Intraoral Periapical Radiographs Research Articles

Radiation exposure during orthodontic treatment: risk to children and adolescents.

To estimate radiation risk to children and adolescents during orthodontic treatment by retrieving number and type of radiographs from the patient records. Radiographs, along with justifications for radiation exposure, were obtained retrospectively from the patient records of 1,790 children and adolescents referred to two Swedish orthodontic clinics. Data were grouped according to treatment stage: treatment planning, treatment, and follow-up. Estimated risk was calculated using the concept of effective dose. Each patient had received around seven radiographs for orthodontic purposes. The most common exposures during treatment planning were one panoramic, one lateral, and three intraoral periapical radiographs. A small number of patients received a tomographic examination (8.2%). Few justifications for treatment planning and follow-up, but more in the actual treatment stage, had been recorded. The most common examinations were to assess root resorption and the positions of unerupted teeth, or simply carry out an unspecified control. The estimated risk of developing fatal cancer was considered low. The radiation risk from orthodontic treatment was equivalent to about 5-10 days of natural background radiation. Children and adolescents sometimes undergo multiple radiographic examinations, but despite the low radiation burden, accumulated radiation exposure should be considered and justified in young patients.

Does Implant Placement Below the Ridge Reduce Crestal Bone Loss? A Split-Mouth Randomized Controlled Clinical Trial.

Reducing crestal bone loss (CBL) around implants allows for soft tissue stability and long-term success. The aim of the present study was to evaluate the extent of CBL in implants placed with the implant shoulder at the equi-crestal level and 2 mm below the alveolar ridge at 2, 12, 36, and 60 months. A split-mouth randomized controlled clinical trial was conducted by selecting subjects with Kennedy Class IV partial edentulism of the lower jaw. Two implants were inserted, of equal length and diameter, one equi-crestal and the other sub-crestal, in the site corresponding to the lateral incisor. Intraoral periapical radiographs with Rinn centering devices were performed at the time of implant insertion (T0), at 2 (T1), 12 (T2), 36 (T3), and 60 months (T4). Descriptive statistics and the T-test were used, setting the significance to P⩽ 0.05. Twenty-five subjects were recruited, with a mean age of 65 years (SD 9.88, range 42-82). No subject dropped out. A total of 50 implants were inserted, 25 at crestal and 25 sub-crest level. At the 60-month follow-up, no implant or prosthetic failure was recorded. An average loss of -0.81 mm was recorded in the crestal implant group (n.25; SD: 0.40; max-min: -1.6 - -0.1) while in the implants positioned below the crest the average CBL was -0.87mm (n.25; SD: 0.41; max-min: -2 - -0.2); however, the higher CBL in the sub-crestal implant group was not statistically significant (P=0.65). Comparing the mean CBL values of the two groups at the various follow-ups, a greater crestal bone resorption was recorded in sub-crest implants between T0 and T1 (-0.25 vs -0.1) and between T1 and T2 (-0.39 vs -0.23), while in subsequent follow-ups a greater, statistically significant (P=0.01), crestal bone loss was recorded in ridge implants between T3 and T4 (-0.05 vs -0.18). Over time, therefore, the extent of CBL seems to be reduced in implants placed below the crest, with bone retention above the implant shoulder. Ultimately, although the position of the implant shoulder relative to the crestal ridge doesn't affect the CBL, sub-crestal placement is recommended in order to reduce the risk of exposure of the rough surface of the implant.

Comparing the Diagnostic Accuracy of Direct Digital and Conventional Intraoral Peri-apical Radiographs in Identifying Interdental Bone Loss: An Observational Study

ABSTRACT The evaluation of conventional two-dimensional radiography is crucial in making the diagnosis of periodontitis. Radio-visiography (RVG) is one of the digital imaging modalities that have received significant recognition as a replacement for film-based radiography due to its improved image quality, quick turnaround time, and minimal radiation dose. In order to compare the diagnostic efficacy of Direct Digital and Conventional Intraoral Peri-apical Radiographs in identifying Interdental Bone Loss, the present investigation was carried out. A cross-sectional observational study was conducted among 96 patients prospectively. Radiographs were exposed using a Gendex Oralix AC machine. Statistical data was analyzed using IBM SPSS statistical software using appropriate statistical tests. For both age categories, the radiographic method yielded a higher mean score than the periodontal probe method. The mean scores were noted to be higher following surgery. The radiographic approach recorded a greater mean score when gender groups were compared than the periodontal probe, which had a lower mean score. The mean scores after surgery were noted to be lower than the radiography approach and higher than the periodontal probe. The results demonstrate the radiographic technique’s significant advantage over clinical tests in determining furcation regions as well as its superior accuracy in spotting periodontal disintegration over clinical probing.

