Periapical Region Research Articles

Management of radicular cyst – A case report

Radicular cysts are common jaw lesions, typically asymptomatic, and often found near the tooth apices. Radiographically, they appear as oval or pear-shaped unilocular radiolucencies in the periapical region. This case report highlights the successful surgical management of a large infected radicular cyst through enucleation and apicoectomy. These procedures were crucial in removing the cyst and promoting healing, with no post-surgical complications. Surgical intervention is vital in managing extensive radicular cysts to prevent further infection and damage to adjacent structures.

Periapical cemento-osseous dysplasia masquerading as asymptomatic chronic apical periodontitis in a Chinese woman: A case report.

Cemento-osseous dysplasia (COD) belongs to a group of fibrous osseous disorders that can masquerade as periapical inflammatory conditions in the jawbones. We present a rare case of COD occurring in a patient who also had periapical periodontitis concurrently. When faced with a patient exhibiting no symptoms, diagnosis may be challenging. COD is a fibrous osseous disorder similar to periapical chronic inflammatory conditions and other cysts in the jaw bones on the radiograph. There is a rare case of COD occurring in a 49-year-old Chinese woman who also had chronic periapical periodontitis concurrently. The lesions were incidentally discovered in the mandibular anterior tooth region during the patient's imaging examination. The patient exhibited no symptoms, and diagnosing the conditions may be challenging due to the confusingly similar radiological features that present as a radiolucent lesion in the periapical region. The final diagnosis was made through pulp vitality tests, cone beam computed tomography (CBCT), and clinical examinations. The COD was recommended for annual follow-up. Root canal therapy has been performed for chronic apical periodontitis. According to the diagnostic process of COD, a thorough history check, multiple clinical examinations, and imaging studies should be emphasized to prevent misdiagnosis and avoid unnecessary or inappropriate therapies. The patient was followed up for 6 years. The recovery of chronic apical periodontitis in tooth #31 and the transformation of osteolytic and osteogenesis of COD had been observed in CBCT.

Impact of Acidic and Alkaline Environments on the Surface Morphology of Biodentine and White Mineral Trioxide Aggregate - An In-vitro Study.

The physical and chemical properties of calcium silicate cement might be affected due to exposure to acidic or alkaline conditions during clinical use. The present study aimed to evaluate the effect of acidic and alkaline environments on the surface morphology of biodentine (BD) and white mineral trioxide aggregate (wMTA). Disc-shaped specimens of BD (n = 30) and wMTA (n = 30) were prepared in a metal mould and wrapped in pieces of gauze. They were divided into three sub-groups according to the storage media: group A, soaked in sterile distilled water at a pH of 7.0; group B, exposed to butyric acid buffered at pH 4.0; and group C, exposed to calcium hydroxide solution buffered at pH 12.0. The specimens were incubated for 7 days at 37°C, followed by examination under scanning electron microscopy at 1000x and 5000x magnification to characterise the microstructural morphology. Definite changes were seen in the microstructure of BD and wMTA on exposure to acidic and alkaline pH. The microstructure of wMTA tends to exhibit reduced cohesion when exposed to an acidic environment, especially when compared to an alkaline pH. Acidic pH exerts a milder influence on the morphological structure of BD when contrasted with its effects on wMTA. Biodentine may emerge as a more prudent choice than wMTA for utilisation in inflamed periapical regions.

Analysis of errors in endodontic treatment according to cone-beam computed tomography

AIM. The aim of the study was to study the frequency of errors in endodontic treatment according to cone beam computed tomography.MATERIALS AND METHODS. 71 cone beam computed tomography (CBCT) scans of patients treated by random sampling who sought treatment and consultation in the period 2022–2023 were studied. 256 teeth previously subjected to endodontic treatment with the presence or absence of radiological signs of chronic apical periodontitis were examined. The assessment of the quality of root canal obturation and the features of the anatomical structure of teeth was carried out. The data of the «Ray RAYSCAN alpha 3D» cone beam computed tomograph were studied using the OnDemand3DDental program. The results were considered statistically significant at p< 0.05.RESULTS. In 57.42% of cases, there were no signs of periapical pathology, and in 42.58%, foci of bone destruction in the periapical region were observed. Homogeneously, 58.59% of root canals were sealed to the apex. In 16.79% of cases, the removal of filling material outside the root canal was noted. 10.54% of teeth with insufficient root canal filling depth and 6.64% of teeth with a missing root canal were also identified.CONCLUSIONS. There is a decrease in the incidence of the most common errors of endodontic treatment. The method of cone beam computed tomography is important at the stage of diagnosis and planning of endodontic treatment to assess the features of the internal structure of the tooth.

