Diagnostic accuracy of periapical radiography and panoramic radiography in the detection of apical periodontitis: a systematic review and meta-analysis

OBJECTIVE

Apical periodontitis (AP) is one of the most common pathologies of the oral cavity. An early and accurate diagnosis of AP lesions is crucial for proper management and planning of endodontic treatments. This study investigated the diagnostic accuracy of periapical radiography (PR) and panoramic radiography (PAN) in the detection of clinically/surgically/histopathologically confirmed AP lesions.

METHOD

A systematic literature review was conducted in accordance with the PRISMA guidelines. The search strategy was limited to English language articles via PubMed, Embase and Web of Science databases up to June 30, 2023. Such articles provided diagnostic accuracy values of PR and/or PAN in the detection of AP lesions or alternatively data needed to calculate them.

RESULTS

Twelve studies met inclusion criteria and were considered for the analysis. The average value of diagnostic accuracy in assessing AP lesions was 71% for PR and 66% for PAN. According to different accuracy for specific anatomical areas, it is recommended to use PR in the analysis of AP lesions located in the upper arch and lower incisor area, whereas lower premolar and molar areas may be investigated with the same accuracy with PR or PAN.

CONCLUSIONS

Two-dimensional imaging must be considered the first-level examination for the diagnosis of AP lesions. PR had an overall slightly higher diagnostic accuracy than PAN. Evidence from this review provided a useful tool to support radiologists and dentists in their decision-making when inflammatory periapical bone lesions are suspected to achieve the best clinical outcome for patients, improving the quality of clinical practice.

Treatment of Retrograde Peri-Implantitis Originating From Apical Periodontitis of an Adjacent Tooth: A Clinical Case Letter

This report aims to present a treatment of retrograde peri-implantitis originating from apical periodontitis of an adjacent tooth in an 84-year-old male. Apical periodontitis of the maxillary left central incisor (#9) extended to the apex of the maxillary left lateral incisor implant (#10), which had been functioning for 16 years. Root canal treatment for #9 was performed, followed by root end surgery to treat the apical periodontitis, which showed a periapical radiolucency measured 1 cm in its greatest dimension. After the root end filling was placed, neither bone substitute materials nor barrier membranes were used to fill and cover the bony defect area. A 2-year postoperative radiograph confirmed the osseous healing around the apices of #9 and #10.

A 22-year follow-up cross-sectional study on periapical health in relation to the quality of root canal treatment in a Belgian population

AIM

To investigate the prevalence of apical periodontitis (AP) and the technical standard of root canal treatment in a Belgian population, assess the association of different variables with periapical status, and compare the results to a similar study conducted 22 years previously.

METHODOLOGY

In this cross-sectional study, 614 panoramic radiographs of first-time adult attendees at the Dental School of the University Hospital of Ghent were examined. Recorded patient-level parameters included gender, age, number of teeth, number of root filled teeth, presence of any AP lesion, and number of implants. The following tooth-level data were collected: tooth presence, coronal status, quality of coronal restoration, post presence, type of root-filling material, length and density of root filling, root-end filling material, presence of AP, and adjacent implant. Multivariable multilevel binary logistic regression was used to explore the association between patient and tooth characteristics and AP prevalence. Risk differences and confidence intervals were calculated to compare the present with the previous study.

RESULTS

The prevalence of AP at patient and tooth level was 46.9% and 5.6%, respectively. Fifty-one per cent of the 614 patients had at least one root filled tooth, and 5.9% of the 14 655 teeth studied were root filled. AP was found in 45% of root filled teeth. Fifty-four per cent of the root-filled teeth were rated as inadequate. Multivariable multilevel logistic regression revealed that more teeth, more implants, fewer root-filled teeth, adequate density, adequate coronal restoration, and no caries reduced the likelihood of AP. There were no statistically significant differences between the two studies regarding the prevalence of root-filled teeth or AP and the technical quality of root canal treatment.

CONCLUSIONS

The prevalence of AP and the technical quality of root canal treatment in Belgium have not substantially changed over the last 22 years, despite the technological advancements and continuing education in the field.

Outcome of root canal retreatment filled with gutta-percha techniques: A systematic review and meta-analysis

OBJECTIVE

The present systematic review and meta-analysis aimed to evaluate the success rate of root canal retreatment filled with gutta-percha and the variables related to retreatment success.

DATA

The PRISMA guidelines were followed for the present review. The study protocol was registered in the International Prospective Database of Systematic Reviews (PROSPERO CRD42021283134). Risk assessment was performed using the Newcastle-Ottawa scale. Funnel plots were used to detect publication bias and asymmetry was assessed using Egger's tests.

SOURCES

PubMed, Scopus, ScienceDirect, Cochrane, and additional sources were searched.

STUDY SELECTION

Studies published until 10 December 2022. Clinical studies evaluating the success of root canal retreatment filled with gutta-percha with at least a 1-year follow-up were selected.

RESULTS

Ten studies and one unpublished study fulfilled the inclusion criteria for quantitative analysis. The success rate of non-surgical root canal retreatment was 71% (95% CI: 66%-76%) with strict criteria and 87% (79% - 93%) with loose criteria for 1-3 years of follow-up, and 77% (66% - 86%) with strict criteria for a 4-5 years of follow-up. Endodontically retreated teeth with periapical lesions had a lower success rate under strict criteria. The tooth type, dental arch, initial periapical index (PAI) score, and the number of visits also affected the treatment success rate under strict criteria. For the loose criteria, teeth with larger periapical lesions and higher initial PAI scores had a lower success rate.

CONCLUSIONS

According to the present systematic review and meta-analysis, non-surgical root canal retreatment results in favourable outcomes. The presence of a periapical radiolucency, periapical lesions >5mm, a higher initial PAI score, multiple-visit retreatments, and mandibular and molar teeth resulted in a lower success rate.

CLINICAL SIGNIFICANCE

Non-surgical root canal retreatment filled with gutta-percha techniques is a relatively predictable procedure with a high success rate. Several variables can affect retreatment success, mainly the presence and size of a periapical lesion and the type of tooth.

