Diagnosis Of Periapical Lesions Research Articles

Segmentation of periapical lesions with automatic deep learning on panoramic radiographs: an artificial intelligence study

Periapical periodontitis may manifest as a radiographic lesion radiographically. Periapical lesions are amongst the most common dental pathologies that present as periapical radiolucencies on panoramic radiographs. The objective of this research is to assess the diagnostic accuracy of an artificial intelligence (AI) model based on U²-Net architecture in the detection of periapical lesions on dental panoramic radiographs and to determine whether they can be useful in aiding clinicians with diagnosis of periapical lesions and improving their clinical workflow. 400 panoramic radiographs that included at least one periapical radiolucency were selected retrospectively. 780 periapical radiolucencies in these anonymized radiographs were manually labeled by two independent examiners. These radiographs were later used to train the AI model based on U²-Net architecture trained using a deep supervision algorithm. An AI model based on the U²-Net architecture was implemented. The model achieved a dice score of 0.8 on the validation set and precision, recall, and F1-score of 0.82, 0.77, and 0.8 respectively on the test set. This study has shown that an AI model based on U²-Net architecture can accurately diagnose periapical lesions on panoramic radiographs. The research provides evidence that AI-based models have promising applications as adjunct tools for dentists in diagnosing periapical radiolucencies and procedure planning. Further studies with larger data sets would be required to improve the diagnostic accuracy of AI-based detection models.

Study of mental foramen in patients coming to government dental hospital, Jamnagar

Introduction: The Mental foramen is one of two funnel-like openings located on the antero- lateral aspect of the body of the mandible. There are variations in it’s anatomical position in different individuals of different populations. Such variations can cause difficulty in diagnosis of peri-apical lesions. It may result in failure of regional anaesthesia during clinical and surgical procedures required to be administered in the mandibular and mental region. Aims And Objectives: This study was performed to determine the position and bilateral positional symmetry of mental foramen on a digital orthopantomogram (OPG) of the population visiting Government Dental Hospital, Jamnagar. The objective was to document the frequency of location of mental foramen in relation with several teeth in close possible proximity to the mental foramen on digital panoramic radiographs. Materials And Methods: The study was conducted in the Department of Oral Medicine and Radiology, Government Dental College and Hospital, Jamnagar. Radiographic study of mental foramen of 1270 participants was carried out by analysing their digital orthopantomographs. Mental foramina were analysed with respect to their positions and bilateral symmetry.

Comparative evaluation to determine the efficacy of conventional radiography, digital radiography, and ultrasound imaging in the diagnosis of periapical lesions

n recent time several imaging modalities have been implicated for diagnosing periapical lesion. The present study is carried out to determine and compare the nature and extent of periapical lesions using conventional radiography, digital radiography, and ultrasound imaging and to confirm the diagnosis with histopathological examination. Thirty patients aged between 15 and 45 years with well-defined periapical radiolucency associated with anterior maxillary or mandibular teeth requiring endodontic surgery or extraction were selected. The pre-operative intraoral periapical radiographs and digital images and were diagnosed by three observers. Ultrasound examination was performed, and the images were assessed by an ultra-sonographer. The periapical tissues were obtained to enable histopathological investigation. The data was statistically analyzed using the kappa procedure, Kruskal Wallis Anova& Mann-Whitney U test. Results showed that the percentage accuracy of diagnosing periapical lesions using conventional radio- graphy, digital radiography and ultrasound was 86.67%, 93.33% & 93.33% respectively. Thus, we conclude that ultrasound helps in distinguishing between periapical granuloma and cyst which is of importance in predicting the treatment outcome.

Comparative evaluation of advanced and conventional diagnostic AIDS for endodontic management of periapical lesions, an in vivo study.

To evaluate efficacy of Colour Doppler ultrasonography (CDUSG), direct digital radiography (DDR) and conventional radiography (CR) in diagnosis of periapical lesions and to clinically correlate treatment plan of periapical diseases. Thirty patients which were diagnosed with periapical lesions in anterior region by using both conventional and digital radiography were examined using colour doppler ultrasound imaging at the site of lesion. The images of each lesion were analysed by two endodontists and by an expert oral radiologist. A tentative differential diagnosis was agreed upon, based on certain principles discussed in article, then a diagnosis between cyst, granuloma and mixed lesions was made. Periapical lesions diagnosed as mixed lesions by colour doppler ultrasonography (CDUSG) were treated non-surgically whereas other periapical lesions were treated surgically. Tissues obtained during endodontic surgery were processed and examined for histopathological findings, and compared with the diagnosis made by ultrasound images. Statistical analysis was done with Chi-Square test and using one-way-Anova. The periapical lesions which were diagnosed as granuloma by ultrasonographic findings, was confirmed by the results of histopathological examination in all 16 surgically treated cases. The lesions in rest of the 14 cases which showed vascularity and were diagnosed as mixed lesions by ultrasonography, were treated non-surgically and had a favourable prognosis. CR and DDR facilitate diagnosis of the presence of periapical disease, but do not provide and information of its nature. CDUSG imaging facilitates accurate information on the pathological nature of the lesion and hence can lead to predictable treatment planning.

