyze, and summarize available evidence on the accuracy of linear measurements when using maxillofacial cone beam computed tomography (CBCT) specifically in the field of implant dentistry.

MATERIAL AND METHODS

The search was undertaken in April 2017 in the National Library of Medicine database (Medline) through its online site (PubMed), followed by searches in the Cochrane, EMBASE, ScienceDirect, and ProQuest Dissertation and Thesis databases. The main inclusion criterion for studies was that linear CBCT measurements were performed for quantitative assessment (e.g., height, width) of the alveolar bone at edentulous sites or measuring distances from anatomical structures related to implant dentistry. The studies should compare these values to clinical data (humans) or ex vivo and/or experimental (animal) findings from a "gold standard."

RESULTS

The initial search yielded 2,516 titles. In total, 22 studies were included in the final analysis. Of those, two were clinical and 20 ex vivo investigations. The major findings of the review indicate that CBCT provides cross-sectional images that demonstrate high accuracy and reliability for bony linear measurements on cross-sectional images related to implant treatment. A wide range of error has been reported when performing linear measurements on CBCT images, with both over- and underestimation of dimensions in comparison with a gold standard. A voxel size of 0.3 to 0.4 mm is adequate to provide CBCT images of acceptable diagnostic quality for implant treatment planning.

CONCLUSIONS

CBCT can be considered as an appropriate diagnostic tool for 3D preoperative planning. Nevertheless, a 2 mm safety margin to adjacent anatomic structures should be considered when using CBCT. In clinical practice, the measurement accuracy and reliability of linear measurements on CBCT images are most likely reduced through factors such as patient motion, metallic artefacts, device-specific exposure parameters, the software used, and manual vs. automated procedures.

Development of a New Cone-Beam Computed Tomography Software for Endodontic Diagnosis

Abstract Cone-beam computed tomography (CBCT) has promoted changes in approaches in Endodontics, and enhanced decision-making in complex clinical cases. Despite the technological advancements in CBCT hardware, the interpretation of the acquired images is still compromised by viewing software packages that often have limited navigational tools and lack adequate filters to overcome some challenges of the CBCT technology such as artefacts. This study reviews the current limitations of CBCT and the potential of a new CBCT software package (e-Vol DX, CDT- Brazil) to overcome these aspects and support diagnosing, planning and managing of endodontic cases. This imaging method provide high resolution images due to submillimeter voxel sizes, dynamic multi-plane imaging navigation and ability to change the volume parameters such as slice thickness and slice intervals and data correction applying imaging filters and manipulating brightness and contrast. The main differences between e-Vol DX and other software packages are: compatibility with all current CBCT scanners with the capacity to export DICOM Data, a more comprehensive brightness and contrast library, as other applications, in which adjustments are limited, do not usually support all the DICOM dynamic range features; Custom slice thickness adjustment, often limited and pre-defined in other applications; Custom Sharpening adjustment, often limited in other applications; advanced noise reduction algorithm that enhances image quality; preset imaging filters, dedicated endodontic volume rendering filters with the ability to zoom the image over 1000x (3D reconstructions) without loss of resolution and automatic imaging parameters customization for better standardization and opportunities for research; capture screen resolution of 192 dpi, with a 384 dpi option, in contrast to the 96 dpi of most similar applications. This new CBCT software package may support decision-making for the treatment of complex endodontic cases and improve diagnosis and treatment results. Effective improvement of image quality favors the rational prescription and interpretation of CBCT scans.

Analysis of association between periodontal disease and thickness of maxillary sinus mucosa using cone beam computed tomography - A retrospective study

Purpose

The aim of this study was to measure the thickness of the mucous membrane lining the maxillary sinus and to correlate this thickening of the Schneiderian membrane with the presence or absence of periodontal bone loss of adjacent teeth, by using cone beam computed tomography (CBCT).

