Endodontic Lesions Research Articles

Beyond The Usual Suspects: A Challenging Case Of Radix Entomolaris With Endodontic-Periodontal Lesion: A Case Report

The purpose of this case report is to present an unusual endodontic periodontal lesion along with radix entomolaris in tooth 46 in a 31-year-old female patient with intermittent pain and sensitivity to hot and cold stimuli. Clinical examination revealed deep dentinal caries and periodontal pocket depth of 5mm in tooth #46.The radiographic examination revealed an extra distal root with a periapical radiolucency in tooth #46. patient was diagnosed with irreversible pulpitis and chronic apical periodontitis, with secondary periodontal involvement due to an endodontic-periodontal lesion. Non-surgical root canal treatment was performed, followed by canal obturation with resin-based sealer and final restoration with a porcelain fused to metal crown. After a 3-month follow-up, the patient remained asymptomatic, radiographs showed bone reposition, and periodontal probing depth decreased, indicating successful treatment.

Management of endodontic periodontic lesions with hemisection: Case reports

Management of endodontic periodontic lesions with hemisection: Case reports

Management of endodontic periapical lesion with palatal swelling: A case report

Management of endodontic periapical lesion with palatal swelling: A case report

Radiographic differences in deep fascial space infections versus localized acute apical abscesses: A cone-beam computed tomographic-based observational study

ABSTRACT Aim: The objective of this study was to evaluate anatomical differences and patterns of bone loss in patients with acute apical abscess (AAA) clinically presenting as a localized swelling or with concomitant fascial space involvement (FSI) using cone-beam computed tomographic (CBCT) imaging. Materials and Methods: Thirty CBCT images of AAA cases presenting with fascial space involvement (FSI) and 31 cases of localized acute apical abscess (LAAA) were evaluated. Factors that were recorded included the presence/absence of cortical disruption, the distance of the involved tooth apex to the buccal and lingual/palatal cortex, the length of the anatomic root/s of the involved tooth, and the volume of the endodontic lesions. Results: The median for the volume of the lesions was 138 mm3 for the FSI group and 154 mm3 for the LAAA group (P > 0.05). Radiographic evidence of cortical disruption was seen in 26.7% of the cases with FSI and 41.9% of the cases with LAAA (P > 0.05). The mean for the distance of the apex to the buccal cortex was the only statistically significant difference between the two groups and was 4.2 mm for the FSI group and 3 mm for the LAAA group (P < 0.05). Conclusions: CBCT assessment showed root apices associated with fascial space involvement tended to be more confined in cancellous bone. Although a significant difference between the two conditions was found, the inflammatory process is complex, and CBCT assessment alone cannot predict AAA remaining as a localized swelling versus spreading to fascial spaces.

Preparation and evaluation activity of silica nanoparticles against bacterial oral infections: in vitro study

Background: Oral infections are commonly encountered among populations and frequently result in chronic inflammatory conditions that impact the dental structures (e.g., caries), the gingival tissues surrounding the dental elements (e.g., gingivitis and endodontic lesions), as well as the supporting structures of the teeth (e.g., periodontitis). Objectives: The objective of this study is to ascertain the minimum inhibitory concentrations of silica nanoparticles in order to evaluate the antibacterial efficacy of these nanoparticles against oral pathogens. Materials and Methods: A total of 100 clinical samples were collected from individuals suffering from diverse oral infections. They were diagnosed based on the culture and microscopic characteristics, as well as the diagnosis with Vitek2 device for the purpose of diagnosis for the level of species. Molecular identification of Viridians Streptococci was performed using PCR to detect the 16sRNA gene. The study also involved the synthesis of silica nanoparticles (SiNPs) using the sol-gel technique. Characterization of the SiNPs was conducted through X-ray diffraction (XRD), transmission electron microscopy (TEM), and field emission scanning electron microscopy with energy-dispersive X-ray spectroscopy (FESEM-EDX). The minimum inhibitory concentration (MIC) of the SiNPs against viridans Streptococci was evaluated using a microdilution assay with the blue-resazurin staining method. The agar well diffusion technique was utilized to assess the antibacterial efficacy of biosynthesized silica nanoparticles against Viridans Streptococci in comparison to a standard antibiotic, utilizing the minimum inhibitory concentration (MIC) as a metric. Results: Fifty pathogenic bacterial strains were obtained from clinical specimens, with the genus Streptococcus comprising 27 of these isolates, which corresponds to 54% of the overall total, thereby constituting the highest proportion observed among all species. Molecular identification of Viridans Streptococci in this study, showed that 10/10(100%) isolates were PCR positive for 16sRNA gene has been applied to pathogenic viridians streptococcal only, which include S. mitis, S. oralis and S. sanguinis. Multidrug-resistant isolates showed significant resistance to various antibiotics, including Erythromycin, Cefotaxime, Cefepime, Ceftriaxone, and Penicillin. Clindamycin also showed resistance. Augmentin showed the highest antimicrobial activity, while Trimethoprim-sulfamethoxazole, Ampicillin, and Vancomycin showed commendable activity. The MIC for the synthesized silica nanoparticles against Viridans Streptococci was determined to be 3.13 mg/mL across all bacterial isolates. The study showed that the bio-synthesized silica nanoparticles had a higher inhibition than the standard antibiotic disc Vancomycin (VA) at a concentration of 3.13 mg/ml, as the average diameter of inhibition reached 26.2 mm, respectively. Conclusion: Silica nanoparticles demonstrated significant efficacy in combating Viridans Streptococci, which are implicated in the etiology of oral infections.

