Diagnóstico clínico, radiográfico e histológico de un caso de fibrosis periapical posendodóntica / Clinical, radiographic, and histologic diagnosis of a postendodontic periapical fibrosis case

Objetivo: La fibrosis periapical posendodóntica es un proceso reparativo asintomático, radiolúcido y no progresivo que se interpreta con frecuencia como una lesión patológica persistente. El diagnóstico de esta entidad suele ser dudoso y sólo puede definirse mediante la correlación de las obser- vaciones clínicas, radiográficas e histológicas. El objetivo de este informe es describir el caso de un paciente que presenta un área radiolúcida periapical persistente y asintomática en un incisivo lateral superior. Caso clínico: Luego de cuatro años y dos meses de ha- ber recibido un tratamiento endodóntico el paciente concurre a la consulta para un examen de rutina. El examen radiográfico del diente revela un área radiolúcida persistente y bien defini- da. A causa de una fractura radicular irreparable, se indicó la extracción de la pieza dentaria. Esto permitió realizar el estu- dio histológico del tejido blando que permanecía adherido en el ápice de la raíz, lo que confirmó y completó el diagnóstico de fibrosis periapical posendodóntica.(AU)

Aim: The postendodontic periapical fibrosis is an asymp- tomatic radiolucent and non-progressive healing process that is often interpreted as a persistent pathological lesion. The diagnosis of this entity is usually uncertain, and it is only de- fined by the correlation of clinical, radiographic and histo- logical observations.The aim of this report is to describe the case of a patient with a long-term persisting asymptomatic and radiolucent area in a upper lateral incisor. Clinical case: Four years and two months after receiv- ing an endodontic treatment the patient comes to our office for a routine control. Radiographic examination revealed the presence of a persistent well defined radiolucent area. Sur- gical tooth extraction was required due to the presence of a complicated root fracture.This allowed to perform a histolog- ical study of the soft tissue attached to the apex of the ex- tracted root, which confirmed and completed the diagnosis of postendodontic periapical fibrosis (AU)

Overview of technical advances in the diagnosis of pulp and periapical diseases / 中华口腔医学杂志

Pulp and periapical diseases are common and frequently occurring diseases of which diagnosis and treatment must be dealt with by the dental clinicians. The diagnostic techniques of these diseases include evaluation of pulp vitality, measurement of pulp blood circulation and analysis and judgment of root canal anatomy. With the continuous emergence of digital and imaging technologies, the correct application of these technologies in clinic will help clinicians improve their abilities in diagnosis and treatment of related diseases. The present article summarizes and reviews the progress of assistant technology for diagnosing dental pulp and periapical diseases in recent years and puts forward some suggestions for its application.

Application and prospect of static/dynamic guided endodontics for managing pulpal and periapical diseases / 中华口腔医学杂志

Root canal therapy and endodontic surgery are conventional treatments for pulpal and periapical diseases. Compared with naked-eye operations, the application of dental operating microscope has enhanced the procedural accuracy and prognosis efficiently. However, root canals with pulp calcification/obliteration, apical lesions with thick cortical bone or adjacent to important anatomic structures are even challenging for experienced operators to achieve predictable clinical outcomes. Recently, with the advances in the field of digitalized information sciences, the above mentioned complicated endodontic cases can be solved under static and dynamic guidance. Before the treatment begins, virtual path is designed from data collected by cone-beam CT and oral image scanning using guidance software. Afterwards, root canal therapy and endodontic surgery can be performed precisely under the assistance of three-dimensional printed guide or dynamic guidance system. The present review describes the classification, features and clinical applications of the guided endodontics.

