Absence Of Periapical Lesions Research Articles

Apical surgery for treatment of persistent sinus tract caused by infected acessory canal

Apical surgery aims to treat periapical infections that endodontic treatment or retreatment has failure. This study aims to reporting 2 years and 8 months follow-up of a surgical retreatment of tooth 23 to solve a persistent sinus tract caused by a persistent root-infection of accessory canal. A 48-years-old male patient sought an endodontist due to a persistent sinus tract in the palatal portion of tooth 23, even after 2 previous endodontic retreatment. The radiographic and tomographic examinations demonstrated satisfactory endodontic treatment, absence of periapical lesion, over filling material, presence of fiberglass post on tooth 23. Also, fistula tract in the bone 5 mm from the apex associated with accessory canal were detected by tomography. The apical surgery was performed to treat and remove the persistent infection. The apicectomy and root-end preparation were performed. The root-end cavity was filled with Sealer 26 in dense consistency and apicoplasty was performed and the flat was sutured. The 2 years and 8 months follow-up of CBCT exam demonstrated a complete healing and the absence of sinus tract trajectory in the bone. In conclusion, the accurate diagnostic and surgical planning were utmost important to success.

Which caries removal method to select?

Searches were carried out using PubMed/MEDLINE and Web of Science databases between January 2008 and January 2023. Only articles in English language were included. Boolean operators were used to search: "permanent teeth" OR "permanent tooth" OR "permanent dentition" AND "deep caries" OR "stepwise" AND "partial caries removal OR "stepwise caries removal" OR "pulp vitality" OR "healing rate". Inclusion criteria were randomised controlled trials, which compared the total removal of carious tissue with either a selective or stepwise removal in permanent teeth with deep carious lesions. Criteria also required a follow up of at least 6 months and publications in English. Exclusion criteria were articles in other languages, articles not comparing different types of total or selective caries removal and articles published before January 2008. Data extraction followed PRISMA guidelines. Two reviewers independently screened articles, analysing titles and abstracts using Rayyan's Intelligent Systematic Review Platform. They also collected data and risk of bias assessed using the Cochrane Risk of Bias Tool for Randomised Trials, dividing articles into high risk of bias, few concerns and low risk of bias. A third researcher resolved conflict or doubt in case of divided opinions. In total, 105 articles were identified, and 10 duplicates removed. 95 articles were reviewed by title and abstract and 75 of these did not meet the inclusion criteria. 20 articles were then read, excluding a further 15 due to comparing only partial removal or non-selective caries removal or absence of numerical data. This left 5 articles which met eligibility criteria. These were randomised controlled trials between 2010 and 2021. Follow up ranged from 1 month to 5 years. The inclusion and exclusion criteria in all studies had similar clinical parameters. 3 studies performed management only on permanent molars, whilst the rest also included management on permanent incisors/canines/premolars and molars. Management of caries was divided into non-selective caries removal vs partial caries removal (either selective or stepwise). All but 2 studies included specific information about the materials used. Liners were calcium hydroxide or Dycal, provisional restorations were glass ionomer cements or Ketax Molar and definitive restorations were Herculite Tetric N-Ceram resin, Ivolclar Vivadent or amalgam. Clinical success or failure was measured using pulp vitality, absence of periapical lesions, radiographic analysis and lack of symptoms. Clinical follow up was evaluated by external examiners, although 2 studies did not specify this clearly. There were a variety of tools used for statistical analysis in each study. When comparing non-selective caries removal with either selective or stepwise, 3 studies proposed statistically significant differences in terms of longevity, marginal integrity and success rate of restorations. 1 study stated inexistence of statistically relevant divergences between procedures. Non-selective caries removal is not highly recommended for deep carious lesions and may be considered invasive and risks pulpal exposure. Both selective and stepwise removal are considered conservative approaches. Selective removal is considered the best management option in the short term (with 1.5 years follow up), predominantly related to a lower risk of pulpal exposure. At 5 years, however, the results of selective were similar to those of non-selective, accepting the null hypothesis. There were also no differences in success rates for materials used for definitive restorations.