Phenotypic Analysis and Antibiogram of Oral Infections-Causing Bacteria Isolated from Dental Patients

Oral infections are commonly observed in individuals and frequently result in enduring inflammatory states that impact the teeth, such as caries, the gingival tissues surrounding the teeth, including gingivitis and endodontic lesions, as well as the structures that provide support to the teeth, such as periodontitis. A total of 100 clinical samples were collected from patients with various oral infections. The individuals in the study encompassed a wide range of ages, ranged from 9 to 70 years, over the timeframe between October 2023 and December 2023. Fifty pathogenic bacterial strains were obtained from specimens of clinical origin, with the genus Streptococcus accounting for 27 of these isolates, representing 54% of the total, the highest proportion observed among all specie. The specimens were identified through the examination of cultural and microscopic features, in addition to being confirmed using the Vitek2 system for species-level diagnosis. The multidrug-resistant isolates exhibited resistance to various antibiotics including Erythromycin (100%) classified under the Macrolide group, Cefotaxime (100%), Cefepime (100%), Ceftriaxone (100%), and Penicillin (96.29%) which falls under the βeta-Lactam category. Additionally, resistance was also observed against Clindamycin (92.59%) which is categorized as a Lincosamide antibiotic. In the susceptibility testing of antibiotics, Augmentin demonstrated the highest level of activity among the tested molecules, thereby affirming its overall efficacy against oral streptococci. Additionally, Trimethoprimsulfamethoxazole and Ampicillin exhibited favorable activity, while Vancomycin also demonstrated effectiveness against oral streptococci.

Artificial Intelligence (AI) Assessment of Pediatric Dental Panoramic Radiographs (DPRs): A Clinical Study.

This clinical study aimed to evaluate the sensitivity, specificity, accuracy, and precision of artificial intelligence (AI) in assessing permanent teeth in pediatric patients. Over one thousand consecutive DPRs taken in Kielce, Poland, with the Carestream CS9600 device were screened. In the study material, 35 dental panoramic radiographs (DPRs) of patients of developmental age were identified and included. They were automatically evaluated with an AI algorithm. The DPRs were then analyzed by researchers. The status of the following dichotomous variables was assessed: (1) decay, (2) missing tooth, (3) filled tooth, (4) root canal filling, and (5) endodontic lesion. The results showed high specificity and accuracy (all above 85%) in detecting caries, dental fillings, and missing teeth but low precision. This study provided a detailed assessment of AI performance in a previously neglected age group. In conclusion, the overall accuracy of AI algorithms for evaluating permanent dentition in dental panoramic radiographs is lower for pediatric patients than adults or the entire population. Hence, identifying primary teeth should be implemented in AI-driven software, at least so as to ignore them when assessing mixed dentition (ClinicalTrials.gov registration number: NCT06258798).

