Cone-beam computed tomography accuracy in pulp chamber size evaluation: An ex vivo study

This study aimed to assess ex vivo the accuracy of cone-beam computed tomography (CBCT), as compared to operative microscope, for evaluating pulp chamber size. A total of forty teeth were extracted for periodontal reasons and a horizontal section was done at the most apical level of the cement-enamel junction. The pulp chamber was photographed using a digital camera connected to an optical microscope. Then, the tooth was scanned with CBCT and the horizontal slide matching the anatomical section of pulp chamber was digitally stored. The pulp chamber section area was measured through image analysis software. The two methods provided similar results, either for monoradicular (P = 0.14) or multiradicular teeth (P = 0.93). Correlation was statistically significant (P < 0.0001), being the coefficient r = 0.89 and 0.94 for monoradicular and multiradicular teeth, respectively. Conclusively, CBCT is suitable for pulp chamber morphology evaluation. However, it has limitations in detecting the anatomical variability of small branches in root canal system

Applications of CBCT in Endodontics

There are many articles published in recent years on the use of CBCT in endodontics and this diagnostic technique is increasingly required in order to have a more accurate prognosis of the teeth to be treated. The purpose of this chapter is to discuss the use of Conical Beam Computed Tomography (CBCT) in the field of endodontics. This issue is controversial at the moment because of the increase in the radiation to which patients are being subjected; however, we know that sometimes the X-rays taken with different angles in relation to some teeth depending on the different cases are incompatible in form and density, which does not allow us to make an exact diagnosis. The use of CBCT would have provided an image of greater diagnostic value in those cases. In addition, the use guidelines published by the American Endodontics Association and the American Radiology Association jointly mark the way forward and the use we can give the CBCT for the diagnosis of complex cases

Comparison of digital and conventional radiographic techniques

This study aimed to evaluate the correlation between conventional and digital radiographic methods in the measurement of periapical lesions in primary molars and compares the time used to obtain the radiographic images betweenboth methods. Material and methods: This crossover study included children between 4 to 8-year-old with periapical lesion in primary mandibular molars. Fifteen molars were randomly assigned firstly to receive conventional or digital periapical radiograph during the steps of endodontic treatment. The time to obtain the radiographic image was evaluated in seconds and compared by the Mann-Whitney test. The periapical lesions measurement (mm2) were performed by the Image J software and the degree of correlation of measurement between both techniques was evaluated by the Spearman correlation test. Data was analyzed using the GraphPad Prism software (α = 0.05). Results: A strong positive correlation between the measurement of lesions occurred on conventional methods in comparison with the measurement on digital methods (r2=0.778; p<0.0006); however, the time to obtain the radiographic images was shorter in the digital method (p<0.0001). Conclusion: The digital method had a shorter amount of time to obtain the images and strong correlation for the lesions measurement in comparison to the conventional method. Therefore, the digital radiograph method is preferable for use in children

Use of Cone Beam Computed Tomography in Endodontics

Cone Beam Computed Tomography (CBCT) is a diagnostic imaging modality that provides high-quality, accurate three-dimensional (3D) representations of the osseous elements of the maxillofacial skeleton. CBCT systems are available that provide small field of view images at low dose with sufficient spatial resolution for applications in endodontic diagnosis, treatment guidance, and posttreatment evaluation. This article provides a literature review and pictorial demonstration of CBCT as an imaging adjunct for endodontics

