Evaluation of Periapical Lesion Healing by Correction of Gray Values

Effect of amniotic membrane and platelet-rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study

The use of membrane barriers and bone grafting materials in endodontic surgery promotes healing by regeneration rather than repair by scar tissue. Due to its valuable regenerative and therapeutic properties, the human amniotic membrane can support ideal periapical rehabilitation and promote better healing after surgery. The current trial aimed to evaluate the amniotic membrane's healing potential and compare it with platelet-rich fibrin using color doppler sonography. The current study is a randomized, double-blinded, parallel-group, single-center study. Thirty-four systematically healthy individuals requiring endodontic surgery who fulfilled all inclusion and exclusion criteria were selected and randomly placed in two groups. Surgical curettage of the bony lesion was performed and filled with hydroxyapatite graft. Amniotic membrane (Group 1) and platelet-rich fibrin (Group 2) were placed over the bony crypt, and the flap was sutured back. The lesion's surface area and vascularity were the parameters assessed with ultrasound and color doppler. and observations: The groups found a significant difference in mean vascularity at 1 month and mean vascularity change from baseline to 1 month (p < 0.05). Mean surface area had no statistically significant difference between the groups. However, in terms of the percentage change in surface area, a significant difference was found from baseline to 6 months (p < 0.05). Amniotic membrane was a significantly better promoter of angiogenesis than platelet-rich fibrin in the current trial. The osteogenic potential of both materials was similar. However, the clinical application, availability, and cost-effectiveness of amniotic membrane support it as a promising therapeutic alternative in clinical translation. Further large-scale trials and histologic studies are warranted.

Evaluation of the radiopacity of restorative materials with different structures and thicknesses using a digital radiography system

Purpose

The aim of this study was to evaluate the radiopacities of various types of restorative materials with different thicknesses compared with enamel, dentin, and aluminum.

Materials and Methods

Four bulk-fill resins, 2 hybrid ceramics, 2 micro-hybrid resin composites, 6 glass ionomer-based materials, 2 zinc phosphate cements, and an amalgam were used in the study. Twelve disk-shaped specimens were prepared from each of 17 restorative materials with thicknesses of 1 mm, 2 mm, and 4 mm (n=4). All the restorative material specimens with the same thickness, an aluminum (Al) step wedge, and enamel and dentin specimens were positioned on a phosphor storage plate and exposed using a dental X-ray unit. The mean gray values were measured on digital images and converted to equivalent Al thicknesses. Statistical analyses were performed using 2-way analysis of variance and the Bonferroni post hoc test (P<0.05).

Results

Radiopacity was significantly affected by both the thickness and the material type (P<0.05). GCP Glass Fill had the lowest radiopacity value for samples of 1 mm thickness, while Vita Enamic had the lowest radiopacity value for 2-mm-thick and 4-mm-thick samples. The materials with the highest radiopacity values after the amalgam were zinc phosphate cements.

Conclusion

Significant differences were observed in the radiopacities of restorative materials with different thicknesses. Radiopacity was affected by both the material type and thickness.

[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.

Cone beam computed tomography - extending its arm to explore new possibilities

Purpose

To determine whether the greyscale value depicted in cone beam computed tomography (CBCT) differentiates different benign osseous lesions of jaws and to measure the greyscale value of various osseous lesions of jaws and to find the correlation (if any) of these greyscale values to that of histopathological diagnosis.

Material and methods

This study was conducted in the Department of Oral Medicine and Radiology of the Dental Institute after obtaining approval from the Ethical Committee. CBCT scans of osseous lesions of jaws confirmed with histopathological reports depicting cystic or tumour-like lesions were included in the study. Greyscale values depicted in CBCT scans of osseous lesions were measured. The greyscale values were grouped as per the histopathological diagnosis, and these ranges were then tabulated and statistically evaluated.

Results

The mean value with standard deviation of greyscale values for cystic lesions was 1208.375 ± 93 and for that of the tumour group was 1603 ± 425.5.

Conclusions

The greyscale value is a useful tool in differentiating between different groups of osseous lesions of jaws.

Endodontic Periapical Lesion: An Overview on the Etiology, Diagnosis and Current Treatment Modalities

Nonsurgical and surgical endodontic treatments have a high success rate in the treatment and prevention of apical periodontitis when carried out according to standard and accepted clinical principles. Nevertheless, endodontic periapical lesions remain in some cases, and further treatment should be considered when apical periodontitis persists. Although several treatment modalities have been proposed for endodontically treated teeth with persistent apical periodontitis, there is a need for less invasive methods with more predictable outcomes. The advantages and shortcomings of existing approaches for the diagnosis and treatment of endodontic periradicular lesions are discussed in this review.

