Signs Of Apical Periodontitis Research Articles

THE ROLE OF ENDODONTICS IN THE TREATMENT OF CHRONIC ODONTOGENIC DISEASES IN PREPARATION FOR PROSTHETICS

Background. When planning orthopedic restoration of significantly destroyed teeth with signs of apical periodontitis, it is necessary to assess the complexity of root canal anatomy as one of the factors influencing successful endodontic dental treatment. Modern approaches in endodontics allow in most cases to achieve the restoration of bone tissue, as well as the elimination of the focus of chronic infection, which allows for subsequent orthopedic dental treatment in order to restore their function and increase the percentage of survival in the oral cavity.
 Purpose. Improving the efficiency of orthopedic restoration of teeth with chronic odontogenic infection.
 Materials and methods. 64 patients aged 18 to 45 were examined. All had clinical signs of failed endodontic treatment of the incisors in the upper and lower jaws with a dark, radiolucent focus in the apex region, as well as significant destruction of the crown requiring orthopedic restoration. The assessment of radiographic parameters was based on CBCT, and mobility was assessed clinically. The results were evaluated after 6, 12, and 24 months.
 Results. All patients showed different signs of restoration of the bone tissue after 6 and 12 months and complete restoration of the bone tissue 24 months after the treatment. No pathological tooth mobility was found 24 months after the end of treatment in 100% (primary endodontic treatment) and 97.5% (repeated endodontic treatment) of patients.
 Conclusion. The analysis of the anatomy of the root canals, and, accordingly, the complexity in biomechanical cleaning and washing of the root canals affects the decision to carry out treatment in one or two visits.

INCREASING THE EFFICIENCY OF THE TREATMENT OF ENDOPARODONTAL LESIONS

Chronic inflammation in the periodontium, pulp and periodontium, through the pocket of which the infection can spread towards the root apex and cause a retrograde development of the inflammatory process in the pulp and periapical tissues, is considered as an odontogenic focus.
 Aim: to study the state of periodontal tissues, periodontitis in the presence of a periapical focus of infection and the dynamics of its change in complex treatment.
 Material and methods. 150 medical records of a dental patient were studied, among them a randomized controlled study of 100 patients with combined endodontic and periodontal lesions and 50 individuals not burdened by this pathology was also conducted. At the next stage a study of 41 patients with EPL was conducted. The patients were divided into two groups depending on the treatment algorithm: I – with a diagnosis of EPL20 patients of the main group, who, along with standard treatment, received additional therapy with decontamination of CC and laser curettage with a dental diode laser (Picasso Life); II with a diagnosis of EPL 21 patients in the control group with traditional treatment. Evaluation of the effectiveness of traditional and proposed methods of treatment of endoperiodontal lesions was carried out by assessing the degree of gingival bleeding (SBI index (Muhlemann H.R. modified by Cowell I., 1975)) and probing depth (PD).
 Results. The age indicators for patients of two groups most often varied within 40-49 years. The second most frequent was the age of the subjects, which amounted to 50-59 years. When studying the influence degree of industrial environment factors with irritating and general toxic properties on the frequency of occurrence of EPl, it was found that in the main group 14.0% of patients with this pathology have been working in such conditions for a long time. In addition, in the control group, the number of persons professionally burdened with inflammatory periodontal diseases without signs of apical periodontitis was 16.0%. In the course of further analysis of the obtained anamnestic data, it was revealed that alcohol abuse occurred in the main group in 36.0% of cases, in the control group in 24.0%. Abuse of tobacco products, against the background of which there is inflammation of the gums in the form of hyperemia, edema, bleeding, was noted by half of the patients in the control group and almost the same number of patients in the main group 48.0%, in whom pathological changes in the periapical region were detected in parallel.
 Conclusion. At certain periods of observation, statistically significant distinguishing intergroup signs were clearly expressed 6 months after the completion of therapeutic and preventive measures, and this trend in a sharp and significant decrease in gum bleeding and periodontal pocket depth continued by the end of observations in the main group when using a laser.

Case Report: Subtherapeutic Vancomycin and Meropenem Concentrations due to Augmented Renal Clearance in a Patient With Intracranial Infection Caused by Streptococcus intermedius.

