Cone beam computed tomography and other imaging techniques in the determination of periapical healing

Prevalence of apical periodontitis and its association with previous root canal treatment, root canal filling length and type of coronal restoration - a cross-sectional study

AIM

To analyse the prevalence of periapical lesions and their association with previous root canal treatment, root canal filling length and type of coronal restoration using in vivo cone-beam computed tomographic (CBCT) assessment.

METHODOLOGY

A global sample of 20 836 teeth, with a combined total of 27 046 roots, from 1160 patients, was analysed via CBCT assessment in eight health centres. Each tooth was evaluated by one out of five examiners after having performed a defined calibration procedure on the basis of 319 teeth. Intra- and inter-rater reliability tests were performed. Each tooth was classified according the tooth number, presence/absence of periapical lesions, presence/absence of previous root canal treatment, length of root canal filling (short, good or overfilling) and type of coronal restoration. The z-test for proportions was used to analyse differences between tooth subgroups, and an odds ratio was determined in order to analyse the association between treatment status and periapical lesions. A P < 0.05 was considered significant.

RESULTS

At a tooth level, the overall prevalence of periapical lesions in the sample was 10.4%. Maxillary teeth were associated with a significantly larger percentage of lesions (13.1%), whilst maxillary first molars had the greater proportion of lesions (21.2%). The prevalence of periapical lesions was significantly larger in root filled teeth (55.5%), short root canal fillings (72.7%) and in teeth restored with crowns (46.1%). At a root level, the mesiobuccal roots of both maxillary first molars had a tendency for a larger percentage of periapical lesions.

CONCLUSION

History of root canal treatment, root canal filling length and type of coronal restoration influenced the presence of periapical lesions. Molars were more commonly associated with periapical lesions on root filled teeth, particularly those with short root fillings and those with crowns.

Rotary Versus Reciprocation Root Canal Preparation: Initial Clinical Quality Assessment in a Novice Clinician Cohort

INTRODUCTION

Reports comparing clinical outcomes using nickel-titanium (NiTi) reciprocating instruments with other instrumentation modalities are scarce. This study examined initial shaping outcomes after an instrumentation change of root canal instrumentation technique in a doctor of dental surgery educational program. Student characteristics, faculty/student ratio, facility, and overall endodontic treatment guidelines remained unchanged.

METHODS

A total of 200 nonsurgical initial molar root canal treatments completed by third-year dental students were evaluated. The cases were examined regarding the number of treatment appointments, access cavity preparation, canal taper, canal transportation, perforations, missed canals, presence of ledges, fractured instruments, obturation length, obturation quality, and sealer extrusion. Two independent evaluators determined the number of appointments per case; 4 independent and blinded evaluators analyzed radiographs at 4 treatment stages: preoperative situation, working length, cone fit, and obturation.

RESULTS

The following factors were significantly different between the 2 cohorts: the number of appointments, preparation length, taper, and occurrence of ledges. The WaveOne (Dentsply Sirona, York, PA) cohort had a significantly reduced treatment time compared with hand/GT rotary instrumentation (Dentsply Tulsa Dental, Tulsa, OK) (average of 3.3 vs 4.3 appointments). Appropriate length control and adequate taper were significantly more frequent in the WaveOne group. The frequency of ledges was significantly larger in the hybrid group. Other variables, such as access cavity preparation, canal transportation, perforations, missed canals, fractured instruments, obturation quality, and sealer extrusion, were statistically similar between the 2 groups.

CONCLUSIONS

NiTi reciprocation instrumentation was superior to hybrid hand/NiTi rotary instrumentation in reducing both patient appointments and the incidence of ledging and in improving obturation length and taper in a dental student clinic setting.

Cone-beam computed tomography versus digital periapical radiography in the detection of artificially created periapical lesions: A pilot study of the diagnostic accuracy of endodontists using both techniques

Purpose

The aim of this study was to compare the diagnostic accuracy of previously trained endodontists in the detection of artificially created periapical lesions using cone-beam computed tomography (CBCT) and digital periapical radiography (DPR).

Materials and Methods

An ex vivo model using dry skulls was used, in which simulated apical lesions were created and then progressively enlarged using #1/2, #2, #4, and #6 round burs. A total of 11 teeth were included in the study, and 110 images were obtained with CBCT and with an intraoral digital periapical radiographic sensor (Instrumentarium dental, Tuusula, Finland) initially and after each bur was used. Specificity and sensitivity were calculated. All images were evaluated by 10 previously trained, certified endodontists. Agreement was calculated using the kappa coefficient. The accuracy of each method in detecting apical lesions was calculated using the chi-square test.

Results

The kappa coefficient between examiners showed low agreement (range, 0.17-0.64). No statistical difference was found between CBCT and DPR in teeth without apical lesions (P=.15). The accuracy for CBCT was significantly higher than for DPR in all corresponding simulated lesions (P<.001). The correct diagnostic rate for CBCT ranged between 56.9% and 73.6%. The greatest difference between CBCT and DPR was seen in the maxillary teeth (CBCT, 71.4%; DPR, 28.6%; P<.01) and multi-rooted teeth (CBCT, 83.3%; DPR, 33.3%; P<.01).

Conclusion

CBCT allowed higher accuracy than DPR in detecting simulated lesions for all simulated lesions tested. Endodontists need to be properly trained in interpreting CBCT scans to achieve higher diagnostic accuracy.

Cone beam computed tomography updated technology for endodontic diagnosis

Cone beam computed tomography has gained acceptance in the endodontic community for assistance with diagnosis, treatment, and evaluation of outcomes. This article reviews a multitude of applications, from basic principles to clinical applications, using specific cases and supporting literature to demonstrate the benefits for both the specialist and general practitioner.

Cone beam computed tomography evaluation of the diagnosis, treatment planning, and long-term followup of large periapical lesions treated by endodontic surgery: two case reports

The aim of this case report is to present two cases where cone beam computed tomography (CBCT) was used for the diagnosis, treatment planning, and followup of large periapical lesions in relation to maxillary anterior teeth treated by endodontic surgery. Periapical disease may be detected sooner using CBCT, and their true size, extent, nature, and position can be assessed. It allows clinician to select the most relevant views of the area of interest resulting in improved detection of periapical lesions. CBCT scan may provide a better, more accurate, and faster method to differentially diagnose a solid (granuloma) from a fluid-filled lesion or cavity (cyst). In the present case report, endodontic treatment was performed for both the cases followed by endodontic surgery. Biopsy was done to establish the confirmatory histopathological diagnosis of the periapical lesions. Long-term assessment of the periapical healing following surgery was done in all the three dimensions using CBCT and was found to be more accurate than IOPA radiography. It was concluded that CBCT was a useful modality in making the diagnosis and treatment plan and assessing the outcome of endodontic surgery for large periapical lesions.