Assessment of Calcium Concentration and pH at the Periapical Environment on Placing Calcium Hydroxide with Different Natural Vehicles – An In vitro Study

Abstract Background: In root canal therapy, the number of microorganisms in canals can be controlled by giving proper intracanal medication dressing. Calcium concentration and changes in pH at the periapical region denote the effect of antibacterial action in the periapical region. Aim: The aim is to determine a suitable natural vehicle for calcium hydroxide (Ca(OH)2) as an intracanal medicament by assessing the calcium concentration and changes in pH at the periapical region. Materials and Methods: A total of 60 extracted single-rooted permanent teeth were equally allotted into four groups – Group I: Ca(OH)2 with distilled water, Group II: Ca(OH)2 with aloe vera, Group III: Ca(OH)2 with coconut water, and Group IV: Ca(OH)2 with neem extract. pH was determined by pH meter and calcium by chromatography. The values were taken on days 1, 2, 3, 7 and 14. Results: All the materials showed alkaline pH and release of calcium ion throughout the study. For day 1, the mean pH value was highest for distilled water (10.06) and lowest for aloe vera extract (9.42). The highest calcium release during day 1 was by coconut water (67.85) and the least calcium release was by aloe vera (42.01). On day 14, the highest calcium release was by distilled water (89.98) followed by coconut water (67.24) and least by neem extract (61.13). pH values and calcium release in four different natural vehicles were significant (P < 0.05). Conclusion: All natural materials used in this study showed good Ca(OH)2 diffusion when used as a vehicle with Ca(OH)2 in root canals.

Evaluation of the pH and Antibacterial Efficacy of Mineral Trioxide Aggregate With and Without the Incorporation of Titanium Tetrafluoride.

Introduction Microorganisms play an important role in causing inflammation in the pulp and periapical regions. Even after undergoing chemo-mechanical procedures during root canal treatment, bacteria may persist within dentinal tubules, posing a risk of disease recurrence. Mineral trioxide aggregate (MTA), introduced as a dental material, has been investigated as a potential antibacterial agent since its early use. Calcium and phosphorus are the primary ions in MTA, and their antibacterial characteristics are attributed to the release of calcium hydroxide through surface hydrolysis of calcium silicate components. Previous studies have shown that MTA has limited antimicrobial properties. Several alterations have been made to enhance the biological properties of MTA, such as incorporating nanoparticles made from silver, zinc, gold, and titanium. Therefore, in this study, titanium tetrafluoride (TiF4) was added to MTA in an effort to enhance its antimicrobial properties. Aim To compare and evaluate the antibacterial efficacy of MTA after the incorporation of TiF4. Materials and methods A total of 56 samples were made by mixing MTA with different weight proportions of TiF4 (1 wt%, 2 wt%, and 3 wt%). Out of these, 28 samples were taken to test each of the following properties: antibacterial efficacy and pH. The specimens were prepared using stainless steel molds of recommended dimensions for testing the pH. The pH was evaluated using a pH meter, and the antibacterial efficacy was assessed using the direct contact test. Data regarding the antibacterial efficacy and pH of MTA with various proportions of TiF4 were investigated for normality using the Kolmogorov-Smirnov test and assessed for normal distribution. The antibacterial properties among the four groups were analyzed using one-way analysis of variance (ANOVA), followed by pairwise multiple comparisons using Tukey's Honest Significant Difference test. The level of statistical significance was determined at p ≤ 0.05. MTA, when incorporated with TiF4, showed enhanced antibacterial properties. Results On day 1, the group treated with MTA containing 3% TiF4 demonstrated the strongest antibacterial effectiveness, with a mean of 4.67 ± 0.04 colony-forming units (CFU)/mL × 10^8. However, the group treated with plain MTA had the lowest mean values, at 5.67 ± 0.25 CFU/mL × 10^8. On day 1, the MTA group with 3% TiF4 also had the highest mean pH values (11.90 ± 0.05), while the plain MTA group had the lowest mean pH values (11.64 ± 0.78). On day 7, the MTA group with 3% TiF4 had the highest pH value (12.85 ± 0.08), whereas the plain MTA group had the lowest pH value (11.92 ± 0.09). Conclusion The inclusion of TiF4 resulted in an augmentation of the antibacterial efficacy of MTA against Enterococcus faecalis (E. faecalis). Hence, the integration of TiF4 into MTA can be considered a promising development against E. faecalis during endodontic procedures.

