Intraoral Periapical Radiographs Research Articles

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.

Solitary Radiopacity Associated with Root of Unerupted Supernumerary Tooth - A Case Report and Differential Diagnosis

Radiopaque lesions of jaws are innumerable and variable in appearance. There are several radiopaque lesions seen in the periapical region of tooth root which are indistinguishable from other lesions. The diagnosis and management of these lesions from clinical and radiographic features could be challenging to the dentist. Alterations in the bone could be inflammatory cystic odontogenic and non-odontogenic neoplastic reactive vascular traumatic dysplastic or metabolic in origin. As intraoral periapical radiographs IOPA provide the best image resolution they can aid in identifying the subtle changes in the bone architecture periodontal ligament Pdl space and lamina dura. Radiographic analysis of the involvement of adjacent structures using panoramic imaging is not sufficient for diagnosis as it provides 2D imaging of a 3D object. Cone Beam Computed Tomography CBCT provides an accurate 3D image of the involvement of bone and adjacent structures. Systematic radiologic analysis of lesions based on their location size shape borders internal structure effect on surrounding structures and consideration of clinical signs and symptoms enable clinicians to arrive at a reliable diagnosis. Here we present a case report of an asymptomatic radiopaque lesion associated with the root of an unerupted supernumerary tooth which was accidentally detected on an IOPA taken for treating the adjacent tooth.

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.

Clinical evaluation of corono-radicular restorative design with fibre post restoration for fractured endodontically treated maxillary incisors: A randomised control trial

ABSTRACT Aim: The primary aim was to evaluate and compare the survivability of corono-radicular direct composite (CRDC) restoration and fiber-reinforced composite post (FRC) followed by coronal restoration for fractured root canal-treated maxillary incisors with a tooth structure loss of 50%–70%. Methods: A total of 56 teeth from 49 patients with fractured maxillary central and/or lateral incisors due to trauma were recruited for the study. The teeth were randomly allocated to two groups randomly by lot method. The two treatment groups were as follows: Group I – CRDC and Group II – FRC followed by coronal restoration. The postoperative review was performed at 3-, 12-, 18-, and 24-month period using intraoral periapical radiographs and clinical photographs. The Patient Satisfaction Questionnaire was administered during 24-month review visit. Kaplan–Meier survival analysis was used to assess the longevity of the restorations. Results: There was no significant difference (P &gt; 0.05) in the survivability of the restorations among the two treatment groups. The mean survival period for CRDC was 24 months and FRC followed by coronal restoration was 23.74 months. The patient’s satisfaction assessed using the questionnaire was higher in CRDC (100%) than FRC followed by coronal restoration (81.5%). Conclusion: Within the limit of the present study, both CRDC and FRC followed by coronal restoration were equally effective in the management of fractured maxillary incisors with 50%–70% tooth structure loss.

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.

ImageJ Software in Periodontics: An Insight

There are various conventional radiological parameters for measuring the periodontal pocket depth apart from clinical measurements such as intraoral periapical radiograph, orthopantomogram and digital such as radiovisiography (RVG), and cone-beam computed tomography (CBCT) to an extent. As CBCT is highly recommended in the field of dentistry, especially in periodontics for an accurate measurement of remaining alveolar bone present from crest to apical region three dimensionally. Many patients cannot afford CBCT due to its cost-effectiveness and time-consuming procedure, and hence, a software was introduced to limit radiation exposure, where all preoperative and postoperative RVGs were placed in a software to measure its osseous defect and bone formation. This technique is introduced to reduce the exposure time to patients as well as for diagnosis of osseous defects radiographically to clinicians. This software can also be used in other fields of dentistry also. The main objective of this short communication is to create awareness regarding the availability of such a tool and recommend its application in periodontal regeneration clinical trials.

Conventional root canal treatment of a mandibular second premolar with three roots and three canals performed by an undergraduate student: A case report with 8-year follow-up

Abstract In developing countries, such as Sudan, there is a lack of advanced endodontic technologies and specialized endodontists. Therefore, challenging endodontic cases are inevitability encountered by undergraduate students and general dental practitioners. Their ability to manage such cases can significantly impact the decision of whether a tooth is saved or extracted. Here, we report the case of a 24-year-old male patient who presented to our clinic with pain in the mandibular second premolar. Tooth #45 had caries and was tender to vertical percussion. An intraoral periapical radiograph (IOPR) revealed a wide periodontal ligament space and thickened lamina dura, with the deep occluso-distal decay reaching the pulp space. A radiograph obtained using the tube shift technique revealed the presence of three distinct roots and canals. The patient was diagnosed with symptomatic irreversible pulpitis and apical periodontitis. His root canal treatment (RCT) was performed by a 5th-year undergraduate student using the conventional radiography technique, hand file instruments, and lateral condensation obturation. At the 8-year follow-up visit, the tooth crown was lost, the patient was asymptomatic, and the IOPR revealed normal periapical bone. This case demonstrates the importance of training undergraduate students from developing countries to perform RCT for challenging endodontic cases using conventional techniques.

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.