En masse retraction of anterior teeth through rapid periodontal distraction by a retraction screw: A randomized control trial

Rapid distraction of the periodontal ligament is an effective method to shorten the orthodontic treatment time. The objectives of the present study were to assess the effects of an HYCON device (Adenta GmbH, Germany) on the rate of en masse retraction of the anterior teeth, duration of retraction, anchorage loss, root resorption, and soft tissue changes. This study was conducted on 60 female patients aged >18 years, divided randomly into two equal groups: Group 1 comprised 30 patients with HYCON, and group 2 comprised 30 patients with nickel-titanium closed coil springs. Skeletal, dental, and soft tissue changes were evaluated on pre- and post-retraction lateral cephalograms, and the rates of anterior tooth movement and anchorage loss were assessed monthly on the dental casts of the patients. Root resorption was assessed using intraoral periapical radiograph. Student's t test was used for the analysis of parametric data, and the Mann-Whitney U test was used for nonparametric data. HYCON significantly shortened the retraction duration by 3 months. The rate of anterior teeth retraction was two times faster in group 1, compared with group 2. There was a significant difference in the anchorage loss between the groups in only first 2 months of treatment. Group 2 showed significantly more root resorption and soft tissue changes than group 1 (P < 0.05). HYCON is an effective device for significantly shortening the duration of retraction with anchorage loss of 2 to 2.5 mm. However, careful monitoring for possible root resorption should be performed.

Diagnostic Accuracy of Cone Beam Computed Tomography and Periapical Radiography for Detecting Apical Root Resorption in Retention Phase of Orthodontic Patients: A Cross-Sectional Study.

Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of "Definitely present". The data suggested that CBCT outperformed PR when using a less stringent criterion ("Definitely present" or "Probably present"), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong's test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients.

Comparative Evaluation of the Anesthetic Efficacy of Needle-Free Anesthesia and Conventional Anesthesia in Patients With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

Introduction Pain is the primary reason for which most of the patients seek endodontic treatment. Local anesthesia is considered to be the most important step in the procedure to reduce the pain. However, the majority of the patients do not cooperate due to the fear of syringe anesthesia. The aim of this clinical trial was to compare the anesthetic efficacy of needle-free anesthesia and conventional anesthesia in patients with symptomatic irreversible pulpitis undergoing root canal therapy. Materials and methods A total of 54 patients were enrolled in the study, and the treatment was administered by a single operator. The initial assessment of vitality included cold testing, heat testing, and electric pulp testing. Preoperative pain was assessed using the Visual Analog Scale (VAS) before the administration of anesthesia. Local anesthesia was administered according to the group assigned: Group 1 (conventional anesthesia) and Group 2 (needle-free anesthesia). The pain was assessed during the administration of anesthesia. Following the administration of anesthesia, the vitality of the tooth was evaluated using cold testing, heat testing, and electric pulp testing. Subsequently, the tooth was isolated with a rubber dam, and the access cavity was prepared. The pain was assessed during access cavity preparation and during the first file insertion. Working length was determined using an apex locator (Root ZX Mini, J Morita, Saitama, Japan) and was confirmed using intraoral periapical radiographs. Later on, further treatment was carried out. Results A total of 54 participants were included in this clinical trial. There was no significant difference in mean age distribution between the two groups (p=0.852). Considering the frequency distribution of gender, there was no significant difference; however, Group 1 had more female participants (59.3%) compared to Group 2 (33.3%). There was a significant reduction in the mean pain score in Group 2 compared to Group 1 during the delivery of anesthetic agents (p=0.000). Conclusion Needle-free anesthesia proves to be equally effective as the conventional syringe system in patients experiencing symptomatic irreversible pulpitis undergoing root canal treatment. However, it is noteworthy that patients exhibited greater comfort levels with needle-free anesthesia systems specifically during the administration of the anesthetic solution.

