Periapical Changes Research Articles

Assessment of the Need for Surgical Debridement of Periapical Tissues Among Patients of Older Age Groups as a Manifestation of Ageism

Endodontic therapy is aimed at cleaning the root canal system and creating barriers to prevent re-infection of roots and peripical tissues. The presence of persistent bacteria or reinfection of a previously mechanically treated and disinfected root system causes the development of apical periodontitis and the need to implement surgical aids. Against the background of an increase in the number of patients of older age groups, characterized by obliteration of the root canal system, the relevance of surgical aids for apical periodontitis increases. At the same time, based on their own life experience, patients of older age groups may perceive the refusal to perform orthodontic therapy and the offer of surgical benefits as age-related egoism. Purpose of work: to study the severity of periapical changes and indications for surgical intervention among patients of older age groups. Materials and methods. The endodontic and periapical status of 300 patients was assessed in the 1st subgroup aged 60 to 70 years and the 2nd subgroup aged over 71 years. The results of the study. The greatest number of ageist conclusions in assessing the feasibility of providing surgical benefits was revealed in women with higher education.

Incorporation of technology in endodontic treatment of a patient with chronic non-progressive encephalopathy: case report

Objective: This work aims to describe the endodontic treatment performed in a single session in a patient with chronic non-progressive encephalopathy under general anesthesia, using technological devices. Method: A 31-year-old male patient diagnosed with chronic non-progressive encephalopathy, sought dental treatment due to tooth pain. He presented ataxia, atrophy of the upper and lower limbs and involuntary spasms. In the intraoral examination a generalized excessive occlusal wear and temporary restoration on tooth 46 was seen. Periapical radiograph showed increased periodontal space and periapical bone rarefaction. The indication was for endodontic treatment of tooth 46 under general anesthesia. After surgical risk assessment and pre-anesthetic evaluation, endodontic treatment was performed under general anesthesia, using an apical locator, mechanized instrumentation and digital radiography. The tooth restauration was performed in the same clinical moment, without complications. Result: The 8-month follow-up showed absence clinical signs and symptoms and radiographic control without periapical changes. Conclusion: In this case, the incorporation of technology in the endodontic treatment of a patient with chronic non-progressive encephalopathy ensured a safe and effective treatment for the patient and the staff, with case resolution, promotion of oral health and quality of life.

Radiographic evaluation of teeth with pulp stones and pulp canal obliteration: characteristics, and associations with dental parameters

ABSTRACT The study aimed to radiographically assess the characteristics of pulp stones (PS) and pulp canal obliteration (PCO) in teeth and examined their associations with various dental parameters such as caries, restorations, periodontal status, and age. This cross-sectional observational study was conducted at the Faculty of Dentistry, King Abdulaziz University between September 2022, and May 2023, involved 101 patients exhibiting 402 teeth with PS or PCO. Data were collected from periapical and bitewing radiographs, and analyzed by two calibrated dentists. Multiple dental parameters were assessed, including caries level, presence and level of restorations, periodontal condition, and age of the patient. The study population consisted of 62 females and 39 males, with an age range of 18–65 years. Inter- and intra-examiner reliability were high (Kappa = 0.88 and 0.98 respectively). PS were more commonly found in molars (81.2%), while PCO were presented in only 115 teeth (23%). Age significantly affected the type of calcification (p < 0.001), with PS more common in the 20–30 age group and PCO more common in individuals over 40. Presence of caries was significantly associated with the type of calcification (p = 0.013), but restoration was not. The majority of teeth with PS (76%) or PCO (93%) had healthy periodontium. Around 40% of teeth with PCO showed signs of periapical changes, a finding significantly different from those with PS (p < 0.001). Pulp calcifications were significantly associated with various dental parameters, including caries presence, age, and periodontal status. The findings provide crucial insights into the epidemiology and aetiology of pulp calcifications.