Effect of Application of One-Time Method and Multiple Root Canals on Cryptic Fracture with Endodontic Lesions and VAS Score

Objective: To evaluate the therapeutic efficacy of primary method root canal treatment (ORCT) and multiple root canal treatment (MRCT) for dental cryptocleidosis with endodontic lesions. Methods: 88 patients with fissured teeth with endodontic lesions who were admitted to the hospital between November 2021 and November 2023 were selected, and after randomized numerical table grouping, 44 cases in the experimental group were included in the ORCT treatment, and 44 cases in the reference group were included in the MRCT treatment, and the total effective rate, root canal filling rate, visual analog scale (VAS) score, periodontal indexes, and the complication rate were compared. Results: The total effective rate and root canal filling rate of the experimental group were higher than that of the reference group; after treatment, the VAS score of the experimental group was lower than that of the reference group, and the periodontal indexes were lower than that of the reference group; and the complication rate of the experimental group was lower than that of the reference group (P < 0.05). Conclusion: ORCT can improve the overall efficacy of patients with fissured teeth with endodontic lesions, ensure the filling rate of root canals, significantly reduce pain symptoms, improve a number of periodontal indicators, have high endodontic safety, and have more therapeutic advantages than MRCT.

Hematolymphoid neoplasm mimicking an endodontic lesion: series of 4 cases

Hematolymphoid neoplasm mimicking an endodontic lesion: series of 4 cases

Lesão endodôntica primária sumulando uma lesão endo-perio

This study aims to present a clinical case of retreatment with the regression of an endodontic lesion, which simulated an endospinal lesion, with monthly changes of calcium hydroxide paste (UltraCal®) and preservation of the lesion repair. A 47-year-old female patient was referred for dental treatment due to the need for retreatment in elements 45 and 46. On clinical examination, the presence of a periodontal pocket fistula of more than 10 millimeters on the mesia and distal surface, respectively, was observed. Cone-beam computed tomography demonstrated the presence of filling material, as well as periapical and lateral bone radiotransparency. The retreatment was performed with rotary instrumentation (Reciproc Blue®), and the preparation of the canal with Reciproc Blue. 2.5% Sodium Hypochlorite was used as an irrigating solution, and the intracanal medication used was calcium hydroxide paste (UltraCal®) and crown sealing was done with glass ionomer cement. After 3 months, a regression of the lesion was observed, at 6 months, treatment success was observed only with endodontic therapy, without the need for periodontal treatment, confirming the diagnosis of primary endodontic lesion with secondary periodontal involvement. It is concluded that endodontic retreatment associated with intracanal medication determined clinical and radiographic success, ruling out the need for periodontal therapy.

Oral Health Status and Treatment Needs Based on Artificial Intelligence (AI) Dental Panoramic Radiograph (DPR) Analysis: A Cross-Sectional Study.

Background: The application of artificial intelligence (AI) is gaining popularity in modern dentistry. AI has been successfully used to interpret dental panoramic radiographs (DPRs) and quickly screen large groups of patients. This cross-sectional study aimed to perform a population-based assessment of the oral health status and treatment needs of the residents of Kielce, Poland, and the surrounding area based on DPR analysis performed by a high-accuracy AI algorithm trained with over 250,000 radiographs. Methods: This study included adults who had a panoramic radiograph performed, regardless of indications. The following diagnoses were used for analysis: (1) dental caries, (2) missing tooth, (3) dental filling, (4) root canal filling, (5) endodontic lesion, (6) implant, (7) implant abutment crown, (8) pontic crown, (9) dental abutment crown, and (10) sound tooth. The study sample included 980 subjects. Results: The patients had an average of 15 sound teeth, with the domination of the lower dental arch over the upper one. The most commonly identified pathology was dental caries, which affected 99% of participants. A total of 67% of patients underwent root canal treatment. Every fifth endodontically treated tooth presented a periapical lesion. Of study group members, 82% lost at least one tooth. Pontics were identified more often (9%) than implants (2%) in replacing missing teeth. Conclusions: DPR assessment by AI has proven to be an efficient method for population analysis. Despite recent improvements in the oral health status of Polish residents, its level is still unsatisfactory and suggests the need to improve oral health. However, due to some limitations of this study, the results should be interpreted with caution.

Linking periodontal pathogens with endoperio lesions.

Endodontic-periodontal diseases pose difficulties for the practitioner in diagnosing and predicting the success of the affected teeth. Therefore, it is of interest to correlate between periodontal infections and endodontic periodontal disorders. 50 patients of both sexes were included in this study. 28 of the 50 patients were men and 22 were women. Participants with a history of endodontic and periodontal lesions on the same tooth were chosen. A polymerase chain reaction experiment was carried out and relationships were formed. Data shows that isolates of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans and Tannerella forsythia were identified in 91% of the periodontium, 12% of the endodontium, and 51% of the endodontium, respectively. Targeted bacterial species were associated with periodontal and endodontic disorders that occurred concurrently. Therefore, it is plausible to speculate that dentinal tubules serve as a channel for the dissemination of microorganisms.

