Periapical X-ray Research Articles

The impact of root end filling material type and the application of bone graft on healing of periapical tissues after endodontic microsurgery (a clinical randomized controlled trial)

To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries.

A Case of Simultaneous Sinus Augmentation and Oroantral Fistula Closure for Implant Preparation.

An oroantral communication (OAC) may form in the upper molar region after tooth extraction. The patient is a 59-year-old female, who is a non-smoker. At the initial visit, teeth #14, #15, and #17 were missing. After tooth #16 was extracted due to apical periodontitis, a bone defect with a diameter of approximately 4 mm was observed, leading to the formation of an oroantral fistula (OAF). Another window was created in the lateral wall adjacent to the superior part of the bone defect at the fistula site to achieve closure of the OAF through bone formation and simultaneously perform sinus floor elevation (lateral approach) for implant placement. Through this lateral window, instruments were inserted into the maxillary sinus towards the bone defect at the fistula site. During this process, the remaining bone between the lateral window and the bone defect at the fistula site was carefully removed with instruments, connecting the two bone defects to facilitate the manipulation of the instruments. The Schneiderian membrane was elevated without enlarging the tear. Six months after these surgeries, a CBCT scan confirmed the closure of the fistula with hard tissue and the elevation of the sinus floor. Subsequently, three implants were placed, and prosthetic treatment was completed. Follow-up data is provided, including periapical X-ray and CBCT images taken two years and three months after surgery (one year and three months after the placement of the final prosthetic structure). The progress so far has been favorable.

Management of Isolated Medial Orbital Wall Fracture with Intraoral Periapical X-ray Film: A Case Report with Literature Review

Management of Isolated Medial Orbital Wall Fracture with Intraoral Periapical X-ray Film: A Case Report with Literature Review

Influence of sex and timing of mixed dentition on discrepancies between chronological age and dental age in Taiwanese children

Background/purposeThe aim of this study was to determine the effects of age and sex on the difference between chronological age (CA) and dental age (DA) predicted using the Demirjian and Willems methods in Taiwanese children. Materials and methodsA total of 232 periapical X-ray images were obtained from children aged 5–12 years in Taiwan. Among them, 119 were boys, and 113 were girls. DA was calculated on the basis of the X-ray images of permanent teeth by using the aforementioned methods. The children were stratified by age (5–9 years [early mixed dentition period] vs. 10–12 years [late mixed dentition period]) and sex (boys vs. girls). Statistical analyses were performed to investigate potential age- and sex-based differences in the correlation between CA and DA. ResultsNo significant difference was observed between the mean CA and DA predicted using the Willems method in children with late mixed dentition and in girls. However, the correlation between CA and DA was stronger in children with early mixed dentition than in those with late mixed dentition and also stronger in boys than in girls. ConclusionFor children in mid-Taiwan, age and sex influence the development of permanent teeth. In addition, the correlation between DA and CA is relatively strong for boys in the early mixed dentition period.

Estimation of doses absorbed by the thyroid and salivary glands, eyes, and brains of pediatric dental patients

In addition to the quality of the image, radiological protection of the patient must be considered to ensure an adequate diagnosis in dental radiology, especially in regard to those parts of the patient's body that are close to the radiation beam, such as the thyroid, salivary glands, and brain. In this work, the doses absorbed by the thyroid, salivary glands, eyes and brain of pediatric dental patients undergoing radiographic examinations are estimated using MCNP 6.2 coupled with virtual anthropomorphic phantoms, based on information from dental scenarios with a periapical X-ray unit. The absorbed doses were estimated for five- and 10-year-old male and female children. In the occlusal position, a higher absorbed dose to the thyroid was found for a five-year-old patient, whereas in the molar tube position, the brain was found to receive a higher absorbed dose for five- and 10-year-old patients. The results obtained here, expressed in terms of the absorbed dose, indicate that the beam direction and the use of different image acquisition techniques strongly influence the entrance dose values for the organs of interest in this study.