Evaluation of Carisolv in the Chemico-Mechanical Removal of Carious Dentine in Primary Molars (In vivo study)

Caries removal by the Chemo-mechanical technique involves the application of chemical agents, to cause a selective softening of the carious dentine and facilitate removal by gentle excavation. Carisolv is one such new chemical agent used in this minimal invasive technique of carious dentine removal. The aims of this study was to evaluate the efficacy of Carisolv in the chemo-mechanical removal of carious dentine in primary teeth, the time taken for caries removal and to evaluate the restorations radiographically. Forty primary 1st and 2nd molars with dentinal carious lesions were excavated using this technique of caries removal. After isolation of the involved tooth, the Carisolv " new gel" marketed by Mediteam Dental AB (Goteborg, Sweden) was applied then the superficial softened carious dentine was gently excavated and scraped using a spoon excavator, the procedure repeated until the cavity was free from caries and the cavity was checked for remaining caries using an explorer. The time taken for the removal of carious dentine, beginning from the application of the gel until the completion of the procedure was evaluated using a stopwatch. After the placement of the restoration an intra-oral periapical radiograph was taken for immediate evaluation and after a period of six months, the longevity of the restorations and the presence of secondary caries at the restoration- dentine interface were evaluated radiographically. The statistical analysis of the results showed that the soft carious dentine was removed more effectively than the hard carious dentine and the removal of the soft carious dentine required a shorter period of time (4.96±0.99) minutes when compared to the removal of hard carious dentine (6.09±1.04) minutes and on radiographic evaluation of the restoration, none of the treated lesions showed the presence of secondary caries. In conclusion, the chemico-mechanical caries removal technique using Carisolv proved to be an effective atraumatic treatment modality with potential interest for use in clinical pediatric dentistry.

Comparison of Root Canal Morphology in Intraoral Periapical Radiographs and Cone-Beam Computed Tomography: An In vitro Study

Backgrounds and Objectives: Intraoral periapical radiographs (IOPAR) are routinely used to fulfill the preoperative, par-operative and postoperative imaging needs in endodontic treatment. IOPAR is not a sensitive tool for identification of complex root canal morphology with failure rates of up to 34%. Cone-beam computed tomography (CBCT) provides three-dimensional imaging and has been recommended when endodontic imaging needs cannot be met by IOPAR. There is a need to understand which anatomic parameters are better viewed in CBCT and which on IOPAR. Hence, this study is planned to compare the root canal morphology on IOPAR and CBCT and correlate with chemically cleared tooth. Methods: One hundred recently extracted teeth were collected and subjected to IOPAR and CBCT scanning. A total of six root canal morphologies were compared in both the imaging modalities and with the teeth itself after making it chemically transparent. Results: CBCT and IOPAR showed a good agreement in detection of fractured tooth roots with P &lt; 0.005. However, CBCT was better than IOPAR in detection of the number of accessory canals, ramifications, and obliterations in the root canal and fractures with P &lt; 0.005. IOPAR showed reduced artifacts with P &lt; 0.005. During working length measurement, both CBCT and IOPAR showed increased values than the cleared teeth although CBCT was more accurate. Conclusion: We can conclude from this study CBCT is more accurate in detection of root canal morphologies in comparison to IOPAR.

Glandular Odontogenic Cyst of Maxillary Anterior Region: Report of a Rare Case

Glandular Odontogenic Cyst (GOC) is a rare odontogenic cyst that indicates the pluripotency of the oral epithelium due to the exhibition of glandular characteristics. It is more prevalent in the mandibular anterior region and shows a predilection in males. The cyst was first described by Padayachee and van Wyk in 1987. It has non distinct clinical and radiographic features but very characteristic histopathological features. Here, the authors report a rare case of GOC occurring in a 36-year-old male patient in the maxillary anterior region. An intraoral periapical radiograph revealed a large unilocular radiolucency from the apex of 11 to the mesial aspect of 15. The cyst was enucleated under local anaesthesia, and endodontic treatment was performed for the associated teeth. No recurrence was seen at the two-month follow-up.

