Periapical Radiographs Research Articles

Clinical outcome of non-surgical root canal treatment using different sealers and techniques of obturation in 237 patients: A retrospective study

ObjectivesThe aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment.Materials and methodsA total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI).ResultsThere were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome.ConclusionsBased on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome.Clinical relevanceA bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

Evaluation of the Alveolar Crest and Cemento-Enamel Junction in Periodontitis Using Object Detection on Periapical Radiographs.

The severity of periodontitis can be analyzed by calculating the loss of alveolar crest (ALC) level and the level of bone loss between the tooth's bone and the cemento-enamel junction (CEJ). However, dentists need to manually mark symptoms on periapical radiographs (PAs) to assess bone loss, a process that is both time-consuming and prone to errors. This study proposes the following new method that contributes to the evaluation of disease and reduces errors. Firstly, innovative periodontitis image enhancement methods are employed to improve PA image quality. Subsequently, single teeth can be accurately extracted from PA images by object detection with a maximum accuracy of 97.01%. An instance segmentation developed in this study accurately extracts regions of interest, enabling the generation of masks for tooth bone and tooth crown with accuracies of 93.48% and 96.95%. Finally, a novel detection algorithm is proposed to automatically mark the CEJ and ALC of symptomatic teeth, facilitating faster accurate assessment of bone loss severity by dentists. The PA image database used in this study, with the IRB number 02002030B0 provided by Chang Gung Medical Center, Taiwan, significantly reduces the time required for dental diagnosis and enhances healthcare quality through the techniques developed in this research.

Differential diagnoses for the bilateral multiple radiopaque materials superimposed in the panoramic and periapical radiographs

Differential diagnoses for the bilateral multiple radiopaque materials superimposed in the panoramic and periapical radiographs

Comparing Bone Graft Success, Implant Survival Rate, and Marginal Bone Loss: A Retrospective Study on Materials and Influential Factors.

Bone grafting serves to restore the alveolar bone defect, providing adequate alveolar bone essential for long-term implant survival. This retrospective study aimed to evaluate the success rate of guided bone regeneration (GBR) bone grafting and investigate the survival rate of implants and the degree of marginal bone loss (MBL) around implants. Furthermore, the influence of confounding factors such as patient conditions, bone graft properties, and implant characteristics was assessed. This study was carried out on treatment outcomes of patients with implants between January 2007 and December 2016, using various graft materials, including autograft, allograft, and xenograft. In a mean follow-up of 70 months (range: 3-10 years), the overall success rate of bone graft (n = 80) was 100%, and the overall survival rate of implant (n = 107) was 97.2% (autograft: 100%, allograft: 100%, and xenograft: 92.9%; P = .03). Mean MBL up to 3 years after implant installation were similar among graft materials, with 0.84 ± 0.48 mm in autograft, 0.73 ± 0.42 mm in allograft, and 1.01 ± 0.59 mm in xenograft (P = .14). Posterior mandibular location had a significant influence on implant survival (P = .003). A significant association of MBL with several factors, including age >60 years (P = .03), both diabetes and hypertension (P = .02), without receiving adjunctive membrane (P = .04), loading within 3-6 months (P < .001), and screw-retained crown (P = .008), was confirmed. Our data substantiated that implant rehabilitation with GBR using autograft and allograft provides the most predictable results. The factors above should be carefully considered with xenograft to enhance long-term clinical outcomes.

Artificial Intelligence in Dental Caries Diagnosis and Detection: An Umbrella Review.

