Clinical indications for digital imaging in dento-alveolar trauma. Part 2: root resorption

Accuracy of three diagnostic tests to detect tooth resorption in unowned unsocialised cats in Denmark

OBJECTIVES

To estimate the relative diagnostic sensitivity and specificity of oral clinical examination, full-mouth dental radiography, and cone-beam CT for the detection of tooth resorption in cats, and to estimate the prevalence of tooth resorption in unowned, unsocialised cats in Denmark.

MATERIALS AND METHODS

Cadavers of 144 adult cats underwent an oral examination, full-mouth dental radiography, and cone-beam CT. Sensitivity and specificity of the three tests, along with the true prevalence, overall and stratified by sex and tooth location, were estimated using latent class methods.

RESULTS

We found cone-beam CT to be the superior image modality, with a sensitivity of 99.5% and a specificity of 99.8%. Dental radiography had a sensitivity of 78.9% and a specificity of 100%, and oral clinical examination had a sensitivity of only 36.0% and specificity of 99.9%. We estimated the prevalence of tooth resorption among unowned unsocialised cats in Denmark to be 40% of adult individuals, and 6.1% of teeth.

CLINICAL SIGNIFICANCE

When dealing with tooth resorption, cone-beam CT can help the operator to find and treat affected teeth that could otherwise go undiagnosed. The prevalence of tooth resorption among unowned, unsocialised cats in Denmark does not appear to differ from other populations of cats.

A review of the iadt 2020 guidelines

Traumatic dental injuries (TDIs) are a relatively frequent occurrence, with roughly a third of adults experiencing a dental trauma at some time in their life.1 TDIs may present to dental professionals working within primary or secondary care settings. Patients presenting at the time of acute injury will require immediate management and careful long term follow up. Patients may also present later reporting a history of TDI, with developing complications and onward management required. To support dental care professionals, the International Association of Dental Traumatology's (IADT) Guidelines are available globally as a standardised tool to aid the assessment, management and follow up of dental trauma. These easy to access guidelines were updated in 2020 with four distinct publications:General Introduction,1 Fractures and Luxations,2 Avulsion of Permanent Teeth,3 and Injuries in the Primary Dentition.4 The current guidelines represent the best evidence based on available literature and expert opinion.1This paper aims to support dental professionals by specifically highlighting and describing updates in guidance, using the 2020 IADT published guidelines. By incorporating the 2020 guidelines into our everyday practice we aim to provide the most appropriate, standardised care, based on the highest level of available evidence to our patients.The full published guidelines are available free online via the IADT website.

Tooth root resorption: A review

Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.

Prognostic markers of post-traumatic dental external root resorption in children-a pilot study

BACKGROUND

External inflammatory root resorption (EIRR) is a frequent complication of traumatic dental injuries (TDI). The aim of this cohort study was to identify novel non-invasive markers of post-traumatic EIRR by assessing the changes in the pulp's blood flow and the composition of gingival sulcus fluid (GCF) in children after dental trauma.

MATERIAL AND METHODS

Thirty-two children were enrolled and assessed within 48 h of a TDI to their permanent incisors and during an additional three visits over a 6-months follow up period. During each visit, a radiograph and laser Doppler flow (LDF) measurements of the pulp blood flow were performed on the injured tooth, and the GCF was sampled. The permanent first molar tooth of the same subject served as a control for the LDF measurements and the GCF sampling. Concentrations of IL-1α in the GCF were measured using enzyme-linked immunosorbent assays. Radiographs were used to confirm EIRR.

RESULTS

EIRR occurred in fourteen (43.8%) teeth in 32 patients. The teeth with EIRR showed diminished LDF readings when compared with controls at all visits. The LDF readings of the injured teeth continued to decrease at follow up visits. In the EIRR group, levels of IL-1α in the GCF of teeth with EIRR were increased and significantly higher than those of the control teeth at the visit when EIRR was diagnosed. The IL-1α levels were significantly higher in the EIRR group when compared to the injured teeth of patients without EIRR at the last follow-up visit.

CONCLUSIONS

The occurrence of EIRR after mechanical trauma of permanent teeth with complete root development is accompanied by a significant reduction in the blood flow of the tooth's pulp. It is accompanied by an increase in concentrations of IL-1α in the GCF of EIRR affected teeth. The results of this pilot study identified the use of IL-1α in GCF and LDF as non-invasive markers of EIRR.