The Morphology of Peri-Implantitis Bone Defects: A Retrospective Study on Periapical Radiographs.

The aims of this study were to assess the morphologic features of peri-implant defects, as measured on 2D intraoral radiographs, and to investigate the possible correlation between such morphology and other parameters related to the position and characteristics of the implant or the implant-supported prosthesis. Implants with peri-implantitis were included in this retrospective study. Data collected were related both to the patients and to the position/characteristics of the implants and the implant-supported prosthesis. Measurements of the morphologic defects were performed by two operators on digitalized intraoral periapical radiographs. Results and Conclusion. In total, 73 implants in 27 patients were included. The measurements of the periapical radiograph suggested that the most common defect conformation was crateriform, with both intraosseous and horizontal components. An inverse correlation was found between the extension of the peri-implant lesion and the time between the radiographic assessment and the implant placement. The total lesion area was strongly correlated to oral hygiene levels. No correlations between lesion extension and smoking, diabetes, history of periodontal were found. In conclusion, the results from this 2D radiographic study showed the prevalence of crateriform peri-implant defects, with a hygiene-correlated extension, perceptible on the mesial and distal aspects; 3D imaging could be used when available for further research and clinical investigation.

Guided endodontics a pathbreaking approach to the management of calcified canals: A case report

Abstract Pulp calcification refers to the accumulation of hard tissue in the root canal space as a response to dental trauma. Despite being a common finding in dental practice, access to an obliterated pulp chamber and subsequent canal negotiation remains challenging for clinicians due to the increased likelihood of iatrogenic errors such as gouging, ledging, or perforation. In this current report, a 21-year-old male patient presented with a discolored maxillary central incisor and reported a history of trauma that occurred 15 years ago. The tooth exhibited sensitivity to percussion; with no vestibular obliteration or periodontal pockets. Intraoral periapical radiograph revealed a completely calcified root canal associated with apical widening, suggestive of apical periodontitis. A 3D-printed endodontic guide was fabricated using the cone beam computed tomography (CBCT) images and digital planning software to aid in locating the root canal orifice. The canal was successfully navigated with the help of the endodontic guide, and a 12-month follow-up revealed that the patient remained clinically asymptomatic, with radiographic evidence indicating periapical healing. For conservative, precise, and predictable outcomes, a digital workflow that makes use of CBCT imaging, planning software, and a 3D-printed endodontic guide may be taken into consideration when managing extensively calcified canals.

Unusual localized gingival redness: a case report

Inflammation of the gingiva is one of the most common and routine findings in dental practice. These routine appearances of inflammatory gingivae can show peculiarity when associated with an underlying systemic condition or because of reactive, benign, or malignant pathologies. This case highlights minute clinical signs of the gingiva that deviate from the routine presentation and warrant further investigations. A 63-year-old woman presented with a chief complaint of severe pain in relation to the lower front teeth region for 1 month. Intraoral examination revealed a gingival lesion on the labial aspect of 41, 42, and 43, and an intraoral periapical radiograph showed mild bone loss. The lesion persisted despite oral prophylaxis, and a biopsy was advised. The final diagnosis was stage 1 gingival squamous cell carcinoma (GSCC). It is important to note that the non-descript presentation of GSCC in early stages often mimics benign traumatic or inflammatory lesions of the gingiva. Peculiar clinical features of GSCC of note include the lack of traditionally associated risk factors and localized red or ulcerative lesions with increased bleeding tendencies that do not respond to routine periodontal treatment within 2 weeks.

Guided Autotransplantation of an Immature Premolar to the Maxillary Incisor Region with Immediate Restoration of Esthetics: A Case Report