Streptococcus intermedius occasionally causes brain abscesses that can be life-threatening, requiring prompt antibiotic and neurosurgical treatment. The source is often dental, and it may spread to the eye or the brain parenchyma. We report the case of a 34-year-old man with signs of apical periodontitis, endophthalmitis, and multiple brain abscesses caused by Streptococcus intermedius. Initial treatment with meropenem and vancomycin was unsuccessful due to subtherapeutic concentrations, despite recommended dosages. Adequate concentrations could be reached only after increasing the dose of meropenem to 16 g/day and vancomycin to 1.5 g × 4. The patient exhibited high creatinine clearance consistent with augmented renal clearance, although iohexol and cystatin C clearances were normal. Plasma free vancomycin clearance followed that of creatinine. A one-day dose of trimethoprim–sulfamethoxazole led to an increase in serum creatinine and a decrease in both creatinine and urea clearances. These results indicate that increased tubular secretion of the drugs was the cause of suboptimal antibiotic treatment. The patient eventually recovered, but his left eye needed enucleation. Our case illustrates that augmented renal clearance can jeopardize the treatment of serious bacterial infections and that high doses of antibiotics are needed to achieve therapeutic concentrations in such cases. The mechanisms for regulation of kidney tubular transporters of creatinine, urea, vancomycin, and meropenem in critically ill patients are discussed.

MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT OF DENTAL TRAUMA

Relevance of the topic. Disruption of the anatomical integrity of the dentition, occurring as a result of dental trauma, not only impairs the patient’s appearance, but can also affect the functional properties of the entire maxillofacial area. Therefore, the choice of optimal methods for treatment of dental traumas remains an urgent problem of dentistry and requires further development.
 The aim of this study was to offer the most effective methods for treatment of dental traumas, with a view to preserve and restore the damaged structures of teeth and provide positive long-term outcomes.
 Materials and methods. The research relied on the study and generalization of modern scientific literature.
 Results and discussion. To diagnose dental traumas and, accordingly, to determine the ways to eliminate their consequences, its classification is of great importance. In this context, the classification by Andreason gained the strongest support in the world dental community. The approaches to the diagnostics and treatment of dental traumas, which have become established in the world of dentistry, largely rely on this classification.
 In modern conditions, computed tomography provides the opportunity to obtain maximum information about the condition of the injured tooth and bone damage. Cone-beam computer devices are used to study the maxillofacial area, providing high image quality at low radiation exposure. Essential diagnostic methods also include pulp vitality tests (cold test and electroodontodiagnostics). In this case, to exclude the diagnosis of pulp necrosis, it is recommended to check its vitality repeatedly.
 Currently, as an alternative to classical restoration in case of fracture of the tooth crown, specialists consider the fixation of the proper fragment of the tooth. Recently, this method of eliminating the effects of fractures of the dental crown is becoming increasingly popular due to the significant improvement in quality and enhanced technological properties of adhesive systems and materials.
 The search for ways to improve medical care in cases of tooth avulsion is mainly associated with the introduction of replantation and autotransplantation of teeth in the clinical practice. It is recommended to replant a tooth with an open apex without its depulpation due to the high ability of the germinal zone and periodontium to revascularize. Immediately after returning the tooth to the alveolus, a flexible splint is applied for a period of 3-4 weeks. Further endodontic treatment is performed only in cases when revascularization does not occur and signs of apical periodontitis appear. When the root apex is formed, the tooth is replanted in the alveolus, splinted for up to 2 weeks. Endodontic treatment should begin before the splint is removed, 7-10 days after replantation.
 Experts suggest replanting permanent teeth with both open and closed root apices, even in cases where the tooth has been in a dry environment for more than 60 minutes. However, not always after the injury the tooth can be found or it can be destroyed so that replantation becomes impossible. Nevertheless, in modern conditions, having received an in-depth biological justification of the process of engraftment of the transplanted tooth, it becomes possible to widely use the method of autotransplantation in the clinical practice.
 Conclusions. Thus, based on the study of a significant array of scientific publications, we can conclude that the problems of dental trauma are increasingly attracting the attention of researchers due to the prevalence of this pathology, the complexity of its diagnostics and treatment. The current approach to the treatment of dental trauma is focused on less invasive and more biologically oriented methods of treatment of hard dental tissues, pulp, periodontal ligament and alveolar bone.
 Research prospects. It is important to develop the best conditions for tooth storage before replantation in order to improve the periodontal regeneration, the quality of the revascularization process, offer better types of splinting, which will ensure the regeneration of periodontal and pulp tissues, prevent inflammatory complications.