Applications of cone beam computed tomography in endodontics

Background

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

Aims and objectives

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

Methods

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

Results

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

Imaging diagnosis of external root resorption in replanted permanent teeth

The present study aimed to evaluate the performance of cone beam computed tomography (CBCT) and digital periapical radiographs (PR) in diagnosing external root resorption (ERR) in human permanent teeth replanted after traumatic avulsion. The samples comprised 39 permanent maxillary incisors replanted after traumatic avulsion. Digital PR and CBCT images were taken from each tooth and independently examined by 2 calibrated examiners to assess the ERR activity regarding type and extension. The degrees of agreement between both imaging examinations were determined by the mean global agreement index using SPSS software. The two imaging examinations diverged greatly in the diagnosis of the type of ERR since CBCT identified more cases as inflammatory ERR and PR as replacement ERR. A discordance level of 69.2% was observed between the two methods in the diagnosis of the type of ERR when CBCT for mesial and distal (MD) surfaces was considered and 61.5% when CBCT for mesial, distal, buccal and lingual (MD/BL) was considered. Likewise, CBCT and PR differed regarding the ERR index. PR examinations classified most cases as moderate or severe (69.2%), while CBCT examinations classified more cases as mild either in the MD surfaces analysis (41.4%) or in the analysis of the MD-BL surfaces (51.3%). In conclusion, the present results highlight a discrepancy between CBCT and digital PR performance in the diagnosis of different types and extent of ERR in replanted teeth.

How standard deviation contributes to the validity of a LDF signal: a cohort study of 8 years of dental trauma

The aim of this cohort study was to document the potential of laser Doppler flowmetry (LDF) for diagnosing tooth vitality in traumatized teeth in a population of 88 referred patients with dental trauma over a period of 8 years (2011-2018). The main reason to refer was tooth discoloration (26%), and the main trauma cause was a traffic injury (35%). Taking into account that referral for LDF is best given within the week after trauma, 66% of referrals were overdue. In 73% of cases, root canal treatment could be avoided, and in 65%, the presence of a fixed orthodontic retainer showed beneficial for pulp recovery. Data of 394 teeth were collected and submitted to multilevel modelling statistics. As a general conclusion, both LDF perfusion and concentration values proved to be highly reliable in the appreciation of tooth vitality. The difference of variability of standard deviation and range of LDF measurements involving intra-subject control teeth showed statistically significant in discriminating between vital and non-vital pulps. In non-vital teeth, the diagnostic combination of LDF, sensibility tests and peri-apical X-ray is advised.

Second Mesiobuccal Canal Evaluation Features with Cone-Beam Computed Tomography

Aim

The aim of the study is to evaluate the difference in MB2 prevalence with different slice thicknesses in maxillary first molars.

Materials and Methods

Two hundred nonfilled MB2 canals in maxillary first molars of 156 people (75 females and 81 males) aged from 20 to 73 years old were evaluated with CBCT with different slice thicknesses: 0.5 mm, 1 mm, 3 mm, and 10 mm. A general analysis was performed out, as well as in the age groups and on gender groups.

Results

Visualization with 0.5 mm and 1 mm slice thicknesses was 100% and generally equal, in both the male and the female group. General MB2 visualization with 3 mm slice thickness was 42% and 29% for the male group and 27% for the female group. No canals were visualized with 10 mm slice thickness. The study did not demonstrate a statistical difference in the MB2 prevalence between gender and age groups with the 3 mm slice thickness.

Conclusion

The most valuable way to evaluate the root canal system in first maxillary molars with CBCT is using 1 mm slice thickness for both genders and every age group.

CBCT analyses of advanced cervical resorption aid in selection of treatment modalities: a retrospective analysis

OBJECTIVES

The selection of treatment for advanced (classes 3 and 4) invasive cervical resorption (ICR) based on a two-dimensional periapical radiograph is challenging. The purpose of the present study is to describe different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation.

MATERIALS AND METHODS

All cases of advanced ICR based on CBCT evaluation in our endodontic department between 2011 and 2016 were included in the study. The dimension, circumferential, and coronal-cervical locations of the entry point of the resorption tissue into the tooth were evaluated. The selected treatment approach for each case was documented, and all the data were summarized and analyzed.