Methods

255 CBCT images were analyzed of which 140 images were selected for the study. Based upon the absence of radiographic periodontal bone loss and presence of 50% or more bone loss, these CBCT images were respectively divided into two groups viz. Group I (Healthy) and Group II (Periodontal Bone Loss Group), each group consisting of 70 images each. The thickening of the mucous membrane lining of the floor of maxillary sinus was measured at four points on the CBCT. These points were the anterior most point of the thickened mucosa, the posterior most point of the thickened mucosa, at the midpoint (MP) (point midway between the anterior most and the posterior most point) and the point of maximum thickness of the sinus mucosa.

Results

The age adjusted mean thickness for Group II was significantly greater than that of Group I (p < 0.001) at all the four points. There was a positive association between presence of periodontal bone loss and thickening of Schneiderian membrane at the floor of the sinus. There was a weak positive association between age and mucosal thickness. Of all the four points measured, the maximum correlation between age and thickness was obtained at MP (r = 0.171), which was statistically significant (p = 0.044).

Conclusion

The present study concluded that there is a positive association between presence of periodontal bone loss and thickening of mucosa of floor of maxillary sinus and also exhibited a weak positive relation between age and increased mucosal thickening of floor of maxillary sinus.

Effect of periodontal therapy on maxillary sinus mucous membrane thickening in chronic periodontitis: A split-mouth study

Background. This study evaluated the effect of periodontal therapy on mucous membrane thickening in maxillary sinus in chronic periodontitis patients using radiovisiography (RVG) and cone-beam computed tomography (CBCT).

Methods. The study population included 30 patients diagnosed with chronic periodontitis, exhibiting bilateral mucosal thickening of maxillary sinus. The selected sites were randomly assigned to group I (control group - not receiving periodontal therapy) and group II (test group - receiving periodontal therapy). The clinical parameters and mucosal thickening of the maxillary sinus were evaluated at baseline and after 9 months.

Results. There was a significant decrease in the PPD, CAL as well as mucosal thickening in group II while, group I showed an increase in these parameters. In group II at the end of 9 months the mean mucosal thickening reduction as assessed by CBCT was 0.76±0.18, 0.73±0.24, 0.88±0.42 and 1.13±0.43 mm at the most anterior point (AP), the most posterior point (PP), the mid-point (MP), point of maximum thickness (MT) as well as in the length of the thickened mucosal lining, respectively.

Conclusion. The results of our study indicated a reduction in the mucosal thickening of the maxillary sinus after surgical periodontal therapy. The trial was registered with the Clinical Trial Registry of India (Trial REF/ 2016/02/010805).

Is Panoramic Radiography an Accurate Imaging Technique for the Detection of Endodontically Treated Asymptomatic Apical Periodontitis?

INTRODUCTION

This study aimed to evaluate the diagnostic accuracy of panoramic radiography (PAN) for the detection of clinically/surgically confirmed apical periodontitis (AP) in root canal-treated teeth using cone-beam computed tomographic (CBCT) imaging as the reference standard.

METHODS

Two hundred forty patients with endodontically treated AP (diseased group) were detected via CBCT imaging using the periapical index system. They were divided into groups of 20 each according to lesion size (2-4.5 mm and 4.6-7 mm) and anatomic area (incisor, canine/premolar, and molar) in both the upper and lower arches. Another 240 patients with root filling and a healthy periapex (healthy group) were selected. All diseased and healthy patients underwent PAN first and a CBCT scan within 40 days. The periapical index system was also used to assess AP using PAN. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value for PAN images with respect to CBCT imaging were analyzed. The k value was calculated to assess both the interobserver reliability for PAN and the agreement between PAN and CBCT.

RESULTS

PAN showed low sensitivity (48.8), mediocre negative predictive value (64.7), good diagnostic accuracy (71.3), and high positive predictive value (88.6) and specificity (93.8). Both interobserver reliability for PAN and agreement between PAN and CBCT were moderate (k = 0.58 and 0.42, respectively). The best identified AP was located in the lower canine/premolar and molar areas, whereas the worst identified AP was located in the upper/lower incisor area and upper molar area.

CONCLUSIONS

PAN showed good diagnostic accuracy, high specificity, and low sensitivity for the detection of endodontically treated AP.