Fractal Analysis of Trabecular Alveolar Bone with Intrabony and Furcation Defects Using Periapical Dental Radiographs

Objective: Fractal analysis (FA) is a non-invasive method that quantitatively measures complex patterned geometric structures present throughout the image. Trabecular morphology of the alveolar bone and the changes occurring in the trabeculae in case of periodontitis can be detected with this method. To examine the periodontal defects in human skull bones using the FA, to compare them with healthy alveolar bone regions. Methods: Furcation and intrabony defects were artificially created in the mandible alveolar bones (n:24). Periapical X-ray images of alveolar bone regions containing teeth with defects were taken using the parallel technique. Fractal analysis was performed by box-counting method using Image J software on images from areas containing healthy and defective trabecular bone. Results: No statistically significant difference was found between the fractal values of healthy tissue and bifurcation defetcs and between the healthy tissue and intrabony defects (p>0.05). Conclusion: Many factors may have affected the outcomes; patient selection, imaging methods, sample size, Region of interest (ROI) selection-location and size, individual and anatomical variations. These variables need to be standardized as much as possible and the limitations of the method need to be improved.

Comparative Analysis of Examination Methods for Periapical Lesion Diagnostics: Assessing Cone-Beam Computer Tomography, Ultrasound, and Periapical Radiography.

Periapical lesions of teeth are typically evaluated using periapical X-rays (PA) or cone-beam computer tomography (CBCT); however, ultrasound imaging (US) can also be used to detect bone defects. A comparative analysis is necessary to establish the diagnostic accuracy of US for the detection of periapical lesions in comparison with PA and CBCT. This study aimed to evaluate and compare the measurement precision of US against PA and CBCT in detecting periapical lesions. This study included 43 maxillary and mandibular teeth with periapical lesions. All teeth were examined clinically, radiographically, and ultrasonographically. Observers evaluated and measured the periapical lesions on CBCT, PA, and US images. The comparison of lesion size showed that it differs significantly between the different methods of examination. A statistically significant difference was found between CBCT and US (mean difference = 0.99 mm, 95% CI [0.43-1.55]), as well as between CBCT and PA (mean difference = 0.61 mm, 95% CI [0.17-1.05]). No difference was found between the US and PA methods (p = 0.193). US cannot replace PA radiography in detecting pathologies but it can accurately measure and characterize periapical lesions with minimal radiation exposure. CBCT is the most precise and radiation-intensive method so it should only be used for complex cases.

Reliability of a forensic odontology method for age-at-death estimation in adults: A Mexican case study

This study aimed to evaluate the reliability of an age estimation method based on the pulp⁄tooth area ratio by assessing intra- and inter-examiner agreement across five observers at different intervals. Using the same X-ray device and technical parameters, 96 digital periapical X-ray images of upper and lower canines were obtained from 28 deceased people in Central America, whose age at death ranged from 19 to 49 years. Excellent and good agreement of results were achieved, and there were no statistically significant differences. The R2 value for upper teeth (54.0%) was higher than the R2 value for lower teeth (45.7%). The highest intraclass correlation coefficient value was 0.995 (0.993–0.997) and the lowest 0.798 (0.545–0.895). Inter-examiner agreement was high with values of 0.975 (0.965–0.983) and 0.927 (0.879–0.955). This method is adequate for assessing age in missing and unidentified people, including victims of mass disasters.