Dental caries is largely preventable, yet an important global health issue. Numerous systematic reviews have summarized the efficacy of artificial intelligence (AI) models for the diagnosis and detection of dental caries. Therefore, this umbrella review aimed to synthesize the results of systematic reviews on the application and effectiveness of AI models in diagnosing and detecting dental caries. MEDLINE/PubMed, IEEE Explore, Embase, and Cochrane Database of Systematic Reviews were searched to retrieve studies. Two authors independently screened the articles based on eligibility criteria and then, appraised the included articles. The findings are summarized in tabulation form and discussed using the narrative method. A total of 1249 entries were identified out of which 7 were finally included. The most often employed AI algorithms were the multilayer perceptron, support vector machine (SVM), and neural networks. The algorithms were built to perform the segmentation, classification, caries detection, diagnosis, and caries prediction from several sources, including periapical radiographs, panoramic radiographs, smartphone images, bitewing radiographs, near-infrared light transillumination images, and so forth. Convoluted neural networks (CNN) demonstrated high sensitivity, specificity, and area under the curve in the caries detection, segmentation, and classification tests. Notably, AI in conjunction with periapical and panoramic radiography images yielded better accuracy in detecting and diagnosing dental caries. AI models, especially convolutional neural network (CNN)-based models, have an enormous amount of potential for accurate, objective dental caries diagnosis and detection. However, ethical considerations and cautious adoption remain critical to its successful integration into routine practice.

Endodontic management and outcome of non-surgical root canal treatment for radix entomolaris associated mandibular molar teeth: A scoping review of case reports

Radix entomolaris (RE) is an anatomical variant of the permanent mandibular molar (MM) with various complex anatomy. However, there is limited literature on the guideline on endodontic management of RE, resulting in unclear understanding on the endodontic treatment outcomes. Hence, this study aimed to map current case reports on endodontic treatment modalities, occurrence of endodontic mishaps, and outcome of MM associated with RE. A systematic search was performed in PubMed, Google Scholar, Scopus, Science Direct, PLOS, and Lilac databases for English articles published between 2000 and 2022 that met the inclusion criteria. The search yielded 1435 results; after screening was completed, only 58 articles were included in the study and critically appraised using JBI critical appraisal tool. Amongst the modifications made in endodontic management of RE were utilising angulated periapical radiograph supplemented with cone-beam computed tomography, extending the access cavity distolingually, and maintaining a small apical size of #25. There were 12% incidence of endodontic mishaps (separated instrument, ledge, missed canal, and extruded sealer) on RE. The success and survival rate of MM associated with RE were 58.7% and 40% respectively, at an average of 8.4 months. The basic management of MM with RE is similar to that of other MM. However, emphasis should be made on RE identification to prevent endodontic mishaps that can influence the endodontic treatment outcome.

REGRESSÃO DE LESÃO RADIOTRANSPARENTE ÓSSEA APÓS TERAPIA ENDODÔNTICA CONSERVADORA

Periapical lesions are found associated with the apex of a tooth without vitality, after contamination of the root canals, characterized radiographically by the presence of a radiolucent image at the apex of the affected element. The objective of this work is to report the regression of a periapical lesion, with a diagnosis of periapical abscess without fistula, after conventional endodontic treatment, confirmed through radiographic examinations and clinical images. A 24-year-old female patient complained of pain in the right anterior region and, days before the initial consultation, reported drainage of purulent secretion through the gums. In the intraoral physical examination, edema was observed at the bottom of the vestibule close to the incisors, pain on horizontal and vertical percussion and on the periapical radiograph the presence of a radiolucent image was observed close to the apex of tooth 36. A cold pulp sensitivity test was performed, obtaining a negative result. . With the purpose of decontaminating the root canals, endodontic treatment was carried out, using a preparation technique associated with the activation of chemical irrigants and intracanal medication between sessions. After a few weeks, the remission of clinical signs of inflammation and infection was observed and, after 3 months, radiographically, the beginning of repair of the lesion with bone formation was evident. The reported case highlights the importance of effective decontamination of the root canal as a determining factor for the regression process of periapical lesions. A longer period of clinical and radiographic follow-up of the case is necessary to verify complete repair.

Comparative Analysis of CNN Methods for Periapical Radiograph Classification

Comparative Analysis of CNN Methods for Periapical Radiograph Classification

Age Estimation Using the Pulp-to-Tooth Area Ratio in an Indian Population Using Cone-Beam Computerised Tomography (CBCT): A Retrospective Study.