Partial Necrosis Consequence of the Infection Spreading from an Adjacent Apical Periodontitis: A Case Report

As the dental pulp could not be directly inspected before endodontic treatment, indirect evaluation of the pulp status via (para)/clinical tests should be performed which need careful inspection. This report presents a root-treated right maxillary first molar with recurrent abscess formation and a radiolucent periradicular lesion surrounding the distobuccal root of the right maxillary second molar. The patient underwent surgical retreatment, employing CEM root-end filling, which resulted in no relief from sign/symptoms. In the cone-beam computed tomography (CBCT), the relationship of the lesion with the mesio-buccal root of the second maxillary molar was detected. Despite the latest tooth showed positive responses to pulp sensibility tests, endodontic therapy was planned for it. During treatment, it became clear that the mesiobuccal canal pulp was necrotic, although vital pulp tissues were present in two other root canals. Following treatment, full recovery from all discomforts was obtained and the lesion healed after 18 months. This case showed that a more complicated evaluation such as CBCT should be used for diagnosis of perpetuated lesions. Furthermore, it might be probable that root canals of vital teeth become necrotic due to involvement in the adjacent apical lesion, a phenomenon known as anachoresis.

Management of a permanent maxillary first molar with unusual crown and root anatomy: a case report

The aim of this article was to showcase the endodontic management of a maxillary first molar with an unusual crown and root anatomy. Clinical diagnosis of the roots and root canal configuration was confirmed by a cone-beam computed tomography (CBCT) and the detection of the canals was made using a dental operating microscope. CBCT images revealed the presence of 5 roots with Vertucci type I canal configuration in all, except, in the middle root which had 2 canals with type IV configuration. The 6 canal orifices were clinically visualized under the dental operating microscope. Clinicians should familiarize themselves with the latest technologies to get additional information in endodontic practice in order to enhance the outcomes of endodontic therapy.

Comparative evaluation of three obturation techniques in primary incisors using digital intra-oral receptor and C.B.C.T-an in vitro study

OBJECTIVES

Successful pulpectomy in primary teeth depends on quality of obturation. It can be evaluated using digital intra-oral receptor (D.I.O.R) and cone beam computed tomography (C.B.C.T). The purposes of this study were to compare 3 different obturation techniques such as lentulospiral, insulin syringe, and endodontic plugger in primary incisors and to evaluate its quality of obturation using D.I.O.R and C.B.C.T technique.

MATERIALS AND METHODS

Thirty-three extracted primary incisors were biomechanically prepared and obturated with zinc oxide eugenol cement by 3 different obturation techniques. The obturation was evaluated for length of obturation and voids using D.I.O.R and C.B.C.T methods.

RESULTS

There was a statistically significant difference between all the groups in length of obturation (P = 0.02) in both D.I.O.R and C.B.C.T. Significant differences (P = 0.03) were present in number of voids among 3 obturation techniques in C.B.C.T. Statistically more voids were observed with D.I.O.R in lentulospiral (P = 0.04) group and in insulin syringe (P = 0.02) group.

CONCLUSIONS

Acceptable result was obtained with lentulospiral in length of obturation compared to insulin syringe and endodontic plugger technique. Insulin syringe technique resulted in increased underfilling with least number of voids. More number of voids were seen in middle one-third and least number of voids were observed at apical one third of the root among all the 3 techniques of obturation. The study concluded that void identification is improved with D.I.O.R compared to C.B.C.T.

CLINICAL RELEVANCE

Lentulospiral reported effective length of obturation, while insulin syringe with least number of voids. D.I.O.R (2-Dimensional) is efficient in detecting voids compared to C.B.C.T (3-Dimensional) in obturated primary teeth.

Second Mesiobuccal Root Canal of Maxillary First Molars in a Brazilian Population in High-Resolution Cone-Beam Computed Tomography

Introduction:

The second canal of the mesiobuccal root (MB2) of the maxillary first molars (MFM) is difficult to detect in conventional radiographs and can be a major cause of failure in endodontic treatments. The aim of this study was to investigate the prevalence and anatomy of the MB2 by using high-resolution cone-beam computed tomography (CBCT).