Hallazgo incidental en tomografía computada de haz cónico / Incidenal finding in cone beam computed tomography

El creciente número de técnicas radiográficas realizadas por paciente para diagnóstico y planificación provoca un aumento en el número de hallazgos incidentales. La descripción de un hallazgo incidental puede desencadenar atención médica adicional, que incluye otros procedimientos y tratamientos de diagnóstico, con lo cual, en muchas ocasiones es necesario derivar al paciente para tratar la patología descubierta en forma incidental. La CBCT puede ayudar a detectar la presencia de lesión periapical no diagnosticada previamente, donde la evaluación clínica previa y las radiografías convencionales no han revelado la patología. La patología asintomática u oculta puede conducir a un diagnóstico tardío, lo que puede afectar negativamente las posibles estrategias de tratamiento y los resultados. La detección temprana y la precisión diagnóstica son esenciales. La CBCT es una técnica que proporciona vistas de zonas anatómicas con las cuales la mayoría de los odontólogos no están familiarizados y que pueden revelar patología oculta, permitiendo diagnósticos más precisos y confiables, y reduciendo así la posibilidad de perder la patología clínicamente relevante. Este articulo trata de sintetizar las ventajas del uso de la tomografía para diagnosticar el hallazgo incidental (AU)

The increasing number of radiographic techniques performed by the patient for diagnosis and planning causes an increase the number of incidental findings. The description of an unexpected finding can trigger additional medical care including, other diagnostic procedures and treatments, therefore, in many occasions it is necessary to refer the patient to treat the pathology discovered incidentally. CBCT may aid in detecting the presence of previously undiagnosed periapical disease, where prior clinical evaluation and conventional radiographs have failed to reveal pathology. Asymptomatic or occult pathology may lead to delayed diagnosis, which may adversely affect eventual treatment strategies and outcomes. Early detection and improved diagnostic accuracy are essential, also, provide views of anatomy that most dentists have never before seen; in addition, they may reveal occult pathology, enabling more accurate and reliable diagnoses thereby reducing the possibility of missing clinically relevant disease (AU)

Peri-implant assessment via cone beam computed tomography and digital periapical radiography: an ex vivo study

OBJECTIVES: This research evaluated detail registration in peri-implant bone using two different cone beam computer tomography systems and a digital periapical radiograph. METHODS: Three different image acquisition protocols were established for each cone beam computer tomography apparatus, and three clinical situations were simulated in an ex vivo fresh pig mandible: buccal bone defect, peri-implant bone defect, and bone contact. Data were subjected to two analyses: quantitative and qualitative. The quantitative analyses involved a comparison of real specimen measures using a digital caliper in three regions of the preserved buccal bone - A, B and E (control group) - to cone beam computer tomography images obtained with different protocols (kp1, kp2, kp3, ip1, ip2, and ip3). In the qualitative analyses, the ability to register peri-implant details via tomography and digital periapical radiography was verified, as indicated by twelve evaluators. Data were analyzed with ANOVA and Tukey's test (α=0.05). RESULTS: The quantitative assessment showed means statistically equal to those of the control group under the following conditions: buccal bone defect B and E with kp1 and ip1, peri-implant bone defect E with kp2 and kp3, and bone contact A with kp1, kp2, kp3, and ip2. Qualitatively, only bone contacts were significantly different among the assessments, and the p3 results differed from the p1 and p2 results. The other results were statistically equivalent. CONCLUSIONS: The registration of peri-implant details was influenced by the image acquisition protocol, although metal artifacts were produced in all situations. The evaluators preferred the Kodak 9000 3D cone beam computer tomography in most cases. The evaluators identified buccal bone defects better with cone beam computer tomography and identified peri-implant bone defects better with digital periapical radiography.

Effects of Zoledronic Acid in Experimental Periapical Lesions in Rats: An Imaging and Histological Analysis