A survey of oral care health behavior compliance and its influencing factors in patients with periodontal and endodontic lesions.

A survey of oral care health behavior compliance and its influencing factors in patients with periodontal and endodontic lesions.

Endodontic-periodontal continuum of tooth: Systematic literature review

INTRODUCTION. The pathogenetic relationship between periodontal and pulp diseases was first described by Simring and Goldberg in 1964. Since then, the term “endodontic-periodontal” lesion (or “endo-perio”) has been used to describe lesions caused by inflammatory products found to varying degrees in both the periodontal and dental pulp tissues. The pulp and periodontium have embryonic, anatomical and functional relationships. The simultaneous presence of changes in pulp tissue and inflammatory periodontal diseases can complicate diagnosis and treatment planning. The etiology, pathogenesis and treatment methods of endodontic-periodontal lesions can vary from quite simple to relatively complex aspects. Knowledge of the basis of concomitant inflammatory processes in the pulp and periodontium is important for making the correct diagnosis.AIM. Carry out a systematic analysis of the literature and summarize the available data on etiopatogenetic relations, diagnostic features and clinical history of endodontic periodontal dental lesions. MATERIAL AND METHODS. A systematic literature analysis was carried out, as well as a manual search in the databases PubMed, Google Search, eLibrary, disserCat, Cyberleninka. Among national and foreign publications corresponding to the topic of this review, 28 publications were selected for systematic analysis, the results of literature review are presented in this article.CONCLUSION. This systematic review found that dental anatomy and the etiology of endodontic periodontal lesions are the basis for difficulties in the diagnosis and treatment of patients with endo-periodontal lesions. Determining the prevalence of infection and the individual characteristics of EPP pathogenesis in patients in this group remains a challenge. In the future, it is necessary to develop new methods of diagnosis, prophylaxis and complex treatment of combined periodontal tissue and tooth pulp, which will improve the prognosis of treatment of injured teeth in the long term.

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.

Histopathologic Evaluation of Periapical Radiolucencies Clinico-Radiographically Diagnosed as Endodontic Lesions: A Retrospective Analysis.

Periapical cyst and granuloma are inflammatory endodontic lesions. Periapical granuloma usually heals spontaneously after endodontic treatment; however, periapical cyst mostly needs to be removed via surgical approaches. Although some clinicians believe that microscopic examination of periapical lesions is unnecessary, it is proved that some of them has non-endodontic nature that need critical consideration. The purpose of this study was to assess the disagreement between clinico-radiographic and microscopic diagnosis of periapical cysts and granulomas in a major center of oral pathology service in Iran. In this retrospective, descriptive cross-sectional study, the archives of the oral and maxillofacial pathology department of Shahid Beheshti University of Medical Sciences served as the source of the material during an 18-year-period for this retrospective, descriptive cross-sectional study. The reports of all patients whose initial clinical diagnosis was a periapical cyst/granuloma were extracted. In the present study, 474 cases were diagnosed with a periapical cyst/granuloma clinico-radiographically, of which 61 cases (12.86%) received a microscopic diagnosis of a non-endodontic pathology. The most frequent lesion was odontogenic keratocyst (n= 12, 19.67%) followed by infected odontogenic cyst (n= 12, 19.67%). About 21.31% of diagnoses were non-cystic lesions and 4.9% were malignancies. The most odontogenic tumors that were diagnosed as periapical cyst/granuloma in clinico-radiography were the ameloblastoma variants (n= 4, 6.55%). A wide variety of microscopic diagnoses, including aggressive lesions such as ameloblastoma, as well as other malignant lesions was noted in this study. These misdiagnoses can lead to an inappropriate treatment plan. It is important to microscopically examine all lesions removed from the jaw.

A retrospective study on the prognostic factors and success, survival, and failure outcomes of treated endodontic-periodontal lesions.