Endodontic Orthograde Retreatments: Challenges and Solutions

Endodontic orthograde retreatments are considered one of the possible treatment options in case of post-treatment diseases considering the promising results present in the literature. Despite this, a plethora of articles have been published on this topic, and drawing conclusions could be challenging. For this reason, this review aims to summarize the crucial points on each aspect of non-surgical endodontic retreatments, discussing and comparing the current protocols, techniques, materials, and indications. Taking into consideration data from the literature, in terms of diagnosis, CBCT should be considered the first choice, since it can thoroughly affect the diagnosis and treatment plan. Regarding the procedural phases, some conclusions can be drawn: when present, coronal restoration materials such as crowns, partial prostheses, post, and core should be removed; the use of magnification devices, ultrasonic instruments, and an in-depth interpretation of radiographic images with both 2D and 3D images are strongly recommended during the orifice location; additional protocols such as irrigants activation, ultrasonic cleaning, and rotary or reciprocating instrumentation of treated canals are strongly recommended for filling materials removal and to achieve a high-quality chemo-mechanical disinfection; perforations should be treated as soon as possible, and the material of choice to treat them is the MTA or other calcium-silicate-based repair materials; the presence of ledges does not intrinsically reduce the success rate of RCRts if properly managed; in case of instrument fragments, their removal should be considered as the first treatment option, however many variables should be considered to select the proper technique or consider the option of bypassing.

Assessment of correlation between clinical, radiographic, microbiological, and histopathological examinations in identification of pulpal diseases - a single-centre study

Aim

This study aimed to analyse the presence of pulpitis using different techniques and compare the findings of the various examination methods.

Methods

A total of 108 patients were enrolled and randomly divided into two groups: 56 patients whose pulp samples were sent for histopathological analysis and 52 patients whose samples were sent for microbiological analysis. All participants underwent endodontic procedures, with clinical evaluation and assessment using periapical radiography. Bacteria were isolated and identified using agar culture and VITEK 2 identification cards.

Results

Histopathology confirmed chronic pulpitis in 33 samples (58.9%) and acute pulpitis in 23 samples (41.1 %). For chronic pulpitis, the histopathological diagnosis agreed with the clinical evaluation diagnosis in 65.2% of cases, and a similar percentage of agreement was observed for acute pulpitis. Chronic pulpitis was observed in 34.8% of patients on clinical examination; however, according to histopathology, these cases were acute. Dilated blood vessels were detected in 56.5% of patients with acute pulpitis and 15.2% of patients with chronic pulpitis. Neutrophilic leucocytes were observed in 43.5% of patients with acute pulpitis and 69.7% of patients with chronic pulpitis. Lymphocytes were observed in 17.4% of acute pulpitis samples but zero chronic pulpitis samples. Microbiological analysis identified gram-positive bacilli in 22 samples, gram-positive cocci in 51 samples, and fungi in 2 samples. Acute pulpitis was typically found to be associated with anaerobic Clostridium bifermentans, aerobic Streptococcus mitis, and Granulicatella elegans, whereas chronic pulpitis was more often associated with two facultative anaerobes, Streptococcus oralis and Streptococcus mitis.

Conclusion

Comparison of clinical, radiographic, and histological examination techniquesrevealed several notable discrepancies. Radiographic imaging only suggested the presence of pulpal pathologies; therefore, histopathological analysis of the pulp material was still ultimately required to verify the clinical diagnosis and exclude other pathologies. Although histopathology remains the gold standard for assessing pulpal disease, performing additional examinations may provide the most comprehensive, and perhaps the most effective, approach.

CBCT in contemporary endodontics

Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality which can aid endodontic diagnosis and treatment planning. While there are guidelines available describing the indications, there are divergent philosophies on when this technology should be applied in clinical practice. This paper reviews the applications of CBCT including the clinical relevance of parameters which can be assessed, highlights the limitations of this technology, and provides guidance on how to maximise its clinical utility.

Relationship between oral health and prognosis in patients with empyema: Single center retrospective study with propensity score matching analysis

BACKGROUND

Empyema is a life-threatening infection often caused by oral microbiota. To the best of our knowledge, no reports have investigated the association between the objective assessment of oral health and prognosis in patients with empyema.

MATERIALS AND METHODS

A total of 63 patients with empyema who required hospitalization at a single institution were included in this retrospective study. We compared non-survivors and survivors to assess risk factors for death at three months, including the Renal, age, pus, infection, diet (RAPID) score, and Oral Health Assessment Tool (OHAT) score. Furthermore, to minimize the background bias of the OHAT high-score and low-score groups determined based on the cut-off value, we also analyzed the association between the OHAT score and death at 3 months using the propensity score matching method.

RESULTS

The 3-month mortality rate was 20.6% (13 patients). Multivariate analysis showed that a RAPID score ≥5 points (odds ratio (OR) 8.74) and an OHAT score ≥7 points (OR 13.91) were significantly associated with death at 3 months. In the propensity score analysis, a significant association was found between a high OHAT score (≥7 points) and death at 3 months (P = 0.019).

CONCLUSION

Our results indicated that oral health assessed using the OHAT score may be a potential independent prognostic factor in patients with empyema. Similar to the RAPID score, the OHAT score may become an important indicator for the treatment of empyema.

Assessment of bone quality of apical periodontitis treated with MTA plug and regenerative endodontic techniques

Fractal analysis (FA) is a quantitative, objective and non-invasive method that facilitates the characterisation of the tissue architecture. This study aims to compare the periapical healing at 1-year follow-up by evaluating newly generated trabecular bone with FA after Mineral trioxide aggregate (MTA) plug and regenerative endodontic treatment (RET). A total of 55 asymptomatic teeth with a single-canal, open apex and periapical lesion, treated with MTA plug or RET, were evaluated retrospectively. After considering the inclusion/exclusion criteria, FA was conducted on 30 periapical images using the box-counting method. In both groups, a significant decrease was observed in the periapical lesion size at 1-year follow-up (p < 0.01). However, there was no significant difference between the MTA plug and RET (p > 0.01). Significantly higher fractal dimension values were detected at 1-year follow-up in both MTA plug and RET cases (p < 0.01). However, the difference was not significant between the groups (p > 0.01). Both procedures seem to improve periapical healing with a new resistant bone of similar density and complexity.