Abstract The aim of this study was to assess the imaging and histological features of experimental periapical lesions, including the adjacent alveolar bone, in rats under zoledronic acid treatment. The study used 40 male Wistar rats distributed into 8 groups of 5 animals each: G1: induction of periapical lesion (PL) and weekly intraperitoneal administration (WIPA) of saline solution (0.9% NaCl) for 4 weeks; G2: PL induction and WIPA of zoledronic acid (0.15 mg/kg/week) for 4 weeks; G3: PL induction and WIPA of saline solution for 8 weeks; G4: PL induction and WIPA of zoledronic acid for 8 weeks; G5:WIPA of saline solution for 4 weeks and subsequent PL induction; G6: WIPA of zoledronic acid for 4 weeks and subsequent PL induction; G7: WIPA of saline solution for 8 weeks and subsequent PL induction; G8: WIPA of zoledronic acid for 8 weeks and subsequent PL induction. The administration of zoledronic acid or saline solution continued after PL induction until the euthanasia. Thus, cone beam computed tomography and histological analysis were performed. Statistical analyzes were performed by ANOVA and Kruskal-Wallis test. Groups treated with zoledronic acid showed significantly smaller size of PL than the groups treated with 0.9% NaCl (p<0.05). PLs were formed by chronic inflammation ranging from mild to moderate, with no difference between groups. In all specimens, no mandibular necrosis was observed. In conclusion, the presence of PLs apparently does not represent an important risk factor for the development of bisphosphonate-related osteonecrosis of the jaws.

Resumo O objetivo deste estudo foi avaliar as características histológicas e de imagem de lesões periapicais experimentais, incluindo o osso alveolar adjacente, em ratos sob tratamento com ácido zoledrônico. O estudo utilizou 40 ratos Wistar, machos, distribuídos em 8 grupos de animais cada: G1: indução de lesão periapical (LP) e administração intraperitoneal semanal (AIS) de solução salina (NaCl 0.9%) por 4 semanas; G2: indução de LP e AIS de ácido zoledrônico (0,15 mg/kg/week) por 4 semanas; G3: indução de LP e AIS de solução salina por 8 semanas; G4: indução de LP e AIS de ácido zoledrônico por 8 semanas; G5- AIS de solução salina por 4 semanas e subsequente indução de LP; G6- AIS de ácido zoledrônico por 4 semanas e subsequente indução de LP; G7: AIS de solução salina por 8 semanas e subsequente indução de LP; G8: AIS de ácido zoledrônico por 8 semanas e subsequente indução de LP. A administração de ácido zoledrônico ou solução salina continuou após indução de LP até a eutanásia. Após isso, tomografia computadorizada de feixe cônico e análise histológica foram realizadas. Análises estatísticas foram realizadas por ANOVA e teste de Kruskal-Wallis. Os grupos tratados com ácido zoledrônico mostraram LPs significativamente menores que os grupos tratados com NaCl 0.9% (p <0.05). LPs eram formadas por inflamação crônica variando de leve a moderada, sem diferença entre os grupos. Em todos os espécimes, necrose mandibular não foi observada. Em conclusão, a presença de LPs aparentemente não representa um fator de risco importante para o desenvolvimento de osteonecrose relacionada ao uso de bisfosfonatos.

Differential diagnosis and clinical management of periapical radiopaque/hyperdense jaw lesions

Abstract Great attention has been given to the study of radiolucent periapical lesions to avert possible misdiagnosis of apical periodontitis associated with certain radiolucent non-endodontic lesions. However, there are a significant number of radiopaque lesions found in the periapical region, which could be equally relevant to endodontic practice. The diagnosis and management of these radiopaque/hyperdense lesions could be challenging to the endodontist. These bone alterations could be neoplastic, dysplastic or of metabolic origin. In the context of the more widespread use of cone-beam CT, a detailed review of radiopaque inflammatory and non-inflammatory lesions is timely and may aid clinicians perform a differential diagnosis of these lesions. Distinguishing between inflammatory and non-inflammatory lesions simplifies diagnosis and consequently aids in choosing the correct therapeutic regimen. This review discusses the literature regarding the clinical, radiographic, histological and management aspects of radiopaque/hyperdense lesions, and illustrates the differential diagnoses of these lesions.

