Radiolucent Lesions Associated with Stainless Steel Mini-Implants During Routine Examination with Cone Beam Computed Tomography-An Observational Study

Diabetes mellitus (DM) may affect the healing and survival of root filled teeth with periapical lesions. To systematically analyse the available clinical literature to evaluate the association between DM and the prevalence of radiolucent periapical lesions in root filled teeth. The review question was 'Is there a difference between the root canal treatment healing outcome (in terms of presence or absence of radiolucent periapical lesions) in diabetic and non-diabetic patients?'. A systematic review of cross-sectional studies and prospective clinical trials was conducted according to the PRISMA checklist. The review involved a search of the electronic databases of PubMed, Scopus and EBSCO host. The research protocol was previously registered in the International Prospective Register of Ongoing Systematic Reviews (CRD42019130954) and included defined inclusion/exclusion criteria. The included studies were related to the root canal treatment outcome in diabetic patients in terms of periapical radiolucent lesions associated with root filled teeth. The selected studies were critically analysed by two evaluators using the Joanna Briggs Institute Critical Appraisal tool. The pooled odds ratio (OR) was recognized as the primary outcome variable and measure of the effect for the occurrence of periapical lesions associated with root filled teeth of control and diabetic patients. The random-effects Mantel-Haenszel method was used, at a 95% confidence interval, to calculate the pooled OR. A funnel plot was created to evaluate possible sources of heterogeneity. Ten studies published between 1989 and March 2019 were selected after thorough analysis and exclusion according to the strict criteria. Seven cross-sectional studies, 1 longitudinal and 2 prospective clinical studies were included. The pooled OR was calculated by comparing 773 diabetic subjects and 1133 control subjects. The pooled OR for the observational studies and clinical studies were 1.42 and 6.36, respectively. This value signified a high prevalence of periapical lesions in root filled teeth in diabetic subjects. There are limited prospective clinical trials on this topic. The majority of the included studies are observational. The data suggest a strong connection between the presence of periapical radiolucency on root filled teeth amongst diabetics as determined by the pooled OR.

Background Oral diseases are among the most prevalent public health issues worldwide, underscoring the importance of early diagnosis and effective prevention programs. Determining the prevalence of jawbone lesions is crucial for developing targeted interventions and ensuring timely treatment. Panoramic radiography, also known as orthopantomogram, has become a cornerstone in radiographic examinations, offering a comprehensive view of the dental and maxillofacial regions. Its accessibility and ability to detect a wide range of pathologies make it an invaluable diagnostic tool. This study aimed to assess the prevalence and distribution of radiolucent and radiopaque jawbone lesions in the population of Hail, Saudi Arabia, using panoramic radiographic analysis. Methodology A retrospective, cross-sectional study was conducted using pre-existing panoramic radiographs of individuals aged 18 years and older in Hail, Saudi Arabia. The radiographs were analyzed for the presence of jawbone lesions, classified as radiolucent, radiopaque, or mixed, and their anatomical distribution was recorded. Statistical analysis was performed using the chi-square test, with a significance level set at p-values <0.05. Results A total of 389 jawbone lesions were identified in 177 subjects, representing a prevalence of 45.5%. Radiolucent lesions were the most common, observed in 153 (39.3%) subjects, while radiopaque lesions were found in 18 (4.6%) subjects, and mixed lesions in six (1.5%) subjects. The mandible was more frequently affected than the maxilla, with 104 (59%) lesions occurring in the mandible and 52 (29%) lesions in the maxilla. The posterior region of the jaw was the most commonly involved site, accounting for 124 (31.9%) cases. Gender and age did not significantly influence the prevalence or type of lesions, although a higher incidence was noted in the 31-45-year age group. Conclusions This study revealed a significant prevalence of jawbone lesions in the Hail population, with radiolucent lesions being the most common type, predominantly affecting theposterior region of the mandible. The findings highlight the importance of early detection and targeted dental health initiatives in this region. Further research, particularly longitudinal studies, is recommended to explore the natural history of these lesions and their impact on oral health over time.