Cone-beam computed tomographic evaluation of biodentine apexification for traumatized necrotic immature permanent incisors: One-year clinical study

Aim: The aim of this study was to assess the outcome of biodentine apexification for the management of traumatized immature teeth with necrotic pulp over a period of 12 months. Methods: Eighty-five human maxillary incisors with traumatized immature necrotic pulp in patients aged 10–50 years were selected for this study. Root canal treatment was initiated and the biodentine apexification procedure was performed in a single appointment for all teeth. Intraoral preoperative and postoperative periapical radiographs were used to assess periapical (PA) changes, changes in root length (RL), and radiographic root area (RRA). Preoperative and postoperative cone-beam computed tomography (CBCT) images were used to assess the three-dimensional (3D) volumetric changes. Patients were recalled at 12 months posttreatment for the evaluation of clinical symptom, percussion, and palpation examination. Descriptive statistics was computed for preoperative demographic, patient-centric data, and treatment success. Paired t-test was used to compare the preoperative and 12-month postoperative changes in RRA, RL, and 3D volumetric changes of the parameters. Results: Forty-eight out of the 49 teeth that completed the study were asymptomatic and functional. Comparing the preoperative and the 12-month review radiographs using the periapical index scores based on the size of the lesion, completely healed lesions were 79.16% while lesions in the process of healing were 20.83%. There was a significant (P &lt; 0.05) increase in RL (14.17%), RRA (40.87%), and dentin volume (26.63%). Conclusion: 3D volumetric analysis suggests that biodentine apexification has the ability to deposit hard tissue 3-dimensionally, and it is an effective alternative to the conventional apexification materials.

Changes in periapical status of root canal-treated teeth after head and neck IMRT: a retrospective study.

The objective of this retrospective study was to analyze the effect of the intensity modulated radiotherapy (IMRT) of the head and neck region on root canal-treated teeth and their periapical changes due to radiation. Patients undergoing IMRT of the head and neck region were evaluated. Different types of teeth (molars, premolars, incisors and canines) were compared. Panoramic and dental radiographs were used to assess the periapical region of root canal-treated teeth using the periapical index (PAI) before and after radiotherapy (RT) and put in relation to the radiation dose per tooth. Further parameters (patient-, therapy- and tooth-related factors) were included in this study. One hundred and twenty-four root canal-treated teeth (maxilla and mandible) of 51 patients were observed. A radiolucency in the periapical region was seen in 34.7% of the samples before IMRT and an increasing number of 46% after IMRT (p-value 0.092). Clinical or radiological signs of osteoradionecrosis could not be determined. The only statistically significant difference was detected in regions irradiated with less than 40 Gy (p-value 0.045). In regions irradiated with higher doses (>40 Gy), comparable pathologies increased in non-significant numbers. A statistically significant increase of periapical pathologies was detected in premolars of the maxilla. The observations reported here suggest that a high radiation dose during IMRT has no significant consequences on root canal-treated teeth. To compare the success of endodontic treatment before versus after IMRT, further research needs to be done.

EVALUATION OF OUTCOME OF FULL PULPOTOMY IN MATURE PERMANENT MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS

Objectives: To assess the outcome of full pulpotomy in patients with symptomatic irreversible pulpitis. Materials and Methods: This observational study was done at the Endodontics Department, Rehman College of Dentistry, Peshawar from April 2022 to April 2023. Eighty-four patients within the age range of 18-50 years with painful vital permanent molar were selected using purposive sampling. Full Pulpotomy procedure was performed. Treatment was completed in two visits. In the first visit, after taking an informed consent the tooth was anesthetized, and full pulpotomy was done. A cotton pellet soaked in 3% sodium hypochlorite (NaOCL) was used to achieve hemostasis. After achieving hemostasis, a 2-4mm of mineral trioxide aggregate was used to seal the root stumps and restored with glass ionomer cement. In the second visit, the glass ionomer cement was removed, and tooth was permanently restored using composite fi lling material. Outcome was evaluated in terms of pain and periapical changes at one week and six month post-operatively. The outcome was considered successful in case of no or mild pain and no periapical changes post-operatively. Data was entered using SPSS version 26.0. Results: In the present study 46.4% males and 53.6% females were included. The mean age was 34.04±10.524. Follow-up showed 95.2% success after one week and 89.3% after six months. No significant association of the outcome with age, gender and tooth type was found (p value &gt; 0.05). Conclusion: Full pulpotomy was successful in patients with symptomatic irreversible pulpitis.