Methods and Materials:

Three radiologists examined 414 high-resolution CBCTs. Of these, the CBCTs of 287 patients (mean age 49.43±16.76) who had at least one MFM were selected, making a total of 362 teeth. Prevalence and its relation with gender and age of the patients, side of the tooth, and Vertucci’s classification were analyzed. Data were statistically analyzed (P<0.05).

Results:

A total of 68.23% of the teeth exhibited the MB2. The presence of the MB2 was equivalent in both genders and significantly higher in younger patients. There was no correlation between the presence of the MB2 in relation to both the sides of the MFM and the FOV size. Smaller FOV recognized higher Vertucci’s grades.

Conclusions:

It was concluded that the prevalence of the MB2 canal in maxillary first molars in this Brazilian population examined with high-resolution CBTCs is 68.23%, being more prevalent in young patients. Gender and the side examined are no factors for determining the presence of MB2. Although the both FOVs of the high-resolution CBTCs (FOV 8 and 5) detect the MB2 canal, smaller FOV (FOV 5) is more accurate in the analysis of the internal anatomy of such root canals, according to the Vertucci´s classification.

Cone-beam CT in paediatric dentistry: DIMITRA project position statement

DIMITRA (dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks) is a European multicenter and multidisciplinary project focused on optimizing cone-beam CT exposures for children and adolescents. With increasing use of cone-beam CT for dentomaxillofacial diagnostics, concern arises regarding radiation risks associated with this imaging modality, especially for children. Research evidence concerning cone-beam CT indications in children remains limited, while reports mention inconsistent recommendations for dose reduction. Furthermore, there is no paper using the combined and integrated information on the required indication-oriented image quality and the related patient dose levels. In this paper, therefore, the authors initiate an integrated approach based on current evidence regarding image quality and dose, together with the expertise of DIMITRA's members searching for a state of the art. The aim of this DIMITRA position statement is to provide indication-oriented and patient-specific recommendations regarding the main cone-beam CT applications in the pediatric field. The authors will review this position statement document when results regarding multidisciplinary approaches evolve, in a period of 5 years or earlier.

Accuracy of Cone-beam Computed Tomographic Image Interpretation by Endodontists and Endodontic Residents

INTRODUCTION

Limited field cone-beam computed tomography (CBCT) imaging has become a modality frequently used by endodontists to evaluate the teeth and surrounding tissues of their patients. Accurate image interpretation is vital to obtain needed treatment information as well as to discern coincidental findings that could be present. The goal of this study was to determine the accuracy of CBCT volume interpretation when performed by endodontists and endodontic residents.

METHODS

Eighteen deidentified limited field CBCT scans were obtained and evaluated by an oral and maxillofacial radiologist and an endodontist experienced in reading CBCT images. Their collective findings were combined as the "gold standard" of interpretation for this investigation. Using standard CBCT software, 4 practicing endodontists and 5 second-year endodontic residents evaluated each scan and recorded any notable findings and whether or not each scan warranted referral to a radiology specialist. Their interpretations were then compared with the gold standard to determine accuracy and any significant differences among the groups.

RESULTS

The overall accuracy was 58.3% for endodontists and 64.3% for residents. Paired t tests showed no statistically significant differences in accuracy between the 2 groups for findings in teeth or in bone, but residents were significantly better for maxillary sinus findings. Endodontists agreed with the gold standard 38.9% of the time and residents 49.8% of the time on necessity of referral. The Cohen kappa coefficient showed moderate agreement between the groups.

CONCLUSIONS

Endodontists and residents had similar accuracy in CBCT scan evaluation. More training and experience are warranted for both groups in order to maximize image assessment accuracy.

Hallmark of success: top 50 classics in oral and maxillofacial cone-beam computed tomography

Purpose

The aim of this study was to identify the top 50 cited articles on the use of cone-beam computed tomography (CBCT) for oral and maxillofacial applications and to summarise the characteristics of the most impactful research articles in this domain.