Diagnóstico diferencial de imagem sugestiva de lesão periapical / Diagnóstico diferencial de imagen sugestiva de lesión periapical / Differential diagnosis of periapical lesion suggestive image

Introdução: o conhecimento da anatomia radiográfica na área odontológica é muito importante para ajudar a estabelecer um diagnóstico correto, na diferenciação entre lesões ósseas e estruturas anatômicas. Objetivo: apresentar uma situação que demonstra confusão no diagnóstico entre o forame mental e lesões periapicais. Dados principais do caso: paciente que se queixava de dente escurecido, assintomático dois anos após um tratamento endodôntico. Na radiografia foi observada radioluscência no ápice do primeiro dente bicúspide inferior esquerdo, o que levou à suspeita de lesão periapical. Foram realizadas mais duas radiografias (mesializando e distalizando da região) observando-se o desligamento da área radiolúcida e um ligamento periodontal sem espaços. Principais comentários: a importância da compreensão da localização forame mentual está relacionada com o diagnóstico diferencial de lesões periapicais(AU)

Introducción: el conocimiento de la anatomía radiográfica en el área odontológica es muy importante para ayudar a establecer un diagnóstico correcto, y poder diferenciar las lesiones óseas de las estructuras anatómicas. Objetivo: presentar una situación que demuestra confusión en el diagnóstico entre el foramen mentoniano y lesiones periapicales. Datos principales del caso: paciente que se quejaba de diente que se oscureció, asintomático, dos años después de un tratamiento endodóntico. En la radiografía se observó radiotransparencia en el ápice de la primera bicúspide inferior izquierda, lo que llevó a la sospecha de lesión periapical. Se indicaron dos radiografías (mesializando y distalizando la región) y se observó la eliminación de la imagen radiolúcida y un ligamento periodontal sin espacios. Principales comentarios: Hay que tener en cuenta la ubicación del agujero mentoniano al realizar el diagnóstico diferencial con lesiones periapicales(AU)

Introduction: the knowledge of radiographic anatomy in the dental field is very important to subsidiary to establish of a correct diagnosis, in differentiation between bone lesions and anatomical structures. Objective: to present a situation that demonstrates confusion at diagnosis between the mental foramen and periapical lesions. Main data of the case: patient who complained of tooth darkened, asymptomatic two years after an endodontic treatment. Radiography was observed radiolucency at the apex of the first bicuspid tooth left lower, which led to suspicion of periapical lesion. There were over two radiographs (mesialing and distalizing the region) and observed the separation of radiolucent and a periodontal ligament without spacing. Main comments: The importance of understanding the location of the mental foramen is related to the differential diagnosis of periapical lesions(AU)

CBCT-based evaluation of integrity of cortical sinus close to periapical lesions

The purpose of the present study was to test the applicability of cone beam computed tomography (CBCT) to evaluate the integrity of the cortical sinus close to periapical lesions. Two observers analyzed samples of 64 alveoli of first molar roots in macerated swine maxillas prepared with perchloric acid to simulate periapical lesions. The specimens were evaluated using CBCT (55-mm high and 100-mm diameter cylinder at 0.2-mm voxel resolution) for the presence of oroantral communication (OAC) caused by the simulated lesions. Sensitivity, specificity, and accuracy were calculated. Fair values were obtained for accuracy (66%-78%) and good values for specificity (70%-98%), whereas the values for sensibility showed relevant variation (41%-78%). For this reason, the interobserver agreement score was weak. CBCT proved capable of evaluating the integrity of the cortical sinus (absence of oroantral communication) when it lies close to an apical periodontitis lesion. However, the low interobserver agreement reflects the difficulty in performing diagnoses when OAC is adjacent to a periapical lesion, using the acquisition protocol adopted in this research. This could be attributed to the high level of image noise.

Periapical radiolucency not requiring endodontic therapy: an unusual case.

The article is a case report of an unusual manifestation of primary hyperparathyroidism seen in the mandible. Primary hyperparathyroidism is a rare disorder that can present its first symptoms in the jaws. The pre- and post-treatment radiographic features of such cases have only rarely been reported in dental literature. This case report highlights the importance of careful clinical and radiographic examination before commencing root canal treatment.