Apikaalne periodontiit: levimus ja etiopatogeneetilised aspektid

Väitekirja elektrooniline versioon ei sisalda publikatsiooneApikaalne periodontiit (AP) on hamba juurekanalisüsteemis paikneva bakterpõletiku tagajärjel tekkinud kahjustus hambajuuretipu ümbruses. AP tekib enamasti kaugelearenenud hambakaariese tagajärjel ning sellega kaasnev hambajuuretipu ümbruse kudede häving on radioloogiliselt nähtav. AP on maailmas laialt levinud haigus, mille esinemist seostatakse vanuse, soo, teiste hambahaiguste, hambaravikvaliteedi ja indiviidi sotsiaalmajandusliku seisundiga. Käesoleva doktoritöö eesmärgiks oli välja selgitada AP levimus Eestis ning seda põhjustavad ja soodustavad faktorid. Selleks viidi läbi 3 suuremat uuringut. AP levimuse hindamiseks vaadeldi 6552 patsiendi radioloogilisi uuringuid, kus hinnati kõikide hammaste seisukorda. AP diagnoositi üle pooltel uuritavatest ja haigusel leiti tugev seos eelnevalt teostatud hambahaiguste ja -ravi kvaliteediga. Haigestumise risk oli oluliselt madalam kvaliteetse hambaravi korral. Mikrobioloogiliseks uuringuks koguti proove 12 hamba juurekanalist, eraldati DNA ja tuvastati bakteri liigid. Mikroobikooslused olid indiviiditi erinevad ja mitmekesised, kuid domineerisid anaeroobsed bakterid. Avastati mitmeid raskesti kultiveeritavaid ja seni juurekanalitest avastamata mikroobiliike. Eelnevast võib järeldada, et kuna AP’d põhjustavad väga paljud mikroobid, siis spetsiifiliste mikrobioloogiliste analüüside teostamine juurekanalisüsteemist ei ole mõistlik ja raviprotsess tuleb suunata kõikide mikroobide ja nende koosluste vastu. Oksüdatiivse stressi (OxS) markerite määramiseks kasutati 86 patsiendi sülge ja juurekanali sisaldust. OxS esines nii kõikide uuritud juureravi vajavate hammaste juurekanalis kui ka kogu organismis. Tervetel inimestel seevastu olid OxS tasemed madalad. Märkimisväärseks osutus OxS seos hambavalu ja hamba juuretipu ümbruse luu hävinguga. Seega on OxS tähtis mehhanism juurekanali põletike korral.Apical periodontitis (AP) is an inflammatory disease around the apex of a tooth root that is caused by infection in root canal system. AP can be considered a sequela of advanced dental caries, and it is radiologically visible as hard tissue destruction around the apex of the tooth root. AP is a widespread condition all around the world and its prevalence is associated with age, gender, level of previous dental diseases and treatment and socioeconomic status of the region. The general aim of the present thesis was to clarify the prevalence, determining factors and etiopathogentic aspects of AP among Estonian population. To clarify the prevalence of AP we analyzed radiographs of 6552 patient, we described and evaluated all teeth and their status. AP was diagnosed over half of the patients and we found a strong correlation between AP and previous dental diseases as well as the quality of previous dental treatment. The prevalence of AP was considerably lower in patients with high quality dental treatment. Microbial samples were collected from 12 root canals, DNA was isolated and the bacteria were characterized. The communities were individually different but anaerobic bacteria predominated as the rule. We discovered several hard to cultivate and even some not yet discovered spices from root canals. Therefore, the microbiological analysis of the root canal content in case of endodontic pathologies is meaningless, and the treatment measures must be directed against wide spectrum of aerobic and anaerobic bacteria. To measure oxidative stress (OxS), the saliva and root canal samples of 86 patients were analyzed. OxS levels were elevated in patients with endodontic pathologies compared to healthy subjects. OxS appeared to be an important pathogenetic mechanism in several endodontic pathologies being significantly associated with essential clinical markers like dental pain and bone destruction area around the apex of the tooth

Prevalence of apical periodontitis and quality of root canal fillings in population of Zagreb, Croatia: a cross-sectional study

Aim To determine the prevalence of apical periodontitis and assess the quality of endodontic fillings in the population of the city of Zagreb, Croatia. Methods A total of 1462 orthopantomograms from new patients at 6 different dental practices was analyzed during 2006 and 2007. The presence of periapical lesions was determined by using the periapical index score (PAI). The quality of endodontic fillings was assessed according to the filling length and homogeinicity. Data were analyzed using t test and ANOVA with Scheffe post-hoc test. Results There were 75.9% of participants with endodontically treated teeth and 8.5% of all teeth were endodontically treated. Only 34.2% of endodontically treated roots had adequate root canal filling length, while 36.2% of root canal fillings had homogenous appearance. From the total number of teeth with intracanal post, 17.5% had no visible root canal filling. Using PAI 3 as a threshold value for apical periodontitis, periapical lesions were detected in 8.5% of teeth. Adequate quality of root canal fillings was associated with a lower prevalence of periapical lesions. Conclusion We found a large proportion of endodontically treated teeth with apical periodontitis and a correlation between the quality of endodontic filling and the prevalence of periapical lesions. This all suggests that it is necessary to improve the quality of endodontic treatment in order to reduce the incidence and prevalence of apical periodontitis