The Changes in Size of Periapical Lesions after Root Canal Treatments Assessed by Digital Periapical Radiography and Cone-Beam Computed Tomography: A 2-Years Prospective Clinical Study

Background and Objectives: There is limited information regarding comparison of long-term dynamics of periapical bone destruction estimated by digital periapical radiography (DPR) and by cone-beam computed tomography (CBCT). This study aimed to compare the radiographically assessed periapical changes of endodontically treated teeth over 2 years of follow-up and to analyse disagreements in periapical lesion size estimates around the same roots using DPR and CBCT. Materials and Methods: A total of 176 endodontically treated teeth, of 128 patients with apical periodontitis, were assessed by DPR and CBCT, at baseline and after 2 years. All periapical radiolucencies were categorised by severity (S0, S1, S2, S3) concerning their size. Descriptive statistics were used to report distribution of the radiolucencies at baseline and at follow-up, and their size transitions over 2 years. Site-specific comparison of the radiolucencies identified by two methods was performed using Z test and Pearson’s chi-square test. Results: majority of the detected radiolucencies were scored as S0: 65% and 68% at baseline; 89% and 83% at follow-up, by DPR and CBCT, respectively. Site-specific score comparison showed that disagreements comprised 18% and 20% of the total number of radiolucencies detected by DPR and CBCT, respectively. There were more disagreements between DPR and CBCT within categories S1 and S2 + S3 compared to S0: at baseline, they comprised 17–33% and after two years 62–95% of all detected radiolucencies within the category. 65% of non-matching score transitions over two years occurred between S0 and S1. The CBCT-based evaluation resulted in negative treatment outcomes for 10 more root canals than the DPR-based result. Conclusions: Most remarkable disagreement between DPR and CBCT recordings was observed within the radiolucency categories S2 and S3. However, the diagnostic accuracy of both radiographic methods was questionable as it resulted in a high proportion of non-matching S0-S1 lesion transitions over 2 years.

The effect of a deep-learning tool on dentists' performances in detecting apical radiolucencies on periapical radiographs

OBJECTIVES

To determine the efficacy of a deep-learning (DL) tool in assisting dentists in detecting apical radiolucencies on periapical radiographs.

METHODS

Sixty-eight intraoral periapical radiographs with CBCT-proven presence or absence of apical radiolucencies were selected to serve as the testing subset. Eight readers examined the subset, denoted the positions of apical radiolucencies, and used a 5-point confidence scale to score each radiolucency. The same subset was assessed by readers under two conditions: with and without Denti.AI DL tool predictions. For the two sessions, the performance of the readers was compared. The comparison was performed with the alternate free response receiver operating characteristic (AFROC) methodology.

RESULTS

Localization of lesion accuracy (AFROC-AUC), specificity and sensitivity (by lesion) detection demonstrated improvements in the DL aided session in comparison with the unaided reading session. Subgroup performance analysis revealed an increase in sensitivity for small radiolucencies and in radiolucencies located apical to endodontically treated teeth..

CONCLUSION

The study revealed that the DL technology (Denti.AI) enhances dental professionals' abilities to detect apical radiolucencies on intraoral radiographs.

ADVANCES IN KNOWLEDGE

DL tools have the potential to improve diagnostic efficacy of dentists in identifying apical radiolucencies on periapical radiographs.

'Is there anything wrong with my teeth and gums?' The challenges of the dental examination and care planning

Patients attend dental professionals with the aim of improving the quality of their lives; they want to be healthier or healthy. This may range from the relief of physical pain, discomfort, or reduced function, to managing the emotional distress of dissatisfaction with appearance. Health, according to the World Health Organisation, is 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity', and oral health therefore becomes an essential component of this definition. To meet these aims, dental practitioners should be concerned with the desires and expectations of their patients, as well as their clinical needs. To achieve this, a wide range of knowledge and skills must be employed to first make a diagnosis, then by making clinical decisions to arrive at a care plan that is appropriate for each individual patient and yet remains within the scope of practice as determined by the General Dental Council. Each stage of the interaction between provider and patient - examination care planning, and disease management - presents physical, clinical and ethical challenges. Further, having established the status of the soft and hard tissues, decisions must be made as to whether it is appropriate to leave the patient with some level of disease process or impairment of function rather than attempt to eliminate it entirely. Enhancements, the ever-increasing demand for cosmetic dentistry, and the tension that is created between the desire of the patient and the clinical, moral and ethical obligations of the practitioner, challenge the dentist not to transition from being a professional into the world of commercialism. This article addresses these challenges.

Apical status and prevalence of endodontic treated teeth among Saudi adults in Eastern province: A prospective radiographic evaluation

Introduction

The main cause for developing periapical lesions (PA) is the root canal infection. The mentioned causes may play a role in not controlling it but are not a “true” cause.

Objective

To determine apical status and prevalence of endodontic treated tooth using radiograph assessment in relation to quality of root canal treatment and clinical factors among Saudi adults in the Eastern province.

Patients and methods

This prospective case series study included 2161 patients who received root canal treatment (RCT) at Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia, between October 21, 2019 and April 22, 2020, after getting ethical approval from the Institutional Research Board (IRB). Saudi natives of either gender, age ≥ 18, with at least one fixed bridge or single dental crown evaluated on a clear, high-quality radiography image were recruited for the study. To determine the periapical state of root canal-filled teeth, the 'periapical index' (PAI) was used. All pertinent patient information was analyzed in SPSS verion-20 (IBM product, Chicago).

Results

Out of 2161 cases, a PA lesion was present in 756 (35.0%). The prevalence of periapical lesions in endodontically treated teeth was 31.2%. PA lesion was associated with molar involvement (50.8% vs. 36.6%, p = 0.001), poor RCT quality (85.2% vs. 51.0%, p = 0.001), and smoking (13.6% vs. 10.5%, p = 0.028). According to logistic regression model, female gender, molar tooth, and poor RCT quality were more likely to expose PA lesion 1.5 times, 1.8 times, and 5 times, respectively.

Conclusion

It is concluded that approximately 1/3rd of endodontically treated teeth are susceptible to the occurrence of periapical lesions in radiographic assessment, which are significantly associated with females, molars, and poor RCT quality, indicating a challenge for endodontists to improve their root canal assessment accuracy.