Age estimation, whether for living or deceased individuals, is crucial in forensic sciences. Traditionally, the pulp-to-tooth area ratio determined from periapical radiographs has been employed as a non-invasive method for estimating age. Cone-beam computed tomography (CBCT) represents a newer technique, providing three-dimensional images of teeth in living individuals. This study aims to estimate age using the pulp-to-tooth area ratio of four teeth (the permanent maxillary central incisor, lateral incisor, canine, and first premolar. The study included ninety subjects ranging in age from 18 to 70 years. This study concluded that the correlation between actual age and estimated age varied across different tooth types. There was a strong positive correlation between the maxillary right central incisor and maxillary right canine tooth, while the maxillary left canine tooth exhibited a slightly weaker but still positive correlation. This indicates that the maxillary right central incisor and maxillary right canine tooth are the most reliable for estimating age. Additionally, the study found that the linear regression results for estimating age based on the pulp-to-tooth area ratio, categorised by sex and each type of tooth, showed strong associations between age and the ratio for the maxillary left central incisor and maxillary left canine teeth in males, and for the maxillary left central incisor in females.

Is a Pre-Existent Cone-Beam Computed Tomography Able to Detect Metal Dental Posts?

(1) Background: In this study, the efficacy of cone-beam computed tomography (CBCT) in detecting dental posts was compared to periapical radiography. (2) Methods: A retrospective evaluation of 53 patients' periapical radiographs and CBCT images was performed. The presence and type of the intra-canal dental post were initially determined on the periapical images (PA) radiographs' examination and were then compared to the observer's ability to detect the dental post on a CBCT image. The effect of the post's type (metal cast or prefabricated) on its detection on CBCT images was determined. (3) Results: 10.5% of teeth that were identified as having a post on a PA radiograph were not identified as having a post on the CBCT examination (p < 0.05). Approximately 17.6% of teeth that were identified as not having a post on a PA radiograph were identified as having a post on the CBCT examination (p < 0.05). Moreover, 16.3% and 50% of teeth with a prefabricated or cast posts on PA radiographs were falsely identified on the CBCT examination, respectively (p < 0.05). (4) Conclusions: A CBCT image is an insufficient tool for the identification of metal prefabricated and cast posts. A PA image is the recommended radiographic tool for achieving information about the post-endodontic restoration status of teeth candidates for endodontic retreatment in patients with a former CBCT scan.

Native vs. ribosome-crosslinked collagen membranes for periodontal regeneration: A randomized clinical trial.

To evaluate whether the ribosome-crosslinked collagen membrane (RCCM) is non-inferior to the natural collagen membrane (NCM) used in regeneration surgery in terms of clinical attachment level (CAL) gain at 6 months. Eighty patients diagnosed as generalized periodontitis presenting with isolated infrabony defect (≥4 mm deep) were enrolled and randomized to receive regenerative surgery, either with NCM or RCCM, both combined with deproteinized bovine bone mineral (DBBM). CAL, pocket probing depth (PPD), and gingival recession (GR) were recorded at baseline, 3, and 6 months postoperatively. Periapical radiographs were taken at baseline, immediately, and 6 months after surgery. Early wound healing index (EHI) and patients' responses were recorded at 2 weeks postoperatively. At 6 months post-surgery, the mean CAL gain was 3.1 ± 1.5 mm in the NCM group and 2.9 ± 1.5 mm in the RCCM group, while the mean PPD was 4.3 ± 1.1 mm in the NCM group and 4.2 ± 1.0 mm in the RCCM group. Both groups demonstrated a statistically significant improvement from the baseline (p < .01). RCCM was non-inferior to NCM concerning the primary outcome (CAL gain at 6 months). The GR at 6 months postoperatively was 1.3 ± 1.2 and 1.2 ± 1.1 mm, which showed no difference compared with baseline. At 6 months follow-up, the radiographic linear bone fill (RLBF) was 6.5 ± 2.8 and 5.5 ± 2.6 mm (p > .05), while the bone fill percentage (BF%) was 102.3 ± 53.5% and 92.3 ± 40.1% (p > .05), in the NCM and RCCM groups, respectively. There was no significant difference in EHI and postoperative responses between two groups. RCCM + DBBM resulted in no-inferior clinical and radiographic outcomes to NCM + DBBM for the treatment of isolated infrabony defect in 6 months.

