In vitro evaluation of a method for obtaining periapical radiographs for diagnosis of external apical root resorption

Diagnostic Accuracy of Periapical Radiography in Detection and Measurement of the External Root Resorption in Primary Molars: A Single-Blind Prospective Clinical Study

Introduction

Identifying the external root resorption plays an important role in treatment planning for deciduous teeth. Although proper accuracy of digital radiography in the diagnosis of external root resorption has been established in permanent dentition, it cannot be at all generalized to the primary root being superimposed by the succeeding permanent teeth. Interestingly, no study has assessed this in primary teeth yet. Thus, this study was undertaken for the first time.

Methods

This was a single-blind prospective clinical diagnostic study performed on 501 observations (observed by 3 observers) pertaining to 167 roots of 45 maxillary/mandibular primary molars (in 6–8-year-old patients) which were indicated for extraction and did have succeeding permanent teeth. Digital parallel periapical radiographs were taken before dental extraction using a PSP sensor. Radiographs were printed and examined by two pediatric dentists. After the extraction, the extent of resorption was directly measured, twice, by third and fourth observers blinded to radiographic estimates. Radiographic errors and absolute errors (mm) were calculated. Various parameters were analyzed statistically.

Results

Of the roots, 56.3% were really resorbed with (mean = 5.01 ± 2.10 mm). First/second observers failed to identify 19.6% and 38.3% of roots, respectively. Average errors were −0.77 ± 2.31 and 0.14 ± 2.19 mm in girls and boys, respectively (P=0.043, t-test). The factors “side, jaw, tooth type, and root type” did not affect errors (P > 0.05). Average absolute errors were 1.79 ± 1.47  mm (significantly above zero, P < 0.0005). No evaluated factor affected it (P > 0.1). Actual lesion sizes correlated with errors (Pearson R = 0.682, P < 0.0005) but not with absolute errors (P=0.464).

Conclusion

Although many deciduous roots might be missed, digital radiography might still provide rather a good accuracy in diagnosis and measurement of external root resorption up to about 1.8 mm absolute error. Observers might overestimate resorption sizes in girls and in cases with actual lesions smaller than 3 mm. Size of the lesion can influence the direction of error (shortening/elongation), but not its directionless magnitude.

Physicochemical properties of three bioceramic cements

This study aimed to compare the physicochemical properties of MTA Angelus (MTA-A), MTA Repair HP (MTA-HP), and Biodentine (BD). Setting times (n = 7) were determined in accordance with ASTM C266-15. Solubility (n = 11), pH (n = 10), and calcium ion release (n = 10) were evaluated up to 28 days in accordance with ANSI/ADA specification no. 57. Radiopacity was assessed by ANSI/ADA (n = 10) and the tissue simulator method (n = 10). In both methods, the specimens were radiographed using an aluminum stepwedge and the digital radiographs were analyzed in Adobe Photoshop, determining the mean grayscale pixel values of the materials, of the 3-mm aluminum stepwedge, and of the dentin, the latter of which was analyzed on the tissue simulator. The data obtained from each test were statistically analyzed and compared (p < 0.05). MTA-A presented longer final setting time compared with the other materials. There were no significant differences in the mass values of materials during the experiment. All materials presented an alkaline pH. BD promoted greater calcium ion release in most of the experimental periods. All materials presented appropriate radiopacity. BD showed lower radiopacity than MTA-A in the tissue simulator method. All groups presented higher radiopacity in the tissue simulator when compared with the ANSI/ADA method. MTA-A, MTA-HP, and BD showed appropriate physicochemical properties and radiopacity, and were considered suitable to be used in clinical practice.

Expression of biological markers in gingival crevicular fluid of teeth with orthodontically induced root resorption

AIM

The goal was to investigate interleukin‑1 receptor antagonist (IL-1ra) and dentin sialophosphoprotein (DSPP) levels in gingival crevicular fluid (GCF) as potential biomarkers for orthodontically induced root resorption (OIRR) using enzyme-linked immunosorbent immunoassay (ELISA).

MATERIALS AND METHODS

In all, 74 subjects were assigned to one of three groups: (1) orthodontic group included orthodontic patients who showed radiographic evidence of 1-3 mm root resorption of a maxillary central incisor, (2) pediatric group included pediatric patients who showed radiographic evidence of physiologic root resorption of a lower second primary molar, and (3) control group included subjects who had no orthodontic treatment and showed no radiographic evidence of root resorption. Samples from the GCF were collected with endodontic absorbent paper points inserted 1 mm below the gingival margin of the tooth. The IL-1ra and DSPP levels were evaluated using ELISA.

RESULTS

The IL-1ra levels were 657.5 ± 51.5, 319.9 ± 181.3, and 129.4 ± 54.9 pg/ml for the control, orthodontic, and pediatric groups, respectively. The DSPP levels were 1.6 ± 1.0, 30.1 ± 9.6, and 39.2 ± 3.3 pg/ml for the control, orthodontic, and pediatric groups, respectively. Post hoc analyses revealed significant differences for IL-1ra and DSPP between any two groups. Sensitivity and specificity of IL-1ra for the diagnosis of OIRR showed 80% reliability and a cutoff value of ≤432.6 pg/ml, while the analysis of DSPP showed 100% reliability and a cutoff value of ≥7.33 pg/ml.