Missed canal as a factor affecting the periapical status

Aim. To identify the relationship between the presence of a "missed" root canal and the periapical status.Materials and methods. 500 CBCT images of patients of both sexes were studied: 2915 teeth after endodontic treatment, of which 1549 were multicanal. Profile diagnostic criteria were used to identify the "missed" canal.Results. 518 "missed" root canals were revealed, which accounted for 33.4% of the number of multi-canal teeth. In 228 cases, changes in periapical tissues were noted, including 1 case of widening of periodontal ligament space, which accounted for 44% of the total number of "missed" canals. It was noted that the risk of developing apical periodontitis is higher for cases with "missed" canals (p &lt; 0.001). The relationship between the untreated canal and the periapical status is statistically assessed as medium or relatively strong, which confirms the relevance of accurate diagnosis of the anatomy and topography of the root canal system at all stages and by all available methods.Conclusions. In case of sufficient duration of observation, absence of symptoms, absence of periapical changes (radiologically) – repeated treatment for the purpose of endodontic treatment of the "missed" root canal is not justified. If there are changes in the periapical tissues, repeated endodontic intervention should be performed. In this case, preference should be given to endodontic re-treatment using a microscope.

Outcome of Direct Pulp Capping Using Calcium Hydroxide: A Long-term Retrospective Study

IntroductionThis retrospective study evaluated the long-term outcome of direct pulp capping in mature teeth using specific case selection and treatment procedures. MethodsTeeth with pulp exposure due to advanced caries and clinical diagnosis of reversible pulpitis were treated by direct pulp capping. Treatments were conducted over a period of 15 years by a single operator. Under magnification, caries was completely removed, the exposed pulp examined, and capped with either pure calcium hydroxide or a calcium hydroxide-based cement. The cavity was restored and the long-term outcome evaluated from 1 to >35 years. Teeth that were asymptomatic, responded to sensibility pulp tests within normal limits, and showed no radiographic periapical changes were categorized as success. Teeth with no response to pulp tests and/or showing radiographic evidence of apical periodontitis were classified as failures. The effects of independent variables (sex, age, symptoms, number and size of pulp exposures, bleeding time, capping material, bases used over the capping material, and final coronal restoration) on the outcome were evaluated. ResultsIn general, 225 teeth from 148 patients were available for follow-up examination in at least one of the evaluated periods. The success rate of the direct pulp capping procedure was 100%, 95%, 95%, 86%, and 89% at 1-, 5-, 10-, 20-, and 35-year follow-up examination, respectively. The main variable significantly affecting the treatment outcome in all follow-up periods was the quality/presence of coronal restoration (P < .001). Other isolated variables associated with the outcome included the size and number of pulp exposures at the 20-year follow-up, and the exposure size, capping material, and restoration type at the 35-year follow-up. Multiple regression analysis confirmed the results for exposure size (P < .05), and disclosed a higher proportion of failures at 5 years when varnish was used as the base. ConclusionsA very high success rate of the direct pulp capping with calcium hydroxide was observed, especially in the first 10 years following treatment. The main variable influencing the outcome was the quality of the coronal restoration.