Diagnostic accuracy of periapical radiolucency using periapical radiography and cone-beam computed tomography

Objectives: This research is aimed to compare the accuracy of periapical radiography in detecting periapical radiolucency with that of Cone-beam Computed Tomography (CBCT) and to assess the additional information that CBCT provides.
 Materials and Methods: 96 patients with a primary diagnosis of endodontic problem had been studied retrospectively. Each root was examined for the presence or absence of periapical lesions according to the Periapical Index (PAI) Score. Roots and root canals identified through perapical radiography and CBCT were recorded. Additional information from CBCT regarding effects of lesions in cortical bone and maxillary sinus was also noted. Sensitivity, specificity, positive predictive value, and negative predictive value were analyzed.
 Results: The result showed that accuracy of periapical radiography as expressed by its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) was 0.65, 0.90, 0.86, 0.75, respectively.
 Conclusion: Periapical radiography has a low sensitivity in detecting periapical lesions compared to CBCT. CBCT also provides more detailed information that is useful in endodontic treatment.

A comparative analysis of periapical status by using cone beam computed tomography and periapical radiography.

The aim of this study was to compare the periapical status of different teeth by using the Periapical (Pa) and the cone beam computed tomography (CBCT) radiographs. Pa and CBCT radiographs were obtained from the patients who required Endodontic treatment. The absence and presence of periapical lesions were investigated using both Pa and CBCT radiographs. Periodontal conditions other than periapical lesions were also observed by using both radiographs and recorded. Cohen's Kappa analysis was performed to observe the inter-rater and intra-rater reliability. Descriptive statistics including frequency and percentages of presence and absence of periapical lesions were analyzed. Independent t-test was conducted to compare the Pa and CBCT for the detection of periapical lesions. Chi-square test was used to investigate the distribution of gender and periapical lesions by both radiographs. A total of 204 teeth from 72 patients (29 female and 43 male) were assessed via CBCT and Pa radiographs. Inter-observer and intra-observer reliability showed the absolute level of agreement. T-test showed there is significant difference between Pa and CBCT radiographs regarding detecting periapical lesions. Chi-square test showed no significant differences between the gender and apical pathosis. CBCT is more reliable to detect periapical lesions compared to the Pa radiographs.

Prevalence of dens invaginatus and its association with periapical lesions in a Western Indian population-a study using cone-beam computed tomography.

This study aimed to assess the prevalence of dens invaginatus (DI) and its association with periapical lesions (PLs) in a Western Indian population by means of cone-beam computed tomography (CBCT). CBCT volumes of 5201 subjects were evaluated. Associations among gender, tooth type, DI type (Oehler's classification), and presence of PL were investigated. PL was codified using Estrela's Cone Beam Computed Tomography Periapical Index (CBCTPAI). Chi-square tests and descriptive statistics were used at p = 0.05. Overall, 7048 CBCTs were assessed, containing 19,798 maxillary and mandibular anteriors, of which 77 maxillary teeth demonstrated DI (0.39% of all anteriors). Of all 5201 subjects, 57 had DI (1.1%). Bilateral DI was more common in females than in males (p = 0.046). DI type distribution was as follows: type I (22.1%), type II (61.03%), type IIIa (10.4%), and type IIIb (6.5%), which was significantly different (p < 0.001). Maxillary lateral incisors were the most associated with PL (p < 0.001). Type I was frequently associated with CBCTPAI scores 1 and 2 (absence of PL), whereas types II, IIIa, and IIIb were associated with CBCTPAI scores 3, 4, and 5 (presence of PL). A prevalence of 1.1% identifies DI as a common developmental tooth anomaly in a Western Indian subpopulation. The percentage of maxillary anteriors affected by DI and associated PLs should be considered before diagnosis and treatment planning. Knowledge about the prevalence of DI and its subtypes, and their association with/without periapical pathosis may aid clinicians in treatment planning and execution to improve patient outcomes.

Association of Inflammatory Periapical Lesions with Maxillary Sinus Abnormalities: a Retrospective Cone-Beam Computed Tomography Study.

