Periapical Radiolucent Lesions Research Articles

Transient Apical Breakdown: Incidence, Pathogenesis, and Healing.

Transient apical breakdown (TAB) is a phenomenon that indicates temporary apical periodontal destruction and root resorption after tooth luxation injuries, followed by the healing process of the dental pulp. Andreasen in 1986, reported that TAB was seen in approximately 4.2% of all luxation injuries. However, there have been no reports thereafter on the types and frequency of the luxation traumatic injuries in which TAB occurs. Therefore, this retrospective study was aimed to assess the incidence and pathogenesis of dental trauma-induced TAB and to suggest a possible mechanism of subsequent healing based on a series of cases. Data analysis included mature teeth (n = 56) of 49 patients aged 9-30 years who presented in a private dental office over a period of 10 years (2012-2022) to investigate the incidence and healing sequala of TAB. TAB was observed in 43.8% of subluxation, 62.5% of extrusive luxation, and 75% of lateral luxation injuries. The average age of patients who developed TAB was 14.5 years, ranging from 9 to 28 years old. TAB can be expected in many cases of luxation injuries with minimal dislocation. Therefore, mild injuries (subluxation, extrusion, and lateral luxation), may exhibit spontaneous healing, recovery of dark discoloration of the crown, disappearance of a periapical radiolucent lesion and return to normal response to EPT as long as 12 months after the traumatic injury. Thus, a decision to perform endodontic treatment in these cases might be postponed until clear evidence for an infection exists.

Machine learning and deep learning models for the diagnosis of apical periodontitis: a scoping review.

To assess the existing literature on the use of machine learning (ML) and deep learning (DL) models for diagnosing apical periodontitis (AP) in humans. A scoping review was conducted following the Arksey and O'Malley framework. The PubMed, SCOPUS, and Web of Science databases were searched, focusing on articles using ML/DL approaches for AP diagnosis. No restrictions were applied. Two independent reviewers screened publications and charted data in predefined Excel tables for analysis. Nineteen publications focused on diagnosing AP by identifying periapical radiolucent lesions (PRLs) in dental radiographs were included. The average sensitivity and specificity for reviewed models were 83% and 90%, respectively. Only three studies explored the direct impact of artificial intelligence (AI) assistance on clinicians' diagnostic performance. Both consistently showed improved sensitivity without compromising specificity. Significant variability in dataset sizes, labeling techniques, and algorithm configurations was noticed. Findings affirm AI models' effectiveness and transformative potential in diagnosing AP by improving the accurate detection of periapical radiolucencies using dental radiographs. However, the lack of standardized reporting on crucial aspects of methodology and performance metrics prevents establishing a definitive diagnostic approach using AI. Further studies are needed to expand AI applications in AP diagnosis beyond radiographic analysis. AI can potentially improve diagnostic accuracy in AP diagnosis by enhancing the sensitivity of PRL detection in dental radiographs without compromising specificity.

Surgical Management of Radicular Cyst with the Application of a Natural Platelet Concentrate and Ostoden: A Case Report

ABSTRACT The most frequent cystic lesions that affect the jaw are radicular cysts. The current case report describes the surgical management of a radicular cyst in the periapical region of maxillary central and lateral incisors, and highlights the efficacy of natural platelet concentrate [platelet-rich fibrin (PRF)] along with Ostoden bone graft material used for postoperative healing. A 46-year-old male patient presented to the department with swelling in the palatal aspect of the maxillary anterior region. On radiographic examination, a radiolucent periapical lesion was evident in relation to the left maxillary central and lateral incisor. In the maxillary anterior region, root canal therapy was performed, followed by periapical surgery, and PRF with Ostoden bone graft was placed in the surgical site to initiate the healing at a faster rate. The patient was recalled at follow-ups after 7 days, 3, 6, and 9 months. No symptoms such as pain, inflammation, or discomfort were observed during the review period.