Radiologic evaluation of associated symptoms and fractal analysis of unilateral dens invaginatus cases.

The aim of this study is to determine the age-based prevalence of dens invaginatus cases and to learn the radiologic findings. In addition, fractal analysis of the periapical regions of unilateral dens invaginatus cases and contralateral teeth was performed to determine the effect of possible microleakage on fractal dimension. A total of 136 patients (170 teeth) identified in panoramic radiographs taken for diagnostic purposes between January 2018 and December 2023 at our Department of Oral and Maxillofacial Radiology were included in the study. Data were analysed using IBM SPSS V23. The Chi-square test was used for comparing categorical variables between groups. The relationship between the FD values calculated around the apexes of the teeth with unilateral dens invaginatus and the contralateral teeth was analyzed by paired t test. A significance level of p < 0.050 was adopted. The mean age of the cases was calculated as 28.1 (8-63) years. 66 (48.5%) of the cases were female, and 70 (51.1%) were male. The lateral incisor was the most affected tooth among these cases. Bilateral cases were observed in 34 patients. Type 2 was detected in 93 patients, Type 1 in 35 patients, and Type 3 dens invagination in 8 patients. Dens invaginatus cases were observed in 134 maxillary and 2 mandibular teeth. Periapical lesions were seen in 22 of these cases. Dens invaginatus cases are a congenital anomaly encountered at any age. Early diagnosis is crucial to prevent the loss of pulp vitality due to these invaginations. It should be noted that these invaginations can affect both jaws. However, due to the prevalence of occurrence in the maxillary anterior teeth and asymptomatic nonvitality, particular attention should be paid to evaluating this region.

Myospherulosis in the periapical region following root canal treatment

This report explores a unique manifestation of myospherulosis in the periapical region of lower anterior teeth following root canal treatment with calcium hydroxide Ca(OH)2. A 38-year-old woman complained of enduring pain in her lower front teeth for the past 15 days. During the clinical examination, it was observed that the labial vestibule in the lower anterior region was obliterated. The teeth exhibited tenderness upon percussion. Radiographic examination indicated an ill-defined radiolucency in the periapical region, prompting further investigation into the delayed healing. Histopathological examination of the periapical tissue unveiled cyst-like spaces containing brownish-black-stained spherules, indicative of myospherulosis. Curettage with apicectomy was performed to address the delayed healing. A 6-month follow-up revealed complete healing of the lesion, emphasizing the successful management of myospherulosis-induced delayed healing. The unintended consequence of myospherulosis development emphasizes the importance of preventing medicament overflow into the periapical region during root canal therapy to minimize the delayed healing process.

Periorbital emphysema following dental procedure: A case report with literature review

We aimed to present a case of periorbital emphysema after tooth extraction in private dental practice. A 20-year-old female patient with the left maxillary first molar tooth extracted under local anesthesia was referred to the ophthalmologist with complaints of swelling and pain around the left eye 6 hours after the procedure. The best visual acuity was logMAR 0.0 in both eyes on visual examination. In the slit-lamp examination, there was periorbital swelling in the left eye, free eye movement, and a light reaction. The right eye followed naturally. Fundus examination of the bilateral optic nerve was normal. On palpation, crepitation was detected in the left periorbital region. A rapid assessment of airway obstruction was made. Diffuse air was observed in the left orbital soft tissue in orbita computed tomography. Prophylactic penicillin-derived antibiotics and nonsteroidal antibiotics were started. The light reaction was followed closely. Periorbital swelling decreased 24 hours after the procedure. During the surgical removal of impacted teeth, air through the air-operated handpiece may cause spread from the periapical region to the periorbital space along the subperiosteal region and fascial planes. Care should be taken to avoid this rare complication after dental procedures.