Statement of the Problem: Odontogenic infections such as periapical lesions (PLs) can cause changes in the adjacent tissues. Infection of the maxillary posterior teeth can be easily transmitted to the maxillary sinus and cause changes in the maxillary sinus mucosa. Cone-beam computed tomography (CBCT) has high accuracy and sensitivity for detection of odontogenic lesions and is efficient for maxillary sinus assessment. Purpose: This study aimed to assess the maxillary sinuses for abnormalities such as mucosal thickening, polyps, and periostitis, and evaluate the periapical status of maxillary posterior teeth considering the presence of PLs, their size and distance from the sinus floor by evaluating CBCT images.Materials and Method: This retrospective, cross-sectional study evaluated the CBCT scans of 143 patients, depicting the posterior maxilla with at least one premolar or molar tooth present in this region. Sinus abnormalities (mucosal thickening, sinus polyps, and periostitis) and presence/ absence of PLs, its size, and its distance from the sinus floor were all assessed on CBCT scans. Data were analyzed using the Chi-square test in SPSS version 21 (a= 0.05).Results: PLs were observed in 31.2% of the cases. In presence of PLs, mucosal thickening was noted in 56.8%, sinus polyps in 29.6% and periostitis in 1.3% of the maxillary sinuses. All teeth with a CBCT periapical index (CBCTPAI) score of 5 were associated with sinus abnormalities; there was neither correlation between the sizes of lesions, nor their distance from the sinus floor with sinus abnormalities (p> 0.05).Conclusion: PLs in the posterior maxilla have a direct correlation with the maxillary sinus abnormalities. However, the size or distance of PLs from the sinus floor had no significant effect on the frequency of sinus abnormalities.

Restorations after selective caries removal: 5-Year randomized trial

ObjectiveTo compare the survival of restorations placed in deep caries lesions after selective caries removal to soft dentin (SCRSD) over a 5-year period. A secondary aim was to investigate whether the material (amalgam or resin composite) affected the survival of restorations. MethodsThis study used data derived from a multicenter randomized controlled clinical trial (Clinical trials registration NCT00887952). Inclusion criteria were: patients with permanent molars presenting occlusal or proximal deep caries lesions (≥1/2 of the dentin thickness on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions. The teeth were randomized into SCRSD and restoration in a single visit or stepwise excavation (SW). Each of these groups was divided according to the filling material: amalgam (AM) or resin composite (RC). Survival analyses were performed to estimate therapy success rates over 5 years (adjusted Weibull regression model). Results172 restorations were evaluated, 95 from SCRSD group and 77 from SW group, being 61 AMG and 111 RC. The 5-year survival analysis showed similar success rates for SW (76 %) and SCRSD (79 %) as well as for AM and RC (p > 0.05). ConclusionThis study showed that, after a 5-year follow-up period, the presence of decayed tissue beneath restorations in deep caries lesions did not seem to affect restoration survival. Amalgam and resin composite restorations had similar survival rates, irrespective of the caries removal technique used – SCRSD or SW. Clinical significanceSelective caries removal to soft dentin can be used in the management of deep caries to avoid pulp exposure and preserve tooth structure without affecting restoration longevity.

Morphological variations of the maxillary sinus floor adjacent to periapical chronic injuries.

Today, there are several diagnostic methods to determine the exact size and nature of periapical lesions. Furthermore, there are studies that described thickening of the mucous membrane of the maxillary sinus (MS) in patients with periapical lesions and demonstrated a causal relation. This study aims to evaluate the morphological variations of the MS floor (MSF) adjacent to chronic periapical lesions in molars and premolars using cone-beam computed tomography (CBCT). Twenty-five CBCTs with periapical lesions adjacent to maxillary molars and premolars were evaluated. A total of 50 maxillary sinuses were analyzed (12 males and 13 women) taking into account density changes within the sinus cavity. The thickening of the sinus mucosa and the periapical lesions was measured in a caudal-cephalic direction. The axial and sagittal axis was taken as reference on the sagittal and coronal sections. Chi-square, Fisher exact, and the Mann-Whitney tests were used in this study. A significant association between the size of the periapical lesions (>4 mm) and the presence of MSF affectation was found on sagittal and coronal views (P < 0.001). No significant differences between the presence or absence of periapical lesions and the thickening of the sinus mucosa were found (P = 0.241). The presence of opacification on the MS had no direct associations with the periapical lesions. Maxillary sinus floor affectation was associated with chronic periapical lesions >4 mm. The opacification or thickening of the sinus mucosa was not related with the periapical lesions.