A Literature Review on Dental Disease Diagnosis

Artificial intelligence (AI) has emerged as a transformative technology in various fields, including dentistry. This literature review provides an overview of recent research papers that explore the application of AI in dentistry and its impact on clinical practice. The selected papers cover a wide range of topics, including dental disease detection, dental imaging analysis, dental education, and diagnostic accuracy assessment. In the domain of dental disease detection, the use of AI algorithms has shown promising results in automating the detection of dental pathologies such as caries, periodontal diseases, and lesions. These algorithms have the potential to improve accuracy, enable early intervention, and enhance treatment planning. Furthermore, the integration of AI in dental imaging analysis has enabled advanced image interpretation and segmentation. Studies have demonstrated the effectiveness of AI algorithms in analyzing panoramic radiographs, cone-beam computed tomography (CBCT), and intraoral radiography, leading to improved identification of dental conditions such as root fractures and periapical radiolucent lesions. Moreover, the integration of AI in dental education has revolutionized the learning experience. Virtual reality simulations, computer-assisted learning, and AI-based assessment tools have enhanced student engagement, skill acquisition, and curriculum updates.Overall, this literature review highlights the potential of AI in transforming dentistry. The selected papers contribute to the growing body of knowledge on AI applications in dentistry and pave the way for further research and advancements in this field. The integration of AI has the potential to revolutionize dental practice, improve diagnostic accuracy, optimize treatment planning, and elevate the quality of patient care.

The Incidence of Retrograde Peri-Implantitis in a Single University Dental Hospital Training Center: A Retrospective Analysis

Background and objective: Retrograde peri-implantitis (RPI) is a periapical radiolucent lesion developed around the implant apex. This study aimed to investigate the Incidence of RPI in a single university dental hospital training center. Materials and Methods: All records of patients who received single Implants between 2016-2020 were screened. For cases that met inclusion criteria, clinical and radiographic data were analyzed. Results: A total of 215 were included and categorized as follows, Category A: implants were placed next to endodontically treated teeth (n = 58, 27%); category B, implants placed at the sites with previous endodontic involvement within 6 months of tooth extraction (n = 25, 11.6%); Category AB: implants placed at sites that fulfill the criteria of groups A and B (n = 18, 8.4%); and Category C: Implants that were placed next to vital teeth and at a site with no previous endodontic treatment or a site that was allowed to heal for more than six (n = 114, 53%). Categories A, B and AB served as the endodontically involved (EI) group, while category C served as non- endodontically involved (NEI) group. Only two sites (0.9%) were confirmed as RPI, both from group A (3.4%). Comparing all groups studied showed no statistically significant difference in RPI incidence. Conclusions: The incidence of RPI is low; however, endodontically treated teeth with periapical lesions (PALs) next to an implant site could contribute to RPI.

NON-SURGICAL TREATMENT OF A TRAUMATIZED TOOTH WITH PERIAPICAL INJURY AND IMMATURE APICE USING MTA AS AN APICAL BARRIER: A CASE REPORT

A clinical case is described of a 17-year-old patient who suffered a trauma at the age of 8, compromising the upper right incisor, which prevented complete apical closure and the presence of a periapical lesion. The patient reports having interrupted the root canal treatment one year ago, in the diagnostic periapical radiograph the endodontic treatment already started is confirmed and temporary crown filling material is observed, the presence perhaps of calcium hydroxide inside the root canal, incomplete apical formation and a periapical radiolucent lesion. Root canal treatment was resumed using K-type manual files until reaching a #140 apical caliber, 5.25% sodium hypochlorite was used as irrigant, Ultrapex (Ca(OH)2 + Iodoform) was placed as intracanal medication for several months. Two years after resuming treatment, the patient was asymptomatic, and in the control periapical radiograph it was possible to observe the considerable decrease in the periapical lesion, therefore it was decided to obturate using the classic lateral condensation technique, AH Plus sealant and previous at this stage, 4mm of MTA was placed as an apical barrier. Conclusions The importance of using intracanal medication in situations of dental necrosis with a periapical lesion of considerable size is shown through this clinical case. This case was caused due to dental trauma which, as we know, can evolve in very different ways and in many situations the dental prognosis ends up being very unfavorable. In addition, because it is an immature apex, the use of an MTA apical barrier was essential for containing the filling materials to avoid their extrusion into the periapical tissues and ensuring a better sealing in the apical third.