Success, Survival Rate, and Soft Tissue Esthetic of Tooth Autotransplantation

IntroductionThe aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth. MethodsThis study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%. ResultsThirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1–25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases. ConclusionsTooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.

Guided root canal preparation using cone beam computed tomography and optical surface scans - an observational study of pulp space obliteration and drill path depth in 50 patients.

To report the precision of guided access cavity preparations in relation to demographical and dental variables in 50 patients. This observational study was carried out during the period 2014-2017. The patients were consecutive referrals to a private endodontic practice. The inclusion criteria were as follows: (i) pulp space obliteration associated with signs of apical periodontitis (PAI score >3 or sensitive to percussion, (ii) teeth with pulp space obliteration in need of a post, where the referring dentist had attempted or failed to negotiate the obliterated root canal (and it was not possible to negotiate using the operating microscope within a reasonable time frame) and (iii) a surgical intervention was not justified. A published methodology for guided endodontics was used. Measures on demographical and previous dental history were analysed and related to drill path precision, being evaluated on radiographs as optimal (centre of the root canal) or acceptable (peripheral/tangential). The chi-square test was used for analyses of correlation between predictor variables and binary logistic regression analysis using backward elimination with degree of obliteration, guided access cavity preparation depth and precision as dependent variables. Significance level was 0.05. Thirty-one female (median age 65year) and 19 males (median age 69year) were enrolled. Overall, 88% (n=44) of the teeth had pulp space obliteration associated with signs of apical periodontitis, whereas the remaining teeth were in need of a post. The pulp space obliterations were longer in maxillary compared with mandibular teeth (P=0.024). The performance of the drill path in mandibular teeth versus maxillary teeth resulted in a significantly greater number of optimal precision scores (P=0.033), and when a previous attempt at access and canal negotiation had occurred versus no attempt (P=0.009). Even in cases with the worst outcome, the technique was still successful clinically. The clinical implementation of guided root canal treatment in fifty serial cases of single-rooted teeth with pulp space obliteration was associated with a precision that in all cases led to the location and negotiation of the root canal and completion of the treatment.

Prevalence of apical periodontitis and root filled teeth in a Belgian subpopulation found on CBCT images.

To investigate the prevalence of apical periodontitis (AP) and root filled teeth found on cone-beam computed tomography (CBCT) scans in a Belgian subpopulation in a retrospective cross-sectional study. At the university hospital of Leuven, 804 patients received a CBCT scan between 01/01/2013 and 01/01/2014. The investigated sample included 631 scans with a permanent dentition and a total of 11117 teeth. Prevalences and their confidence intervals are reported and the association between treatment, position of a tooth, gender and age with AP was determined using logistic regressions. A total of 656 teeth (5.9%) had signs of AP and 1357 teeth (12.2%) had been root filled. AP was present in 212 of the 9760 nonroot filled teeth (2.2%) and in 444 of the 1357 root filled teeth (32.7%). Adequate root fillings were detected in approximately half (49.3%) of the root filledteeth. The prevalence of AP was 22.8% when the root filling was adequate, when scored inadequate the prevalence increased to 41%. Univariate and multivariable logistic regression analyses revealed a significant relation of tooth position and treatment with AP. No difference in the prevalence of AP between male and female patients was detected. The prevalence of AP was comparable with findings in other epidemiological studies. Root filled teeth had significantly more AP than nonroot filled teeth. The technical quality of the root fillings had a significant impact on the presence of AP. Therefore, emphasis on the quality of work and continuing education in the field of Endodontology must be provided in Belgium.