Long-term survival of different deep dentin caries treatments: A 5-year clinical study.

The aim of this in-vivo study was to evaluate the long-term clinical survival of different deep dentin caries treatment options. : In total, 391 patients with at least one permanent tooth with clinically diagnosed deep dentin caries were inspected. Two hundred and fourteen patients were examined at recall visits. Inclusion criteria were teeth with deep caries lesions with pulp vitality but absence of spontaneous pain and periapical alterations. The subjects received either stepwise removal (SWR), complete caries removal (CCR), or direct pulp capping (DPC). The radiological and clinical exams were performed after a mean observation time of 62 months. Success was defined as pulp sensitivity to vitality test and absence of periapical lesions as well as a clinical symptom. Data were statistically analyzed using Kaplan-Meier and log-rank (Mantel-Cox) tests (α = 0.05). Of the total 214 patients evaluated, 126 received SWR, 88 received CCR, and 67 received DPC treatment. One hundred and twenty-seven restorations were amalgam and 141 were composite. The mean observation period was 62 months. Survival rates were 85.7%, 90.9%, and 59.7% for SWR, CCR, and DPC, respectively (P = 0.001). Success rates of amalgam restorations (86.6%) were similar to composite restorations (83%), and both were found to be successful (P = 0.401). SWR treatment should be considered to preserve pulp vitality of deep dentin lesions instead of CCR or DPC. SWR method for deep dentin caries management had acceptable results over 5 years.

Influence of VistaScan image enhancement filters on diagnosis of simulated periapical lesions on intraoral radiographs

To evaluate whether image enhancement filters of VistaScan system improve the diagnostic accuracy of simulated periapical lesions. 10 sockets were prepared on bovine ribs to fit a bovine tooth. Bone defects were created and successively enlarged providing four groups (n = 10): Group 0, absence of lesions; Group 1, periapical lesions with 1.6 mm in diameter; Group 2, with 1.8 mm in diameter; and Group 3, with 2.1 mm in diameter. Periapical radiographs were taken using a photostimulable storage phosphor plate and DBSWIN software. VistaScan filters were applied and the images were allocated into seven groups: Nonfiltered, Fine, Caries 1, Caries 2, Endodontic, Periodontal and Noise Reduction. All the 280 images were assessed about the presence or absence of periapical lesions. Pixel intensities standard deviation were compared between nonfiltered and filtered images. Two-Way Analysis of Variance and the post hoc Tukey's test were used to compare area under the ROC curve, sensitivity and specificity. VistaScan filters showed no significant difference for area under receiver operating characteristic curve (p = 0.124), sensitivity (p = 0.835) and specificity (p = 0.832). Area under receiver operating characteristic curve (p = 0.000) and sensitivity (p = 0.000) in 2.1 mm lesions size were significantly higher than in 1.6 mm and 1.8 mm lesions size. Pixel intensities standard deviation was significantly changed in the filtered images compared to nonfiltered ones (p < 0.01), except for Fine in the bone region (p > 0.05). VistaScan enhancement filters do not influence the diagnostic accuracy of simulated periapical lesions. On the other hand, larger lesions were more frequently detected. The filters change the pixel intensities reducing or intensifying the differences between similar regions.

Partial caries removal in deep caries lesions: a 5-year multicenter randomized controlled trial.