[Success rate of retreated teeth with periapical lesions: a clinical and radiographic evaluation]

As for other dental treatments, root canal therapy may lead to failure. Correction of these conditions will be faced with problems and complexities, particulary if any periapical lesion is peresent. The aim of this study was to evaluate the success rate of retreament in teeth with apical lesions. In this descriptive study 60 teeth with failed root canal therapy which had been retreated by an endodontist were reevaluated clinically and radiographically between 6 to 12 monthis after retreatment. Clinical examinations were performed by a clinician and comparison with the primary symptoms, recorded in patiants file, was obtained. Periapical radiographs were prepared by parallel technique and E speed film with the same proccessing conditions. Periapicel lesion size was evaluated and comparison was made before and 6-12 month after retreament, using photoshop software [version7] .The data were analyzed by chi-square test and agreemental tables. Statistically, there was no correlation between variables and success rate. The success and failure percentage of retreatment was 81.7% and 5%, respectively and 13.3% of cases were uncertain. The most success rate was observed in group of 31-40 years old [95%], keeping in mind that most patients were in this age group. The least success was in group over 50 years old. According to this study, the high success rate could be expected in retreatment of teeth with periapical lesion

Tratamiento no quirúrgico de lesiones periapicales / Non-surgical treatment of periapical lesions

El tratamiento de dientes con lesiones periapicales crónicas ha sido estudiado por diferentes autores en el campo endodóntico. Basados en los resultados obtenidos en diferentes trabajos experimentales, nos propusimos realizar la presente investigación, tomando 30 dientes humanos que al momento de realizar el tratamiento pulpo-radicular mostraban presencia de lesiones periapicales con diámetros variables, por encima de los 5 mm . Se tuvieron en cuenta 2 grupos: en uno de ellos se les realizaron a los conductos radiculares rellenos temporales de pasta de hidróxido de calcio y agua destilada; en el otro grupo a estos conductos se les realizaron rellenos temporales con pasta de hidróxido de calcio, agua destilada y paramonoclorofenol alcanforado. Se evaluó la disminución de las lesiones periapicales en ambos grupos a los 3 y 6 meses de iniciado el tratamiento, sin que se observaran diferencias estadísticamente significativas. Igual ocurrió en la evaluación de la reparación ósea periapical a los 9 meses de iniciado el tratamiento. Con ambas técnicas los resultados fueron satisfactorios, lo que demuestra una participación activa del hidróxido de calcio en la reparación de las lesiones periapicales, independientemente de su asociación con el paramonoclorofenol alcanforado(AU)

The treatment of teeth with chronic periapical lesions has been studied by different authors in the endodontics field. Based on the results attained in different experimental works, we proposed ourselves to make the present research taking 30 human teeth that at the time of applying the pulpar radicular treatment presented periapical lesions with variable diameters over 5 mm. Two groups were taken into account: in one of them, the radicular ducts were temporarily filled up with calcium hydroxide paste and distilled water, whereas in the other one these ducts were filled up with calcium hydroxide paste, distilled water and camphorated paramonochlorophenol. The decrease of the periapical lesions was evaluated in both groups 3 and 6 months after the beginning of the treatment. No statistically significant differences were observed. The same occurred in the evaluation of the periapical osteal repair 9 months after initiating the treatment. The results were satisfactory with both techniques. The active participation of calcium hydroxide in the repair of periapical lesions independently of its association with camphorated paramonochlorophenol was proved(AU)

Efficacy of various eugenol and non-eugenol root canal sealers in the treatment of teeth with periapical radiolucent area--a clinical and radiological study.

A clinical and radiological study was conducted to compare the efficacy of various eugenol containing Viz. Zinc oxide eugenol, CRCS and Rosen's Cement and non eugenol containing sealers and N2 on forty eight non-vital anterior teeth, with a periapical radiolucent area of 1-7mm in diameter. The patients were recalled after 30,90,150 and 210 days On radiological examination after 210 days CRCS showed maximum decrease in periapical radiolucency from 4.39 mm. to 1.80mm. The teeth treated with N2 as root canal sealer showed minimum decrease in the periapical radiolucency from 3.0 mm. to 2.15mm. On clinical examination the results were 100% successful in both the eugenol and non-eugenol groups. The radiological findings indicate that the eugenol containing are better as compared to non-eugenol containing root canal sealer. Out of eugenol containing root canal sealers CRCS showed maximum decrease in radiolucency and from non-eugenol containing group N2.