Foreign Body Granuloma in the Maxillofacial Region: Report of an Unusual Case

This paper aimed to present a clinical case presenting an unusual periapical radiolucent lesion, its approach and treatment, and as an element of differential diagnosis in periapical pathology. Foreign body granuloma (FBG) is a tissue reaction that is triggered by the deposit of a foreign material affecting the skin and internal organs that the immune system tries to delimit and, if possible, eliminate. FBG may constitute a complication of a surgical procedure or a new pathology for the patient, which precedes an iatrogenic event causing diagnostic difficulties. This study presented an unusual periapical radiolucent lesion in a male patient with a periapical radiolucent area found in panoramic radiography; the lesion was enucleated, histopathologically confirming an FBG, which was the result of a biomaterial used in surgery for nasal polyps and deviated septum performed years before. This case shows us a very unusual presentation of an FBG within the maxillary bone after surgery for nasal polyps and deviated septum. The appropriate use of the available imaging tools and histopathological study and interpretation is emphasized, to be able to carry out a successful long-term treatment with the lowest chances of recurrence. In addition, an interdisciplinary approach is very important, which leads us to the comprehensive treatment of the patient. The proper use of diagnostic and imaging methods that we currently have, as well as knowledge of differential diagnoses, is essential to successfully diagnose and treat injuries in the maxillofacial area.

Automatic Detection of Periapical Osteolytic Lesions on Cone-beam Computed Tomography Using Deep Convolutional Neuronal Networks

IntroductionCone-beam computed tomography (CBCT) is an essential diagnostic tool in oral radiology. Radiolucent periapical lesions (PALs) represent the most frequent jaw lesions. However, the description, interpretation, and documentation of radiological findings, especially incidental findings, are time-consuming and resource-intensive, requiring a high degree of expertise. To improve quality, dentists may use artificial intelligence in the form of deep learning tools. This study was conducted to develop and validate a deep convolutional neuronal network for the automated detection of osteolytic PALs in CBCT data sets. MethodsCBCT data sets from routine clinical operations (maxilla, mandible, or both) performed from January to October 2020 were retrospectively screened and selected. A 2-step approach was used for automatic PAL detection. First, tooth localization and identification were performed using the SpatialConfiguration-Net based on heatmap regression. Second, binary segmentation of lesions was performed using a modified U-Net architecture. A total of 144 CBCT images were used to train and test the networks. The method was evaluated using the 4-fold cross-validation technique. ResultsThe success detection rate of the tooth localization network ranged between 72.6% and 97.3%, whereas the sensitivity and specificity values of lesion detection were 97.1% and 88.0%, respectively. ConclusionsAlthough PALs showed variations in appearance, size, and shape in the CBCT data set and a high imbalance existed between teeth with and without PALs, the proposed fully automated method provided excellent results compared with related literature.

Impact of systemic health on treatment outcomes in endodontics.

The healing of periapical lesions after root canal treatment (RCT) is not the result of the curative action of the treatment. The process of healing begins with inflammation, and is resolved by the clearance of the immunogen that induces the immune response. Then, the periapical tissue itself carries out the healing of the periapical lesion, by repair or by a combination of repair and regeneration, depending on the host's reparative response working properly. The ultimate objective of RCT is to achieve wound healing by removing the source of bacterial antigens and toxins, allowing chronic inflammatory tissue to become reparative tissue. Some systemic conditions increase the susceptibility of the host to infection or impair the tissue reparative response, maintaining the inflammatory process and periapical bone resorption after RCT. This can cause the failure of RCT and even the need for extraction of the affected tooth. To analyse the scientific literature on the possible influence of systemic conditions on the treatment outcomes in endodontics, as well as to discuss the biological mechanisms that may be involved. The search was carried out in PubMed, SCOPUS and EMBASE. The inclusion criteria established were original scientific articles reporting data about some systemic condition in relation to treatment outcomes in endodontics, including clinical studies and studies carried out in animal models. Systemic factors (age, nutrition, stress, hormones, smoking habits), and systemic diseases, such as diabetes, cardiovascular diseases, osteoporosis, HIV infection, inflammatory bowel disease, and others, can influence or interfere in the repair of periapical tissues after RCT. Some of these systemic diseases can alter bone turnover and fibroblast function, preventing or delaying periapical wound healing. Others can alter the microvasculature, reducing nutrients and oxygen supply to periapical tissues. As a result, these systemic conditions can decrease the success rate of RCT and provoke incomplete wound healing (typically granulomatous tissue formation) in the periapical region. The results of this narrative review show worse success rate of RCT, with higher percentage of postoperative radiolucent periapical lesions and higher proportion of non-retained teeth (RFT), associated with several systemic conditions, such as smoking habits and diabetes.