The effectiveness of root canal treatment depending on used sealer

Objective – to determine the effectiveness of root canal treatment while using different groups of sealers based on a long-term result of radiological examination.Materials and methods. An analysis of the data of various types of X-ray examination (computed tomography, digital orthopantomography, and focused digital X-ray) of teeth where root canal treatment had been done using sealers based on zinc-oxide-eugenol or resorcinol-formalin (active sealers), or sealers based on epoxy resins (passive sealers) was performed. The radiological picture of 579 teeth, and 1120 roots, in particular, was evaluated based on radiological images of patients aged 18 to 68 years. Computer programs based on Microsoft Excel 2019 were used for the statistical processing of the research material.The results. Changes in periapical tissues were observed significantly less often when using sealers based on epoxy resins, on average at 27.42%. X-ray changes were absent for 21.92% more often when active sealers were used, which is probably due to a higher frequency of their use in the examined group of patients. It was found that in (62.67±3.95)% of cases, periapical changes were present when the level of obturation was more than 3 mm to the apex of the root and with the use of active sealers, while when using passive, periapical changes occurred significantly more often - in (82.43±4.42)%. It was determined that with preserved sealing of the orifice part, periapical changes were noticed in (55.71±3.43)% when using active sealers, while with broken sealing, these changes occurred more often - in (69.16±2.63)%. However, when using passive sealers and coronal leakage, periapical changes were only (30.84±2.63)%, which may indicate the high sealing properties of sealers based on epoxy resins.Conclusions. Periapical changes occurred significantly less often in the root canals of patients whose filling was performed with epoxy-based sealers, the absence of periapical changes was determined 27.42% more often than when using active sealers. At the obturation level of 3 mm and &gt;3 mm to the apex of the root canal, filling with active sealers gave better efficiency due to a significantly lower number of complications in the form of periapical changes. Periapical changes occur much more often when there is coronal leakage, mainly when active sealers are used and constitute (69.16±2.63)% of cases.

Components of the Effectiveness of Endodontic Treatment Based on Long-term X-ray Criteria

The objective of the research was to determine the effectiveness of obturation of the root canals and crown part of the teeth, and to identify the most important factors influencing its results, based on the X-ray examination.&#x0D; Materials and methods: The study was conducted at the Dental Center (University Clinic, Ivano-Frankivsk National Medical University). Evaluation of 140 orthopantomograms, computed tomograms and digital intraoral images of patient, aged 18-68 years with endodontically treated teeth, was made with the aim to determine the obturation state of root canals and the state of periodontal tissues. The radiological picture of 579 teeth and 1120 roots in particular was evaluated.&#x0D; Results: the state of apical constriction, the state of obturation of root canals, sealing conditions of coronal part of the tooth, the state of periodontal tissues were analyzed, compared and discussed.&#x0D; Conclusions: According to the results obtained in this study, the relationships between the presence of periapical changes and state of apical constructions, obturation level of filling material in roots canals, coronal leakage, and periodontal tissue changes were found.&#x0D; Keywords: periapical changes, endodontic treatment, coronal leakage, x-ray examination

The Changes in Size of Periapical Lesions after Root Canal Treatments Assessed by Digital Periapical Radiography and Cone-Beam Computed Tomography: A 2-Years Prospective Clinical Study.