RESULTS

Twenty-three cases of advanced ICR were included in the study. Approximately, 74% were diagnosed in stage 4, and 26% were diagnosed in stage 3. The narrow entry point was identified in 43% (10 cases), while in 57% (13) of cases, the entry point was wide. Circumferentially, 70% (16) were located on the proximal side. Coronal-cervically, 43% (10) were located more than 1.5 mm above the crestal bone. All narrow entry point cases were treated using a minimally invasive technique, while different treatment approaches were chosen for cases with a wide entry point.

CONCLUSIONS

The present study proposes different treatment approaches for advanced ICR based on CBCT. The CBCT evaluation of the entry point may facilitate choosing the appropriate treatment approach for advanced ICR cases.

CLINICAL RELEVANCE

The description of different treatment approaches for advanced invasive cervical resorption based on cone-beam computed tomography evaluation enables the clinician to choose the optimal treatment approach for each advanced ICR case.

Root Resorption Classifications: A Narrative Review and a Clinical Aid Proposal for Routine Assessment

Root resorption (RR) refers to noninfectious damage related to the loss of hard and soft dental tissue that results from clastic cell activity. It is observed as a pathologic process that is predominantly asymptomatic in the permanent dentition and physiological during the shedding of primary teeth. Roots are protected by unmineralized organic cementoid and predentine. RR occurs because of the inability of the clastic cells to adhere to unmineralized surfaces. Since the first RR classification was described by Andreasen in the 1970s, several classifications have been proposed with diverse terminology. A narrative literature review was undertaken on the current classification, diagnosis, pathophysiology, and treatment of RR. A bibliographic search resulted in 434 titles and abstracts, and from those, 17 articles were obtained that alluded to 15 RR classifications. A total of 28 articles that met the inclusion criteria were included. Results showed that Andreasen’s classification is the most widely used for classifying RR. In terms of epidemiologic data, studies are scarce, although RR pathophysiology is well described in the literature. Overall clinical guidelines are summarized in a new RR classification diagram. The choice of RR treatment application should be in line with the RR type and the dentist’s experience. However, an earlier and correct diagnosis will significantly improve final outcomes and long-term prognosis, especially with the current evolution of advanced imaging techniques, such as cone-beam computed tomography and bioceramic-based endodontic sealers.

Clinical Management of Root Resorption: A Report of Three Cases

Root resorption is a pathological condition that may be an endodontic challenge if not diagnosed and treated correctly. The recent advances in the imaging technologies and material science have enabled the clinician to visualize the structural changes accurately and repair them with materials providing favourable seal ability. In this article, we report three cases of root resorption with different presentations which were diagnosed with the help of cone beam computed tomography (CBCT) and successfully managed. The series highlights the importance of diagnosis in unusual clinical situations and recommends early commencement of optimal management for longevity of tooth for health and function.

Guidelines for the Management of Traumatic Dental Injuries: 1. Fractures and Luxations of Permanent Teeth

Traumatic dental injuries (TDIs) of permanent teeth occur frequently in children and young adults. Crown fractures and luxations are the most commonly occurring of all dental injuries. Proper diagnosis, treatment planning and followup are important for improving a favorable outcome. Guidelines should assist dentists and patients in decision making and for providing the best care effectively and efficiently. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the best current evidence based on literature search and professional opinion. The primary goal of these guidelines is to delineate an approach for the immediate or urgent care of TDIs. In this first article, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.

Accuracy of linear and volumetric measurements of artificial ERR cavities by using CBCT images obtained at 4 different voxel sizes and measured by using 4 different software: an ex vivo research

OBJECTIVES

To compare the accuracy of linear and volumetric measurements of artificial external root resorption (ERR) cavities by cone beam CT (CBCT) images obtained at four voxel sizes and by using four different software ex vivo.

METHODS

ERR cavities were created on 40 extracted single rooted anterior teeth. Images were obtained by using Planmeca CBCT unit at endo mode (0.075 mm); high-resolution mode (0.1 mm); high-definition mode (0.15 mm) and normal resolution mode (0.2 mm) voxel sizes. Images were analyzed by two observers using four different software (Romexis, 3D Doctor, ITK-SNAP, and OsiriX). (1) Diameter; (2) height; (3) depth; and (4) volume of the ERR were measured. CBCT measurements were then compared with direct physical measurements. ANOVA was used with general linear model analysis. The significance level was set at p < 0.05.

