Cross-sectional evaluation of the periapical status as related to quality of root canal fillings and coronal restorations in a rural adult male population of Turkey

<p>Abstract</p> <p>Background</p> <p>To determine the prevalence of periapical lesions in root canal-treated teeth in a rural, male adult, Turkish population and to investigate the influence of the quality of root canal fillings on prevalence of periapical lesions.</p> <p>Methods</p> <p>The sample for this cross-sectional study consisted of 552 adult male patients, 18-32 years of age, presenting consecutively as new patients seeking routine dental care at the Dental Sciences of Gulhane Military Medicine, Ankara. The radiographs of the 1014 root canal-treated teeth were evaluated. The teeth were grouped according to the radiographic quality of the root canal filling and the coronal restoration. The criteria used for the examination were slightly modified from those described by De Moor. Periapical status was assessed by the Periapical Index scores (PAI) proposed by Orstavik.</p> <p>Results</p> <p>The overall success rate of root canal treatment was 32.1%. The success rates of adequately root canal treatment were significantly higher than inadequately root canal treatment, regardless of the quality or presence of the coronal restoration (P < .001). In addition, the success rate of inadequate root canal treatment was also significantly affected by the quality of coronal restorations.</p> <p>Conclusions</p> <p>Our results revealed a high prevalence of periapical lesions in root canal treatment, which is comparable to that reported in other methodologically compatible studies from diverse geographical locations. In addition, the results from the present study confirm the findings of other studies that found the quality of the root canal treatment to be a key factor for prognosis with or without adequate coronal restoration.</p

Cone Beam Computed Tomography - radiation dose and image quality assessments

Diagnostic radiology has undergone profound changes in the last 30 years. New technologies are available to the dental field, cone beam computed tomography (CBCT) as one of the most important. CBCT is a catch-all term for a technology comprising a variety of machines differing in many respects: patient positioning, volume size (FOV), radiation quality, image capturing and reconstruction, image resolution and radiation dose. When new technology is introduced one must make sure that diagnostic accuracy is better or at least as good as the one it can be expected to replace. The CBCT brand tested was two versions of Accuitomo (Morita, Japan): 3D Accuitomo with an image intensifier as detector, FOV 3 cm x 4 cm and 3D Accuitomo FPD with a flat panel detector, FOVs 4 cm x 4 cm and 6 cm x 6 cm. The 3D Accuitomo was compared with intra-oral radiography for endodontic diagnosis in 35 patients with 46 teeth analyzed, of which 41 were endodontically treated. Three observers assessed the images by consensus. The result showed that CBCT imaging was superior with a higher number of teeth diagnosed with periapical lesions (42 vs 32 teeth). When evaluating 3D Accuitomo examinations in the posterior mandible in 30 patients, visibility of marginal bone crest and mandibular canal, important anatomic structures for implant planning, was high with good observer agreement among seven observers. Radiographic techniques have to be evaluated concerning radiation dose, which requires well-defined and easy-to-use methods. Two methods: CT dose index (CTDI), prevailing method for CT units, and dose-area product (DAP) were evaluated for calculating effective dose (E) for both units. An asymmetric dose distribution was revealed when a clinical situation was simulated. Hence, the CTDI method was not applicable for these units with small FOVs. Based on DAP values from 90 patient examinations effective dose was estimated for three diagnostic tasks: implant planning in posterior mandible and examinations of impacted lower third molars and retained upper cuspids. It varied between 11-77 μSv. Radiation dose should be evaluated together with image quality. Images of a skull phantom were obtained with both units varying tube voltage, tube current, degree of rotation and FOVs. Seven observers assessed subjective image quality using a six-point rating scale for two diagnostic tasks: periapical diagnosis and implant planning in the posterior part of the jaws. Intra-observer agreement was good and inter-observer agreement moderate. Periapical diagnosis was found to, regardless of jaw, require higher exposure parameters compared to implant planning. Implant planning in the lower jaw required higher exposure parameters compared to upper jaw. Substantial dose reduction could be made without loss of diagnostic information by using a rotation of 180°, in particular implant planning in upper jaw. CBCT with small FOVs was found to be well-suited for periapical diagnosis and implant planning. The CTDI method is not applicable estimating effective dose for these units. Based on DAP values effective dose varied between 11-77 μSv (ICRP 60, 1991) in a retrospectively selected patient material. Adaptation of exposure parameters to diagnostic task can give substantial dose reduction

Radiographic assessment of the marginal bone level after implant treatment : a comparison of periapical and Scanora detailed narrow beam radiography