The Role of Macrophage Efferocytosis in the Pathogenesis of Apical Periodontitis.

Macrophages (Mφs) play a crucial role in the homeostasis of the periapical immune micro-environment caused by bacterial infection. Mφ efferocytosis has been demonstrated to promote the resolution of multiple infected diseases via accelerating Mφ polarization into M2 type. However, the Mφ efferocytosis-apical periodontitis (AP) relationship has not been elucidated yet. This study aimed to explore the role of Mφ efferocytosis in the pathogenesis of AP. Clinical specimens were collected to determine the involvement of Mφ efferocytosis in the periapical region via immunohistochemical and immunofluorescence staining. For a further understanding of the moderator effect of Mφ efferocytosis in the pathogenesis of AP, both an in vitro AP model and in vivo AP model were treated with ARA290, a Mφ efferocytosis agonist. Histological staining, micro-ct, flow cytometry, RT-PCR and Western blot analysis were performed to detect the inflammatory status, alveolar bone loss and related markers in AP models. The data showed that Mφ efferocytosis is observed in the periapical tissues and enhancing the Mφ efferocytosis ability could effectively promote AP resolution via facilitating M2 Mφ polarization. Collectively, our study demonstrates the functional importance of Mφ efferocytosis in AP pathology and highlights that accelerating Mφ efferocytosis via ARA290 could serve as an adjuvant therapeutic strategy for AP.

Influence of the severity of periodontal disease on the outcome of non-surgical endodontic therapy: A prospective cohort study.

To investigate the influence of severity of periodontal disease on periapical healing after non-surgical endodontic therapy (NSET). In this prospective study, subjects (n = 45) requiring NSET in a mandibular molar tooth with the diagnosis of pulp necrosis and asymptomatic apical periodontitis exhibiting radiographic periapical index (PAI) score ≥ 3 and concomitant endodontic periodontal lesion (CEPL) without communication were enrolled. After dividing as per the classification of Periodontal and Peri-Implant Diseases and Conditions, subjects were equally allocated into three groups. Group I- only endodontic lesion {control: healthy periodontium (n = 15)}, Group II- CEPL having stage I and II periodontitis (n = 15) and Group III- CEPL having stage III periodontitis (n = 15). Standardized two-visit NSET was performed with 2% chlorhexidine gel as an intracanal medicament. Periodontal therapy was instituted wherever required. Subjects were recalled at 6-and 12-months for clinical and radiographic assessment. Chi-square test was performed to evaluate the difference between the groups. At 12-month follow-up, all teeth in the three study groups were asymptomatic. On radiographic evaluation of the periapical region, healing was observed in 80%, 47% and 50% of teeth in Groups I, Group II and Group III, respectively. However, the difference was not statistically significant between the groups (p = 0.150). The severity of periodontal disease had no influence on periapical healing after NSET in teeth with concomitant endodontic periodontal lesions without communication. Periodontal disease has significant impact on apical periodontitis however severity of the periodontitis does not negatively impact the apical periodontitis.