Analysis of Alveolar Crest Reduction Post Extraction with the Use of Platelet Rich Fibrin (PRF)

One of the treatments that can be done to treat dental and oral diseases is tooth extraction. However, this procedure can cause significant changes in the dimensions of the alveolar ridge that are unfavorable in subsequent oral rehabilitation. One of the most important things is the preservation of the remaining alveolar ridge after the tooth extraction procedure. The use of Platelet Rich Fibrin (PRF) for the regeneration of soft and hard tissue in wound healing, in the form of immune concentrate and platelets obtained from a single fibrin membrane which contains all the blood constituents useful for healing and immunity. This research is an unblinded, randomized clinical trial with a sample size of 36 patients undergoing tooth extraction. To see the effect of ridge resorption analysis, namely the reduction of the alveolar crest with PRF application. Each research sample is analyzed at each evaluation time. There was a significant difference in alveolar crest reduction in the treatment and control groups which was found in the mesial region (post-extraction days 60 and 90) and distal region (post-extraction days 30, 60 and 90) with a significance value p<0.05. There was a significant difference in the periapical x-ray image in the reduction of the post-extraction alveolar crest in the PRF application group, with better results compared to the group without PRF.

Clinical Evaluation of a Novel Premixed Tricalcium Silicate Containing Bioceramic Sealer Used with Warm Carrier-Based Technique: A 12-Month Prospective Pilot Study

Background: This pilot prospective study analysed the clinical use of a new bioceramic premixed CaSi-containing sealer in association with a warm carrier-based technique. Methodology: Healthy patients (n = 38) requiring 40 root canal treatments were enrolled. Periapical X-rays were taken preoperatively, after root canal filling and after 1, 6, and 12 months. Two evaluators assessed the Periapical Index (PAI) and the sealer extrusion. The healing rate and survival rate were also evaluated. Barnard test was used to assess the relationship of each potential prognostic factor with periapical index (PAI) at 12-month follow-up. The significance level was set at 0.05. Results: Root canal treatments (n = 38) were analysed at the end-line (12 months). The total drop-out was 5% (two patients; two teeth). A total of 31 teeth (82%) (PAI 1-2) showed complete healing, while 7 (18%) are still healing. Cumulative survival was 100%. Apical extrusion of the sealers was observed in 18 cases (47%). Of these extrusions, nine (50%) resulted radiographically undetectable after 12 months. Conclusions: The study supports the use of premixed CaSi-based bioceramic sealers in association with carrier-based techniques. Periapical extrusion of the sealer and its radiographic modification or disappearance are possible events reported in the first 12 months.

Association Between Palatally Impacted Maxillary Canine and Anomalous Maxillary Lateral Incisor - A Case Control Study

OBJECTIVE: To determine the association between palatally impacted maxillary canine (PIC) and anomalous upper lateral incisor. METHODOLOGY: This case control study was conducted on records of 60 participants (30 with PIC and 30 without). The inclusion criteria were participants without syndromes, palatal canine impaction (cases only), and age range from 12 to 30 year. Subjects with buccally impacted canine, history of previous orthodontic treatment and non-Pakistani nationals were excluded. Cases were those having PIC and controls were without PIC. Participant's OPG and periapical X-rays were used to diagnose PIC by horizontal parallax technique. Dental anomalies in upper lateral incisor were diagnosed by using casts and OPGs. Logistic regression and chi-square test was applied to determine association between PIC and anomalous upper lateral incisor. RESULTS: The mean age of the participants was 18.916±4.3 years. The frequency of missing lateral incisor was higher in cases (n=3, 10%) than control (n=1, 3.3%). Similarly peg shape laterals was more in cases (n=4, 13.3%) than controls (n=2, 6.7%). However this association was not statistically significant (P=0.37). The odd of having anomalies in lateral incisor was 2.73 times higher in cases than controls but the results were not statistically significant (P=0.177). CONCLUSION: Though the frequency of anomalous maxillary lateral incisors is higher in participants with PIC than controls but this association was not statistically significant. KEYWORDS: Palatal canine impaction, missing upper lateral incisors, peg shape upper lateral incisors, dental anomalies

Deep Learning-Based Recognition of Periodontitis and Dental Caries in Dental X-ray Images.