Root canals-from concretion to patency

Teeth with calcification provide an endodontic treatment challenge; traumatized teeth usually develop partial or total pulpal obliteration which is characterized by apparent loss of the pulp space radiographically and a yellow discoloration of the clinical crown. Since only 7-27% of such teeth develop pulp necrosis with radiographic signs of apical periodontitis, it is difficult to decide whether to treat these teeth immediately upon detection of the pulpal obliteration or to wait until signs and symptoms of pulp and/or apical periodontitis occur. This article reviews the etiology, prevalence, classification, mechanism, diagnosis as well as treatment options for teeth with pulp obliteration and the various management approaches and treatment strategies for overcoming potential complications. A search of articles from PubMed and Medline from 1965 to present was done with the keywords dental trauma, discoloration, pathfinding instruments, pulp canal obliteration, and root canal treatment was conducted. A total of 94 abstracts were collected, of which 70 relevant articles were read and 31 most relevant articles were included in this article.

Prevalence of apical periodontitis and frequency of root canal treatments in liver transplant candidates

Aim: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects. Material and Methods: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression. Results: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002). Conclusions: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects. Key words:Apical periodontitis, endodontics, hepatic cirrhosis, liver disease, liver transplant, oral health, root-canal treatment.

Healing of a tooth with an overinstrumented apex, extensive transportation and periapical lesion using a 5 mm calcium hydroxide apical plug: an 8-year follow-up report

Besides the risk of filling material extrusion throughout the apex, a satisfactory apical seal can be difficult to achieve in canals with open apices or iatrogenic enlargements of the apical constriction. These situations pose a challenge to root canal filling. This paper describes the root canal filling of a maxillary right canine with an overinstrumented apex, complete loss of the apical stop, extensive canal transportation and apical periodontitis. A 5 mm calcium hydroxide apical plug was placed before root canal filling. The plug was made by soaking paper points with saline, dipping the points in calcium hydroxide powder and then applying it to the apex several times, until a consistent apical plug was obtained. The canal was then irrigated with saline in order to remove any residual calcium hydroxide from the root canal walls, dried with paper points and obturated with an inverted #80 gutta-percha cone and zinc oxide-eugenol based sealer by the lateral condensation technique. An 8-year radiographic follow-up showed formation of mineralized tissue sealing the apical foramen, apical remodeling and no signs of apical periodontitis.

Managing severe curvature of radix entomolaris: three-dimensional analysis with cone beam computed tomography

To present a case of a mandibular first molar with an additional distolingual root [radix entomolaris (RE)] and to discuss the use of cone beam computed tomography (CBCT) for its identification and management during root canal treatment. A 52-year-old Caucasian woman was referred for root canal treatment of the right mandibular first molar (tooth 46). After clinical and radiographic examination, a symptomatic irreversible pulpitis was diagnosed. Three periapical radiographs with different horizontal angulations revealed the presence of an additional distolingual root. This extra root, termed RE, has an incidence of <5% in the Caucasian population. A CBCT examination was also taken, which revealed a severe root canal curvature, especially in the middle third, of this supernumerary root. CBCT provided more accurate information in terms of RE inclination and root canal curvature before commencing root canal treatment. The conventional access opening was modified into a more trapezoidal cavity, and five root canals were found. All canals were instrumented with new nickel-titanium (NiTi) files to reduce the risk of fractured instruments. After preparation, the root canals were filled using thermoplastified techniques. The 1-year follow-up periapical radiographs and CBCT images revealed a continuous periodontal space with no signs of apical periodontitis. • Cone beam computed tomography imaging is useful in identifying the root canal system and the surrounding structures. • An accurate detection of supernumerary roots, such as RE, can avoid complications during and after root canal treatment. • The analysis of root canal curvature is important because instrument fracture has been linked to angle and radius of curvature. • The use of new instruments can reduce the incidence of instrument fracture.

Retrospective radiological assessment of root canal treatment in young permanent dentition in a Turkish subpopulation