The widths of the medial and lateral pedicle walls in adolescent idiopathic scoliosis with major thoracic curves

Background contextThe widths of medial and lateral pedicle walls in the normal spine of middle-aged and elderly adults have been investigated and these studies found that the medial pedicle wall was thicker than the lateral pedicle wall. However, none had evaluated the widths of medial and lateral pedicle walls on adolescent or young adult scoliotic spines. PurposeThis study aims to identify the distribution and variation of medial and lateral pedicle wall widths throughout the different vertebral levels of the scoliotic spine and its differences according to age, gender, body mass index (BMI), maturity, curve types and curve severity in adolescent idiopathic scoliotic (AIS) patients with major thoracic curves. Study DesignRetrospective study. Patient sampleA total of 6,230 pedicles (right: 3,064, left: 3,166) from 191 patients were included in this study, with 264 (right: 183, left: 81) fully corticalized pedicles excluded from analysis. Outcome measuresDemographic data were age, gender, height, weight, BMI, Risser grade, Lenke curve types and Cobb angles. The main outcome measures were medial and lateral pedicle wall widths. Associations between pedicle wall widths and demographic data were calculated. MethodsThis was a subanalytical retrospective study done on the same patient population as the previously published study on pedicle grading. The data was obtained from the main computed tomography (CT) scan pedicle study dataset. Medial and lateral pedicle wall widths were measured in the axial slices of CT scans from T1 to L5 vertebrae. ResultsA total of 6,230 pedicles (right: 3,064, left: 3,166) from 191 patients were included in this study with 264 (right: 183, left: 81) fully corticalized pedicles excluded from analysis. Right-sided medial pedicle wall widths were narrower from T4–T10 (0.75±0.23 mm) compared to T1–T3 (0.89±0.28 mm) and T11–L5 (0.92±0.30 mm). Left-sided medial pedicle wall widths were narrower from T4 to T7 (0.76±0.24 mm) compared to T1–T3 (0.88±0.26 mm) and T8–L5 (0.90±0.27 mm). Medial cortical wall widths were significantly thicker compared to lateral cortical wall widths for all vertebras from T1 to L5 (right medial 0.85±0.28 mm vs lateral 0.64±0.26 mm (p<.001), left medial 0.86±0.26 mm vs lateral 0.64±0.26 mm (p<.001)). The left medial pedicle wall widths were marginally significantly (p<.001) thicker than the right side (right medial 0.85±0.28 mm vs left 0.86±0.26 mm). The main notable significant differences were located at the periapical region of the thoracic curve between T7 to T10 with the left concave medial pedicle width being thicker than the right convex medial pedicle width. The thinnest medial pedicle walls were located at right concave T7 (0.73±0.24 mm) and T8 (0.73±0.23 mm). We generally found no significant associations between the medial and lateral pedicle wall widths with age, gender, BMI, Risser grade, Cobb angle and curve types. ConclusionsKnowledge on the widths of medial and lateral pedicle walls, their distribution and differences in a scoliotic spine is important for pedicle screw fixation, especially during pedicle probing to find the pedicle channel. The medial pedicle wall widths were significantly thicker than the lateral pedicle wall widths in AIS patients with major thoracic curves. The right concave periapical region had the thinnest medial pedicle walls.

The Role of Three-Dimensional Imaging (CBCT) in Enhancing Diagnostic Accuracy in Endodontics: A Randomized Controlled Trial

ABSTRACT Background: In the field of endodontics, accurate diagnosis is pivotal for successful treatment outcomes. This randomized controlled trial (RCT) explores the potential of cone-beam computed tomography (CBCT) as a tool to enhance diagnostic accuracy in endodontic procedures Materials and Methods: An RCT was conducted with a sample of 120 patients presenting with endodontic issues. The patients were divided into two groups: Group A received traditional two-dimensional radiography, while group B underwent CBCT scans. The diagnostic accuracy was assessed by comparing the radiographic findings with the clinical evaluation by experienced endodontists. Results: The results indicated a significant improvement in diagnostic accuracy in the CBCT group (group B) with an arbitrary value of 88% accuracy, compared with the traditional radiography group (group A) with only 65% accuracy. The CBCT group showed a clearer visualization of root canal anatomy, periapical lesions, and the presence of additional canals, contributing to the enhanced diagnostic capability Conclusion: This RCT demonstrates that CBCT significantly enhances diagnostic accuracy in endodontics compared with traditional two-dimensional radiography. The improved visualization of root canal anatomy and periapical regions allows for more precise treatment planning, ultimately leading to better treatment outcomes.

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.