Contemporary imaging for the diagnosis and treatment of traumatic dental injuries: A review

Traumatic dental injuries (TDI) have an array of presentations. Diagnostic challenges are common and clinicians' ability to correctly identify specific injuries dictates the optimal course of treatment(s). The aim of this review was to outline and assess all dental imaging techniques and their applications to traumatic dental injuries. A particular interest is given to the advancement of 3D imaging techniques and their role in diagnosis and treatment planning. The benefits of achieving a more accurate diagnosis are paramount to perfecting clinical judgments and outcomes.

Evaluation of mineral trioxide aggregate as root canal sealer: A clinical study

Aim:

The aim of this study was to compare the clinical and radiological outcome of mineral trioxide aggregate (MTA) or epoxy resin as a root canal sealer compared with zinc oxide eugenol sealer.

Materials and Methods:

45 single rooted teeth with periapical index Score 2 or more were allotted to three groups with 15 teeth in each group. Root canal treatment was performed in two visits and obturated with Gutta-percha as obturating material and zinc oxide eugenol as sealer in Group 1, epoxy resin as sealer in Group 2 and MTA mixed with propylene glycol as sealer in Group 3. Visual analog scale, periapical index and VixWin digital Pro image analysis software were used for evaluation. The quantitative data was analyzed by t-test and analysis of variance. Ordinal data was analyzed by Wilcoxon's signed rank test, Mann-Whitney and Kruskall-Wallis test.

Results:

Results suggested that there exists no statistically significant difference in clinical or radiological outcome of root canal therapy with three different types of sealers used in this study.

Conclusions:

MTA could be used as a root canal sealer with equal effectiveness compared with epoxy resin and zinc oxide eugenol sealers. Further long-term studies should be carried out to prove the effectiveness.

Radiopacity of Flowable Composite by a Digital Technique

The aim of this in vitro study was to evaluate the radiopacity of 19 current dental flowable composite materials by a digital technique. Digital radiographs were obtained with a CCD sensor using an aluminum step wedge, a 1-mm-thick tooth slice, and a 1-mm-thick flowable composite specimen using five different combinations of exposure and voltage. The radiopacity in pixels was determined using Digora 2.6. software. The equivalent thickness of aluminum for each material was then calculated based on the calibration curve. All of the tested flowable composite materials had higher radiopacities than that of dentin, but in almost every combination of exposure and voltage, there were some composite materials that exhibited radiopacities equal to or slightly greater than enamel p&gt;α; α=0.01). Of the flowable composite materials tested, 37% showed lower radiopacities than enamel, and 21% of the tested materials had higher radiopacities than the 3-mm aluminum equivalent. The highest radiopacity at all exposure values was produced by the Majesty Flow and Charisma Opal Flow materials, which had radiopacities almost twice that of enamel. Flowable composite materials should have radiopacities greater than that of enamel (ISO 4049), an important consideration for the introduction of new materials to the market. The digital radiopacity analysis techniques used in this study provide an easy, reliable, rapid, and precise method to characterize radiopacity of dental flowable composite materials.

A fractal dimensional approach to successful evaluation of apical healing

AIM

To evaluate whether the initial healing of apical radiolucencies 1 year after root canal treatment could be quantitatively identified by the change in fractal dimension (FD) values for the eventually completely healed cases.

METHODOLOGY

Twenty-six patients with successful root canal treatment were recruited. All teeth were associated with complete healing either before or at 1 year following treatment (six of 26) or still undergoing healing at 1 year after treatment but completely healed thereafter (20 of 26). Two radiographs were selected for the same patient, one taken before treatment and the other taken 1 year after treatment. Eight regions of interests (ROIs) were selected from each radiograph, two as the experimental group located close to the infected root apex, two as the control group in the healthy bone and the other four in the healthy bone ensuring the image quality.

RESULTS

Based on the FD values of the four ROIs in the healthy bone, the two radiographs were confirmed to have been taken with similar projection angles and exposure. The FD values were shown to significantly increase (P = 0.006) and decrease (P = 0.000) around the root apex and the neighbouring region of the apical lesion, respectively.

CONCLUSION

Changes in fractal dimension values may serve as a necessary condition to quantitatively indicate the initial healing status 1 year after root canal treatment.