Material and methods

A database was generated by combining the search results from Thomson Reuters Web of Science and Elsevier's Scopus to ensure that all top-cited publications were captured. We used three search fields to generate the database: 1) CBCT, 2) oral and maxillofacial pathologies, and 3) oral and maxillofacial anatomical structures. Publications were then ranked by citation counts and reviewed by two independent reviewers.

Results

A total of 50 top publications were included in the study. Their citation count ranged from 43 to 170 with a median of 55.5. Five publications were cited more than 100 times. All except for one paper were published after 2000. The most well published journal was the American Journal of Orthodontics and Dentofacial Orthopedics (n = 12), and the United States of America (n = 15) was the most productive country in the field. The majority of the studies (n = 27) discussed the imaging of primary tooth pathologies, but there are also a significant number of articles that discuss imaging of bone grafts or dental implants (n = 7), upper airways (n = 5), the skull (n = 4), and other maxillofacial structures (n = 7).

Conlcusions

Our study identifies 50 research articles with the highest number of citations in oral and maxillofacial CBCT, discusses the characteristics and commonalities between these articles, and predicts future trends in the field.

The Risk Factors that Can Increase Possibility of Mandibular Canal Wall Damage in Adult: A Cone-Beam Computed Tomography (CBCT) Study in a Chinese Population

Background

The objective of this study was to analyze the factors that can increase the possibility of mandibular canal (MC) defect in Chinese people, to evaluate the risk of nerve impairment, and to choose the proper operative method to reduce the risk of mandibular alveolar nerve injury during the extraction of mandibular third molar (MTM).

Material/Methods

A total of 954 patients (1,304 MTMs) who underwent orthopantomography (OPG) and cone-beam computed tomography (CBCT) between July 2014 and December 2014 were included in this study. The age and gender of patients, impacted type (high impaction, moderate impaction, and low impaction), Winter classification of MTM, position of MTM relative to MC, vertical classification of MTM and MC, and the feature images of OPG were collected and compared to the imperfection of the MC wall in CBCT images.

Results

The wall situation of MC was significantly correlated with the age of the patient, the depth of the molar, the position of the roots, and six imaging appearances on OPG. There was no significant difference based on gender.

Conclusions

Most incomplete walls of MCs could be inferred by OPG. However, images based on CBCT could clarify the defect of the MC and also could clearly display the spatial relationship between the root and inferior alveolar canal.

Prevalence of apical periodontitis and quality of root canal treatment in an adult Saudi population

Objectives:

To determine the health status of periradicular tissue and the quality of root canal fillings in an adult Saudi population attending dental clinics for the first time.

Methods:

This cross sectional study was conducted in the dental clinics at King Saud University, Riyadh and other dental centers (Jeddah, Najran, and Albaha City), Kingdom of Saudi Arabia between year 2010 and 2012. Good-quality panoramic radiographs of 926 Saudi subjects (540 males and 386 females)were analyzed based on the gender, age, health status, smoking habits, periapical status of the endodontically treated teeth, technical quality of the root canal fillings, and the presence or absence of coronal restoration. Data were calibrated and statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) version 17.

Results:

Of the 25,028 teeth examined, 1,556 teeth (6.2%) had apical periodontitis (AP). Male subjects aged over 55 years and females between 36 and 45 years had higher AP. A total of 36 diabetic and 87 smokers subjects had AP. The AP was more common in male diabetics than female (p=0.383), and in female smokers more than male (p=0.44). Only 42.2% of male and 57.7% of female teeth had adequate root canal treatment.

Conclusions:

Apical periodontitis was significantly related to diabetes, smoking, and inadequate endodontic treatment.