Background and Objectives: There is limited information regarding comparison of long-term dynamics of periapical bone destruction estimated by digital periapical radiography (DPR) and by cone-beam computed tomography (CBCT). This study aimed to compare the radiographically assessed periapical changes of endodontically treated teeth over 2 years of follow-up and to analyse disagreements in periapical lesion size estimates around the same roots using DPR and CBCT. Materials and Methods: A total of 176 endodontically treated teeth, of 128 patients with apical periodontitis, were assessed by DPR and CBCT, at baseline and after 2 years. All periapical radiolucencies were categorised by severity (S0, S1, S2, S3) concerning their size. Descriptive statistics were used to report distribution of the radiolucencies at baseline and at follow-up, and their size transitions over 2 years. Site-specific comparison of the radiolucencies identified by two methods was performed using Z test and Pearson’s chi-square test. Results: majority of the detected radiolucencies were scored as S0: 65% and 68% at baseline; 89% and 83% at follow-up, by DPR and CBCT, respectively. Site-specific score comparison showed that disagreements comprised 18% and 20% of the total number of radiolucencies detected by DPR and CBCT, respectively. There were more disagreements between DPR and CBCT within categories S1 and S2 + S3 compared to S0: at baseline, they comprised 17–33% and after two years 62–95% of all detected radiolucencies within the category. 65% of non-matching score transitions over two years occurred between S0 and S1. The CBCT-based evaluation resulted in negative treatment outcomes for 10 more root canals than the DPR-based result. Conclusions: Most remarkable disagreement between DPR and CBCT recordings was observed within the radiolucency categories S2 and S3. However, the diagnostic accuracy of both radiographic methods was questionable as it resulted in a high proportion of non-matching S0-S1 lesion transitions over 2 years.

Long term outcomes of en-block autotransplantation of a tooth.

Repositioning of impacted teeth in the dental arch through en-bloc autotransplantation showed short-term efficacy of 89%. The objective of this study was to evaluate the technique for long-term efficacy. The analysis involved 23 teeth transplanted to the alveolar ridge through harvesting the tooth with the adjacent bone tissue. Development of the root was completed and the apical foramen was closed in all the teeth. The teeth were examined clinically and radiologically (CBCT) and compared to contralateral ones. The obtained data were analysed statistically. The efficacy of the procedure amounted to 81% including two teeth lost at an early stage and another two lost during follow-up. The mean age of patients upon performing the procedure was 29.8. The long-term follow-up amounted to the mean of 34.3months. In the study group recession of 1-2mm as well as 3-5mm was found, which was not noted on the control group. In 11.1% of the study group teeth the external root resorption was observed. No transplanted tooth underwent root canal treatment, no periapical changes were observed at CBCT and 77.8% of those showed positive reaction to ethyl chloride. One case of ankylosis was observed in tooth 11 and in two cases increased mobility of the transplanted tooth was found. Regeneration of nerves as well as revascularization in the en-bloc autotransplantation proceeded with high predictability and the risk of ankylosis of the treated tooth seemed to be negligible. Gingival recession was observed more often in case of en-bloc transplantation compared to the control group. The long-term follow-up suggested that this the technique does not prevent external resorption in 100%.

ОБРАБОТКА КЛКТ-ДАННЫХ ИСКУССТВЕННЫМ ИНТЕЛЛЕКТОМ ПРИ ДИАГНОСТИКЕ КАРИЕСА И ЕГО ОСЛОЖНЕНИЙ

Over the past few years, artificial intelligence (AI) technologies have been actively used in many areas of medicine, including dentistry. &#x0D; The aim of the study is to determine the diagnostic value of IS in the detection of caries and its complications according to cone beam computed tomography (CBCT) data in comparison with clinical examination. &#x0D; Materials and methods. CBCT images of 15 patients with carious and periodontal lesions were analyzed by an experienced dentist, who also specializes in radiology, and the Diagnocat AI software. The dentist also performed a visual examination of these patients. &#x0D; Results. Most of all contact caries were determined using AI (n = 20), and occlusal caries − during clinical examination (n = 10). The greatest number of periapical changes was also detected using IS (n = 22). The difference between the indicators of detection of pathological foci in the assessment of IS and the radiologist was statistically insignificant, which indicates the equivalence of these methods. X-ray image evaluation revealed more contact caries compared to clinical examination (14 vs. 7, p &lt; 0.05), but clinical examination was superior in detecting occlusal caries (10 vs. 2, p &lt; 0.03). Periodontal disease was more accurately diagnosed by X-ray (17 vs. 9, p &lt; 0.05). The average time for evaluation of CBCT images by a radiologist was 21.54 ± 4.4 minutes, and the AI completed the report in 4.6 ± 4.4 minutes from the moment the loading of CBCT was completed (p &lt; 0.01). &#x0D; Conclusion. The use of AI technologies in the analysis of CBCT images can improve the accuracy of diagnosing caries and its complications by up to 98%, as well as significantly speed up the time for making a diagnostic decision.