Evaluation of Infection and Effective Factors in Impacted Mandibular Third Molar Surgeries: A Cross-Sectional Study.

Materials and Methods This cross-sectional study was performed on 148 patients. The incidence of infection was recorded one week, two weeks, and one month after surgery. Independent variables included age, gender, the presence of periapical radiolucent lesions measuring ≥3 mm, the caries of the adjacent second molar, education level of the surgeon, difficulty index, suture type, and flap type. The outcome variable was the incidence of infection. Results Among the study subjects, 37.2% were male and 62.8% were female. The mean age was 25.24 ± 4.31 years at the time of surgery. Although early onset infection occurred in 3.4% of patients, none of them developed a delayed-onset infection during the four weeks after surgery. Pederson difficulty index (OR = 3.81, P=0.03) and the education level of the surgeon (OR = 0.14, P=0.021) were associated with postop infection. Conclusions Based on the results of the current study, postop infection was rare. Furthermore, both the Pederson difficulty index and the education level of the surgeon could predict the risk of infection after impacted mandibular third molar surgeries.

Periapical and endodontic status of patients with inflammatory bowel disease: Age- and sex-matched case-control study.

AimCrohn's disease (CD) and ulcerative colitis (UC) are two chronic recurrent inflammatory processes of the gastrointestinal tract, grouped under the name inflammatory bowel disease (IBD), causing clinical episodes of intestinal inflammation. The aim of this study was to investigate the possible association between IBD and the prevalence of apical periodontitis (AP) and root canal treatment.MethodologyA case–control study design matched to age and sex was used. The study group (SG) included 28 patients with IBD (13 with CD, 15 with UC). Another 28 healthy subjects, without IBD and age‐ and sex‐matched, were included in the control group (CG). Radiographic records were analysed and AP was diagnosed as radiolucent periapical lesions (RPLs), using the periapical index score. Student's t‐test, χ2 test and multivariate logistic regression were used in the statistical analysis.ResultsIn the CG, only 17 subjects (61%) had at least one tooth with AP, whilst in the SG group they were 23 patients (82%; OR = 2.98; 95% CI = 0.87–10.87; p = .08). The number of subjects with one or more root filled teeth (RFT) in the CG was 14 (50%), whilst in the SG they were 22 (79%; OR = 3.67; 95% CI = 1.14–11.79; p = .026). At least one RFT with AP was evident in three subjects (10.7%) in the CG, whilst in the SG 15 patients (53.6%) showed RFT with AP (OR = 9.60; 95% CI = 2.35–39.35; p = .001). In the multivariate logistic regression analysis, only endodontic status was found to be associated with IBD (OR = 1.86; 95% CI = 1.24–2.80; p = .003).ConclusionIBD, UC and Crohn’s disease are associated with higher prevalence of RFT and higher percentage of RFT with periapical lesions. Dentists should consider these findings when caring for IBD patients by monitoring the evolution of periapical lesions of endodontically treated teeth.

Guided endodontic access of severe calcified tooth without incisal edge case report

Pulp tissue may suffer calcification because of trauma, operative procedures or carious lesions. This paper aimedto report and discuss the guided endodontic access as an alternative treatment. A 52 years old female patient hadsevere root canal calcification of tooth #11 associated with a radiolucent periapical lesion. Firstly, the crown andmetal post and core were removed. A digital impression and cone-beam computed tomography “CBCT” scanswere performed and imported to implant planning software (SimPlant Version 11; Materialise Dental, Leuven,Belgium).The guided endodontic access template was designed to allow the drill to reach a distance of 2 mmshort of the apical foramen, once printed, it was tested in the mouth to evaluate its insertion and stability in thedental arch. The calcified root canal was penetrated using the access drill rotating by a low-speed hand-piece(10,000 rpm) under saline solution irrigation through advancing movements. Then, the apical foramen wasnegotiated with C-Pilot files #10 and #15. The working length was measured using the iPex-II apex locator.The instrumentation was carried out with Reciproc R50 and 2.5% sodium hypochlorite. One week later, a fullceramiccrown preparation was performed, and polyvinyl siloxane impression was carried out. A total of threefollow-up sessions were performed after one week, one and twelve months. Bone neoformation was observed inthe site of the periapical lesion and the patient had no signs or symptoms of any discomfort. Therefore, guidedendodontics is indicated for severe calcified root canals.KEYWORDSGuided endodontics; Calcified root canals; Access cavity.