This multicenter randomized controlled clinical trial aimed to compare the outcomes of stepwise excavation (SW) and partial caries removal (PCR) regarding the maintenance of pulp vitality in deep caries lesions over 5years. At baseline, 299 permanent molars with deep caries lesions were randomly assigned to control or test groups. The control group received the stepwise excavation treatment (SW), while the test group received partial caries removal from the pulpal wall followed by restoration in a single session (PCR). Treatments were conducted in two centers located in the cities of Porto Alegre (South Brazil) and Brasília (Midwest Brazil). Survival analysis was performed to compare PCR and SW over time (Weibull regression models). The primary outcome of this study was pulp vitality, determined by the combination of the following characteristics: positive response to cold test, negative response to percussion, absence of spontaneous pain, and absence of periapical lesion (radiographic examination). This 5-year study includes data pertaining to 229 teeth: 121 teeth actually examined at the 5-year appointment, and 108 teeth contributed with data collected in previous follow-ups (18months or 3years). Survival analysis showed success rates of 80% in PCR group and 56% in SW group (p<0.001). Failure was significantly associated with treatment [PCR, HR=0.38; 95%CI=0.23-0.63)] and region [South, HR=2.22; 95%CI=1.21-4.08]. PCR significantly reduced the occurrence of pulp necrosis when compared with SW. This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

Radiographic analysis of 1000 cast posts in Sergipe state, Brazil

Abstract Introduction Endodontically treated teeth with extensive coronary destruction require posts and cores to enable prosthetic restoration. Despite the increasing use of prefabricated posts, cast metal posts and cores are still widely used. The quality of the latter is important for the longevity of restorative treatment, and failure can occur if the fundamental principles are not followed. Objective To radiographically evaluate the prosthetic principles of 1000 cast metal post-and-core restorations performed in single-rooted teeth and their coherence with the principles used for their confection. Material and method Digital periapical radiographs of 1000 endodontically treated, single-rooted teeth with cast metal posts and cores were selected from the collection of a radiology clinic (Centro de Imagem, Aracaju/SE, Brazil). The images were analyzed using a measurement software (ImageJ, USA) in accordance with the fundamental prosthetic principles: length and diameter of the post, ratio between post and bone crest, contiguity of post to the root canal, gap between post and the remaining root canal filling, amount of remaining root canal filling, and absence of periapical lesion. The data were qualitatively analyzed, classified into ideal and not ideal, and submitted to the chi-square test (α=0.05). Result Only 6.7% of the cast metal posts analyzed were satisfactorily fabricated. Conclusion Many prosthetic criteria are neglected during the manufacturing of cast metal post and cores, resulting in inadequate work that may compromise the longevity of restorative treatments.

Zirconia-based versus metal-based single crowns veneered with overpressing ceramic for restoration of posterior endodontically treated teeth: 5-year results of a randomized controlled clinical study

ObjectivesThe aim of this 5-year randomized controlled trial was to compare the longevity and clinical behavior of single posterior crowns made with pressable ceramic on zirconia and on metal frameworks, and if failures occur, to delineate the contributing factors. Methods72 patients, who needed the covering of at least a molar and/or premolar, were included in the study. All teeth were endodontically treated, with absence of periapical lesion or active periodontitis. Ninety single crowns were made with zirconia or metal framework and covered with pressable veneering ceramics. Two independent examiners assessed the survival of restorations at 6 months, 1–4 and 5 years after restoration placement including periapical radiographs, intraoral photographs, and USPHS modified criteria. The statistical analyses were performed with the Kaplan-Meier method. ResultsOne core fracture occurred in Zircad/Zirpress crowns and one metal ceramic crown was lost for root fracture. Chipping fracture of the veneering ceramic was detected in 2 metal-ceramic crowns and in 3 zirconia-based crowns. The Estimate Cumulative Survival (ECS) and the Estimate Cumulative Success (ECSs) with standard deviation (SE) were respectively 97,73±2,19 and 92,64±4,14 for zirconia-based crowns whereas 97,44±2,39 and 91,11±4,27 for porcelain fused to metal crowns. ConclusionsThe present randomized controlled trial shows that the survival of zirconia-based and metal-based single crowns is similar over a follow-up period of 5 years. No significant differences in esthetic, functional and biological outcomes were demonstrated between the two groups. The main failure mode was the chipping fracture of the veneering ceramic in both materials. Study number on ClinicalTrial.gov NCT02758457. Clinical significanceAccording to the results of this clinical study, zirconia-based rehabilitations with overpressing veneering technique represent a valid alternative to metal-based for posterior single crown restorations.