CONCLUSIONS

The levels of IL-1ra and DSPP detected in the orthodontic and pediatric groups indicate a possible association with OIRR. Efforts to develop tests for screening, diagnosis, and monitoring OIRR based on biological markers should continue.

Evaluation of Root Resorption, Tooth Inclination and Changes in Supporting Bone in Class II Malocclusion Patients Treated with Forsus Appliance

OBJECTIVE

The aim of our study was to evaluate apical root resorption and changes in tooth inclinations, marginal bone height, and labio-lingual bone thickness at the mid-root and apical level in mandibular anterior teeth during the Forsus treatment using cone beam computed tomography (CBCT).

METHODS

CBCT scans of 16 subjects (8 males and 8 females) with Class II malocclusion (age group: 13-29 years) taken before and 6 months after the Forsus treatment were evaluated for apical root resorption, tooth inclination, marginal bone height, and thickness of bone at the mid-root and apical level in mandibular anterior teeth.

RESULTS

There was statistically significant root resorption of central incisors (0.39 mm) and canines (0.66 mm); a decrease in the angle of inclination for all teeth; an increase in the marginal bone measurement in labial (1.31 mm) and decrease in lingual (0.93 mm) aspect at the canine region; and an increase in bone width by 0.87 mm and 0.75 mm in central and lateral incisor regions, respectively, at the mid-root level lingually. At the apex level in the canine region, bone width increased by 1.4 mm labially, while it decreased by 2.18 mm lingually; it increased significantly for incisors in the lingual region.

CONCLUSION

The Forsus appliance therapy causes clinically insignificant root resorption and bone changes, and clinically significant proclination of mandibular anterior teeth. The findings of the present study aid clinicians in proper case selection and reinforce the prevention of incisor proclination while using the Forsus therapy to achieve better treatment results and stability.

Comparative study of root resorption of maxillary incisors in patients treated with lingual and buccal orthodontics

OBJECTIVE

To compare the magnitude of external apical root resorption (EARR) of maxillary incisors in patients with mild to moderate anterior crowding, treated with lingual and conventional (labial) orthodontics.

MATERIALS AND METHODS

The sample comprised 40 patients divided into two groups: lingual (20 patients) and conventional buccal brackets (20 patients). Patient ages ranged from 11 to 45 years, and the study included 12 men and 28 women. Apical root resorption was measured from periapical radiographs obtained at the beginning of treatment (T1) and at the end of the leveling phase (T2). Periapical radiographs were scanned and transferred to the CorelDraw X7 image-processing program, in which measurements of root lengths were performed. For intragroup and intergroup comparisons between the T1 and T2 phases, paired and independent t-tests, respectively, were used at 5% significance.

RESULTS

There was significant apical root resorption for all teeth evaluated; the magnitude of the EARR (T2-T1) ranged from -0.35 mm to -0.63 mm in the lingual group, and from -0.66 mm to -0.85 mm in the conventional group. Although there was an intergroup variation in the magnitude of EARR observed, no statistically significant differences were found. Neither group presented any teeth with resorption ≥1 mm.

CONCLUSIONS

The magnitude of apical root resorption in maxillary incisors in patients with anterior crowding was similar regardless of orthodontic technique, lingual or conventional. Both techniques resulting in an apical rounding considered clinically insignificant.

A posteriori registration and subtraction of periapical radiographs for the evaluation of external apical root resorption after orthodontic treatment

Purpose

Materials and Methods

Results

Conclusion

A new in vitro method to evaluate radio-opacity of endodontic sealers

OBJECTIVES

To evaluate a new method for assessing the radio-opacity of endodontic sealers and to compare radio-opacity values with a well-established standard method.

METHODS

The sealers evaluated in this study were AH Plus(®) (Dentsply DeTrey GmbH, Konstanz, Germany), Endo CPM Sealer (EGEO SRL, Buenos Aires, Argentina) and MTA Fillapex(®) (Angelus Dental Products Industry S/A, Londrina, Parana, Brazil). Two methods were used to evaluate radio-opacity: (D) standard discs and (S) a tissue simulator. For (D), ten standard discs were prepared for each sealer and were radiographed using Digora(®) phosphor storage plates (Soredex; Orion Corporation, Helsinki, Finland), alongside an aluminium stepwedge. For (S), polyethylene tubes filled with sealer (n = 10 for each) were radiographed inside the simulator as described. The digital images were analysed using Adobe Photoshop(®) software v. 10.0 (Adobe Systems, San Jose, CA). To compare the radio-opacity among the sealers, the data were analysed by ANOVA and Tukey's test, and to compare methods, they were analysed by the Mann-Whitney U test. To compare the data obtained from dentin and sealers in method (S), Student's paired t-test was used (=0.05).