Successful regenerative endodontic treatment in a tooth with incomplete root apex and posttreatment apical periodontitis: A case report

This case report describes the procedure and outcome of regenerative endodontic treatment (RET) in a tooth with incomplete root apex and posttreatment apical periodontitis. A 44-year-old patient was referred to the endodontist because of a periapical lesion on tooth #21 and a recent episode of acute periapical abscess. On clinical and radiographic examination, this tooth presented with tenderness to percussion and palpation, periapical radiolucent lesion, external apical resorption, and incomplete apex formation. After coronal access, the filling material was removed, and the canal was gently prepared with hand files, using 1% NaOCl as the main irrigant followed by final irrigation with 17% EDTA, activated with XP-endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The root canal was filled with a double antibiotic paste with ciprofloxacin and metronidazole (1:1). After three weeks, RET was performed by stimulating bleeding into the canal, and when a clot was formed, a bioceramic (EndoSequence BC Sealer, Brasseler USA, Savannah, GA) plug was placed on it, followed by coronal restoration. The tooth remained asymptomatic since RET was concluded. Clinical and radiographic follow-ups showed complete repair of the apical periodontitis lesion and the absence of symptoms after eight months. This satisfactory outcome was confirmed after 34 months. Key words:Bioceramic material; ciprofloxacin; metronidazole; persistent apical periodontitis; regenerative endodontic treatment.

Clinicopathological study of periapical scars

Background/purposePeriapical scar (PS) is an alternative healing process with the formation of scar tissue after appropriate endodontic treatments/retreatments with or without periapical surgeries. This retrospective study evaluated the clinical, radiographic, and histopathological features of 7 PSs. Materials and methodsThe clinical, radiographic, and histopathological data of 7 PSs were collected and analyzed. ResultsThe 7 PSs were taken from the maxilla (3 cases) and mandible (4 cases) of 3 men and 4 women. The most frequently involved teeth were maxillary or mandibular incisors (4 cases) and first or second molars (3 cases). Of 7 PS patients, 6 had none of symptoms, 5 had previous nonsurgical endodontic treatments/retreatments, and 2 had previous endodontic treatments/retreatments plus periapical surgery. Radiographically, all 7 PS cases presented as a persistent and well-defined periapical radiolucent lesion for a long period of time. Microscopically, all 7 surgical specimens of PS showed dense fibrous collagenous tissues with one having amalgam particles in the scar tissue. ConclusionPSs do have their common clinical and radiographic features. When the periapical radiolucent lesion is well-defined, persistent without a significant change of its size, and free from symptoms and signs after a long-term follow-up; the involved tooth has no evidence of root fracture and healthy periodontium except the periapical radiolucency; and the previous endodontic treatment/retreatment or periapical surgery is well performed with an adequate root canal or retrograde filling, then the PS may be a possible diagnosis and a close follow-up may be a more conservative treatment strategy for this condition.

Non-endodontic periapical lesions clinically diagnosed as endodontic periapical lesions: A retrospective study over 15 years.

BackgroundThis study aimed to provide the frequency and demographic data of non-endodontic periapical lesions clinically misdiagnosed as endodontic periapical lesions from a Southeast Asian population over a 15-year period. Material and MethodsA retrospective study was conducted from departmental archives between 2005 and 2019. Cases clinically diagnosed as endodontic periapical lesions were retrieved. Then, cases with a histopathological diagnosis of non-endodontic periapical lesion were selected. Demographic data of non-endodontic periapical lesions were recorded. Radiographic features of cases with available radiographs were analyzed. ResultsOf 1,566 cases clinically diagnosed as endodontic periapical lesion, 157 cases received a histopathological diagnosis of non-endodontic origin. Eighteen different histopathological diagnoses were identified. The most frequent lesion was dentigerous cyst (n= 51, 32.48%) followed by odontogenic keratocyst (n=31, 19.75%), nasopalatine duct cyst (n=18, 11.46%) and ameloblastoma (n=15, 9.56%). Three cases of malignant tumors, including adenoid cystic carcinoma, mucoepidermoid carcinoma, and metastatic papillary thyroid carcinoma were observed. ConclusionsNon-endodontic periapical lesions constituted 10.03% of cases clinically diagnosed as endodontic periapical lesions. Histopathological examinations of non-endodontic periapical lesions revealed a variety of lesions ranging from foreign body reaction, cysts, fibro-osseous lesions, benign tumors and primary or metastatic malignant tumors. Of clinical significance is that some non-endodontic periapical lesions had different treatment modalities and prognoses compared with endodontic lesions. Therefore, dentists must be aware that periapical radiolucent lesions are not always a consequence of pulpal necrosis. Key words:Ameloblastoma, dentigerous cyst, endodontic periapical lesions, non-endodontic periapical lesions, odontogenic keratocyst.