The Influence of a New Clinical Motion for Endodontic Instruments on the Incidence of Postoperative Pain.

Previous studies showed that motor motions play an important role in determining apical extrusion of debris. Therefore a new clinical motion (MIMERACI) has been proposed. The basic idea is to progress slowly (1mm advancement), and after each 1mm, to remove the instrument from the canal, clean flutes and irrigate. The aim of the study was to prove whether the clinical use of MIMERACI technique would influence or not postoperative pain. 100 teeth requesting endodontic treatment were selected for the study and divided into two similar groups based on anatomy, pre-operative symptoms and vitality, presence or absence of periapical lesion. All teeth were shaped, cleaned and obturated by the same operator, using the same NiTi instruments. The only difference between the two groups was the instrumentation technique: tradional (group A) vs MIMERACI (group B). Assessment of postoperative pain was performed 3 days after treatment. Presence, absence and degree of pain were recorded with a visual analogue scale (VAS), validated in previous studies. Collected data statistically analyzed using one-way ANOVA post hoc Tukey test. For VAS pain scores MIMERACI technique showed significantly better results than group A (p=0,031). Overall, both incidence and intensity of symptoms were significantly lower. Flare ups occurred in 3 patients, but none treated with the MIMERACI Technique. Since extruded debris can elicit more postoperative pain, results obtained by using MIMERACI technique are probably due to many factors: better mechanical removal and less production of debris and more efficient irrigation during instrumentation.

Radiographic evaluation and predictors of periapical lesions in patients with root-filled and nonroot-filled teeth in Kuwait

Objective: The objective of this study was to determine the association between periapical health status with the quality of the root filling and was the coronal restoration and identify the predictors of periapical lesion. Subjects and Methods: It was conducted among 197 adult patients who visited Kuwait University. Periapical status was measured by periapical index. The presence or absence of periapical lesions was evaluated using panoramic radiographs. Statistical Analysis: Data were analyzed using the Statistical Package for Social Sciences. Chi-square tests were performed to assess associations between categorical variables. Results: Of the 4,841 teeth examined, 2.7% were root-filled (n = 130). Thirty-four percent of the root-filled teeth (n = 44), and 3% of the nonroot-filled teeth (n = 141 of 4711) exhibited periapical radiolucency. Of the root filled teeth, 49% were judged to be inadequate (n = 64) and 91% of the inadequate ones had short root filling (n = 58). The presence of periapical lesion was significantly predicted by inadequate coronal restoration, dental caries, periodontal bone loss, and the presence of post crown. Conclusion: This study demonstrated a large number of untreated teeth with periapical pathology. The quality of root fillings in this population appeared to be poor and was significantly associated with a high prevalence of apical periodontitis.

Randomized Trial of Partial vs. Stepwise Caries Removal

This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions — partial caries removal (PCR) and stepwise excavation (SW) — with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).

The detection of periapical pathosis using periapical radiography and cone beam computed tomography – Part 1: pre‐operative status

Part 1 of this 2 part study aims to compare the prevalence of periapical lesions on individual roots viewed with intraoral (periapical) radiographs and cone-beam computed tomography (CBCT) of teeth treatment planned for endodontic treatment. Diagnostic periapical radiographs and CBCT scans were taken of 151 teeth in 132 patients diagnosed with primary endodontic disease. The presence or absence of periapical lesions was assessed by a consensus panel consisting of two calibrated examiners, a consensus agreement was reached if there was any disagreement. The panel viewed the images under standardised conditions. Part 2 will compare the radiographic outcome 1 year after completion of primary root canal treatment. Two hundred and seventy-three paired roots were assessed with both radiological systems, periapical lesions were present in 55 (20%) and absent in 218 (80%) roots assessed with periapical radiographs. When the same 273 sets of roots were assessed with CBCT, lesions were present in 130 (48%) and absent in 143 (52%) roots. Seventy-five additional roots were detected with CBCT. The limitations of periapical radiographs which may hinder the detection of periapical lesions are overcome with CBCT. This results in firstly, more roots being assessed, and secondly, more periapical lesions being detected with CBCT.