RESULTS

One-way ANOVA general linear model analysis showed no significant difference between or within observers for diameter, height, depth and volume measurements (p > 0.05). We found significant differences for diameter and volume measurements among softwares in terms of mean differences as compared to mean standard direct measurements (p < 0.05). We found statistically significant differences among voxel sizes and software for height measurements (p < 0.05). In addition, we found significant differences for diameter and volume measurements (p < 0.05) suggesting more accurate measurements for the cervical region when compared to apical region.

CONCLUSIONS

Observers using CBCT images obtained at four voxel sizes performed similarly in the quantification of artificial ERR with clinically insignificant distinction between CBCT softwares used.

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

Introduction:

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

Methods and Materials:

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

Results:

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

Conclusions:

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

Management of extensive external apical root resorption leading to root perforation

Resorption is both a physiological and pathological process which results in loss of hard tissues of the tooth, i.e , cementum and dentine and the surrounding bone. External resorption is much more common than internal resorption and can occur when tooth is luxated or avulsed. If remained unchecked, resorption can eventually lead to loss of the tooth. Timely management of the affected tooth can slow down the resorptive lesion and increase the prognosis of the survival of the tooth. This case report describes the surgical management of extensive external root resorption leading to perforation of apical one-third of the root area which was managed through root canal along with periapical surgery and bone grafting. A 6-month follow-up showed arrest of the resorptive defect and progressive healing as evident on the cone-beam computed tomography.

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.

Orthodontic Traction of Impacted Canine Using Cantilever

The impaction of the maxillary canines causes relevant aesthetic and functional problems. The multidisciplinary approach to the proper planning and execution of orthodontic traction of the element in question is essential. Many strategies are cited in the literature; among them is the good biomechanical control in order to avoid possible side effects. The aim of this paper is to present a case report in which a superior canine impacted by palatine was pulled out with the aid of the cantilever on the Segmented Arch Technique (SAT) concept. A 14.7-year-old female patient appeared at clinic complaining about the absence of the upper right permanent canine. The proposed treatment prioritized the traction of the upper right canine without changing the occlusion and aesthetics. For this, it only installed the upper fixed appliance (Roth with slot 0.018), opting for SAT in order to minimize unwanted side effects. The use of cantilever to the traction of the upper right canine has enabled an efficient and predictable outcome, because it is of statically determined mechanics.

Computed tomography: Will the slices reveal the truth

With the advances in the field of imaging sciences, new methods have been developed in dental radiology. These include digital radiography, density analyzing methods, cone beam computed tomography (CBCT), magnetic resonance imaging, ultrasound, and nuclear imaging techniques, which provide high-resolution detailed images of oral structures. The current review aims to critically elaborate the use of CBCT in endodontics.

CBCT Post-Processing Tools to Manage the Progression of Invasive Cervical Resorption: A Case Report

Abstract This case report aimed to highlight the usefulness of cone beam computed tomography (CBCT) and its post-processing tools for the diagnosis, follow-up and treatment planning of invasive cervical resorption (ICR). A 16-year-old female patient was referred for periapical radiographic examination, which revealed an irregular but well demarcated radiolucency in the mandibular right central incisor. In addition, CBCT scanning was performed to distinguish between ICR and internal root resorption. After the diagnosis of ICR, the patient was advised to return shortly but did so only six years later. At that time, another CBCT scan was performed and CBCT registration and subtraction were done to document lesion progress. These imaging tools were able to show lesion progress and extent clearly and were fundamental for differential diagnosis and treatment decision.

Effect of Voxel Size on Detection of External Root Resorption Defects Using Cone Beam Computed Tomography

BACKGROUND

Selecting a voxel size that yields minimal radiation dose with no significant compromise of the diagnostic accuracy of cone beam computed tomography (CBCT) is particularly important.

OBJECTIVES

This study aimed to assess the effect of voxel size on detection accuracy of simulated external root resorption defects using NewTom CBCT system.

MATERIALS AND METHODS

In this diagnostic study, the roots of 90 extracted human central incisors were hypothetically divided into cervical, middle, and apical thirds. Variable-size defects were prepared in the buccal and lingual surfaces of the roots and CBCT scans were obtained with four different voxel sizes (150, 200, 250, and 300). Presence or absence of defects on CBCT scans was determined by three radiologists and the results were compared with the gold standard (actual size and depth of defects). Sensitivity and specificity values were calculated and reported for different groups.