A Rare Presentation of Radicular Cyst: A Case Report and Review of Literature

The radicular cyst is the most common inflammatory odontogenic cyst in the jaws. It is a periapical lesion associated with non-vital teeth in the tooth-bearing regions of the jaws with a slight male predilection. A radicular cyst is typically asymptomatic, but if large or secondarily infected may cause swelling. The usual radiographic appearance of a radicular cyst is that of a periapical radiolucent lesion. This case report documents a rare case of 61-year-old male with a mixed-density periapical lesion diagnosed as a radicular cyst. The lesion presented as a well-defined, expansile, space occupying, corticated, sclerotic, hydraulic, unilocular, mixed density lesion, associated with the right mandibular second premolar that was predominantly radiolucent with scattered foci of radiopacities. Microscopic examination revealed fragments of lining epithelium along with small fragments of inflamed fibrous connective tissue, aggregates of necrotic cellular debris, and bacterial colonies intermixed with foci of dystrophic calcifications. The histopathological diagnosis was a radicular cyst with dystrophic calcification. Although rare, this entity should be considered in the differential diagnosis of mixed-density periapical lesions. Complete history and proper diagnosis is important in this type of rare cases as treatment varies between a radicular cyst and other odontogenic neoplasms.

Smoking and Radiolucent Periapical Lesions in Root Filled Teeth: Systematic Review and Meta-Analysis.

Aim: This systematic review and meta-analysis aimed to investigate the association between smoking habits and the prevalence of radiolucent periapical lesions (RPLs) in root-filled teeth (RFT). Methods: The Population, Intervention, Comparison, and Outcome (PICO) question was: in adult patients who have RFT, does the absence or presence of a smoking habit affect the prevalence of RPLs associated with RFT? Systematic MEDLINE/PubMed, Wiley Online Database, Web of Science, Scopus, and PRISMA protocol were used to evaluate and present the results. Studies comparing smokers with control non-smoker subjects, including RFT, and providing data on the prevalence of RFT with RPLs, were included. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. The risk of bias was assessed according to Cochrane Collaboration common scheme for bias and ROBINS-I tool. Cumulative meta-analysis was performed with a random effects model. PROSPERO registration code: CRD42020165279. Results: Four studies reported data on inclusion criteria, representing data from 9257 root-filled teeth—4465 from non-smokers and 4792 from smoker patients. The meta-analysis provided an odds ratio indicating a significant association between smoking and higher prevalence of root filled teeth with radiolucent periapical lesions (OR = 1.16; 95% CI = 1.07–1.26; p = 0.0004). The certainty of the literature assessment was moderate per GRADE. The ROBINS-I tool classified three studies as low risk of bias, and the fourth as moderate risk of bias. Conclusions: Moderate, quality scientific evidence indicates a weak but significant relationship between smoking and the prevalence of RPLs in RFT. Smoking can be considered a negative prognostic factor for the outcome of root canal treatment. Endodontic providers should be aware of the relationship between smoking and persistent apical periodontitis, assessed as RPLs, in RFT.