This case report describes the treatment of two maxillary central incisors following a traumatic injury with tooth #8 developing replacement resorption and #9 developing inflammatory root resorption. A 10-year-old girl presented complaining of pain in her maxillary central incisors. Upon clinical examination, teeth #8 and #9 were tender to percussion and palpation of the buccal soft tissues. Thermal and electrical pulpal sensitivity tests for teeth #8 and #9 were negative. An intraoral periapical radiograph revealed resorptive defects in tooth #8, which were filled with bone-like tissue, while tooth #9 had radiolucent resorptive defects along the root surface and a periapical radiolucency. A diagnosis of replacement resorption was made for tooth #8 and external inflammatory root resorption for tooth #9. Tooth #8 was treated with a multidisciplinary approach utilizing a guided template for premolar autotransplantation with an immediate veneer restoration, while tooth #9 was managed with root canal treatment using a tricalcium silicate cement to fill the canal. At the 1, 4, 8, 12, and 24-month follow-ups, the patient remained asymptomatic, and there was no radiographic evidence of root or periapical pathosis on either tooth. The root-end of the donor tooth transplanted to the #8 site continued to develop. This case report highlights successful interdisciplinary management of two forms of root resorption using modern treatment strategies that provided immediate function and esthetics to the maxillary central incisors in a young patient following trauma.

Predictors of periapical bone healing associated with teeth having large periapical lesions following nonsurgical root canal treatment or retreatment: A cone beam computed tomography-based retrospective study.

Several factors influence the condition of the periapical tissues associated with root filled teeth. The primary objective of this study was to retrospectively evaluate the extent and speed of bone healing of large periapical lesions associated with nonsurgical root canal treatment or retreatment. The secondary objective was to analyse the relationship between the time to complete healing when analysed using cone beam computed tomography (CBCT) and other possible predictors that affect healing. Seventy-nine patients were treated during the years 2013-2020 with large periapical lesions of endodontic origin (10-15 mm) as observed on intraoral periapical radiographs (IOPAR) were included. IOPAR and CBCT were available before treatment and during the follow-up (IOPAR every 6 months and CBCT every 12 months). The volume of periapical lesions was calculated by OsiriX Lite software. Variables such as initial volume of the lesion, age, gender, type of treatment or type of root canal filling were compared to identify the differences between healed and unhealed lesions. Pearson's Chi-square test was used for categorical variables, the t-test for age and the Wilcoxon test for initial volume of the lesion. The association between time to healing and the variables was assessed using univariate analysis and multivariate analysis. The Wilcoxon test was used to observe the association of healing time with categorical variables and the correlation index was measured with the quantitative variables. Of the 79 cases analysed, 60 lesions (76%) were completely healed as verified by CBCT in a mean healing time of 19 months, of which 60% healed fully between 12 and 18 months. Increase in age of patient and larger initial volume of the lesion were associated with a significantly longer healing time (p < .001). Gender, filling material and type of treatment did not have a significant effect on the healing process (p > .05). Clinicians should be aware that periapical lesions in older patients and larger areas of bone loss take longer to heal. CBCT monitoring of large periapical lesions is critical and it can help clinicians in the decision-making process.

Estimation of Cancellous Changes Using Fractal Analysis in Patients with Periodontitis.

Periodontal disease is a broad term given when the periodontium is affected by inflammation. There are several methods to diagnose periodontitis, but no method to quantify the cancellous bone is presently used. For this purpose, a non-invasive tool that is efficient in analyzing bone quality called fractal analysis can be employed. The objective of the study was to utilize fractal dimension (FD) to evaluate cancellous patterns of interproximal alveolar bone using a digital intraoral periapical radiograph (IOPAR) in different clinical presentations of periodontitis classified according to the latest classification by the World Workshop for Periodontal and Peri-Implant Diseases and Conditions, 2017 (WWDC, 2017). The study aimed to numerically calculate the periodontitis changes in the cancellous bone around the affected tooth on an IOPAR using fractal analysis and to provide an additional criterion for the staging of periodontitis. In this cross-sectional observational study, 75 patients were selected and equally allotted to five groups based on the staging system proposed by the WWDC, 2017. The region of interest was selected on the IOPA radiograph of the tooth with the site having the most significant clinical attachment loss, and FD was calculated using Image J analysis. The association of gender and age with stages of periodontitis was studied using the chi-square test of independence. A comparison of % bone loss and fractal dimension among stages was studied by using the non-parametric Kruskal Wallis test. The relationship between % bone loss and fractal dimension within stages and gender was studied by using the Karl Pearson correlation. A receiver operating characteristic (ROC) curve analysis was performed for FD value as a marker of periodontitis patients. We demonstrated that the FD values decreased significantly with the increase in stages (p < 0.0001). The overall relationship between % bone loss and FD showed a significantly strong negative correlation of -0.739 (p < 0.0001), except for stages III and IV. FD can be utilized as a quantitative method for detecting cancellous bone changes in different stages of periodontitis, aiding in diagnosing periodontitis.