Objectives: To compare assessments of the marginal bone level around dental implants in the mandible using periapical radiography and Scanora detailed narrow beam (DNB) radiography. METHODS: Forty patients treated with Brånemark dental implants in the lower jaw were examined with periapical and Scanora DNB radiography. Ten implants were selected from each of the four dental regions (molar, incisor, canine, premolar), and no more than one implant was selected from the same patient. Seven observers assessed the level of the marginal bone on the mesial and distal surfaces of the implants. Three of the observers made all the assessments twice. RESULTS: Agreement between the methods was 61 %. The highest agreement was found in the molar region. In DNB radiography the marginal bone level was observed to be situated more “coronally” in 17 % and more “apically” in 22 % compared with periapical radiography. The kappa value for interobserver agreement for all observers was 0.33 for periapical radiography and 0.27 for DNB radiography. The weighted kappa value for intraobserver agreement ranged from 0.75 to 0.99 for DNB radiography and from 0.94 to 0.98 for periapical radiography. CONCLUSIONS: Scanora multimodal radiography simplifies examination of implants in the mandible, and observer variation is comparable with that in intraoral periapical radiography

Longitudinal study of root resorption on incisors caused by impacted maxillary canines-a clinical and cone beam CT assessment

Objective To evaluate the long-term status of incisors with canine-induced root resorption (CIRR).Materials and methods Subjects with impacted maxillary canines (IMC) and persisting incisors with CIRR examined with cone beam computed tomography (CBCT), diagnosed >= 5 years earlier, were recalled. The resorption grade in the horizontal and vertical plane was assessed on CBCT images at baseline (T0) and follow-up (T1). Clinical examination was done at T1 which included probing depth, gingival retraction, mobility, ankylosis, discoloration and vitality test. In addition, patients completed a questionnaire regarding symptoms from the incisors.Results Forty subjects (mean age 13.7 +/- 2.1 years) with 43 IMC and 47 incisors with CIRR were recruited. The IMC either spontaneously erupted, were surgically exposed or surgically removed. Thirty-four of the patients were treated with a fixed appliance and six had no orthodontic treatment. The follow-up range was 5.5-14.6 years. None of the incisors were lost or endodontically treated at T1. The horizontal resorption grade was unchanged in 38, improved in 7, and worsened in 2 teeth. The corresponding results for the vertical resorption grade were unchanged in 20 and worsened in 27 teeth. Three incisors with severe horizontal resorption at T0 were significantly more obliterated at T1 (P = .01). No significant differences were found in clinical parameters or patient-reported outcomes between incisors with CIRR and non-resorbed contralateral incisors at T1.Limitations The extent of root resorption during active orthodontic treatment was not possible to assess as only CBCT images from T0 and T1 were available.Conclusion Incisors with CIRR caused by IMC have a high survival rate in a long-term perspective and do not cause more symptoms or exhibit more signs of pathology than non-resorbed contralateral incisors. Extraction of asymptomatic incisors based solely on root resorption should not be performed routinely

Evaluation of subjective image quality in relation to diagnostic task for cone beam computed tomography with different fields of view

AIMS: To evaluate subjective image quality for two diagnostic tasks, periapical diagnosis and implant planning, for cone beam computed tomography (CBCT) using different exposure parameters and fields of view (FOVs). MATERIALS AND METHODS: Examinations were performed in posterior part of the jaws on a skull phantom with 3D Accuitomo (FOV 3cm×4cm) and 3D Accuitomo FPD (FOVs 4cm×4cm and 6cm×6cm). All combinations of 60, 65, 70, 75, 80kV and 2, 4, 6, 8, 10mA with a rotation of 180° and 360° were used. Dose-area product (DAP) value was determined for each combination. The images were presented, displaying the object in axial, cross-sectional and sagittal views, without scanning data in a random order for each FOV and jaw. Seven observers assessed image quality on a six-point rating scale. RESULTS: Intra-observer agreement was good (κ(w)=0.76) and inter-observer agreement moderate (κ(w)=0.52). Stepwise logistic regression showed kV, mA and diagnostic task to be the most important variables. Periapical diagnosis, regardless jaw, required higher exposure parameters compared to implant planning. Implant planning in the lower jaw required higher exposure parameters compared to upper jaw. Overall ranking of FOVs gave 4cm×4cm, 6cm×6cm followed by 3cm×4cm. CONCLUSIONS: This study has shown that exposure parameters should be adjusted according to diagnostic task. For this particular CBCT brand a rotation of 180° gave good subjective image quality, hence a substantial dose reduction can be achieved without loss of diagnostic information

Limited cone-beam CT and intraoral radiography for the diagnosis of periapical pathology

Objective To compare intraoral periapical radiography with 3D images for the diagnosis of periapical pathology. Study design Maxillary molars and premolars and mandibular molars with endodontic problems and examined with periapical radiographs and a 3D technique (3D Accuitomo) were retrospectively selected and evaluated by 3 oral radiologists. Numbers of roots and root canals, presence and location of periapical lesions, and their relation to neighboring structures were studied. Results Among 46 teeth, both techniques demonstrated lesions in 32 teeth, and an additional 10 teeth were found in the Accuitomo images. As regards individual roots, 53 lesions were found in both techniques, and 33 more roots were found to have lesions in Accuitomo images. Artefacts were sometimes a problem in Accuitomo images. In 32 of the 46 cases, all observers agreed that additional clinically relevant information was obtained with Accuitomo images. Conclusions A high-resolution 3D technique can be of value for diagnosis of periapical problems