RESULTS

In the lingual surfaces, the highest specificity and sensitivity belonged to 300µm voxel size (92.9%), and 200 and 250µm voxel sizes (both 97.4%) in the cervical third, respectively. In the middle third, the highest specificity and sensitivity belonged to 250 and 200µm voxel sizes (84.6% and 100%, respectively). In the apical third, the highest specificity and sensitivity belonged to 300 µm voxel size (100% and 97.9%, respectively). In the buccal surfaces, the highest specificity and sensitivity belonged to 150 (75.0%), 300 and 250 µm voxel sizes (100%) and the minimum values belonged to 200 µm voxel size (60% and 97.3%) in the cervical third. In the apical third, the highest specificity and sensitivity were noted in 300 µm voxel size (100% and 97.6%, respectively) and the minimum values were seen in 200 and 150 µm voxel sizes (93.8%, 90.5%, respectively). In the middle third, 300, 250 and 200 µm voxel sizes yielded the highest specificity (88.9%), while 150 µm voxel size yielded the highest sensitivity (98.8%).

CONCLUSION

Considering the similar diagnostic efficacy of all voxel sizes, 300 µm voxel size can be used with adequate efficacy for detection of external root resorption defects with minimal patient radiation dose and the shortest scanning time.

Diagnosis of acute dental trauma: the importance of standardized documentation: a review

In 1985 Andreasen and Andreasen published a paper on the diagnosis of luxation injuries and outlined the importance of standardized clinical, radiographic, and photographic techniques. Now 30 years later, these recommendations remain current in the International Association of Dental Traumatology (IADT) guidelines for the management of dental trauma and describe circumstances surrounding the time of injury, the extent of trauma (e.g., type of luxation injury), healing potential (e.g., stage of root development) as well as information concerning subsequent treatment. The purpose of this review was to include findings for other types of trauma and to discuss more recent studies that augment and/or improve on the original findings from 30 years ago. The present review discusses the use of a standardized clinical registration (pulpal sensibility testing, laser Doppler flowmetry, mobility testing), radiographic survey, and photographic registration of the traumatized patient. Moreover, the value of digital radiographs and recent developments in computer tomography with respect to possible enhancement of the trauma diagnosis are discussed.

Management of an Intruded Tooth and Adjacent Tooth Showing External Resorption as a Late Complication of Dental Injury: Three-Year Follow-Up

Treatment and prognosis of intrusive luxation can vary depending on the age of the patient, type of dentition, stage of root development, and time and severity of the trauma. Some studies have demonstrated that intrusions of up to 3.0 mm have an excellent prognosis, whereas teeth with severe intrusion or teeth that are intruded more than 6.0 mm present an unfavorable prognosis because of the occurrence of inflammatory resorption and pulp necrosis. The aim of this case report is to present an 11-year-old male patient with complete intrusion of the permanent maxillary left lateral incisor, associated with the adjacent central tooth presenting external resorption, treated by immediate surgical repositioning and root canal treatment with a favorable prognosis. After long-term (3-year) clinical and radiographic follow-up, the teeth appeared normal and the patient was pleased with the outcome.

Three-dimensional imaging modalities in endodontics

Recent research in endodontics has highlighted the need for three-dimensional imaging in the clinical arena as well as in research. Three-dimensional imaging using computed tomography (CT) has been used in endodontics over the past decade. Three types of CT scans have been studied in endodontics, namely cone-beam CT, spiral CT, and peripheral quantitative CT. Contemporary endodontics places an emphasis on the use of cone-beam CT for an accurate diagnosis of parameters that cannot be visualized on a two-dimensional image. This review discusses the role of CT in endodontics, pertaining to its importance in the diagnosis of root canal anatomy, detection of peri-radicular lesions, diagnosis of trauma and resorption, presurgical assessment, and evaluation of the treatment outcome.

A cone-beam computed tomography study of the root canal morphology of anterior teeth in a Turkish population

Objective:

The aim of this study was to determine the root and canal morphology of the maxillary and mandibular anterior teeth in a Turkish population by analyzing cone-beam computed tomography (CBCT) images.

Materials and Methods:

CBCT images of 417 females and 410 males with a mean age of ranging from 14 to 70 years were examined in this study. A total of 1453 maxillary central incisors, 1504 maxillary lateral incisors, 1523 maxillary canines, 1582 mandibular central incisors, 1603 mandibular lateral incisors, and 1604 mandibular canines were analyzed. The number of root canals and the canal configurations were investigated and then were classified according to Vertucci's classification. The data were analyzed with the Pearson Chi-square test.