To determine the range and demographic and clinical features of radiolucent inflammatory jaw lesions. Histopathology reports were reviewed to identify radiolucent jaw lesions. There were no clinical exclusive criteria, and the samples represented a wide range of clinical presentation and treatment history from multiple providers. Data were analysed using SPSS. To evaluate concordance of clinical and histological diagnoses, the clinician's provisional diagnosis was compared with the final histopathological diagnosis. A total of 17 038 specimens were reviewed; of these, 4983 (29.2%) were radiolucent jaw lesions, of which inflammatory lesions accounted for 72.8% (n = 3626). Periapical granulomas (59.7%) were the largest group followed by radicular cysts (29.2%). The mean age was 44 years (range 2-100 years), men and women were equally represented and the anterior maxilla was the most common site for the biopsied lesions. A provisional diagnosis was correct for only 48.3% of periapical granulomas and 36% of radicular cysts. This study included all presentations of periapical radiolucent lesions and showed that the incidence of cystic change in periapical lesions of endodontic origin is high at approximately 30% of all inflammatory lesions. Notwithstanding the relative frequencies, demographics and location of radiolucent inflammatory lesions presenting in the New Zealand population are comparable to that of other populations. No inflammatory radiolucent lesion can be reliably accurately diagnosed from clinical presentation and/or radiographic appearance alone.

The aim of this paper is to present two case reports of pulp necrosis and radiolucent periapical lesions, which were treated without surgical treatment. The first was a mandibular molar with periapical lesion of endodontic origin extending towards the furcation in a 20-year-old woman, and the second affected a maxillary right lateral incisor with a large periapical lesion in a 22-year-old woman. The endodontic treatments were carried out in two sessions, with crown-down instrumentation, irrigation with 2.5% sodium hypochlorite and intracanal medication with calcium hydroxide paste. After 30 days, the root canals were filled with gutta-percha and Sealapex sealer by the lateral condensation technique. The clinical and radiographic examination after 1 year revealed complete repair. The appropriate diagnosis of lesions of endodontic origin and the treatment and obturation of the infected canals allowed complete repair of these large radiolucent periapical lesions without surgical treatment.

Regional odontodysplasia: Orthodontic treatment and transplantation of premolars

The aim of the study. Conduct a digital analysis of the distribution of relative force occlusal load in the area of the second permanent mandibular molars before and after their mesialization.&#x0D; Research methods. In order to evaluate the distribution of inter-occlusal force load in the process of mesialization of molars on the mandible, two clinical study groups were formed. The first group consisted of 32 persons (18 women / 56.25% and 14 men / 43.75%) aged from 18 to 25 years, who had orthodontic treatment using braces and mini-implants. The second group included 30 people (19 women / 63.33% and 11 men / 36.67%), orthodontic treatment was performed using a brace system without additional intraosseous support on the mini-implants.&#x0D; T-scan apparatus investigated the distribution of relative force occlusal load in the area of the second permanent mandibular molars before and after orthodontic intervention.&#x0D; Results of the study. The use of the T-scan apparatus is an accurate and informative tool for analyzing the distribution of functional occlusal force load within the dentition. During the analysis of the parameters of the chewing load in the area of the second permanent molars on the mandible before orthodontic treatment, an increase of this index was found in almost all patients of both study groups. In the first group in 4 (12.5%) persons the maximum relative occlusive force load in the area of the second permanent molars on the mandible was 10–20%, which is the range of the norm; in 15 (46.9%) cases this indicator was 20–30. %, in 10 (31.2%) patients had 30-40%, and in 3 (9.4%) exceeded 40%. In the second group, the parameters of the relative force occlusal load in the area of the second permanent molar on the mandible were as follows: in 5 (16.7%) persons in the range of 10-20%, in 13 (43.3%) persons - 20-30%, in 10 (33.3%) patients - 30-40% and in 2 (6.7%) patients more than 40%.&#x0D; After treatment, normalization of the relative occlusal force load was observed in the area of the second permanent molars on the lower jaw in the majority of patients of both study groups. In particular, in the first group in 21 (65.6%) persons the parameters of occlusal load were in the range of 10–20%, in 11 (34.4%) persons were 20–30%. In the second study group, 17 (56.7) patients observed parameters of the occlusal load on the second molar in the range of 10-20%, in 12 (40%) persons - 20-30% and in one (3.3%) patient 30-40%.&#x0D; In addition, moving molars involves changing the usual occlusal ratios associated with the non-identity factor in the shape and size of the first and second molars.&#x0D; At the same time, occlusal contacts on all other teeth are altered due to their alignment with the orthodontic equipment and the appearance of new contact points that did not interact before the start of treatment.&#x0D; Conclusions. The analysis of the distribution of the relative occlusal load in the area of the second permanent molars on the lower jaw with the help of T-scan after orthodontic treatment revealed the normalization of this indicator in the majority of patients in both study groups. Specifically, in the first group, 21 (65.6%) subjects had parameters of relative occlusal load within the range of 10–20%, and in 11 (34.4%) individuals were 20–30%. In the second study group, 17 (56.7%) patients were in the range of 10–20%, 12 (40%) patients - 20–30% and one (3.3%) patients 30–40%. The data obtained in both the first and second study groups indicate the need to perform procedures of grinding after orthodontic intervention to achieve appropriate occlusive normalization, the volume of which in each clinical situation is determined individually under the control of the T-scan apparatus.