The outcome of endodontic treatment using an enhanced infection protocol in specialist practice

Objectives This study aims to determine the outcome of primary root canal treatment with specific enhanced infection control protocol. The secondary aim was to compare percentages of successful outcomes in this study with a previous study undertaken by the same operator using both periapical radiograph (PR) and cone beam computed tomography (CBCT).Materials and methods Root canal treatment of 110 teeth in 95 patients carried out by a single operator using an enhanced infection control procedure (disinfection of gutta percha before obturation, changing of gloves after each intraoperative radiograph and also before the start of the root canal obturation). PR and CBCT scans of 94 teeth in 87 patients were assessed 12 months after completion of primary root canal treatment and compared with their respective pre-treatment (diagnostic) PR and CBCT scans. Healing was assessed by a consensus panel consisting of two calibrated examiners. Comparison of the PR and CBCT images for 'healed' and/or 'healing' outcomes was performed using McNemar's test.Results The 'healed' rate (absence of periapical radiolucency) was 89.4% using PR and 78.7% for CBCT (p <0.046). This rate increased to 95.7% for PR and 92.6% for CBCT when the 'healing' group (reduced size of periapical radiolucency) was included (p <0.046).Conclusion The frequent changing of gloves during the course of endodontic treatment and disinfection of gutta percha points before obturation, together with the use of contemporary rotary files, resulted in a high success rate of primary root canal treatment compared to similar clinical studies conducted previously.

Radiolucent Lesions of the Jaws: An Attempted Demonstration of the Use of Co-Word Analysis to List Main Similar Pathologies

(1) Background: Many radiolucent jaw lesions exist, and they often show a radiographic resemblance, rendering diagnosis a challenging act. Closely related lesions should be frequently mentioned together in the academic literature, which might be helpful for junior practitioners in determining their differential diagnosis. The usefulness of bibliometric analysis in this respect has yet to be demonstrated. (2) Methods: This study evaluated academic publications on radiolucent jaw lesions, as indexed by the Web of Science Core Collection database. The mentions of radiolucent jaw lesions were extracted from the complete bibliographic records of the publications, and co-word analyses were conducted with the aid of VOSviewer. (3) Results: Based on 1897 papers, visualization maps were synthesized to evaluate co-occurrences of the radiolucent jaw lesions. Ameloblastoma was frequently mentioned together with odontogenic keratocyst, dentigerous cyst, and radicular cyst. Osseous dysplasia was co-mentioned with osteomyelitis, ossifying fibroma, odontoma, fibrous dysplasia, and apical periodontitis. (4) Conclusions: The co-word analysis, a form of bibliometric analysis, could demonstrate a relatedness of radiolucent jaw lesions that could be considered at differential diagnosis.

Differential Diagnosis of Cysts and Granulomas Supported by Texture Analysis of Intraoral Radiographs

The aim of this study was to evaluate whether textural analysis could differentiate between the two common types of lytic lesions imaged with use of radiography. Sixty-two patients were enrolled in the study with intraoral radiograph images and a histological reference study. Full textural analysis was performed using MaZda software. For over 10,000 features, logistic regression models were applied. Fragments containing lesion edges were characterized by significant correlation of structural information. Although the input images were stored using lossy compression and their scale was not preserved, the obtained results confirmed the possibility of distinguishing between cysts and granulomas with use of textural analysis of intraoral radiographs. It was shown that the important information distinguishing the aforementioned types of lesions is located at the edges and not within the lesion.

[Interpretation of periapical healing in radiological images. A review]

Interpretation of the state of healing of chronic apical periodontitis or apical curettage with apicoectomy in radiological images is based on the analysis of changes in the appearance of the periapical area and in the bone structure adjacent to the site of inflammation or surgical intervention, which are projected onto normal bone structures. However, distortion of structures or the superposition of anatomical images should be considered when interpreting radiographs. We compared conventional studies of evaluation of the periapical area following treatment, together with 2D images, with the periapical index and the criteria of evaluation in both successful and unsuccessful cases of endodontic surgical treatment. Some studies have reported that the radiographic appearance of the tooth crown and root may facilitate interpretation of the periapical area. In addition, cone-beam computed tomography can show the relationship between injured and repairing tissue using buccal and lingual tables to measure the periphery in transverse reconstruction. Indeed, complex biological events and mechanisms can occur during the healing process of periapical and root tissues. Knowledge of the diversity of tissues is essential to identify the dynamics of the signs of regeneration or the presence of healing due to repair. Hence, the aim of this article was to identify the criteria used to interpret periapical healing in two-dimensional or three-dimensional images and their relationship with diagnosis and treatment according to the literature currently available.

Interexaminer Agreement in the Radiologic Identification of Apical Periodontitis/Rarefying Osteitis in the National Dental Practice-Based Research Network PREDICT Endodontic Study

INTRODUCTION

Periapical images are routinely made in endodontics to support diagnosis and treatment decisions, but conventional imaging may not readily demonstrate inflammatory changes. This study aims to quantify disagreement in the radiologic interpretation of apical periodontitis/rarefying osteitis between 2 expert examiners and to determine if differences exist based on anatomic location.

METHODS

We used 1717 pretreatment periapical images made before orthograde endodontic treatment as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted within the National Dental Practice-Based Research Network. Periapical changes were assessed independently by 2 board-certified specialists, an oral and maxillofacial radiologist and an endodontist, blinded to other clinical information. If the examiners disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was justified, an adjudication was made by a third examiner.

RESULTS

The overall prevalence of this radiologic diagnosis in the periapical images was 55%, and interexaminer agreement measured with the Cohen kappa statistic was calculated to be 0.56 (95% confidence interval, 0.52-0.60). Diagnostic disagreements between the 2 examiners occurred for 377 teeth (22%), with disagreements more frequent for jaw location (P = .038) and tooth type (P = .021). Differences between root number (P = .058) and jaw location and tooth groups (P = .069) were found not to be statistically significant.

CONCLUSIONS

The variability of diagnostic disagreements across anatomic location and tooth type may reflect the inability of periapical images to reveal bone changes masked by the complexity and density of overlying anatomic structures, a limitation that could potentially be overcome with the use of 3-dimensional imaging.

Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer

INTRODUCTION

Bone-modifying agents (BMAs) are indispensable to cancer therapy. However, the number of patients with medication-related osteonecrosis of the jaw (MRONJ) is increasing according to the BMA administration. Oral factors predisposing to development of MRONJ are receiving attention, and oral management is recommended for prevention of MRONJ; however, the strategy and criteria have not yet been established. Therefore, we investigated the oral risk factors associated with MRONJ development in this study.

MATERIALS AND METHODS

A retrospective study was carried out on 398 cancer patients who had received oncological-dose BMAs between 2007 and 2018; general health factors, demographic, and dental factors were examined along with MRONJ development in all the patients. The cumulative occurrence rate of MRONJ was calculated using a Kaplan-Meier analysis. Clinical factors were analyzed using the Cox regression analysis.

RESULTS

MRONJ occurred in 42 of the 398 patients. The cumulative MRONJ incidence rates were 4.5, 12.9, 17.7, and 21.6% at 1, 2, 3, and 4 years, respectively. Age (p = 0.038), male sex (p = 0.002), initiation of dental interventions before BMA administration (p = 0.020), alveolar bone loss involving more than half the root (p < 0.001), and torus mandibularis (p < 0.001) were significantly associated with MRONJ.

CONCLUSIONS

Our findings suggest that patients with alveolar bone loss involving more than half the root on panoramic radiographs and torus mandibularis carry a high risk of MRONJ development. Early dental intervention before BMA administration and oral management during the treatment are important for preventing MRONJ.

Evaluation of effect of low level laser therapy with intracanal medicament on periapical healing: A randomised control trial

Objective(s)

Photobiomodulation, also commonly referred to as low level laser therapy (LLLT), uses light energy to elicit biological responses from the cell and normalise cell function. Using LLLT on bone has been demonstrated to be effective in modulating inflammation, accelerating bone cell proliferation and enhancing the healing process. The objectives of this study were to evaluate postoperative pain and periapical healing in two different groups.

Materials and Methods

40 subjects with periapical lesion were selected and were assigned randomly into two groups. Group I: Conventional root canal therapy along with LLLT. Group II: Conventional root canal therapy only. Radiographs were obtained and assessed at baseline, 3, 6 and 9 months postoperatively. The VAS pain scale was assessed post operatively at 0, 7^th and 14^th day respectively. The Independent t-test was used for evaluation of the data.

Results

Significant differences were noted in reduction of periapicallesion at 3 and 9 months follow-up. The healing was better in Group I that received LLLT with the conventional Root Canal Treatment (RCT). Values for postoperative pain was lower in Group I than Group II, but were statistically non-significant.

Conclusion(s)

LLLT when used as an adjunct with conventional root canal treatment showed acceleration of the healing process of periapical lesions. LLLT has a positive effect on modulating the immune response for favourable healing.

The Radiological Assessment of Root Features and Periodontal Structures in Endodontically Treated Teeth Subjected to Forces Generated by Fixed Orthodontic Appliances. A Prospective, Clinical Cohort Study

The various side effects of orthodontic treatment with fixed orthodontic appliances (FOAs) and their impact on apical and periodontal structures have been widely reported. However, the existing data is not yet conclusive. Aims and objectives: To investigate the status of roots and periodontium in endodontically treated teeth that have undergone orthodontic treatment with the use of FOAs and to evaluate their impact on apical/periodontal structures. Material and methods: The prospective clinical cohort study initially involved 69 participants aged 16–40, without underlying systemic conditions, who received orthodontic treatment with ligatureless FOA systems due to different types of mild and moderate malocclusions. To meet the required criteria, 88 teeth in 34 patients were assessed clinically and radiologically. Participants had at least one tooth treated endodontically while the corresponding tooth from the same anatomical group on the opposite side was vital and intact (a ‘split-mouth’ approach). Four cohorts were allocated: Group IA consisted of 15 teeth, treated utilising the principles of modern endodontics, that were subjected to orthodontic forces no less than six months after completing the root canal obturation. Group I consisted of 13 similarly endodontically treated teeth, which commenced orthodontic treatment at least six months after the completed endodontic therapy. Group II contained 16 teeth treated by conventional endodontic methods and the control group, Group III, contained 44 clinically and radiologically intact teeth (incisors and premolars) with vital and sound dental pulp. The response of apical and periodontal structures to FOAs was determined by data collected from intraoral periapical radiographs taken within the course of five consecutive appointments during the orthodontic treatment. Results: No statistically significant differences were observed in susceptibility to FOA-induced external apical root resorption (EARR) between combined Groups IA + IB and II. An association was, however, demonstrated, between the occurrence of EARR and the degree of expansion of the periodontal ligament (PDL) space, regardless the method of root canal treatment. Cumulative data revealed a positive correlation between the width of the PDL space and the stage of FOA treatment (the third and the fourth appointment). The subtle changes in radiological length of roots have been observed (min 0 mm/max 0.38 mm), particularly between the second and third appointment in Group II (p < 0.05). Conclusions: The standard orthodontic therapy with FOAs is a safe option with predictable outcome for persons who have recently received endodontic therapy. The anterior teeth, predominantly incisors, were more susceptible to minimal EARR than premolars, which suggests that the rate of EARR occurrence may depend upon the original morphology of the apical portion of the root. The use of additional orthodontic forces increases the risk of EARR and is associated with a higher incidence of radiologically detected PDL space widening.

Low-dose Multidetector Computed Tomographic and Cone-beam Computed Tomographic Protocols for Volumetric Measurement of Simulated Periapical Lesions

INTRODUCTION

The purpose of this study was to evaluate the accuracy of low-dose multidetector computed tomographic (LD-MDCT) imaging for the volumetric measurement of simulated periapical lesions.

METHODS

Eighteen monoradicular teeth were introduced in bone blocks, and periapical lesions were simulated at the periapical region of each tooth. All teeth were imaged using 4 acquisition protocols: large (dentoalveolar) field of view (FOV) cone-beam computed tomographic (CBCT) imaging (120 kV, 5 mA, and 0.2-mm voxel), small (dental) FOV CBCT imaging (90 kV, 10 mA, and 0.2-mm voxel), standard multidetector computed tomographic imaging (120 kV, 50 mA, and 0.62-mm voxel), and LD-MDCT imaging (120 kV, 10 mA, and 0.62-mm voxel). Tomographic images were evaluated by a single trained and calibrated examiner (intraclass correlation coefficient = 0.991) using ITK-SNAP segmentation software (University of Pennsylvania, Philadelphia, PA). The gold standard was obtained by the impressions of the lesions with regular fluid addition silicone and individual weighing using a precision analytical scale. Data were evaluated by the repeated measures analysis of variance test; the significance level was defined as P < .05.