RESULTS

In both methods, the sealers showed significant differences, according to the following decreasing order: AH Plus, MTA Fillapex and Endo CPM. In (D), MTA Fillapex and Endo CPM showed less radio-opacity than aluminium. For all of the materials, the radio-opacity was higher in (S) than in (D). Compared with dentin, all of the materials were more radio-opaque.

CONCLUSIONS

The comparison of the two assessment methods for sealer radio-opacity testing validated the use of a tissue simulator block.

Apical root resorption during orthodontic treatment. A prospective study using cone beam CT

OBJECTIVE

To investigate the incidence and severity of root resorption during orthodontic treatment by means of cone beam computed tomography (CBCT) and to explore factors affecting orthodontically induced inflammatory root resorption (OIIRR).

MATERIALS AND METHODS

CBCT examinations were performed on 152 patients with Class I malocclusion. All roots from incisors to first molars were assessed on two or three occasions.

RESULTS

At treatment end, 94% of patients had ≥1 root with shortening >1 mm, and 6.6% had ≥1 tooth where it exceeded 4 mm. Among teeth, 56.3% of upper lateral incisors had root shortening >1 mm. Of upper incisors and the palatal root of upper premolars, 2.6% showed root shortenings >4 mm. Slanted surface resorptions of buccal and palatal surfaces were found in 15.1% of upper central and 11.5% of lateral incisors. Monthly root shortening was greater after 6-month control than before. Upper jaw teeth and anterior teeth were significantly associated with the degree of root shortening. Gender, root length at baseline, and treatment duration were not.

CONCLUSION

Practically all patients and up to 91% of all teeth showed some degree of root shortening, but few patients and teeth had root shortenings >4 mm. Slanted root resorption was found on root surfaces that could be evaluated only by a tomographic technique. A CBCT technique can provide more valid and accurate information about root resorption.

Root resorption diagnosed with cone beam computed tomography after 6 months of orthodontic treatment with fixed appliance and the relation to risk factors

OBJECTIVES

To investigate root resorption after 6 months of active orthodontic treatment and its relation to possible risk factors.

MATERIALS AND METHODS

Ninety-seven patients (10-18 years) with a Class I malocclusion and crowding treated with fixed appliance and premolar extractions were examined with cone beam computed tomography before and after 6 months of active treatment. The exposure covered all teeth from first molar to first molar in both jaws. The Malmgren index was used to evaluate the degree of root resorption. Irregular root contour (score 1) was seen in most teeth already before active treatment, and therefore resorptions were registered only as score 2 (<2 mm, minor resorption) or higher.

RESULTS

Minor root resorption was noted in 10% of the patients and severe root resorption, >2 mm (score 3) was found in four patients. Root resorption was more frequently seen in the upper jaw, especially the incisors. There was no statistically significant correlation of root resorption with any of the selected risk factors.

CONCLUSIONS

After 6 months of treatment, clinically significant resorption was diagnosed in 4% of the patients, ie, in 96% of the patients the radiographic examination did not reveal any significant information. The selected risk factors did not have any impact on the amount of resorption after 6 months of active treatment.

Vertical alveolar growth in subjects with infraoccluded mandibular deciduous molars

INTRODUCTION

Our objective was to compare vertical alveolar growth in areas adjacent to infraoccluded deciduous molars with growth in areas of deciduous molars and normal occlusion for a period of at least 1 year by using digital subtraction radiography.

METHODS

This case-control study included 40 pairs of panoramic radiographs of growing patients with infraoccluded deciduous molars and 40 pairs of radiographs of patients without infraoccluded deciduous molars. One radiograph at baseline was obtained at diagnosis, and the other at least 1 year later. The subjects and the controls were matched according to chronologic age and time interval between the 2 radiographs. The 2 groups were compared with regard to vertical alveolar growth and vertical tooth movement. Measurements were assessed by using nonparametric tests (Mann-Whitney and Friedman) and a multiple comparison test. Significance was set at 5%.

RESULTS

A statistically significant difference was observed between the groups with regard to vertical alveolar growth measured on the bone crest between the first permanent molars and second premolars.

CONCLUSIONS

Vertical alveolar growth between the first permanent molar and the second premolar adjacent to the infraoccluded teeth was smaller than in areas adjacent to teeth with normal occlusion.

Cone beam computed tomography for assessment of root length and marginal bone level during orthodontic treatment

OBJECTIVE

To evaluate the accuracy and precision of cone beam computed tomography (CBCT) with regard to measurements of root length and marginal bone level in vitro and in vivo during the course of orthodontic treatment.

MATERIALS AND METHODS

Thirteen patients (aged 12-18 years) from an ongoing study and a dry skull were examined with CBCT using multiplanar reformatting for measurements of root length and marginal bone level. For in vivo evaluation of changes in root length, an index according to Malmgren et al was used, along with a modification of this method.

RESULTS

The in vitro mean difference between physical and radiographic measurements was 0.05 mm (SD 0.75) for root length and -0.04 mm (SD 0.54) for marginal bone level. In vivo the error was <0.35 mm for root length determinations and <0.40 mm for marginal bone level assessments.

CONCLUSION

Despite changes in tooth positions, the CBCT technique yields a high level of reproducibility, enhancing its usefulness in orthodontic research.