Dental X-ray images are important and useful for dentists to diagnose dental diseases. Utilizing deep learning in dental X-ray images can help dentists quickly and accurately identify common dental diseases such as periodontitis and dental caries. This paper applies image processing and deep learning technologies to dental X-ray images to propose a simultaneous recognition method for periodontitis and dental caries. The single-tooth X-ray image is detected by the YOLOv7 object detection technique and cropped from the periapical X-ray image. Then, it is processed through contrast-limited adaptive histogram equalization to enhance the local contrast, and bilateral filtering to eliminate noise while preserving the edge. The deep learning architecture for classification comprises a pre-trained EfficientNet-B0 and fully connected layers that output two labels by the sigmoid activation function for the classification task. The average precision of tooth detection using YOLOv7 is 97.1%. For the recognition of periodontitis, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve is 98.67%, and the AUC of the precision-recall (PR) curve is 98.38%. For the recognition of dental caries, the AUC of the ROC curve is 98.31%, and the AUC of the PR curve is 97.55%. Different from the conventional deep learning-based methods for a single disease such as periodontitis or dental caries, the proposed approach can provide the recognition of both periodontitis and dental caries simultaneously. This recognition method presents good performance in the identification of periodontitis and dental caries, thus facilitating dental diagnosis.

Teeth Lesion Detection Using Deep Learning and the Internet of Things Post-COVID-19.

With a view of the post-COVID-19 world and probable future pandemics, this paper presents an Internet of Things (IoT)-based automated healthcare diagnosis model that employs a mixed approach using data augmentation, transfer learning, and deep learning techniques and does not require physical interaction between the patient and physician. Through a user-friendly graphic user interface and availability of suitable computing power on smart devices, the embedded artificial intelligence allows the proposed model to be effectively used by a layperson without the need for a dental expert by indicating any issues with the teeth and subsequent treatment options. The proposed method involves multiple processes, including data acquisition using IoT devices, data preprocessing, deep learning-based feature extraction, and classification through an unsupervised neural network. The dataset contains multiple periapical X-rays of five different types of lesions obtained through an IoT device mounted within the mouth guard. A pretrained AlexNet, a fast GPU implementation of a convolutional neural network (CNN), is fine-tuned using data augmentation and transfer learning and employed to extract the suitable feature set. The data augmentation avoids overtraining, whereas accuracy is improved by transfer learning. Later, support vector machine (SVM) and the K-nearest neighbors (KNN) classifiers are trained for lesion classification. It was found that the proposed automated model based on the AlexNet extraction mechanism followed by the SVM classifier achieved an accuracy of 98%, showing the effectiveness of the presented approach.

The Limitations of Periapical X-ray Assessment in Endodontic Diagnosis-A Systematic Review.

Diagnosis is a key aspect in endodontic treatment, in a decade where invasive interventions are misapprehended as social tendency instead of medical necessity. All diagnostic facets should be considered before intending the operative phase. Intraoral endodontic radiology-based diagnosis has been shown to be limited. Periapical X-ray is the most used endodontic imaging, yet it does not provide high accuracy. Traditionally, dentists have been trained to diagnose a cyst by certain aspects (size, shape and appearance); hence, an assumption that teeth are affected by "periapical cyst" were subjected to unnecessary extraction or apicoectomy. The aim of this systematic review is to critically appraise the publications that relate the histological diagnosis of a periapical lesion (considered the gold standard) to intraoral X-ray investigation. Ovid Medline, PubMed, ScienceDirect, Mendeley and Scopus were searched for English-language studies comparing periapical diagnosis obtained by using two techniques (histopathology and X-ray). Sixteen articles were included for the final analysis (qualitative and quantitative evaluation) out of which only two supported the statement that periapical diagnosis can be coherently assessed through periapical imaging. Although there is not enough evidence to deliver a definitive conclusion, there are many publications that refute the diagnosis of a cyst via periapical X-ray.

Defect angle as prognostic indicator in the reconstructive therapy of peri-implantitis.