Comparison of cone beam computed tomography and intra oral periapical radiography in detecting periapical lesions –A systematic review

Introduction: Cone-beam computerized tomography (CBCT) is a medical image acquisition technique based on a cone-shaped X-ray beam centered on a two-dimensional (2D) detector. The source-detector system performs one rotation around the object producing a series of 2D images. The images are reconstructed in a three-dimensional (3D) data set using a modification of the original cone-beam algorithm developed by Feldkamp 1 et al in 1984. This technique is widely used in different industrial and biomedical applications such as micro- CT. Among the first clinical applications were single photon emission computerized tomography (SPECT), angiography and image-guided radiotherapy. Dedicated cone-beam computerized tomography scanners for the oral and maxillofacial (OMF) region were pioneered in the late 1990s independently by Arai 2 et al. in Japan. This Systematic review aims at comparing cone -beam computerized tomography and periapical radiography in detection of periapical lesion. Objective: To compare the accuracy of cone beam computed tomography (CBCT) and intra oral periapical radiography (IOPA) in diagnosis of periapical pathology Search Strategy: Database such as Pub med Central and Medline were searched for the related topics from February 1996 till July 2013. Selection Criteria: Trials were selected if they met the following criteria: Clinical trials comparing the accuracy of Cone beam computed tomography (CBCT) and intra oral periapical radiography (IOPA). Data Collection and Analysis: All the studies included were based on the data extraction and analysis of the studies for quality and publication bias. The data collection form was customized. The primary outcome is to compare Cone beam computed tomography (CBCT) and intra oral periapical radiography (IOPA) in detection of periapical lesions. Main Results: The review concluded that cone beam computed tomography is superior to conventional intra oral periapical radiography in detection of periapical lesions. Conclusion: The probability of detecting periapical lesions was more in case of cone-beam computerized tomography when compared to conventional intra oral periapical radiography where external factors such as anatomical noise and poor irradiation geometry which are not in operators control are eliminated. I. Background Traditionally, the diagnosis of periapical lesion was based on clinical and radiographic presentations; confirmatory diagnosis was only by a biopsy which was highly impossible in the case of a non surgical procedure. If biopsy is taken the treatment is no longer a non surgical procedure (Simon et al 1980)

Cone Beam Computed Tomography Evaluation of the Diagnosis, Treatment Planning, and Long-Term Followup of Large Periapical Lesions Treated by Endodontic Surgery: Two Case Reports

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

The value of ultrasound and color doppler ultrasonography in the evaluation of periapical lesions in comparison to histopathological and/or surgical findings

Imaging techniques play a very important role in the specialty of endodontic. The ultrasonographic technique is non-expensive procedure, safe, and reproducible. The aim of the study was to determine the sensitivity, specificity, and accuracy of ultrasound and color Doppler ultrasonography in evaluation of periapical lesions (cyst, granuloma, mixed lesion cyst within graulomas mass, and abscess. Subject, Material and method: The sample consists of prospective study for 64 Iraqi participants who attended Karbalaa Specialized Center for Dentistry (males & females). Those patients were diagnosed clinically and radiographically as having periapical lesions of dental origin. They were examined by real time ultrasound and color Doppler ultrasonography with echographic predilection about the type of the lesion based on three parameters measured by ultrasound including: content, outline, and the vascularity. The echographic diagnosis was compared to the final histopathological and /or surgical findings obtained from the periapical surgeries. Results: The sensitivity, specificity and accuracy of ultrasound diagnosis were respectively as follow: for periapical cyst, they were 92.3%, 96.1%, and 95.3%. While for periapical granulomam, they were 87.0%, 92.7%, and 90.6%. For mixed lesions, they were 66.7%, 98.4%, and 96.9% and lastly for periapical abscess, they were 92.0%, 97.4%, and 95.3%. The ultrasound diagnosis in our study had an overall agreement of 89% between ultrasound diagnosis and final diagnosis based on histopathological and/ or surgical findings. Conclusion: Ultrasound is a non- invasive, low cost, and complementary method for examination and diagnosis of periapical lesions and there is correlation of ultrasonographic findings with histopathological and /or surgical findings for final diagnosis.

Unicystic Ameloblastoma Mimicking Apical Periodontitis: A Case Series

IntroductionThe purpose of this study was to describe a series of unicystic ameloblastomas (UAs) that presented clinical and radiographic similarities to apical periodontitis in order to call the attention of clinicians to the fact that several different diseases are able to mimic endodontic periapical lesions. MethodsA retrospective clinicopathological analysis of 5 patients who had periapical lesions in the mandible initially diagnosed as apical periodontitis but with a final histologic diagnosis of UAs is presented. ResultsThree men and 2 women with a mean age of 26.4 years presented lesions involving the posterior mandible. No patient reported pain, and 3 patients showed pulp vitality of the involved teeth. Radiographically, all lesions presented periapical well-defined radiolucencies, ranging from 2 to 3 cm in diameter, and 3 cases presented root resorption. Endodontic therapy was applied in 2 patients who were referred to our clinics because of a lack of involution of the periapical lesions. All patients were submitted to periapical surgical curettage and histologically diagnosed as UA. After a mean follow-up of 45.6 months, all patients are well without signs of recurrence. ConclusionsUA may involve the periapical area of teeth, mimicking an inflammatory lesion of endodontic origin. The diagnosis of periapical lesions should be determined based on clinical and radiographic aspects. Recalcitrant lesions should be surgically explored and submitted to histologic evaluation. The early diagnosis of nonendodontic lesions mimicking apical periodontitis such as UA may prevent unnecessary endodontic treatment and wide surgical resections.