RESULTS

No statistical differences (P > .05) were found among the groups regardless of the device, milliamperage, FOV, or voxel size.

CONCLUSIONS

LD-MDCT shows performance comparable with other standard reference methods for measuring the volume of periapical lesions and can be a useful and safe protocol in clinical situations in which CBCT imaging is not available, such as in cases of patients admitted to hospitals.

Three-dimensional pattern of inflammatory periapical lesion extension in the premolar's region: an application of K-means clustering

BACKGROUND

Cone-beam computed tomography (CBCT) provides better diagnosis of endodontic lesions.

INTRODUCTION

The present study would assess the pattern of periapical lesion extension in premolar teeth using CBCT.

METHOD

In this descriptive study' 330 roots in the regions of maxillary and mandibular premolars have been evaluated. Maximum periapical lesion extensions in the three orthogonal planes (axial, coronal and sagittal) were measured and recorded in millimeters. Measurements were compared based on gender' dental arch, tooth type and root. Statistical analysis was performed using repeated measure ANOVA, Bonferroni, Chi-square tests and clustering data analysis (K-means method). The significant level was set at 0.05.

RESULT

There were significant differences between the lesion expansions in the three dimensional planes (p-value<0.001). The highest average of lesion extension in the premolar regions of the examined population was reported in the vertical dimension (4.1± 1.3), followed by horizontal buccolingual dimension (3.4±1.1) and horizontal mesiodistal dimension (3.1±1.0) respectively. According to independent variables, in the premolar region only tooth roots showed significant differences in the lesion extension (p-value=0.002). Clustering data analysis showed that the majority of the participants categorized in a cluster with lower lesion extension. Based on clustering data analysis, the small lesions were significantly observed in the first premolar and buccal roots.

CONCLUSION

Since the periapical lesion extension in the buccolingual dimension, which could not be detected in the 2-D imaging techniques, was rather high in the region of premolar teeth, CBCT -as a 3-D imaging technique- is a suitable option for the precise evaluation of periapical lesion extension. Also, the majority of the lesions in this tooth area are small and located in the buccal roots.

What is the best long-term treatment modality for immature permanent teeth with pulp necrosis and apical periodontitis?

PURPOSE

To evaluate and assess the current knowledge about apexification and regenerative techniques as a meaningful treatment modality and to map the scientific evidence for the efficacy of both methods for the management of traumatised immature teeth with pulp necrosis and apical periodontitis.

METHODS

This systematic review searched five databases: PubMed, Web of Science, Cochrane Library, Ovid (Medline), and Embase. Published articles written in English were considered for inclusion. The following keywords were used: Regenerative endodontic treatment OR regenerat* OR revital* OR endodontic regeneration OR regenerative endodontics OR pulp revascularization OR revasculari* OR 'traumatized immature teeth'. Only peer-reviewed studies with a study size of at least 20 cases followed up for 24 months were included. Eligibility assessment was performed independently in a blinded manner by three reviewers and disagreements were resolved by consensus. Subgroup analyses were performed on three clinical outcomes: survival, success, and continued root development.

RESULTS

Seven full texts out of 1359 citations were included and conventional content analysis was performed. Most of the identified citations were case reports and case series.

CONCLUSIONS

In the present systematic review, the qualitative analysis revealed that both regenerative and apexification techniques had equal rates of success and survival and proved to be effective in the treatment of immature necrotic permanent teeth. Endodontic regenerative techniques appear to be superior to apexification techniques in terms of stimulation of root maturation, i.e. root wall thickening and root lengthening. Knowledge gaps were identified regarding the treatment and follow-up protocols for both techniques.

Relationship between Apical Periodontitis and Metabolic Syndrome and Cardiovascular Events: A Cross-Sectional Study

Aim: Both apical periodontitis (AP) and metabolic syndrome (MetS) are associated with atherosclerotic cardiovascular disease (ACVD), the main cause of cardiovascular events. The aim of this study was to investigate the prevalence of AP and the oral inflammatory burden in control subjects and patients suffering cardiovascular events, analyzing the possible association between AP and the oral inflammatory burden with MetS. Materials and Methods: Using a cross-sectional design, 83 patients suffering a cardiovascular event were recruited in the study group (SG), and 48 patients without cardiovascular events were included in the control group (CG). Periapical index (PAI) was used to diagnose AP, and total dental index (TDI) was used to assess the total oral inflammatory burden. Diagnosis of MetS was made by meeting three or more American Heart Association Scientific Statement components. Results: In the multivariate logistic regression analysis, the number of teeth with AP (OR = 2.3; 95% C.I. = 1.3–4.3; p = 0.006) and TDI scores (OR = 1.5; 95% C.I. = 1.2–1.9; p = 0.001), significantly correlated with cardiovascular events. MetS was strongly associated (OR = 18.0; 95% C.I. = 6.5–49.7; p = 0000) with cardiovascular events. Higher TDI scores were significantly associated with MetS (OR = 1.3; 95% C.I. = 1.1–1.6; p = 0.003. Neither the number of root-filled teeth (RFT) (OR = 0.9; 95% C.I. = 0.6–1.3; p = 0.61) nor the number of teeth with apical periodontitis (OR = 1.1; 95% C.I. = 0.8–1.7; p = 0.49) were associated with MetS. Conclusions: Apical periodontitis is significantly associated with cardiovascular events. Total oral inflammatory burden assessed by TDI, but not AP alone, is associated with MetS.

Dental follow-up and maintenance index: the development of a novel multidisciplinary protocol

Objectives

To develop a comprehensive yet simple dental follow up and maintenance protocol based on existing guidelines and recommendations.

Methods

A multidisciplinary team reviewed available maintenance and follow up guidelines and recommendations then developed a single protocol for adult dental patients.