Measurement of the Dentin Wall Thickness of the Maxillary Central Incisor in Relation to the Stage of Root Development: A Pilot Study.

The aim of this study was to determine the average dentin wall thickness (DWT) of the maxillary central incisor (MCI) required for performing finite element analysis (FEA) models of root development. A total of 137 intraoral periapical radiographs of MCI in children aged 7 to 11 years were examined and then classified into 5 groups according to root development stages, which included 1/2 of root development (S1), 3/4 of root development (S2), more than 3/4 of root development (S3), complete development with wide-open apex (S4) and complete development with closed apex (S5). DWT was measured at three reference (horizontal) lines: at a distance of 1 mm from the apex (M), 4 mm from the apex (L) and at the cervical line (K). The distal dentin wall thickness (M1, L1, and K1), the pulp thickness (M2, L2, and K2), the mesial dentin wall thickness (M3, L3, and K3), and the apex thickness (N) were measured using the diagnostic software Soredex Scanora 5.1.2.4. Statistical analysis compared the values of the parameters K, L, and M between developmental stages (multivariate ANOVA) and the linear correlations between the parameters (Pearson's correlation analysis). All analyses were performed at significance level α = 0.05. There were statistically significant differences between the developmental stages for parameters L and M, while no significant differences were found for parameter K. Most of the correlations between the parameters were statistically significant, with the values of the Pearson correlation coefficient R > 0.6 considered practically significant. All parameters on the same reference line for distal and mesial dentin wall thickness and for pulp thickness correlated well with each other (R = 0.46 - 0.68), but there was no statistically significant correlation with total root thickness on the same reference line (parameters K, L, or M), except for parameter K3 (R = 0.42). Despite the limitations of this study, the mean values of the selected parameters for the 5 groups of developmental stages of the maxillary central incisor could be used to model dentin wall thickness using finite element analysis.

Comparative evaluation of periapical healing in response to calcium hydroxide, polydimethyl siloxane and calcium silicate based endodontic sealers using radiograph

Background: Success of root canal treatment depends upon 3-D seal obtained after obturation without any presence of post-operative symptoms. The focus of this investigation is on ability of a sealer to form 3D seal and to reduce periapical lesion. The study aims to evaluate periapical healing of teeth treated with calcium hydroxide, polydimethyl siloxane and calcium silicate based endodontic sealers using radiograph. The objectives of this study will be to evaluate periapical healing ability of root canal treated teeth with Sealapex, Nanoseal-S and Bio-ceramic sealers over the time period of 3, 6 and 9 months; and to compare the periapical healing ability of a root canal treated tooth. Methods: A total of 60 subjects having periapical radiolucencies will be divided into 3 groups of 20 subjects each; Group I- Calcium hydroxide based, Group II- Polydimethyl siloxane based and Group III- Calcium Silicate based sealers. Root canal procedure will be done. Patients will be recalled after 3, 6, 9 months for the evaluation of periapical healing and PAI score check-up using intraoral periapical radiograph. Expected results: It is expected that among the material used in the study Bio-Ceramic and Nanoseal-S sealer may give better results as compared to Sealapex used in routine practice due to its ability of anti-microbial properties, optimal biocompatibility and excellent sealing ability. Conclusion: Comparison amongst the three sealers would provide us with the information about the best material which offers better periapical healing to get the best outcome of the root canal treatment by clinician.

Assessment of Digital Intraoral Periapical Radiograph for the Detection of Apical Root Resorption in Inflammatory Periapical Pathologies: A Radiovisiography Study.