Evaluation of the visibility of the materials used in furcation perforation in imaging devices

Background: Variable radiographic techniques are used for postoperative evaluation of the materials used in furcation perforation. Since it is easily accessible clinically and the radiation dose which the patient is exposed to, is lower than the advanced imaging methods, intraoral imaging is applied. In cases that cannot be determined by 2D radiographs, cone beam computed tomography is more relevant because of the absence of superimpositions and allowing for multiplanar imaging. The aim of this study was to assess the diagnostic acceptability of the radiographic visibility of the materials used in furcation perforations and to find out which radiographic technique was efficient to view the materials. Methods: One hundred and twelve lower molar teeth were used according to the study criteria. Biodentin, BioAggregate, MTA and Endosequence were applied individually to the teeth, in order to repair the perforation zone. Periapical radiographs were obtained with Soredex Digora Optime with photostimulated phosphor plates. Other radiographic images were obtained using Planmeca Dixi 3 CCD, while CBCT images were obtained using Morita Veraviewepocs 3D R100. An endodontist and two dentomaxillofacial radiology specialists evaluated the images of CBCT and periapical radiographs. Teeth were evaluated randomly for the visibility of the repair materials in furcal perforations and scored. Results: MTA and Biodentine presented low image clarity while Bioaggregate and Endosequence had high image clarity. Morita Veraviewepocs 3D R100 depicted the highest sharpness, but no difference was observed between Soredex Digora Optime and Planmeca Dixi 3 devices. Conclusion: In the postoperative follow-up of the materials used in the treatment of furcation perforations, the usage of CBCT and the use of Bioagregate and Endosequence, which provide the best image clarity, has been suggested

The detection of periapical pathosis using periapical radiography and cone beam computed tomography -Part 1: pre-operative status

Aim Part 1 of this 2 part study aims to compare the prevalence of periapical lesions on individual roots viewed with intraoral (periapical) radiographs and cone-beam computed tomography (CBCT) of teeth treatment planned for endodontic treatment. § Methodology Diagnostic periapical radiographs and CBCT scans were taken of 151 teeth in 132 patients diagnosed with primary endodontic disease. The presence or absence of periapical lesions was assessed by a consensus panel consisting of two calibrated examiners, a consensus agreement was reached if there was any disagreement. The panel viewed the images under standardised conditions. Part 2 will compare the radiographic outcome 1 year after completion of primary root canal treatment. Results Two hundred and seventy-three paired roots were assessed with both radiological systems, periapical lesions were present in 55 (20%) and absent in 218 (80%) roots assessed with periapical radiographs. When the same 273 sets of roots were assessed with CBCT, lesions were present in 130 (48%) and absent in 143 (52%) roots. Seventy-five additional roots were detected with CBCT. Conclusion The limitations of periapical radiographs which may hinder the detection of periapical lesions are overcome with CBCT. This results in firstly, more roots being assessed, and secondly, more periapical lesions being detected with CBCT

Diagnostic Accuracy of Cone-Beam Computed Tomography and Periapical Radiography in Internal Root Resorption

Introduction: The aim of this study was to compare the diagnostic value of cone-beam computed tomography (CBCT) and periapical (PA) radiography in detecting internal root resorption. Methods and Materials: Eighty single rooted human teeth with visible pulps in PA radiography were split mesiodistally along the coronal plane. Internal resorption like lesions were created in three areas (cervical, middle and apical) in labial wall of the canals in different diameters. PA radiography and CBCT images were taken from each tooth. Two observers examined the radiographs and CBCT images to evaluate the presence of resorption cavities. The data were statistically analyzed and degree of agreement was calculated using Cohen’s kappa (k) values. Results: The mean±SD of agreement coefficient of kappa between the two observers of the CBCT images was calculated to be 0.681±0.047. The coefficients for the direct, mesial and distal PA radiography were 0.405±0.059, 0.421±0.060 and 0.432±0.056, respectively (P=0.001). The differences in the diagnostic accuracy of resorption of different sizes were statistically significant (P&lt;0.05); however, the PA radiography and CBCT, had no statistically significant differences in detection of internal resorption lesions in the cervical, middle and apical regions. Conclusion: Though, CBCT has a higher sensitivity, specificity, positive predictive value and negative predictive value in comparison with conventional radiography, this difference was not significant.Keywords: Cone-Beam Computed Tomography; Periapical Radiography; Root Resorptio