Results

The protocol includes ten questions that categorize dental patients into one of three risk categories. Based on the risk category, each patient is assigned a recall interval and recommendations for in office and at home dental care.

Conclusions

Development of a single multidisciplinary follow up and maintenance protocol.

The effectiveness of ultrasound examination to assess the healing process of bone lesions of the jaws: a systematic review

OBJECTIVE

To assess the potential of ultrasound examination (USE) as an adjunctive method to conventional radiology to evaluate the healing processes occurring after the treatment of bone lesions of the jaws. The research question was: what is the effectiveness of USE to evaluate the healing of intra-osseous bone lesions when compared to radiological or clinical examination?

MATERIALS AND METHODS

Six databases (PubMed, the Web of Science, Scopus, Embase, the Cochrane Library, and Best Evidence) were searched from their inception (PROSPERO CRD42019134482). A quality assessment was performed combining the Downs and Black tool and the Newcastle-Ottawa scale. The risk of bias was calculated using the Cochrane collaboration tool to assess the risk of bias.

RESULTS

A total of 4404 records were screened, and 7 studies meeting the inclusion criteria were included in the systematic review. USE allowed to evaluate the healing of jaw bone lesions by assessing their reduction in size, the increase in echogenicity of the affected area, and the progressive decrease\disappearance of the vascular flow signal within the lesions.

CONCLUSIONS

USE implemented with color power Doppler is an advanced imaging technique feasible to monitor the early and long-term response of the intra-osseous lesions of the jaws to both surgical and nonsurgical treatment.

CLINICAL RELEVANCE

This systematic review brought evidence that USE can constitute a safe alternative imaging technique in the dental clinical practice for the management of central lesions of the maxillary bones.

Evaluation of Pulpal Involvement, Ulceration, Fistula, and Abscess Index and Periapical Index in Screening for Endodontic Disease: Reliability and Accuracy

INTRODUCTION

The pulpal involvement, ulceration, fistula, and abscess (PUFA) index was developed to screen for the clinical consequences of untreated dental caries. The aim of this study was to compare the diagnostic accuracy of the PUFA index and the periapical index (PAI) in identifying pulpal and periapical diseases.

METHODS

A cross-sectional study was conducted using consecutive sampling. Each participant went through screening using the PUFA index, orthopantomography assessment using PAI, and comprehensive clinical examination to derive pulpal and apical diagnoses. The outcomes were dichotomized. Reliability was estimated using the Cohen kappa coefficient. Sensitivity, specificity, and predictive values were calculated. The area under the receiver operating characteristic curve was compared using the chi-square test.

RESULTS

A total of 165 participants were examined, 98.2% of whom had a decayed, missing, or filled tooth index >0. Of 4115 teeth assessed, 16.2% (n = 666) were diagnosed with pulpal disease and 7.9% (n = 325) with periapical disease. Interexaminer reliability for the PUFA index and PAI was 0.87 and 0.80, respectively. Intraexaminer reliability was 0.83 and 0.76 for the PUFA index and 0.75 and 0.72 for PAI. For pulpal diagnosis, the sensitivity of the PUFA index and PAI was 67.6% and 41.7%, respectively; the specificity of the PUFA index and PAI was 99.8% and 99.2%, respectively. For apical diagnosis, the sensitivity of the PUFA index and PAI was 87.7% and 75.4%, respectively; the specificity of the PUFA index and PAI was 95.4% and 98.4%, respectively. The PUFA index is statistically more accurate than PAI for pulpal diagnosis and apical diagnosis (P < .05).

CONCLUSIONS

The PUFA index can be used in screening for pulpal and periapical diseases with some limitations.

WNT gene polymorphisms and predisposition to apical periodontitis

Single nucleotide polymorphisms (SNPs) in WNT genes may impact gene/protein function and contribute to individual predisposition to apical periodontitis (AP). Here, we investigated the association of SNPs in/nearby WNT3, WNT3A, WNT5A, WNT8A, WNT9B and WNT11 genes with AP using a case-control dataset. Cases were defined as individuals with deep caries and AP (n = 188); controls had deep caries and no AP (n = 230). Genotyping was performed using Taqman chemistry in real time PCR. Data analyses was performed using Fisher Exact tests assuming a Bonferroni correction threshold value of 0.005. Single-SNP association analysis revealed a trend for association with WNT3 rs9890413 genotypes (P = 0.009) under a dominant model and allelic association for WNT3A rs1745420 (P = 0.009). Haplotypes involving WNT3-WNT9B-WNT3A alleles were also significantly associated with AP (P ≤ 0.003). Luciferase reporter assays showed higher transcriptional activity (1.4-fold) with the alternate G allele in rs1745420. Expression of WNT3, WNT3A and WNT5A in AP tissues was significantly higher than in control tissues, and inversely correlated with the expression of SERPINB1, COL1A1 and TIMP1 (P < 0.05). Our results suggest that WNT genes have a role in modulating AP and polymorphisms in these genes may increase susceptibility to AP.

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.

Association between C-reactive protein, neutrophil to lymphocyte ratio and the burden of apical periodontitis: a case-control study

OBJECTIVE

Endodontic originated chronic apical periodontitis (AP) is an inflammatory disease of periapical tissue. High-sensitivity C-reactive protein (hsCRP) as an inflammatory marker and hemogram indexes provide valuable information to clinicians for diagnosis, screening and follow-up of various diseases. The aim of this study was to investigate AP in terms of its association with hemogram indices and hsCRP levels.

MATERIAL AND METHODS

Study includes 104 patients with AP and 40 participants as the control group. 160 teeth were diagnosed as AP through digital radiographic images and scored with respect to Periapical Index (PAI) scoring. Afterwards, patients were categorized into 3 grades in accordance with both the number and the severity of AP. AP grade 0 was considered for the control group with regard to a new scoring system. Patients with only one tooth involved with AP with a PAI score of 3 or 4 were categorized as an AP Grade 1, when a patient had more than one tooth with a PAI score of 3 or 4 he was classified as an AP Grade 2 and a patient with at least one tooth scored as a PAI 5 was rated as an AP Grade 3. Hemograms and hsCRP levels were measured for each individual to establish a correlation with inflammatory markers.