To analyze the influence of the characteristics of bone defects caused by peri-implantitis on the clinical resolution and radiographic bone gain following reconstructive surgery. This is a secondary analysis of a randomized clinical trial. Periapical x-rays of bone defects, caused by peri-implantitis exhibiting intrabony component, were analyzed at baseline and 12-month follow-up after reconstructive surgery. Therapy consisted of anti-infective therapy along with a mixture of allografts with or without a collagen barrier membrane. The association of defect configuration, defect angle (DA), defect width (DW), and baseline marginal bone level (MBL) with clinical resolution (based on a prior defined composite criteria) and radiographic bone gain was correlated by means of generalized estimating equations. Overall, 33 patients with a total of 48 implants exhibiting peri-implantitis were included. None of the evaluated variables yielded statistical significance with disease resolution. Defect configuration demonstrated statistical significance when compared to class 1B and 3B, favoring radiographic bone gain for the former (p = 0.005). DW and MBL did not demonstrate statistical significance with radiographic bone gain. On the contrary, DA exhibited strong statistical significance with bone gain (p < 0.001) in the simple and multiple logistic regression analyses. Mean DA reported in this study was 40°, and this resulted in 1.85 mm radiographic bone gain. To achieve ≥1 mm of bone gain, DA must be <57°, while to attain ≥2 mm of bone gain, DA must be <30°. Baseline DA of peri-implantitis intrabony components predicts radiographic bone gain in reconstructive therapy (NCT05282667-this clinical trial was not registered prior to participant recruitment and randomization).

Cystectomy of An Apical Root Cyst: Clinical Case and Literature Review

The root cyst is a cyst of odontogenic epithelial origin and inflammatory cause. It represents one of the most frequent cyst found on the oral cavity and has greater frequency at the maxillary level. The diagnosis is usually a casual finding on a routine X-ray. They are associated to tooth with negative vitality and the size is very variable. The treatment is a combined endodontic (root canal treatment) and surgical treatment (excision of the lesion). The diagnosis of certainty is obtained by a histopathological analysis. In this clinical case, a common situation of this type of lesions is shown, although in this case the patient comes to the clinic with symptoms. The root canal treatment of the affected tooth was performed. The periapical lesion did not disappear, so cystectomy was performed. The sample was sent for histopathological analysis that confirmed the diagnosis of radicular cyst. After 6 months follow-up, a periapical x-ray revealed how the lesion was ossifying.

Long-term results of autologous periosteum-derived micro-grafts with poly(lactic-go-glycolic acid) in sinus lift augmentation surgeries: A 7-years follow-up observational study

Introduction and importanceThe study aimed to present the long-term results of autologous and homologous micrografts for bone regeneration aimed at positioning dental implants after sinus lift augmentation surgeries, by combining autologous Rigenera® micrografts with poly(lactic-go-glycolic acid). Case presentationA total of 5 patients (2 males and 3 females) from 36 to 71 years were involved in the observational study. All the patients showed a good health status system (ASA1 and 2), according to their clinical history with neither system diseases, nor under medication able to interfere with osseointegration. Clinical discussionThe radiographic evaluations, after the implant placement and during the continuous follow-up upto 7 years, were carried out through periapical endoral x-rays. The survival and implant success rate was 100 %. Histological analyses were performed after 3 and 7 months after the surgical procedure. ConclusionNo adverse events have been observed that can be traced back to the use of autologous micrografts with poly(lactic-go-glycolic acid), showing safety and predictable results even in long term.