PREVALENCE OF RADIOLUCENT PERIAPICAL LESIONS IN PATIENTS WITH PRIMARY SJOGREN SYNDROME

Objective: Define prevalence of radiolucent periapical lesions (RLP) in patients with primary Sjogren syndrome (SSP) and characterize the teeth associated with RLP. Methods: The radiographs were analyzed using Image J software by a radiologist. A socioeconomic questionnaire was applied. The salivary flow was evaluated through the collection of nonstimulated saliva. Mean and standard deviation (SD) for the quantitative variables and absolute and relative frequency of the qualitative variables was calculated. The χ2 test (95% CI) compared the difference between proportions of the qualitative variables, and the Student t test compared means of quantitative variables between patients with and without periapical lesions. Results: All 24 patients were female, aged between 20 and 71 years, with xerostomia, and 80% had hyposalivation. At least 1 RLP was found in 70.8% of patients. The mean number of teeth per patient was 23.3 ± 3.1 with a prevalence of RLP in the teeth of 7.86% of patients. The teeth with RLP had a higher percentage of root-fillings and caries located more in the central superior sextant (P

Diabetes mellitus and the healing of periapical lesions in root filled teeth: a systematic review and meta-analysis.

Diabetes mellitus (DM) may affect the healing and survival of root filled teeth with periapical lesions. To systematically analyse the available clinical literature to evaluate the association between DM and the prevalence of radiolucent periapical lesions in root filled teeth. The review question was 'Is there a difference between the root canal treatment healing outcome (in terms of presence or absence of radiolucent periapical lesions) in diabetic and non-diabetic patients?'. A systematic review of cross-sectional studies and prospective clinical trials was conducted according to the PRISMA checklist. The review involved a search of the electronic databases of PubMed, Scopus and EBSCO host. The research protocol was previously registered in the International Prospective Register of Ongoing Systematic Reviews (CRD42019130954) and included defined inclusion/exclusion criteria. The included studies were related to the root canal treatment outcome in diabetic patients in terms of periapical radiolucent lesions associated with root filled teeth. The selected studies were critically analysed by two evaluators using the Joanna Briggs Institute Critical Appraisal tool. The pooled odds ratio (OR) was recognized as the primary outcome variable and measure of the effect for the occurrence of periapical lesions associated with root filled teeth of control and diabetic patients. The random-effects Mantel-Haenszel method was used, at a 95% confidence interval, to calculate the pooled OR. A funnel plot was created to evaluate possible sources of heterogeneity. Ten studies published between 1989 and March 2019 were selected after thorough analysis and exclusion according to the strict criteria. Seven cross-sectional studies, 1 longitudinal and 2 prospective clinical studies were included. The pooled OR was calculated by comparing 773 diabetic subjects and 1133 control subjects. The pooled OR for the observational studies and clinical studies were 1.42 and 6.36, respectively. This value signified a high prevalence of periapical lesions in root filled teeth in diabetic subjects. There are limited prospective clinical trials on this topic. The majority of the included studies are observational. The data suggest a strong connection between the presence of periapical radiolucency on root filled teeth amongst diabetics as determined by the pooled OR.

Regenerative Endodontic Procedures for Traumatized Immature Permanent Teeth with Severe External Root Resorption and Root Perforation

External root resorption (ERR) is often a complication of traumatic injury to the teeth. Traditionally, external inflammatory root resorption is treated with calcium hydroxide. The outcome of ERR, especially replacement resorption, is unpredictable. The purpose of the present case report was to describe regenerative endodontic procedures (REPs) for 1 replanted avulsed tooth with severe external root resorption and root perforation (tooth #9) and 1 extruded tooth (tooth #8). A 9-year-old girl was referred for the treatment of teeth #8 and #9 4 months after the initial trauma. Clinical examination showed that tooth #9 had a sinus tract present near the periapical area, was tender to percussion and palpation, and did not respond to pulp sensibility tests. Tooth #8 responded to pulp sensibility tests. Periapical radiographic and cone-beam computed tomographic examination showed that tooth #9 had a periapical radiolucent lesion and severe ERRs with a root perforation. Tooth #9 was diagnosed with a necrotic pulp and symptomatic apical periodontitis. Regenerative endodontic procedures (REPs) were initiated. Tooth #8 became nonresponsive to pulp sensibility tests and developed a periapical lesion 12 months after REPs of tooth #9 and was also treated with REPs. The clinical symptoms and apical lesions resolved for both teeth after REPs. The severe ERRs were arrested, and root perforation was repaired for tooth #9. Teeth #8 and #9 underwent canal obliteration by hard tissue formation after REPs and were in function at 18 months and 30 months, respectively. REPs may be used to manage traumatized immature permanent teeth with a necrotic pulp and apical periodontitis associated with severe ERR and root perforation.