Odontogenic sinusitis: a comprehensive review

Odontogenic sinusitis (OS) is a highly prevalent, underappreciated and underdiagnosed disease that has been known for over 100 years. Apical periodontitis, periodontal disease and iatrogenic extrusion of foreign bodies into the sinus are the main causes of OS. Although the prevalence of sinus pathosis of dental origin is still controversial, otolaryngologists recognize that in the presence of recalcitrant sinusitis, a dental origin should be considered and properly treated. Currently, cone-beam computed tomography is the gold-standard imaging technique to assess the relationship between dental conditions, especially apical periodontitis and sinus diseases, and whenever this association is detected, patients should be seen by both a dentist and an otolaryngologist in order to achieve complete recovery. This article reviews the current concepts regarding the definitions, diagnosis and management of OS from a clinical point of view.

Association between demographic and radiographic characteristics of the schneiderian membrane and periapical and periodontal diseases using cone-beam computed tomography scanning: A retrospective study

Background. This study was undertaken to assess the pathological and spatial associations between periapical and periodontal diseases of the maxillary first molars and thickening of maxillary sinus mucosa with cone-beam computed tomography.

Methods. A total of 132 CBCT images of subjects 20‒60 years of age were evaluated retrospectively. The patients' sex and age and demographic and pathologic findings of the maxillary sinus in the first molar area were recorded, graded and analyzed.

Results. Approximately 59% of patients were male and 41% were female, with no significant difference in the thickness of schneiderian membrane between males and females. Based on the periapical index scoring, the highest frequency was detected in group 1. Based on the results of ANOVA, there were no significant differences in the frequencies of endodontic‒periodontal lesions and an increase in schneiderian membrane thickness. There were significant relationships between periapical and periodontal infections (P<0.001) and schneiderian membrane thickness. Furthermore, a significant relationship was detected between the thickness of the schneiderian membrane and the distance between the sinus floor and the root apices (P=0.38).

Conclusion. A retrospective inspection of CBCT imaging revealed that periapical lesions and periodontal infections in the posterior area of the maxilla were associated with thickening of the schneiderian membrane. In addition, there was a significant relationship between the location of maxillary posterior teeth, i.e. the thickness of bone from the root apex to the maxillary sinus floor, and schneiderian membrane thickness.

A Comparison of 2- and 3-dimensional Healing Assessment after Endodontic Surgery Using Cone-beam Computed Tomographic Volumes or Periapical Radiographs

INTRODUCTION

The aim of this study was to compare the assessment of healing after endodontic microsurgery using 2-dimensional (2D) periapical films versus 3-dimensional (3D) cone-beam computed tomographic (CBCT) imaging.

METHODS

The healing of 51 teeth from 44 patients was evaluated using Molven's criteria (2D) and modified PENN 3D criteria. The absolute area (2D) and volume (3D) changes of apical lesions preoperatively and at follow-up were calculated by segmentation using OsiriX software (Pixmeo, Bernex, Switzerland) and ITK-Snap (free software).

RESULTS

There was a significant difference between the mean preoperative lesion volumes of 95.34 mm³ (n = 51, standard deviation [SD] ±196.28 mm³) versus 6.48 mm³ (n = 51, SD ±17.70 mm³) at follow-up (P < .05). The mean volume reduction was 83.7%. Preoperatively, mean lesion areas on periapical films were 13.55 mm² (n = 51, SD ±18.80 mm²) and 1.83 mm² (n = 51, SD ±.68 mm²) at follow-up (P < .05). According to Molven's criteria, 40 teeth were classified as complete healing, 7 as incomplete healing, and 4 as uncertain healing. Based on the modified PENN 3D criteria, 33 teeth were classified as complete healing, 14 as limited healing, 1 as uncertain healing, and 3 as unsatisfactory healing. The variation in the distribution of the 2D and 3D healing classifications was significantly different (P < .05). Periapical healing statuses incomplete healing or uncertain healing according to Molven's criteria could be clearly classified using 3D criteria.

CONCLUSIONS

CBCT analysis allowed a more precise evaluation of periapical lesions and healing of endodontic microsurgery than periapical films. Significant differences existed between the 2 methods. Over the observation period, the mean periapical lesion sizes significantly decreased in volume. Given the correct indications, the use of CBCT imaging may be a valuable tool for the evaluation of healing of endodontic surgery.