Dental and Endodontic Management in a Patient with Familial X-Linked Hypophosphatemic Rickets

The term rickets refers to insufficient or retarded mineralization of the osteoide matrix. X-linked hypophosphatemic (XLH) rickets is a rare genetic disorder characterized by biochemical changes in bone mineralization due to inactivation of the phosphate regulating gene and primary defect of the osteoblasts. The aim of this article was to report a clinical case of XLH, its oral manifestations, periapical changes and dental management. A 31-year old woman female patient was referred to the school of dentistry with pain and sensitivity in the teeth. She had a childhood history of rickets, hypophosphatemia and alteration in Vitamin D. In the oral exam, enamel hypoplasia, microdontia, fistula, caries and periapical lesions and periodontal disease were diagnosed. The radiographic and tomographic exams exhibited the presence of periapical lesions involving various teeth with radiolucent images, suggestive of granuloma or periapical cysts. The treatme nt prioritized the urgency of eliminating pain and removing the foci of infection. Endodontic treatment began in the teeth that had fistula or periapical lesions and in parallel, oral hygiene guidance was provided and periodontal treatment was performed. There was an improvement in the clinical condition with reduction in inflammation and mobility of the teeth. Dentists and health professionals must evaluate the patient as a whole, considering the relations between systemic and oral health. Knowledge of systemic diseases associated with rickets and their characteristics is essential for making a correct oral diagnosis and planning the dental treatment.

Influence of Periapical Lesion on Healing in Sinus after Endodontics

Abstract Objective The goal of primary and secondary endodontic treatment is to eliminate the cause of inflammation inside the tooth and in the surrounding tissues. When the inflammation from the root canal system of the tooth spreads beyond the apex of the root, periapical changes in the bone tissue and, in the case of upper premolars and molars, inflammatory changes in the Schneider membrane may occur. Materials and Methods In a retrospective documentation analysis of root canal treatments, three-dimensional (3D) computed tomography images before and after endodontic treatment were assessed to measure the thickness of the Schneider membrane. Forty-five endodontically treated patients aged 21 to 62 years were enrolled in the study. Inflammation of the maxillary sinus was considered when the Schneider membrane was thicker than 2 mm. Statistical analyses were performed with Statistica 12 by StatSoft and StatXact by Cytel using the Shapiro–Wilk test, Student's t-test, and the Mann–Whitney test. Results Out of 12 comparisons between variables, only 3 comparisons were significant. There was a relationship between the treatment effect (reduction in maxillary sinus inflammation 3 months after treatment) and the maximum height of the Schneider membrane (p = 0.004). There was a relationship between the presence of a periapical lesion and the minimum height of the Schneider diaphragm (p = 0.02), and there was a relationship between the presence of a periapical lesion and the maximum height of the Schneider diaphragm (p = 0.04). Conclusion Primary and secondary root canal treatments of maxillary premolars and molars reduce the inflammation of the maxillary sinus 3 months after treatment.