To determine the technical quality of root fillings as well as the periapical status of root filled teeth and non-root filled teeth in young permanent dentitions using a retrospective analysis of orthopantomographs (OPTGs) in a Turkish subpopulation. Included in this study were the digital OPTGs taken as a part of diagnostic and planning procedures for all 19-year-old adolescents who attended the Faculty of Dentistry, Marmara University (Istanbul, Turkey) for the first time during the period from June 2007 to May 2009. The periapical status of all teeth and the technical quality of the root fillings were assessed by radiographic criteria. Statistical analysis was performed by the Mann-Whitney U, chi-squared, Fisher's exact and Cohen's kappa tests. The survey involved OPTGs of 1077 19-year-old adolescents: 663 (61.6%) women and 414 (38.4%) men. Of the 28974 teeth examined, 459 (1.6%) were root filled, of which 193 (42.0%) had radiological signs of apical periodontitis (AP), and 454 (1.6%) were non-root filled teeth with AP. No significant difference was found between women and men regarding the number of teeth present, the number of root filled teeth and the number of non-root filled teeth with AP (P>0.05). The most commonly treated teeth were molars (54.2%), followed by pre-molars (27.0%) and incisors (18.8%). Length was adequate in 57.3%, and homogeneity was adequate in 50.5% of the root fillings. Statistically, both the length and the homogeneity of the root fillings were significantly associated with periapical status individually (P<0.01). The overall technical quality was inadequate in 60.1% of the root fillings, and 67.0% of these were associated with signs of AP. Amongst root filled teeth, the frequency of AP in connection with molars was significantly higher (57.0%) than that for incisors (27.9%) and pre-molars (21.8%) (P<0.01). The results of this study indicated that the frequency of root filled teeth with AP, non-root filled teeth with AP and of technically inadequate root fillings amongst all root filled teeth was high in this selected adolescent Turkish population.

Prevalence of oral pathologic findings in an ancient pre‐Columbian archeologic site in the Atacama Desert

To determine the prevalence of oral pathologic findings in an ancient culture that inhabited the Atacama Desert. A systematic examination was performed on the remains of 83 individuals unearthed from a prehistoric burial ground. A total of 57 skeletal remains achieved appropriate inclusion criteria, from which estimated age at death, gender, ante- and postmortem tooth loss, prevalence and location of caries, apical periodontitis sequela, alveolar bone resorption and attrition were recorded. From the analyzed skeletal remains (13 male, 22 female and 22 not identifiable), the mean age estimated was 29.9 +/- 13.8 years. A total of 89.4% of them presented permanent dentition with a mean ante-mortem tooth loss of 9.0 teeth and a postmortem mean tooth loss of 14.4 teeth per subject. In all, 46.4% of the postmortem remaining permanent teeth (n = 237) showed caries lesions. Interproximal caries was most frequently observed (31.5%), followed by occlusal (25.9%) and cervical caries (19.4%). Root remnants were found in 23.1% of the cases. In addition, 58.0% of the adults presented attrition, 26.0% signs of apical periodontitis and 44.0% loss of alveolar bone support >5 mm. The remains of jaws and teeth of the individuals examined in this study presented sequelae of severe oral health damage due to caries and periodontal disease.

Investigation of the effect of the coronal restoration quality on the composition of the root canal microflora in teeth with apical periodontitis by means of T‐RFLP analysis

To investigate the effect of the radiographic and clinical quality of coronal restorations on the composition of the root canal flora of teeth with necrotic pulps and teeth with root fillings associated with apical periodontitis. Twenty-eight necrotic pulps and 35 root filled canals with signs of apical periodontitis were studied. Both the coronal filling (presence of radiographically or clinically deficient margins and/or secondary caries) and the root filling (homogeneity and length) were scored. Bacterial root canal samples were taken with sterile paper points under rubber dam and using measures to prevent contamination. A DNA-based nonculture bacterial identification technique was used, namely terminal restriction fragment length polymorphism (T-RFLP) analysis. Twelve samples were negative for bacterial DNA. A total of 33 different terminal restriction fragments (TRFs) were detected. The Fusobacterium nucleatum/Streptococcus mitis group was the most frequently encountered TRF. The mean number of TRFs per necrotic pulp was 6.2 and 5.8 for the groups with acceptable and unacceptable coronal restorations, respectively. This difference was not significant. In the root filled group, these values (respectively, 5.2 and 8.6) were statistically significantly different (P < 0.05). The following parameters in root filled teeth had no significant influence on the mean numbers of TRFs detected: the length and homogeneity of the root filling and the type of tooth (anterior-premolar-molar). T-RFLP allowed the rapid assessment of bacterial biodiversity in root canal samples. The technique revealed the presence of bacteria that have rarely been described in the root canals of teeth with apical periodontitis. Biodiversity in the root filled group was high, as compared with culture-dependent studies where monoinfections were more frequently reported. Only in root filled teeth did defective coronal restorations have a statistically significant influence on the mean numbers of detected TRFs per sample.