Anatomical abnormalities in multiple permanent teeth.

Central odontogenic fibroma World Health Organization (WHO)-type (OFWT) is a rare lesion that has differential diagnosis with other radiolucent periapical lesions. It has a slow growth and is usually an asymptomatic lesion found in routine examinations. We report a case of a central OFWT occurring in the maxilla, for which the first symptom was teeth mobility, simulating a periodontal condition. A 54-year-old woman, with superior premolar mobility, was referred to our clinic. An oral examination showed teeth vitality and advanced periodontal disease. Radiography showed a unilocular radiolucent area between the left superior lateral incisor and first left molar, with bone reabsorption. The granulomatous tissue was removed and microscopic examination revealed cellular connective tissue with multiple islands of odontogenic epithelium, covered by stratified squamous epithelium, confirming the OFWT diagnosis. The central OFWT is a non-aggressive lesion, with rare recidivism. Biopsy is an important procedure for correct diagnosis and treatment, as some radiolucent lesions can lead to misdiagnosis.

Background: Impacted teeth occur when teeth fail to erupt or cannot fully erupt along the dental arch in the normal pattern of dental growth. Untreated impacted teeth can cause pain, tooth decay, inflammatory lesions, odontogenic cysts, and tumors. Pathological lesions in impacted teeth that are not clinically visible are usually found on routine radiographic examinations. Panoramic radiography is used as an initial imaging technique to evaluate impacted teeth and associated lesions. Purpose: This study aims to see the characteristics of radiolucent lesions associated with impacted teeth based on panoramic radiographic archives of patients at RSGM Unpad. Methods: This is an observational descriptive study with purposive sampling technique using secondary data of panoramic radiographs from the Dental Radiology Installation RSGM Unpad. The radiographs were inverted to enhance the visualization of characteristics such as location, shape, borders and associations. The data is presented in the table of frequency and distribution. Results: 346 samples of radiolucent lesions associated with impacted teeth were obtained from 8034 impacted teeth. There were 323 (93,4%) pericoronal lesions, 344 (99,4%) monolocular lesions, 218 (63%) had well-defined borders, and 345 (99,7%) lesions caused bone destruction. The prevalence of radiolucent lesions associated with impacted teeth is 4.3%. Conclusion: The characteristics of radiolucent lesions associated with impacted teeth at the Dental Radiology Installation RSGM Unpad most common are pericoronal lesions, monolocular shape, well-defined borders, and the effect on the surrounding structure is bone destruction.Impacted, Panoramic Radiograph, Radiolucent Lesion

Cemento-osseous dysplasia (COD) is a non-neoplastic condition, characterized by the replacement of normal cancellous bone with fibrous tissues containing woven bone and cementum in the tooth-bearing areas. This report presents the case of a 21-year-old male who developed COD following orthodontic treatment. A panoramic radiograph showed a periapical radiolucent lesion in the right mandibular canine area. Cone beam computed tomography revealed a mixed radiolucent and radiopaque lesion. Histologically, the lesion exhibited cementum-like calcifications and woven bone scattered within the hemorrhagic fibrous tissue. Ultimately, the lesion was diagnosed as cemento-osseous dysplasia, focal type. This case highlights the importance of careful monitoring of orthodontic forces to minimize risks and prevent unexpected complications during orthodontic treatment.

Evaluation of Periapical Lesions and Their Association with Maxillary Sinus Abnormalities on Cone-beam Computed Tomographic Images

BackgroundThis study aimed to provide the frequency and demographic data of non-endodontic periapical lesions clinically misdiagnosed as endodontic periapical lesions from a Southeast Asian population over a 15-year period.Material and MethodsA retrospective study was conducted from departmental archives between 2005 and 2019. Cases clinically diagnosed as endodontic periapical lesions were retrieved. Then, cases with a histopathological diagnosis of non-endodontic periapical lesion were selected. Demographic data of non-endodontic periapical lesions were recorded. Radiographic features of cases with available radiographs were analyzed. ResultsOf 1,566 cases clinically diagnosed as endodontic periapical lesion, 157 cases received a histopathological diagnosis of non-endodontic origin. Eighteen different histopathological diagnoses were identified. The most frequent lesion was dentigerous cyst (n= 51, 32.48%) followed by odontogenic keratocyst (n=31, 19.75%), nasopalatine duct cyst (n=18, 11.46%) and ameloblastoma (n=15, 9.56%). Three cases of malignant tumors, including adenoid cystic carcinoma, mucoepidermoid carcinoma, and metastatic papillary thyroid carcinoma were observed. ConclusionsNon-endodontic periapical lesions constituted 10.03% of cases clinically diagnosed as endodontic periapical lesions. Histopathological examinations of non-endodontic periapical lesions revealed a variety of lesions ranging from foreign body reaction, cysts, fibro-osseous lesions, benign tumors and primary or metastatic malignant tumors. Of clinical significance is that some non-endodontic periapical lesions had different treatment modalities and prognoses compared with endodontic lesions. Therefore, dentists must be aware that periapical radiolucent lesions are not always a consequence of pulpal necrosis. Key words:Ameloblastoma, dentigerous cyst, endodontic periapical lesions, non-endodontic periapical lesions, odontogenic keratocyst.