The objective of this retrospective study was to determine possible prognostic factors of endodontic-periodontal lesions and to compare success, survival, and failure outcomes of treated endodontic-periodontal lesions across different treatment modalities, demographic variables, and anatomical tooth variations. Data was collected from patient records in the patient management system (Salud, Titanium Solutions) from the Griffith University Dental Clinic between January 2008 and December 2021. The search strategy used the terms "endodontic periodontal lesion," "periodontal endodontic lesion," "endo perio lesion," "perio endo lesion," and "EPL." The 88 cases which met inclusion and exclusion criteria were analyzed. The overall success rate was 46.6%, with 21.6% of teeth surviving and 31.8% of teeth failing. Bone loss extending to the apical third (OR = 0.3, 95% CI [0.104, 0.866]), and probing depths of 5-7 mm (OR = 0.147, 95% CI [0.034, 0.633]) and 8-10 mm (OR = 0.126, 95% CI [0.029, 0.542]) were associated with a statistically significant lower odds of success (p < .05). A history of no periodontal disease (OR = 7.705, 95% CI [1.603, 37.037]) was associated with a statistically significant higher odds of success (p < .05). Practitioners should be aware of bone loss to the apical third, deep probing depths, and a history of periodontal disease as possible prognostic factors that can affect the success rate when treating endodontic-periodontal lesions. Further research with more stringent control over operator factors should be done to investigate these variables.

Comparative Evaluation of Microbial Flora of Endodontic Origin in Teeth with Endo-Perio Lesions

ABSTRACT Background: Endodontic microbial flora plays a pivotal role in the development and persistence of periodontal endodontic lesions (PELs). Understanding the composition and prevalence of microbial species in PELs is essential for effective treatment strategies Materials and Methods: Microbial samples were collected from 50 teeth diagnosed with PELs. Sterile paper points were used to obtain samples from the root canals. Deoxyribonucleic acid (DNA) was extracted and subjected to polymerase chain reaction (PCR) amplification of the 16S ribosomal RNA (rRNA) gene to identify bacterial species. The obtained data were analyzed using statistical methods. Results: The microbial analysis revealed a diverse range of bacterial species in PELs. The most prevalent species were Porphyromonas gingivalis (32.5%), Treponema denticola (28.0%), and Fusobacterium nucleatum (22.5%). Streptococcus mutans (9.0%) and Actinomyces naeslundii (8.0%) were also frequently detected. Additionally, Prevotella intermedia (7.0%), Aggregatibacter actinomycetemcomitans (3.5%), and Enterococcus faecalis (2.5%) were present in lower frequencies Conclusion: The presence of a diverse microbial flora in teeth with PELs underscores the polymicrobial nature of these lesions. The predominance of periodontal pathogens such as Porphyromonas gingivalis, Treponema denticola, and Fusobacterium nucleatum suggests a strong association between periodontal and endodontic infections. A comprehensive understanding of the microbial profile in PELs is crucial for tailored therapeutic approaches targeting the specific pathogens involved.

Lesions Misdiagnosed as Endodontic Pathosis: A Narrative Review

ABSTRACT In daily practice, clinicians come across certain radiographic abnormalities which may or may not be asymptomatic. This abstract discusses radiographic abnormalities encountered by clinicians in daily practice, some of which resemble endodontic lesions. Prompt attention is crucial as these lesions can be benign or malignant. The article emphasizes the importance of differential diagnosis for accurate identification of periapical pathosis.

A video-based decision aid improved knowledge and decreased decisional conflict for asymptomatic persistent endodontic lesions.

This prospective cohort study aimed to (i) evaluate patients' treatment decisions, decisional conflict and knowledge levels before and after use of a video-based decision aid (DA) on asymptomatic persistent endodontic lesions (APEL) and to (ii) elicit important decision factors for patients in the decision-making process. A video DA modelled after the International Patient Decision Aids Standards (IPDAS) was designed. The video was pilot-tested, revised and used on 50 patients referred to the graduate endodontic clinic and presenting with an incidental finding of APEL detected on radiographs, with informed consent (DSRB 2020/00133). Recruitment was conducted from June 2020 to November 2021. Patients' treatment decisions and decision-making process were studied. Patients also completed a questionnaire on knowledge gain, decisional conflict and confidence levels. Forty-three patients (48 teeth) out of 50 patients chose long-term monitoring of APEL while 7 patients (7 teeth) decided on endodontic intervention. Median knowledge scores increased from 58.3 (IQR: 41.7, 75.0) to 87.5 (IQR: 75.0, 100.0) (p < .001); median decisional conflict scale (DCS) scores decreased from 25.0 (IQR: 12.5, 34.4) to 3.1 (IQR: 0, 23.8) (p < .001), and 44 (88%) patients were confident or very confident with their treatment decisions. Statistical analyses showed that asymptomatic condition of tooth was the sole decision factor with statistical significance while socioeconomic factors (age, gender, race, education and income levels) showed no significant trend. The majority of patients presenting with APEL in this study chose long-term monitoring over immediate intervention. Using the video-based DA in the decision-making process significantly improved patients' knowledge and decreased their decisional conflict levels.