Evaluation of Post-Operative Pain and Healing in Single-Visit versus Multiple-Visit Root Canal Therapy

ABSTRACT Background: “Root canal therapy (RCT)” is a common endodontic procedure targeted at preserving teeth compromised by pulp infection. The debate over the optimal number of visits for RCT remains inconclusive, with single- and multiple-visit approaches both being advocated. Methods: A prospective research was conducted on 100 subjects undergoing RCT at a tertiary care center. Subjects were randomly ascribed to the single-/multiple-visit group. Post-operative pain was assessed using a “visual analog scale,” and healing outcomes were evaluated through peri-apical radiographs. Results: Post-operative pain levels were comparable between the single- and multiple-visit clusters at all time points. However, healing outcomes differed significantly, with a higher percentage of healed cases observed in the single-visit group compared to the multiple-visit group. Conclusion: While both single-visit and multiple-visit RCT protocols resulted in similar post-operative pain levels, the single-visit approach demonstrated superior healing outcomes. These findings emphasize the need for personalized treatment approaches based on patient characteristics and clinical considerations in endodontic practice.

Effect of supracrestal tissue height on marginal bone level changes at platform-switching dental implants placed crestally and subcrestally: A randomized clinical-trial

ObjectivesThe presence of insufficient peri-implant supracrestal tissue height (STH) may increase marginal bone resorption. This study aims to evaluate the effect of STH on marginal bone level changes (ΔMBC) in platform-switching posterior implants placed crestally and subcrestally. MethodsA total of 80 implants were included in this study. There were two main groups in the study; STH≤2 mm (A) and STH> 2 mm (B) and four subgroups according to the implant placement level, crestally (I) and subcrestally (II): A-I, A-II, B-I, and B-II. Intraoperatively, STH and placement depths of implants were measured from mesial and distal aspects. The mesial and distal peri-implant marginal bone levels were measured on periapical radiographs at immediately (T0), 6 months (T1), 9 months (T2), and 12 months (T3) after functional loading, and the difference between the marginal bone levels was calculated as the ΔMBC. ResultsStatistically significantly more mesial ΔMBC was detected in the A-I than in the B-I at the time of T0–T1. In the group with STH greater than 2 mm, the difference in ΔMBC between the crestally and subcrestally placements was not statistically significant. ConclusionsThis study was found that STH is effective at protecting the marginal bone in the early period, and in cases where the STH is insufficient, subcrestally placement may increase long-term implant success by preventing marginal bone loss from occurring beyond the implant shoulder. The clinical trial number is NCT05595746. Clinical significanceIn this study, it was demonstrated that an STH greater than 2 mm is important for marginal bone stabilization, regardless of crestal and subcrestal levels, and that subcrestally placement is beneficial in cases of insufficient STH.

Comparative evaluation of the accuracy of six different apex locators in working length determination of molars using intraoral periapical radiographs: An in vivo study.

One of the crucial steps in endodontic treatment is determining the working length (WL). There are various methods for performing this procedure, one of which is an electronic apex locator (EAL) measurement. The aim of this study was to determine the accuracy of six EALs, i.e.. Root ZX, Root ZX Mini, Propex PiXi, Innvopex-1, Woodpex III, and Raypex 6 for WL estimation in the mandibular first molars. The study included 180 root canals with symptomatic irreversible pulpitis, divided into six groups using different apex locators. WL determination was compared with intraoral periapical radiographs. Results were categorized as accurate, short, or long. The data were statistically analyzed. ROOT ZX had an accuracy of 96.7%, Root ZX Mini had an accuracy of 93.3%, PiXi had an accuracy of 90.0%, Innvopex-1 had an accuracy of 90.0%, Woodpex III had an accuracy of 86.7%, and Raypex 6 had an accuracy of 83.4%, respectively. There was a statistically nonsignificant difference between groups (P < 0.05). Newly developed apex locators, such as the Innvopex-1, have shown accuracy comparable to well-established EALs like the Root ZX. This highlights the importance of conducting more extensive, large-scale research to confirm and validate their effectiveness.