Successful Root Canal Treatment of an Atypical Mandibular Canine with a Boomerang-shaped Root and Canal System with a Large Periapical lesion—A Case Report with 9-year Follow-up

AimThis report describes an atypical mandibular canine with a single boomerang-shaped root and root canal system with a large periapical lesion managed by root canal treatment. MethodsThe chief complaint of a 16-year-old male was acute pain and an abnormal sensation in the right mandibular canine (tooth #27). The clinical examination revealed that tooth #27 had an unusual coronal morphology. The buccal aspect of the tooth resembled that of a normal canine but was significantly broader than expected. On the lingual aspect of the crown; however, there was an unusual cusp-like structure with ridges that was slightly less prominent than the buccal incisal tip. The intraoral periapical radiographs revealed a complex root with an obvious cow horn-shaped canal mesially and distally, but with the suggestion of a root structure joining the mesial and distal extensions. A large periapical lesion was present. Computed tomography revealed the presence of a single root and canal system shaped like a boomerang. Root canal treatment was performed and the patient was followed-up for 9 years. ResultsFollowing root canal treatment, the patient had no symptoms, no mobility, no periodontal pockets, or root resorption. At 9 years, the cone beam computed tomography images confirmed that satisfactory healing of the periapical tissues had occurred. ConclusionThe mandibular right canine had a unique boomerang-shaped root and canal system. Effective shaping and cleaning of the complex canal shape plus thermoplastic root filling aided the successful healing of the periapical lesion.

VISUALIZATION OF INCISIVE FORAMEN USING TWO INTRAORAL PERIAPICAL RADIOGRAPHIC TECHNIQUES

Background: Intraoral periapical radiographs are reported to show the incisive foramen as a typical anatomical landmark. In order to assess the visibility of the incisive foramen in the bisecting angle and paralleling angle approaches, as well as how visible it is in routine periapical radiographs, the current study was conducted. Methods: This descriptive cross-sectional study evaluated 90 intraoral periapical radiographs of maxillary central incisors. These were scored for visibility of incisive foramen by a radiographic expert using two intraoral radiographic techniques. The data was entered in Microsoft Office Excel sheet 2007 and calculated using SPSS version 20. Results: In both the paralleling and bisecting radiographs, the incisive foramen could be seen in a total of 63.8% and 36.2% of the images, respectively. Conclusions: The dentist must have a thorough awareness of how the incisive foramen appears on standard intraoral radiographs. Our research demonstrates that when compared to the bisecting angle technique, the paralleling technique delivers superior visibility of the incisive foramen. Therefore, it is recommended to use the paralleling technique approach to see the foramen.

Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents in Primary Teeth: A Randomized Controlled Trial.

Preservation of healthy pulp tissue is detrimental for the function and vitality of carious primary teeth. Several hemostatic agents used for pulpotomy in primary teeth showed adverse effects on viable surrounding structures. To assess the clinical and radiographic success of chitosan (CH) pulpotomy in primary molars and to compare it with ferric sulphate (FS). A total of 40 carious lower primary second molars in 5-9 years children are selected for conventional pulpotomy technique. Over radicular stumps, FS is placed for 15 seconds in the control group, and CH for 4-5 minutes in the study group, followed by intermediate restoration (IRM). Intraoral periapical radiographs were taken immediately after 1 week and after 3rd and 6th months. The clinical and radiographic success rate is assessed and statistically analyzed. Chitosan (CH) showed a 65% radiographical and 100% clinical success rate, and FS showed 55 and 95%, respectively. Chitosan (CH) showed better results than FS as a pulpotomy agent in primary teeth. Guguloth S, Jamnapalli SR, Patloth T, et al. Evaluation of Chitosan and Ferric Sulphate as Pulpotomy Agents in Primary Teeth: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2023;16(2):223-226.

A Gradually Increasing Painless Swelling in the Upper Maxilla – A Case Report of Peripheral Giant Cell Granuloma

Peripheral giant cell granuloma (PGCG) is a benign inflammatory hyperplasic, exophytic lesion of unknown etiology. It develops on the gingiva and alveolar ridge. It could represent a local reaction to trauma or irritation. Management requires a surgical excision of the lesion and elaborate recall due to possible recurrence. This article describes the clinical and histopathological features and management of PGCG as it appeared in the maxillary anterior region of a 35-year-old female patient with a chief complaint of painless swelling in the anterior maxillary region. Intraoral periapical radiograph showed the features that suggested a soft-tissue lesion causing cupping resorption of the maxilla. The lesion was completely excised, biopsy was performed after that, under local anesthesia, and the tissue was examined histopathologically. The lesion was diagnosed as PGCG after thorough clinical, radiologic, and histopathologic examinations. A surgical excision of the growth, including its base, as well as the eradication of any underlying causes should be included in the therapy due to its fast growth pattern and propensity to resorb bone with subsequent tooth movement. Regular postsurgical follow-up is crucial to preventing the tumor from reoccurring.

Comparative Evaluation of Two Implant Designs Based on Bone Loss and Stability with Early Loading Method.

The study evaluated the implant bone loss and stability of implant changes with diverse designs with early placement at eight weeks and eight months' time. The subjects for the current study had partial tooth loss in the posterior mandibular arch. A total of 30 samples were split into two groups of 15, one with a flared crest module and a buttress thread design, the other with a parallel crest module and a V-shaped thread design. Ostell assessed each subject's implant stability four times, at baseline, eight weeks, four months, and eight months. At intervals of eight weeks, four months, and eight months, intraoral periapical radiographs were examined using ImageJ software to measure crestal bone loss. When Group I and Group II's implant stability quotient (ISQ) values at baseline, eight weeks, four months, and eight months were compared; Group I's ISQ values at each of the four measured time periods were statistically significant. At eight weeks in Group I, the ISQ value was very considerable. At eight weeks, four months, and eight months, there was a statistically significant bone loss in Group II in comparison to Group I. At eight months, Group II's bone loss value was very considerable. In contrast to Group II implant designs, it was found that Group I implants demonstrated enhanced implant-less bone loss and stability.