RESULTS

The neutrophil/lymphocyte ratio (NLR) levels of patients with AP Grade 3 were significantly higher than all other AP grades (p < .05). hsCRP levels in patients with an AP Grade 2 and 3 were higher than both AP Grade 0 and 1 (p < .05).

CONCLUSIONS

hsCRP levels of patients were reliable predictive indicators for AP severity in correlation with the new proposed scoring system for AP.

Influence of VistaScan image enhancement filters on diagnosis of simulated periapical lesions on intraoral radiographs

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.

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.

Apical periodontitis in southern Estonian population: prevalence and associations with quality of root canal fillings and coronal restorations

Background

Apical periodontitis (AP) is an inflammatory disease around the apex of a tooth root. Reported prevalence of AP ranges from 27% to 83% while the data about most post-Soviet countries are still missing. Knowing the prevalence of AP within a certain population helps to plan the treatment need and evaluate the success of endodontic interventions. We aimed to collect data about prevalence and determining factors of AP for the first time in Estonia.

Methods

The cross-sectional study included 6552 patients (age 35.5±19.2 years). Radiographic examination was applied to investigate the prevalence of AP and quality of endodontic treatment.

Results

AP was diagnosed in 54.7% of subjects. Endodontically treated teeth were present in 58.2% of subjects. Periapical finding was present in 44.6% of endodontically treated and in 30.8% of untreated teeth.

Out of 181,495 teeth, 52.7% were intact. AP was diagnosed in 6.3% of teeth, 6.9% of teeth were endodontically treated.

Risk factors for AP included caries (OR = 2.30), male gender (OR = 1.44), too short (OR = 1.76) or too long root canal filling (OR = 2.51), root canal filling of low density (OR = 1.61) while not orthodontic appliance. Lower AP risk was associated with restoration of the tooth – filling (OR = 0.45), crown (OR = 0.34) and bridge (OR = 0.33).

Conclusions

AP is highly prevalent in Southern Estonian population. Most cases are associated with root canal-treated teeth. The overall quality of root canal fillings tends to be low, consistent with the mediocre outcome of treatment. Considerable efforts are required to improve the standards of endodontic treatment.

Electronic supplementary material

The online version of this article (10.1186/s12903-017-0429-7) contains supplementary material, which is available to authorized users.

Clinical validation of a nanodiamond-embedded thermoplastic biomaterial

Detonation nanodiamonds (NDs) are promising drug delivery and imaging agents due to their uniquely faceted surfaces with diverse chemical groups, electrostatic properties, and biocompatibility. Based on the potential to harness ND properties to clinically address a broad range of disease indications, this work reports the in-human administration of NDs through the development of ND-embedded gutta percha (NDGP), a thermoplastic biomaterial that addresses reinfection and bone loss following root canal therapy (RCT). RCT served as the first clinical indication for NDs since the procedure sites involved nearby circulation, localized administration, and image-guided treatment progress monitoring, which are analogous to many clinical indications. This randomized, single-blind interventional treatment study evaluated NDGP equivalence with unmodified GP. This progress report assessed one control-arm and three treatment-arm patients. At 3-mo and 6-mo follow-up appointments, no adverse events were observed, and lesion healing was confirmed in the NDGP-treated patients. Therefore, this study is a foundation for the continued clinical translation of NDs and other nanomaterials for a broad spectrum of applications.

Diagnostic accuracy of periapical radiography and cone beam computed tomography in detecting apical periodontitis using histopathological findings as a reference standard

AIM

To compare the diagnostic accuracy of periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting apical periodontitis (AP) using histopathological findings as a reference standard.

METHODOLOGY

Jaw sections containing 67 teeth (86 roots) were collected from unclaimed bodies due for cremation. Imaging was carried out to detect AP by digital PR with a central view (DP group), digital PR combining central with 10˚ mesially and distally angled (parallax) views (DPS group) and CBCT scans. All specimens underwent histopathological examination to confirm the diagnosis of AP. Sensitivity, specificity and predictive values of PR and CBCT were analysed using rater mean (n = 5). Receiver-operating characteristic (ROC) analysis was carried out.

RESULTS

Sensitivity was 0.27, 0.38 and 0.89 for DP, DPS and CBCT scans, respectively. CBCT had specificity and positive predictive value of 1.0 whilst DP and DPS had specificity and positive predictive value of 0.99. The negative predictive value was 0.39, 0.44 and 0.81 for DP, DPS and CBCT scans, respectively. Area under the curve (AUC) for the various imaging methods was 0.629 (DP), 0.688 (DPS), and 0.943 (CBCT).

CONCLUSIONS

All imaging techniques had similar specificity and positive predictive values. Additional parallax views increased the diagnostic accuracy of PR. CBCT had significantly higher diagnostic accuracy in detecting AP compared to PR, using human histopathological findings as a reference standard.

Comparative analysis of dentognathic pathologies in the Dmanisi mandibles

OBJECTIVES

Due to the scarcity of the fossil record, in vivo changes in the dentognathic system of early Homo are typically documented at the level of individual fossil specimens, and it remains difficult to draw population-level inferences about dietary habits, diet-related activities and lifestyle from individual patterns of dentognathic alterations. The Plio-Pleistocene hominin sample from Dmanisi (Georgia), dated to 1.77 million years ago, offers a unique opportunity to study in vivo changes in the dentognathic system of individuals belonging to a single paleodeme of early Homo.

MATERIALS AND METHODS

We analyze dentognathic pathologies in the Dmanisi sample, and in comparative samples of modern Australian and Greenlander hunter-gatherer populations, applying clinical protocols of dentognathic diagnostics.

RESULTS

The Dmanisi hominins exhibit a similarly wide diversity and similar incidence of dentognathic pathologies as the modern human hunter-gatherer population samples investigated here. Dmanisi differs from the modern population samples in several respects: At young age tooth wear is already advanced, and pathologies are more prevalent. At old age, hypercementosis is substantial.

CONCLUSIONS

Results indicate that dentognathic pathologies and disease trajectories are largely similar in early Homo and modern humans, but that the disease load was higher in early Homo, probably as an effect of higher overall stress on the dentognathic system. Am J Phys Anthropol 160:229-253, 2016. © 2016 Wiley Periodicals, Inc.