Ultrasonography and computed tomography in the diagnosis of periapical lesions - A case report

Recent developments in imaging sciences have enabled dental researchers to visualize structural and biophysical changes effectively. Accurate diagnosis of periapical lesion solely based on clinical and radiographie examination is a difficult task and lias its own limitations. To circumvent these limitations, new approaches for the accurate diagnosis of periapical lesion have been attempted using advanced imaging techniques such as ultrasonography and computed tomography. Dental literature evidences the effectiveness of these imaging techniques in the differential diagnosis as well as to assess the outeome of healing lesions of periapical origin. These newer advances in the periapical diagnostics may help to rule out the need for surgical intervention thus helping the clinician to accurately plan the treatment. These case reports compare the efficacy of two imaging techniques, ultrasonography and computerized tomography in the diagnosis of periapical lesions.

Ultrasonography with color Doppler and power Doppler in the diagnosis of periapical lesions

Aim:To evaluate the efficacy of ultrasonography (USG) with color Doppler and power Doppler applications over conventional radiography in the diagnosis of periapical lesions.Materials and Methods:Thirty patients having inflammatory periapical lesions of the maxillary or mandibular anterior teeth and requiring endodontic surgery were selected for inclusion in this study. All patients consented to participate in the study. We used conventional periapical radiographs as well as USG with color Doppler and power Doppler for the diagnosis of these lesions. Their diagnostic performances were compared against histopathologic examination. All data were compared and statistically analyzed.Results:USG examination with color Doppler and power Doppler identified 29 (19 cysts and 10 granulomas) of 30 periapical lesions accurately, with a sensitivity of 100% for cysts and 90.91% for granulomas and a specificity of 90.91% for cysts and 100% for granulomas. In comparison, conventional intraoral radiography identified only 21 lesions (sensitivity of 78.9% for cysts and 45.4% for granulomas and specificity of 45.4% for cysts and 78.9% for granulomas). There was definite correlation between the echotexture of the lesions and the histopathological features except in one case.Conclusions:USG imaging with color Doppler and power Doppler is superior to conventional intraoral radiographic methods for diagnosing the nature of periapical lesions in the anterior jaws. This study reveals the potential of USG examination in the study of other jaw lesions.

Application of ultrasonography in dentistry

Summary Recent development of the ultrasonography (US) equipments enables the visualization of fine detail of the surface structure of the face and neck soft tissue. In this article, some studies referring to the clinical usefulness of the US in dentistry in the diagnosis of lymph node metastases, tongue carcinomas, periapical lesions and temporomandibular joint disorders are reviewed. For the early detection of lymph node metastases, follow-up US is recommended at an interval of no more than 1 month if a wait-and-see policy is adopted. US-elastography has a potential to be a promising method offering complementary information to conventional US. In order to determine the appropriate treatment planning of tongue carcinoma (including the prediction of subsequent lymph node metastases), intraoral US should be routinely used as one of the standard technique for the evaluation of the depth of tumor invasion. In the diagnosis of periapical lesions, US can provide useful information about the extent of the lesions and the location of the tooth root apices once the surface cortical bone around the lesion is eroded. Moreover, US is reported to be useful as an alternative imaging technique for visualization of disk position, joint effusion and bone abnormalities for the evaluation of temporomandibular joint disorders.

A study of periapical lesions correlating the presence of a radiopaque lamina with histological findings

To compare the presence or absence of a radiopaque lamina of 60 human periapical lesions with the histological findings from a case study in dental practice. Paralleling radiographs were taken of 60 teeth with periapical radiolucencies. The periapical radiographs were scanned, and standardized images were evaluated on a computer screen for the presence or absence of a radiopaque lamina by 2 calibrated observers according to agreed criteria. The serially sectioned histological specimens were obtained from the extraction of 13 endodontically treated teeth and 27 nontreated teeth, as well as 20 post-treatment teeth with apical periodontitis removed during periapical surgical procedure; the specimens were classified according to agreed criteria. The findings of the 2 evaluations were compared. Out of 57 electronic images that could be interpreted, 10 lesions had a radiopaque lamina, but of these only 3 were histologically diagnosed as cysts, while 7 were granulomas or abscesses. Out of 47 lesions without a radiopaque lamina, 40 were histologically diagnosed as granulomas or abscesses, while 7 were cysts. The diagnosis of periapical lesions cannot be made on the basis of the presence or absence of a radiopaque lamina, but requires histological examination of serial sections.