How does the periapical inflammatory process compromise general health?

Several lines of evidence support the causative role of oral inflammatory lesions and certain systemic diseases, such as atherosclerosis and cardiovascular diseases, adverse pregnancy outcome and lung diseases. Properly executed epidemiologic studies identified increased odds ratios. Local or metastatic spread of oral microorganisms, local production of microbial or host‐derived soluble regulatory molecules, that may initiate or sustain inflammatory events in remote tissues and organs and the presence of (a) common – extrinsic‐ or intrinsic‐pathological mechanism(s) may result in or contribute to both local and systemic inflammation. A number of cross‐sectional studies addressing a possible association between oral health and systemic diseases have also investigated the presence or the absence of periapical lesions. However, these studies cannot either confirm or refute a role of the periapical inflammatory lesion in the observed associations, since other variables of oral health might have exerted an inestimable influence on general health of the assessed population. The literature, dealing with patients with root canal infections and apical periodontitis as sole oral inflammatory lesions is extremely sparse. Our group has demonstrated that young adults with apical periodontitis exhibit certain biochemical changes, such as elevated levels of C‐reactive protein and an increased whole blood chemiluminescence, which have been shown to elevate the risk for cardiovascular diseases. Future research will be required to determine whether and to what extent may endodontic diseases affect general health.

Factors associated with endodontic interappointment emergencies of teeth with necrotic pulps

Despite significant progress in the field of endodontics, the causes of interappointement emergencies are not well defined and are a subject of controversy. To delineate some of the major factors related to the incidence of these emergencies, information from the charts of 2,000 patients who had received root canal therapy for necrotic pulps was recorded and analyzed. One-half of the patients were those who had interappointment pain or swelling which required a nonscheduled emergency visit for urgent care. The other half were patients who reported no complications after cleaning and shaping of their root canals. The results of this study show that some factors, such as age, sex tooth type, presence of preoperative pain, presence of allergies, absence of periapical lesions, sinus tract stomas, retreated cases as well as those receiving prescribed analgesics, had significant effects on the incidence of endodontic interappointment emergencies. In contrast, presence of systemic diseases, use of intracanal medications, and penetration of the foramen with small instruments during length determination had no significant effect on the frequency of these emergencies. Despite significant progress in the field of endodontics, the causes of interappointement emergencies are not well defined and are a subject of controversy. To delineate some of the major factors related to the incidence of these emergencies, information from the charts of 2,000 patients who had received root canal therapy for necrotic pulps was recorded and analyzed. One-half of the patients were those who had interappointment pain or swelling which required a nonscheduled emergency visit for urgent care. The other half were patients who reported no complications after cleaning and shaping of their root canals. The results of this study show that some factors, such as age, sex tooth type, presence of preoperative pain, presence of allergies, absence of periapical lesions, sinus tract stomas, retreated cases as well as those receiving prescribed analgesics, had significant effects on the incidence of endodontic interappointment emergencies. In contrast, presence of systemic diseases, use of intracanal medications, and penetration of the foramen with small instruments during length determination had no significant effect on the frequency of these emergencies.

Vital root resection

To date, ten maxillary molars have been treated. In each case, either the distobuccal or the mesiobuccal root was resected. Nine of the pulps remain vital, and the tooth is functional in each case. The absence of periapical lesions in the radiographs is coincident with the results of vitalometer, temperature, and percussion tests. The patients describe the tceth as being completely asymptomatic. Histologically, however, we are dealing with assumption until such time as we are able to section a tooth and observe the cellular composition; hopefully, this will be accomplished in the near future.