High-Fat Diet Influences Dendritic Cells and T-Cell Infiltration in Apical Periodontitis in Mice

IntroductionDiet-induced metabolic syndrome may influence the progression and healing of apical periodontitis (AP). The aim of this study was to evaluate the inflammatory immune response of dendritic cells (DCs) and T helper (Th) cells in normal versus obese mice with AP. MethodsTwenty male C57BL/6 mice were divided into 2 groups: normal chow (NC) and high-fat diet (HFD) for 12 wk. AP was induced in both groups by creating pulp exposure of the right first maxillary molar to the oral environment. Contralateral first molars from each mouse were used as a control. The animal's body mass was recorded on a weekly basis, and they were euthanized after 30 d. The maxillae were removed and processed for micro-computed tomography (micro-CT), histologic analysis, and immunofluorescence staining for DCs (CD11c), Th17 (IL-17A), and T regulatory cells (FOXP3 and IL-10). Different groups were analyzed by Mann-Whitney U test, Student t test, and ordinary 1-way analysis of variance followed by Tukey's multiple comparisons test. The level of significance (α) was set at 0.05. ResultsThe HFD group showed larger AP lesions than the NC group from micro-CT analysis. For the NC group, induction of AP significantly increased immune cell infiltration when compared with control. HFD showed increased DCs and Th17 infiltration in the control group without AP. In addition, there was no significant change in the amount of DCs and Th17 in the HFD-AP group when compared with the NC-AP and HFD-control groups. ConclusionsHFD resulted in an increased immune cell infiltration in the periapical area without AP. Despite the larger AP lesion observed in HFD-AP than that of NC-AP, the amount of infiltrated inflammatory cells did not differ significantly. The results of this study suggest that the DCs and Th17 inflammatory pathways are affected by HFD in the periapical region, but their contribution toward AP complicated by metabolic syndrome requires further investigation.

Effect of Rotary and Reciprocating File System on Postoperative Pain in Single Visit Endodontic treatment: A Randomised Clinical Trial

Introduction: In modern times, endodontic intervention is preferred and tooth extraction is becoming increasingly rare. Root Canal Therapy (RCT) is well-established, with success rates exceeding 90%. A key contributor to post-endodontic pain is the extrusion of debris into the periapical region, which causes inflammation and nerve compression. The amount of debris extruded varies with instrumentation techniques and no current technology completely prevents it. Rotary and reciprocating Nickel-Titanium (NiTi) instruments, each with distinct designs and kinematics, play a critical role in managing this complication. Aim: To evaluate postoperative pain using rotary and reciprocating file systems in single visit endodontics. Materials and Methods: This prospective, parallel-group, singlecentre, double-blinded, equivalence, randomised clinical study was conducted at the Department of Conservative Dentistry and Endodontics, School of Dental Sciences, Krishna Vishwa Vidyapeeth (Deemed To be University), Karad, Maharashtra, India, from October 2023 to March 2024, with the aim of comparing postoperative pain following endodontic therapy using two reciprocating systems, WaveOne Gold (WOG) and E-Flex Rec, versus two rotary systems, Mtwo and XP Endo Shaper (XPES). A total of 80 patients with symptomatic irreversible pulpitis were enrolled and randomly assigned to four groups, each treated with one of the four endodontic file systems. Patients were randomised into four groups: 1A-Mtwo (Dentsply-Maillefer, Ballaigues, Switzerland); 1B-XP Endo Shaper (XPS; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland); 2A-Eighteeth E-Flex Rec File; and 2B-WOG (Dentsply Sirona, York, PA). Postoperative pain scores were measured using the Visual Analogue Scale (VAS) at 24, 48 and 72 hours and seven days post-treatment. Statistical analysis was conducted using One-way Analysis of Variance (ANOVA) with Tukey’s post-hoc test and Chi-square tests for categorical data using Statistical Package for Social Sciences (SPSS) software version 21.0, with p-values&lt;0.05 considered significant. Results: According to the study’s findings, postoperative pain was significantly higher in the rotary file systems compared to the reciprocating file systems at all time intervals (p-value&lt;0.001). The mean ages were 39.00±12.70 years for Group 1A, 34.70±9.48 years for Group 1B, 42.15±12.59 years for Group 2A, and 39.10±13.65 years for Group 2B. Additionally, the consumption of analgesics was significantly higher in the rotary file systems compared to the reciprocating file systems at 24 hours (p-value=0.001) and 48 hours (p-value=0.003), highlighting the importance of file design and kinematics in managing postoperative pain. Conclusion: Compared to the rotary systems (XPES and Mtwo), the use of the reciprocating instrumentation systems (WOG and E-Flex) demonstrated noticeably less postoperative pain, both in terms of intensity and duration.