Results:

The Type 1 canal configuration was most prevalent in the maxillary anterior teeth (96.8-99.7%). The Types 2, 3, 4, and 5 canal configurations were observed within the range of 0-1.3%, 0-0.8%, 0-0.7%, and 0-1.8%, respectively. In the mandibular anterior teeth, the Type 1 canal configuration was most prevalent (77-95%). The Types 2, 3, 4, and 5 canal configurations were observed within a range of 0.2-2.7%, 0.2-1.6%, 0.9-5.9%, and 1.8-14.4%, respectively. The prevalence of two canals was higher in males than in females both in the maxillary and mandibular anterior teeth (P < 0.05).

Conclusions:

Type 1 was the most prevalent canal configuration of maxillary and mandibular anterior teeth in the Turkish population. Type 5 was the most frequently observed canal configuration of the two canalled teeth. The incidence of root canal numbers and configurations differed with sex.

Healing complications of traumatized permanent teeth in pediatric patients: a longitudinal study

BACKGROUND

Traumatic dental injuries (TDI) can affect soft and hard dental tissues and supporting structures in different ways and severity.

AIM

This study describes the complications associated with health in traumatized permanent teeth (TPT) over a 12-month period and assesses the relationships between TDI, involved tissues, and root development (RD).

DESIGN

The study enrolled 294 patients with 548 TPT. Data were collected on the TDI, RD, and the healing complication (HC) and when they were examined (03, 06, and 12 months). Frequencies are described and analyzed using the chi-squared test, relative risk (RR), and Mantel-Haenszel analysis (P≤0.05).

RESULTS

Healing complications were present in 201 (36.68%) teeth and were more frequently diagnosed 3 months (63.68%) after the TDI. Pulp necrosis was the most common HC (38.3%), and it was significantly associated with avulsion (P=0.023). Teeth with complete RD showed a tendency of developing HC over time, independent of TDI (P=0.05). HC in teeth with complete RD related to support tissue trauma (P=0.005) and avulsion (P<0.001) appeared more frequently after 3 months.

CONCLUSION

Healing complications are more common in teeth that have suffered trauma in supporting tissues and avulsion, especially in teeth with complete RD. The HC occur more frequently in the first 3 months, and a necrotic pulp was the most common complication.

CBCT evaluation of multiple idiopathic internal resorptions in permanent molars: case report

BACKGROUND

Internal inflammatory root resorption is a rare condition in permanent teeth, which requires the presence of necrotic and infected pulp tissue within the coronal portion of the root canal system as well as inflamed pulp tissue apical to the resorptive defect. The aetiology of internal root resorption is not completely understandable, trauma and chronic pulpitis are considered the main risk factors.

CASE PRESENTATION

We report a rare case of the multiple idiopathic resorption in the permanent maxillary and mandibular molars in a healthy 33-year-old female patient. In addition to clinical examination the patient was imaged using conventional radiography techniques and cone beam computed tomography (CBCT).The patient had recurrent throbbing pain in her # 46. The radiographic examination including "panoramic radiography and CBCT" revealed that radiographic evidence of internal resorption in #37 #36 #35 #34 #33 #47 #46 #45 #44 #43 #16 #15 #14 #13 and also including in unerupted #17, #26, #27, #28 teeth. The definitive diagnosis was made with the histopathological examination of the extracted tooth.

CONCLUSIONS

Internal root resorption is a rare clinical process that should be examined using different radiographic modalities. CBCT seems to be useful in evaluation of the lesions with superior diagnostic performance.

Clinical utility of dental cone-beam computed tomography: current perspectives

Panoramic radiography and computed tomography were the pillars of maxillofacial diagnosis. With the advent of cone-beam computed tomography, dental practice has seen a paradigm shift. This review article highlights the potential applications of cone-beam computed tomography in the fields of dental implantology and forensic dentistry, and its limitations in maxillofacial diagnosis.

CBCT study of root and canal morphology of permanent mandibular incisors in a Chinese population

OBJECTIVE

To evaluate root canal morphology of permanent mandibular incisor teeth in a Chinese population using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

CBCT images of Chinese patients were collected and 1553 permanent mandibular incisors in the images were included. The following observations on the included teeth were to determine the number of roots, root morphology and canal configuration. The root canal configurations were classified. The effect of gender on the incidence of the second canal was investigated.