THE EFFECT OF KASTURI LEAF EXTRACT ON THE HEMOGLOBIN LEVEL EXPOSED TO PERIAPICAL RADIOGRAPHY X-Rays

ABSTRACTBackground: Periapical radiographic x-ray exposure can damage living cells, one of which is erythrocytes which contain hemoglobin by forming free radicals. Antioxidant compounds are needed to counteract the effects of these free radicals. One of the natural antioxidant compounds is kasturi leaves which contain flavonoids, triterpenoids and tannins. Purpose: To analyze the effect of kasturi leaf extract on hemoglobin levels of male mice exposed to periapical x-ray radiography. Methods: This study used a true experimental method with a post test only design with a control group design. The samples used were 24 male mice aged 3-4 months which weighed 20-25 grams. Mice were divided into 4 groups, each group consisted of 6 mice. Group P1 was a group exposed to radiation 1 times a dose of 1 mGy with a dose of 0,2 ml of kasturi leaf extract, group P2 was a group exposed to radiation 7 times a dose of 1 mGy with a dose of 0,2 ml of kasturi leaf extract, Group P3 was a group exposed to radiation 10 times at a dose of 1 mGy with a dose of 0,2 ml of kasturi leaf extract, and group P4 was a group given the extract without radiation exposure. Results: The results showed hemoglobin levels in the P1 group = 7.2833 g/dL, the P2 group = 7.4800 g/dL, the P3 group = 12.7800 g/dL, and P4 = 12.4200 g/dL. Conclusion: The results showed that there was an effect of kasturi leaf extract on the hemoglobin levels of male mice exposed to periapical x-ray radiography. The results of the Mann Whitney test showed that the results of the P1 and P2 groups were significant to P3 and P4. Keywords: Antioxidant, kasturi leaf extract, periapical radiography

Analysis of Bone Density and Bone Morphometry by Periapical Radiographs in Dental Implant Osseointegration Process.

This research aimed to analyze the differences in bone density and bone morphometry by periapical implant radiography in the dental implant osseointegration stages. This experimental research uses 12 periapical radiographs of tibial bones from a New Zealand white rabbit (Oryctolagus cuniculus). The analysis was performed on day 3, 14, and 28 of the osseointegration stages with density, trabecular thickness (Tb.Th.), trabecular separation (Tb.Sp.), and trabecular number (Tb.N.) as parameters. The implant used is a titanium alloy and coated by SA (sunblasted with alumina acid) of 4 mm in diameter and 7 mm in length. The radiographic assessment of the osseointegration process is obtained with the region of interest (ROI) segmentation results. Additionally, each ROI was analyzed for bone density and morphometry using the open-source ImageJ software with the BoneJ plugin. The significant difference was evaluated by analysis of variance (F-test) with p < 0.05 and nonparametric Kruskal-Wallis test with p < 0.05. Analysis of the osseointegration images of dental implants at day 3, 14, and 28 with the periapical X-ray modality shows significant differences (p < 0.05) in the parameters measuring density and trabecular thickness (Tb.Th.). In the variables of trabecular separation (Tb.Sp.) and number (Tb.N.) (p > 0.05), there is no significant difference. Based on the results, density and trabecular thickness (Tb.Th.) showed a significant difference between healing times. However, trabecular separation (Tb.Sp.) and trabecular number (Tb.N.) showed no difference in healing time.

In vitro evaluation of the accuracy of the fourth generation electronic apex locator: Apex ID

Background: To achieve success in endodontic treatment, the working length must be precisely defined and maintained during preparation. The introduction of the electronic apex locator makes it possible to determine the working length quickly and accurately. Apex ID is the 4th generation electronic apex locator, which can determine the working length in humid conditions. The objective of the study was to evaluate the accuracy of the Apex ID apex locator. Materials and methods: In vitro study on 50 orthodontic extracted mandibular premolars, measured working length by Apex ID apex locator. The measured value was compared with the actual length of the canal and the working length was determined by periapical X-ray. The accuracy of Apex ID was assessed through the distribution of measured values within an acceptable deviation of 0.5mm from the apical foramen. Result: The working length measured by the Apex ID machine was shorter than that measured by the periapical X-ray and the actual length of the canal (p&lt;0.05). Within the accuracy of ±0.5mm compared to the apical foramen, the working length measured by the apex locator had an accuracy of 90%, higher than that measured by the X-ray at the rate of 80% (p&lt;0.05). Conclusion: Apex ID apex locator has high accuracy, and can replace X-ray film in determining working length in clinical practice. Key words: working length, electronic apex locator, Apex ID, in vitro