Assessment of The Impact of Quality of Canal Obturation, Coronal and Apical Seal on The Healing Of CBCT-Diagnosed Periapical Lesions in Endodontically Treated Teeth in Sri Lanka

Background: Previous literature has investigated the association between the attribute of coronal restoration and root canal obturation with the radiographic periapical status of endodontically treated teeth. Objectives: This study intends to assess the status of periapical lesions/pathology and, the main factors influencing the healing of periapical lesions of root canal-treated teeth clinically and radiographically exploiting CBCT. The quality of coronal restoration, canal obturation, and apical seal were selected to be assessed, as they have a greater impact on healing peri apical pathology. Method: This analysis was conducted at the Department of Restorative Dentistry and the Division of Oral Medicine and Radiology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. All the patients who presented between January 2020 and January 2021, had root canal treatment done at least one year prior, were referred for CBCT assessment for some other conditions, and fulfilled the inclusion criteria, were selected. Root canal-treated teeth were recognized by radio-opaque filling material inside the canals in any anterior or posterior teeth. Results: A sum of 50 CBCT reports from 50 patients was encompassed in the dissertation. Median age was 26 (±4) years, with 37.5% of reports belonging to males. Statistical analysis was performed utilizing Statistical Package for Social Sciences (SPSS) version 20.0 software (IBM Corp). Out of fifty patients, 32 had been found to have adequate clinical coronal seal while 31 have been found to have adequate radiographical coronal seal. Further, 31 patients were found to have insufficient obturation and 28 were found to have adequate apical seal. A significant association was observed between periapical healing and adequate coronal restoration in root-filled teeth (p=0.048). However, the association between the healing of the periapical region, and adequate root canal obturation (p=0.09) and adequate apical seal (p=0.777) were found to be non-significant. Conclusion: The most influential factor for the healing of periapical lesions in endodontically treated teeth appears to be adequate coronal restoration, compared to root canal obturation and apical seal, in a cohort of patients in Sri Lanka

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

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

The Quantitative Method for Following Radiologic Healing in Endodontic Retreatment; 1-Year Follow-up Study

Objectives: This study aimed to quantitatively evaluate the changes in the internal bone structure at the periapical bone regions after retreatment in endodontics using fractal analysis method on periapical radiographs.&#x0D; Materials and Methods: 29 single-rooted, asymptomatic, single-visit retreatment teeth with apical lesion were included in the study. All teeth included in the study were selected from the maxilla anterior region. Periapical radiograph (T0) was taken for baseline diagnosis at the start of retreatment. Second periapical follow-up radiograph (T1) of the patients was taken at the end of 1 year. The first evaluation phase of the 1-year results of endodontic retreatment is based on the periapical index (PAI). Fractal dimension (FD) was calculated by box-counting method. The paired-sample t-test was used to compare T0 and T1 FDs. The independent samples t-test was employed to compare FD changes between the sexes. The significance level was set to 0.05.&#x0D; Results: PAI scores were found to be statistically significantly decreased in T1 radiographs compared to T0 (p

Triple Antibiotic Paste: Boon to Dentistry

Microorganisms must be removed from the root canal (RC) and periapical region for endodontic success. A sterile state cannot be achieved with only endodontic instrumentation. Local administration of antibiotics has been studied in light of the development of non-instrumentation endodontic treatment, tissue healing and lesion sterilization. Triple antibiotic paste (TAP) with metronidazole, ciprofloxacin, and minocycline works well for non-vital young permanent teeth and the RC pathogen. Present review of literature aims to discuss role of TAP in endodontic treatment.