Impact of Interproximal Features on Marginal Bone Level Changes of Autograft, Allograft, and Xenograft after Functional Loading: A Retrospective Study

Abstract Aim: This study aims to investigate the marginal bone level changes (MBLCs) concerning interproximal features of posterior implant-supported single crowns using different bone grafts. Materials and Methods: This retrospective study included 27 patients requiring 46 dental implants using autograft, allograft, or xenograft between January 2007 and December 2016. MBLCs were assessed using digital periapical radiographs at 3 months (T1), 12–15 months (T2), and 21–24 months (T3) after prosthesis delivery. The influence of interproximal features, such as embrasure surface area, emergence angle, and horizontal distance to adjacent teeth/implants, was assessed. Secondarily, age, gender, diabetes and smoking, arch distribution, implant locations, implant characteristics, average gonial angle, antagonist type, clinical crown-to-fixture ratio, retention method, and nearby tooth/implant were considered. Wilcoxon signed-rank test, Mann–Whitney U tests, and Kruskal–Wallis tests were employed with statistical significance set at a P value of &lt;0.05. Results: The results revealed that mean MBLCs at T3–T1 were similar (autograft 0.5 ± 0.47 mm, allograft 0.51 ± 0.35 mm, and xenograft 0.57 ± 0.42 mm). There were significant increases in MBLCs associated with EA ≤ 30° in autograft (P = 0.04), and HD ≤ 3 mm in allograft (P = 0.03). Mesial/distal MBLCs showed no significant differences, except in cases with HD ≤ 3 mm in the distal area of autograft (P = 0.03). Regarding secondary factors, significant differences in MBLCs emerged between autograft and xenograft in the molar area (P = 0.03), and between premolar and molar areas within the xenograft group (P = 0.01). Conclusion: This study concludes that interproximal features, EA ≤ 30° and HD ≤ 3 mm, markedly influenced MBLCs for specific types of bone grafts. Furthermore, MBLCs exhibited a direct relationship with the posterior placement of dental implants.

Single-Piece Implant Systems and its Longterm Stability: An Evaluative Research.

The objective of this research was to compare the longstanding stability of single-piece implant systems to typical two-piece systems by analyzing patient records retrospectively. A retrospective examination of patient records from January 2010 to December 2020 was undertaken at the Department of Oral Implantology, University Hospital. The research included dental rehabilitation patients who got single- or two-piece implant systems. Patient demographics, implant features, surgical procedures, and follow-up results were extracted. Implant success rates, stability defined by resonance frequency analysis (RFA) utilizing Osstell ISQ®, and peri-implant bone loss evaluated by standardized periapical radiographs at baseline and follow-up visits were the main outcomes. The research involved 320 patients (160 per cohort). The average patient age was 52.7 years, with 55% men. The mandibular region received 65% of implants, and the maxillary region the rest. Single-piece cohort A had 94.6% implant success, and two-piece cohort B 96.2%. Implant success rates were similar between cohorts (P = 0.412). The mean ISQ scores were 72.4 ± 4.8 in cohort A and 74.8 ± 5.1 in cohort B (P = 0.086). Peri-implant bone loss was 1.8 ± 0.7 mm in cohort A and 1.4 ± 0.6 mm in cohort B (P = 0.031). Single-piece implant systems provide a stable and successful alternative to classic two-piece systems. However, patient selection, surgical technique, and monitoring are essential to reduce peri-implant problems and improve clinical results. To improve implant dentistry patient care and evidence-based clinical practice, single-piece and two-piece implant systems' design, biomechanical features, and longstanding performance should be studied.

Impact of passive ultrasonic irrigation on the outcome of non-surgical root canal treatment: a systematic review and meta-analysis of randomized clinical trials.