Management of pulp canal obliteration using static-guided endodontic technique: Case series

The present case series aims to describe the management of teeth with pulp canal obliteration (PCO) using the novel static-guided endodontic technique. Traumatic dental injury may result in partial or complete PCO, with and without periapical rarefaction and pose challenges during endodontic management. Three young adolescent patients presented to the department with a chief complaint of pain/discoloration/broken upper front teeth. The teeth were tender on percussion. Thermal and electrical pulp tests were negative for the concerned incisors. The periapical radiographic examinations revealed PCO and signs of periapical changes. A diagnosis of pulp necrosis; symptomatic apical periodontitis was established and nonsurgical endodontic treatment using the guided endodontic approach was planned with the patient consent. A cone-beam computed tomography (CBCT) scan and intraoral scanning were obtained using the special software to facilitate guided endodontics procedure. The surgical guides and a customized drill were fabricated. The drilling depth for the access to the calcified part was established using CBCT data, ensuring straight-line access. Conventional root canal treatment was completed. One-year follow-up examination revealed the absence of pain and periapical healing. In complicated cases with PCO and apical periodontitis, a CBCT and “Guided Endodontics” could be useful to save the tooth with minimal destruction of tooth structure and increase the chances of endodontic success.

Pulpal and Periapical Status of the Vital Teeth Used as Abutment for Fixed Prosthesis-A Systematic Review and Meta-Analysis.

This is a systematic review to identify the incidence of pulp necrosis and/or periapical changes among vital teeth which are used as an abutment for crown and fixed partial dentures (FPDs). Two reviewers independently searched two electronic databases, PubMed and Scopus. The search was complemented from references of included studies and published reviews. Studies published in the English language through January 2021 that had assessed and documented the clinical and radiographic failure of crown or FPD in vital permanent teeth due to pulpal or periapical pathology with a follow-up of at least 12 months were selected. Data screening, data collection and extraction of data was performed. Quality of studies involved was analyzed using the Newcastle-Ottawa Quality Assessment Scale for cohort studies. Meta-analysis was done using random effects model. Publication bias was assessed using funnel plots. Electronic searches provided 10,075 records among which 20 studies were selected for systematic review and 7 studies were selected for meta-analysis. With respect to quality assessment, all the studies involved were considered as high quality as the score in scale ranged between 6 and 9 as per the Newcastle-Ottawa Quality Assessment Scale for cohort studies. The meta-analyses showed that there was no statistically significant difference in the incidence of the loss of pulp vitality or pulp necrosis through clinical and radiographic examination with the follow up period of 5 years: p < 0.001, 95% CI: 0.96-1.00, I2 = 77.84%; 10 years: p < 0.001, 95% CI: 0.88-0.95, I2 = 93.59%; 15 years: p < 0.001, 95% CI: 0.92-0.96, I2 = 94.83%; and 20 years: p < 0.001, 95% CI: 0.94-0.96, I2 = 95.01%. The meta-analysis revealed clinical and radiographic success rate ranging between 92% to 98% at different follow up periods ranging between 5 years and 20 years. Future high-quality randomized clinical controlled trials with a larger population are required to confirm the evidence as only observational studies were considered in this paper.

Prognostic validity of the Periapical and Endodontic Status Scale for the radiographically assessed 2-year treatment outcomes in teeth with apical periodontitis: a prospective clinical study

BackgroundEndodontic treatment planning and treatment success evaluation are largely based on radiographic assessment of anatomical and treatment-related parameters of teeth with apical periodontitis (AP). This prospective clinical study aimed to assess radiographically the 2-year endodontic treatment outcomes for teeth with AP, and to evaluate prognostic validity of Periapical and Endodontic Status Scale (PESS).MethodsA total of 128 patients, representing 176 teeth with AP were examined by cone-beam computed tomography at baseline and at 24 months after endodontic treatment. Treatment outcome was evaluated using estimates of periapical radiolucency and the relationship between anatomical structures and location. The strength of the associations between these and treatment-related parameters was tested by logistic regression analysis. PESS sensitivity and specificity were calculated for every treatment risk group (low, moderate, high) of teeth.ResultsOne hundred and fifty-seven teeth, representing 350 root canals had a positive treatment outcome, while 19 teeth, representing 53 root canals had a negative treatment outcome at 24 months. The probability of negative outcome was 25 times higher in the moderate/high-risk group than in the mild-risk group of teeth (OR = 25.1; 95%CI [12.2–51.5]). Pre-treatment complications and retreatment cases with radiolucency were associated with negative outcomes (OR = 35.9; 95%CI [12.6–102.4]; OR = 26.437; 95%CI [10.9–64.1], respectively). PESS sensitivity and specificity was over 80% in all risk groups except for high risk group, due to very low number of cases.ConclusionsEndodontic treatment outcome depends on the severity of periapical changes. The presence of complications and retreatment cases with periapical lesions are associated with negative treatment outcome. The PESS is a valid instrument to predict outcome of teeth with low-moderate treatment risk of AP.