Objectives Unlike a CBCT scan which has a large field of view (FOV), a scan with a small FOV may not involve the base of the skull. Therefore, routinely used reference planes may not be available to evaluate treatment outcome. The present study was undertaken to determine if the palatal plane and a molar occlusal plane may be used as reference planes to measure the change in the axial inclination of the maxillary central incisor and the maxillary first permanent molar towards the end of orthodontic treatment on a CBCT scan captured with a small FOV. Materials and methods A lateral cephalogram and a CBCT scan with a small FOV were taken for fifteen young adults prior to, and six months after, mini-implant supported, distal movement of the maxillary arch. CBCT multi-planar slices were sequentially viewed to obtain an image that contained the entire length of the maxillary central incisor and the maxillary first permanent molar in the tangential view. The axial inclination of the maxillary central incisor and the maxillary first permanent molar was measured from the palatal plane and the molar occlusal plane on both sides. The same parameters were evaluated on the lateral cephalogram using the palatal plane as a reference. An independent t test (p = 0.05) was conducted to compare the results. A Bland–Altman plot with linear regression was constructed to measure accuracy, method agreement and reliability. Results There was no statistically significant difference when a change in the axial inclination of the maxillary central incisor and the maxillary first permanent molar was measured using the two reference planes. The change in axial inclination of the maxillary central incisor and maxillary first permanent molar had a 95% confidence interval of -1.82 to 4.19 and -4.48 to 3.05 and a p-value of 0.425 and 0.701 on the right side, respectively, and a 95% confidence interval of -1.76 to 4.79 and -4.41 to 2.79 and p-value of 0.350 and 0.650 on the left side. Conclusions The molar occlusal plane and the palatal plane may be used as reference planes for measuring change in the axial inclination of the maxillary central incisor and the first permanent molar in a CBCT scan taken with a small FOV.

Human teeth has always been known for morphological variations in both the crown and root structures. The corono-morphological variations can be in the form of extra cusp or missing cusp. Permanent maxillary first molars are the biggest teeth in maxillary arch and have a high anchorage value and are known for their four cusp and five cusp patterns, if present with cusp of Carebelli. The aim of this study was to determine the prevalence of cuspal variations and quantification of cusps of permanent maxillary first molar in Malwa population. A total of 1249 individuals were studied at Government College of Dentistry, Indore, Madhya Pradesh, India, to evaluate the number of cusps in permanent maxillary first molars. Of the studied 1249 individuals, permanent maxillary first molars had five cusps in 407 (32.6%) cases while 838 (67.08%) cases had four cusp and four (0.32%) cases had three cusps. The four cases having three cusp permanent maxillary first molars were present unilaterally and only in females. This article emphasizes the presence of permanent maxillary first molar with only three cusps in the Malwa population of India. It also reviews the literature in respect to this rare anomaly and calls for continuous and close monitoring to report such cases in the future.

The prevalence of molar incisor hypomineralisation (MIH), the degree of severity of experienced molars, their medium-term survival rate are factors that have reintroduced the decision to extract first permanent molars, forced extractions or chosen therapeutic option. The author summarizes pedodontic and orthodontic clinical studies in the management of patients with compromised first permanent molars in order to analyze the consequences of single or multiple extractions of these teeth. Firstly, the consequences of extractions of the first permanent molars in the absence of malocclusion are studied. The goal is the establishment of all the teeth without orthodontic treatment. The impact of the age at which the extraction is practiced is a key factor. In a second step, extractions of first permanent molars in the presence of orthodontic anomalies are analyzed to define the optimal therapeutic strategies, the precautions during these treatments, the contraindications. Consultation and good coordination between the generalist dentist / pediatric dentist and orthodontist are the key factors for stable and functional end-of-treatment results and optimized treatment duration. Clinical experience and knowledge make it possible to properly select patients qualified for these therapies who obtain multidisciplinary planning and good biomechanical control. By bringing together optimal decision-making conditions, extraction is a therapeutic option that often proves to be superior to a restorative option in providing our patients with the greatest long-term service.