This systematic review aimed to assess the impact of Passive Ultrasonic Irrigation on the periapical healing rate of primary root canal treatment compared to conventional syringe irrigation. Registered a priori in the PROSPERO database, this review was conducted by two independent reviewers who performed an electronic search up to December 2023. The search included databases such as MEDLINE (PubMed), Scopus, Web of Science, Embase, LILACS, and the Cochrane Library, as well as grey literature. We included randomized clinical trials (RCTs) that focused on patients undergoing primary root canal treatments. The study compared intervention groups using PUI with control groups that did not use activation techniques. Periapical healing was assessed over follow-up periods of at least six months, utilizing either periapical radiographs or cone-beam computed tomography. To synthesize the findings, a meta-analysis and trial sequence analysis were conducted, employing the Relative Risk as the measure of effect, with a 95% confidence interval. The GRADE approach was utilized to assess the certainty of the evidence. The meta-analysis incorporated three RCTs, involving 474 patients (501 teeth). The analysis revealed that PUI led to a higher rate of periapical healing compared to CSI (Relative Risk: 1.10; 95% Confidence Interval: 1.01-1.21, I² = 0%), with moderate certainty of evidence. Despite the limited number of high-quality RCTs, the findings showed a positive impact of PUI on periapical healing rates in primary root canal treatments, in comparison to CSI. CRD42021290894.

Comparison of two CBCT analysis techniques with conventional periapical radiographs in assessment of tertiary dentin after indirect pulp capping in young permanent teeth

Comparison of two <scp>CBCT</scp> analysis techniques with conventional periapical radiographs in assessment of tertiary dentin after indirect pulp capping in young permanent teeth

Radiographic Errors in Intraoral Periapical Radiographs

Background: Radiographs are considered as pivotal aid in the diagnosis and treatment planning of various Oro-dental pathologies. Changes in the quality of radiographs may lead to misinterpretation, which results in incorrect diagnosis and treatment planning. The technical and processing errors can largely influence the radiographic interpretation. Both paralleling and bisecting angle techniques can have both technical and manual errors. Aims: To estimate the frequency of radiographical errors in conventional radiographs taken by undergraduate dental students. Materials And Method: Thousand (1000) dental radiographs taken by undergraduate students were examined. Patient's age ranged between 5 -75 years. X- ray films were examined on X-ray film viewer and were classified according to type of errors and anatomical distribution. Results: The study aimed to identify common faults encountered during routine radiography. The most frequently observed error was Improper Vertical Angulation. Interns performed better in obtaining radiographs compared to Final year students. Keywords: Radiographic errors, Dental students, Bisecting angle technique.

Effect of Cantilever Extension on Bone Loss in Mandibular Complete-Arch Implant-Supported Fixed Prostheses with Three and Four Implants.

To compare the peri-implant bone loss of mandibular complete-arch implant-supported fixed prostheses (FPSs) supported by three and four implants and to correlate with the size of the horizontal and vertical distal cantilever at prosthesis placement (T1) and after 1 year (T2). A total of 72 external hexagon (EH) type implants were placed in 20 participants. Of these, 24 supported an FPS with three implants (G3I) and 48 with four implants (G4I). The mandibular implants were named 1, 2, 3, and 4 according to their location in the arch, in a clockwise direction. Digital periapical radiographs were taken at times T1 and T2 for analysis and measurement of peri-implant bone loss. The horizontal and vertical distal cantilevers were measured with a digital caliper and correlated with peri-implant bone loss. The survival rate of implants in G3I was 91.66%, and in G4I it was 97.91%. The mean bone loss in G3I was 0.88 ± 0.89 mm, and in G4I it was 0.58 ± 0.78 mm (P = .225). There was no correlation between distal horizontal cantilevers and bone loss in the studied groups, with G3I being -0.25 (P = .197) and G4I -0.22 (P = .129). Larger vertical cantilevers of implants 1 (P = .018), 3 (P =.015), and 4 (P = .045) correlated with greater bone loss in G4I. The number of implants in an FPS did not influence peri-implant bone loss after 1 year of follow-up. Larger vertical cantilevers influenced greater bone loss in complete-arch implant-supported fixed prostheses supported by four implants.