Interexaminer Agreement in the Radiologic Identification of Apical Periodontitis/Rarefying Osteitis in the National Dental Practice-Based Research Network PREDICT Endodontic Study

IntroductionPeriapical images are routinely made in endodontics to support diagnosis and treatment decisions, but conventional imaging may not readily demonstrate inflammatory changes. This study aims to quantify disagreement in the radiologic interpretation of apical periodontitis/rarefying osteitis between 2 expert examiners and to determine if differences exist based on anatomic location. MethodsWe used 1717 pretreatment periapical images made before orthograde endodontic treatment as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted within the National Dental Practice-Based Research Network. Periapical changes were assessed independently by 2 board-certified specialists, an oral and maxillofacial radiologist and an endodontist, blinded to other clinical information. If the examiners disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was justified, an adjudication was made by a third examiner. ResultsThe overall prevalence of this radiologic diagnosis in the periapical images was 55%, and interexaminer agreement measured with the Cohen kappa statistic was calculated to be 0.56 (95% confidence interval, 0.52–0.60). Diagnostic disagreements between the 2 examiners occurred for 377 teeth (22%), with disagreements more frequent for jaw location (P = .038) and tooth type (P = .021). Differences between root number (P = .058) and jaw location and tooth groups (P = .069) were found not to be statistically significant. ConclusionsThe variability of diagnostic disagreements across anatomic location and tooth type may reflect the inability of periapical images to reveal bone changes masked by the complexity and density of overlying anatomic structures, a limitation that could potentially be overcome with the use of 3-dimensional imaging.

Avaliação dos critérios de diagnóstico das doenças pulpares e periapicais realizados pelos cirurgiões-dentistas da atenção básica do Município de Arcoverde/PE

O diagnóstico correto é o ponto chave no tratamento de qualquer enfermidade evitando imprevistos, complicações e agravos. Na endodontia, o diagnóstico das patologias pulpares e periapicais são realizados na atenção básica odontológica do serviço público brasileiro de saúde. Visando a melhoria do serviço de saúde bucal, este estudo teve como objetivo avaliar a conduta dos cirurgiões-dentistas do município de Arcoverde\PE no diagnóstico das alterações pulpares e periapicais. Foi realizado um estudo quantitativo-descritivo, por meio de questionário online aplicado aos profissionais das Unidades Básicas de Saúde. Após organização e categorização, os resultados obtidos revelaram que a maior parte dos profissionais são pós-graduados (88,9%), concursados (77,8%) e possuem menos de 3 anos de atuação na atenção básica do município de Arcoverde (66,66%). Existe alta frequência do diagnóstico das alterações pulpares e periapicais nas UBSFs (39,74%). Os profissionais se considerarão aptos para o reconhecimento da maioria dos aspectos clínicos das doenças pulpares e periapicais (85,47%) e para o diagnóstico endodôntico (61,11%). Apenas 36,56% foi a média de acertos para a identificação das características clínicas, 35,07 % dos aspectos radiográficos e 35,69% das respostas aos testes semiotécnicos. De acordo com a metodologia empregada, pode-se concluir que a maioria dos cirurgiões-dentistas da atenção básica do município de Arcoverde/PE possuem conhecimento insuficiente e utilizam de forma deficiente os critérios de diagnóstico das doenças pulpares e periapicais.