RESULTS

Of permanent mandibular incisors, 86.8% had a single root with single canal. Mandibular lateral incisors (17.5%) had a higher incidence of a second canal compared with mandibular central incisors (8.9%) (p = 0.000). A slightly higher percentage of incidence of a second canal was found in males (14.6%) than in females (11.9%) (p = 0.129).

CONCLUSIONS

Permanent mandibular incisors with two canals had a relatively low incidence in this Chinese population. The incidence of a second canal did not differ between males and females. CBCT is a valuable aid during root canal treatment.

Diagnosis of invasive cervical resorption by using cone beam computed tomography: report of two cases

A radiographic interpretation is essential to the diagnosis of invasive cervical resorption (ICR) and the difficulty in distinguishing this lesion from internal root resorption has been highlighted in the literature. This paper reports the use of cone beam computed tomography (CBCT) in the diagnosis of ICR. The cases reports describe how CBCT can be used to make a differential diagnosis and also show that the use of this technology can provide relevant information on the location and nature of root resorption, which conventional radiographs cannot. As a result, the root canal treatment was not initially considered. The patients will be monitored and will undergo a scan after a short period of time to detect any small changes. It was observed that both cases benefited from CBCT in the diagnosis of ICR, because this imaging modality determined the real extent of resorption and possible points of communication with the periodontal space.

Comprehensive management of a complex traumatic dental injury

A 24-year-old female patient presented with complaint of palatal swelling and a sinus tract facial to tooth #22. She reported an injury to the tooth 15 years earlier and no recollection of treatment, although there was evidence of an endodontic access into the crown. Radiographically the root appeared to have stopped developing, and it was associated with a large periapical lesion. After 3 unsuccessful attempts at apexification using calcium hydroxide (CH), further examination including use of cone-beam computed tomography (CBCT) was carried out. The latter allowed for better evaluating the situation and for better planning a more comprehensive treatment plan to include surgical removal of the apical lesion. The large radiolucent area extended from tooth #21 to #23. Using a dedicated software tool developed to be used in conjunction with CBCT, volumetric assessment of the lesion was carried out for healing follow up. The root end was filled from the apical direction with newly developed accelerated silicate cement 4-5 mm into the apical part of the canal. Subsequently, the rest of the canal was filled with the same type of cement. At the 1-year postsurgical follow up, the tooth remained asymptomatic, and using the CBCT volumetric program, bony healing could be demonstrated.

Apical root resorption: the dark side of the root

INTRODUCTION

The diagnosis of apical root resorption is usually based on routine radiographs. However, these methods are limited because the images reflect the superimposition of the whole root structure and can lead to underestimation of the extent of apical root resorption. In this study, we aimed to determine the lengths of the labial and lingual surfaces of incisors with apical root resorption and compare them with the longest radicular length obtained on sagittal images of cone-beam computed tomography, and to create a qualitative visual scale of the different patterns of apical root resorption.

METHODS

Eighty-two incisors with apical root resorption from 25 patients had their labial and lingual root surfaces and the longest radicular lengths determined in the sagittal plane and compared. Five orthodontists, at 2 times, classified the images of each incisor according to a visual scale developed by the authors.

RESULTS

There was no significant difference between the labial and lingual surfaces; however, the longest radicular length was significantly greater than the shortest surface length. The visual scale showed intraobserver agreement of 0.615 and interobserver agreements of 0.74 and 0.52 at both times, respectively.

CONCLUSIONS

The difference between the longest and shortest root lengths suggests that radiographic superimposition underestimates the extent of the resorption lesion. The proposed visual scale showed a frequency of agreement above 65% and a coefficient of reproducibility varying from moderate to substantial.

Tooth resorption part II - external resorption: Case series

External tooth resorption usually follows trauma to the periodontal ligament. It can be classified into five categories based on its clinical and histological manifestations. Calcium hydroxide has long been used as an intracanal medicament to slow down the resorption process due to its alkaline pH. A combination of both external and internal resorptions can also occur on the same tooth, making the management more complex. Five case reports of external resorption have been presented in this article along with pertinent review of literature. Successful management was possible in two cases, while extractions had to be advised in 3 cases due to advanced nature of the lesions.