Radiopacity of composite dental materials using a digital X-ray system

The aim of this study was to evaluate the radiopacity of 32 current dental composite materials with digital technique. Digital radiographs with CCD sensor along with an aluminum step wedge, 1-mm-thick tooth slice and 1mm thick composite specimen were taken in five different combinations of exposition/voltage. The radiopacity in pixels was determined using Digora 2.6. software. The equivalent in thickness of aluminum for each material was then calculated from the calibration curve. 74.9% of all tested materials in all exposure combinations had radiopacity between 2 mm and 4 mm aluminum equivalent. The radiopacity of composites ranged from 0.61 mm Al (Gradia Direct Anterior) to 4.78 mm Al (Te-Econom). The average radiopacity for enamel and dentine was 2.05 and 1.11 mm Al. The use of digital technique for radiopacity is an easy, reliable, fast and precise way to analyze different dental materials. Most of the tested composite materials fulfill the requested criteria for radiopacity with a few exceptions.

Radiological and histopathological evaluation of experimentally-induced periapical lesion in rats

Objective

This study evaluated experimentally-induced periapical bone loss sites using digital radiographic and histopathologic parameters.

Material and Methods

Twenty-seven Wistar rats were submitted to coronal opening of their mandibular right first molars. They were radiographed at 2, 15 and 30 days after the operative procedure by two digital radiographic storage phosphor plates (Digora^®). The images were analyzed by creating a region of interest at the periapical region of each tooth (ImageJ) and registering the corresponding pixel values. After the sacrifice, the specimens were submitted to microscopic analysis in order to confirm the pulpal and periapical status of the tooth.

Results

There was significant statistically difference between the control and test sides in all the experimental periods regarding the pixel values (two-way ANOVA; p<0.05).

Conclusions

The microscopic analysis proved that a periapical disease development occurred during the experimental periods with an evolution from pulpal necrosis to periapical bone resorption.

Endodontic management of horizontally placed molars after gunshot injury to mandible: a case report

A 37-year-old man reported to our department with the history of gunshot injury to the mandible 15 years before. His anterior mandible had been resected earlier and bone graft was seen. Intraoral examination of lower jaw revealed 4 remaining mandibular molars. These teeth were severely rotated such that they lay horizontal with respect to the mandibular base. Preoperative Dentascan spiral computerized tomography (CT) of the patient revealed obliteration of the mesial canals of the mandibular right first molar and pear-shaped internal resorption defect in the distal canal of the same tooth. This paper reports the challenging endodontic management of a rare case of severely angulated teeth also exhibiting traumatic sequelae in both roots of the impact tooth. It also highlights the usefulness of spiral CT scan in diagnosis of traumatic sequelae such as pulp canal obliteration and internal resorption.

Clinical indications for digital imaging in dento-alveolar trauma. Part 1: traumatic injuries

Traumatized teeth present a clinical challenge with regard to their diagnosis, treatment plan, and prognosis. Recent developments in imaging systems have enabled clinicians to visualize structural changes effectively. Computed tomography, magnetic resonance imaging and cone beam computed tomography are among the most commonly used systems for dental and maxillofacial surgery. The purpose of this review is to describe the advantages and disadvantages of each technique and the clinical application for dento-alveolar trauma. Three clinical cases are described to illustrate the potential use of the NewTom 3G for diagnosis and treatment plan of dento-alveolar traumatic injuries.

Echographic evaluation of bone lesions of endodontic origin: report of two cases in the same patient

We report on two periapical lesions of endodontic origin detected in the maxillary bone of the same patient, whose echographic examination was used to address a tentative differential diagnosis between a granuloma and a cystic lesion. The patient on whom two periapical lesions were diagnosed with clinical and conventional radiographic findings and scheduled for endodontic surgery, was also examined using echography and color power doppler at the site of the lesions. The lesions were echographically described in each case according to a scheme from a previous work. A tentative differential diagnosis between a cystic lesion and a granuloma was made. One lesion was described as a cyst, the other as a granuloma. After surgical excision, the lesions were examined under light microscopy. In both cases the two echographic diagnoses were confirmed by the histopathologic examination.

Differential diagnosis of large periapical lesions using cone-beam computed tomography measurements and biopsy

This study compared the differential diagnosis of large periapical lesions (granuloma versus cyst) to traditional biopsy using Cone Beam Computed Tomography (CBCT), the NewTom 3G. Large lesions were scanned and a preoperative diagnosis based on gray value measurements of the imaged lesion area was made. After surgery a biopsy report was obtained and compared to the CBCT diagnosis. In 13 out of 17 cases, the diagnosis coincided. In 4 out of 17 cases, the CBCT read cyst with the oral pathologist's diagnosis being granuloma. Thus, the CBCT may provide a more accurate diagnosis than biopsy and histology providing a diagnosis without invasive surgery and/or waiting a year to see if nonsurgical therapy is effective.