Introduction Resorption often takes the form of external inflammatory root resorption. Apical periodontitis or an apical cyst is the most typical cause of external inflammatory root resorption. Failure of endodontic treatment can occur if severe apical root resorption occurs.This is due to the difficulty of reaching these sites.Apical root resorption is usually discovered during routine radiographs and is usually in its later stages. If the lesion is advanced, extraction is the only viable solution. An accurate diagnosis of incipient root resorption is essential.This research is designed to analyze the effectiveness of digital intraoral periapical radiographs in assessing apical root resorption (ARR) related to periapical pathologies. Material and methods Thiscross-sectional radiographic observational researchwas conductedin a dental college and hospital in central India. Radiovisiography (RVG) images of 190 patients' teeth with inflammatory periapical pathologies were evaluated to determine the presence or absence of resorption in the apical area of the root. After the radiographic assessment of the apical root resorption, the extraction of the affected teeth was done under all aseptic conditions. The periapical tissue was sent for histological analysis and the extracted tooth sample was examined for the presence or absence of apical root resorption. Results In comparison to apical periodontitis, the proportion of severe root resorption patients was significantly higher in abscess and periapical granuloma. Using Pearson's Chi-square test, the difference in patient proportions according to the kind of resorption in the three radiological diagnosis groups was statistically significant with a p-value of 0.0058. Conclusion It was concluded that on radiographic examination, digital intraoral periapical radiographs were found to be accurate in determining periapical apical pathologies and apical root resorption.

Artificial Intelligence Techniques for Automatic Detection of Peri-implant Marginal Bone Remodeling in Intraoral Radiographs

Peri-implantitis can cause marginal bone remodeling around implants. The aim is to develop an automatic image processing approach based on two artificial intelligence (AI) techniques in intraoral (periapical and bitewing) radiographs to assist dentists in determining bone loss. The first is a deep learning (DL) object-detector (YOLOv3) to roughly identify (no exact localization is required) two objects: prosthesis (crown) and implant (screw). The second is an image understanding-based (IU) process to fine-tune lines on screw edges and to identify significant points (intensity bone changes, intersections between screw and crown). Distances between these points are used to compute bone loss. A total of 2920 radiographs were used for training (50%) and testing (50%) the DL process. The mAP@0.5 metric is used for performance evaluation of DL considering periapical/bitewing and screws/crowns in upper and lower jaws, with scores ranging from 0.537 to 0.898 (sufficient because DL only needs an approximation). The IU performance is assessed with 50% of the testing radiographs through the t test statistical method, obtaining p values of 0.0106 (line fitting) and 0.0213 (significant point detection). The IU performance is satisfactory, as these values are in accordance with the statistical average/standard deviation in pixels for line fitting (2.75/1.01) and for significant point detection (2.63/1.28) according to the expert criteria of dentists, who establish the ground-truth lines and significant points. In conclusion, AI methods have good prospects for automatic bone loss detection in intraoral radiographs to assist dental specialists in diagnosing peri-implantitis.

Evaluation of 3D MRI for early detection of bone edema associated with apical periodontitis.

To detect and evaluate early signs of apical periodontitis using MRI based on a 3D short-tau-inversion-recovery (STIR) sequence compared to conventional panoramic radiography (OPT) and periapical radiographs in patients with apical periodontitis. Patients with clinical evidence of periodontal disease were enrolled prospectively and received OPT as well as MRI of the viscerocranium including a 3D-STIR sequence. The MRI sequences were assessed for the occurrence and extent of bone changes associated with apical periodontitis including bone edema, periradicular cysts, and dental granulomas. OPTs and intraoral periapical radiographs, if available, were assessed for corresponding periapical radiolucencies using the periapical index (PAI). In total, 232 teeth of 37 patients (mean age 62±13.9 years, 18 women) were assessed. In 69 cases reactive bone edema was detected on MRI with corresponding radiolucency according to OPT. In 105 cases edema was detected without corresponding radiolucency on OPT. The overall extent of edema measured on MRI was significantly larger compared to the radiolucency on OPT (mean: STIR 2.4±1.4 mm, dental radiograph 1.3±1.2 mm, OPT 0.8±1.1 mm, P=0.01). The overall PAI score was significantly higher on MRI compared to OPT (mean PAI: STIR 1.9±0.7, dental radiograph 1.3±0.5, OPT 1.2±0.7, P=0.02). Early detection and assessment of bone changes of apical periodontitis using MRI was feasible while the extent of bone edema measured on MRI exceeded the radiolucencies measured on OPT. In clinical routine, dental MRI might be useful for early detection and assessment of apical periodontitis before irreversible bone loss is detected on conventional panoramic and intraoral periapical radiographs.